The Effect of Mixing Events on the Dynamics of pH1N1 Outbreaks at Small Residential Colleges

Abstract Objective: The authors examine the dynamics and the impact of all-campus events on pH1N1 spread at Bates College in fall 2009, with comparisons to 3 other campuses. Participants: Students (N = 285) presented or called in to the Bates Health Center with symptoms consistent with influenza-like illness. Methods: Health Center staff at Bates collected data on the outbreak; data from other colleges are from Web sites and journal articles. Data were analyzed using a mathematical model for influenza. Results: Bates held 2 vaccine clinics mid-outbreak. The data are consistent with the hypothesis that the vaccine clinics may have altered routine student interactions, facilitating transmission of pH1N1 among students who otherwise might not have encountered each other. Conclusion: The vaccine clinics, held when vaccine became available, were too late to halt transmission. The disruptions to campus rhythms due to the vaccine clinics may instead have contributed to pH1N1 spread.     

A/H1N1 Vaccine Intentions in College Students: An Application of the Theory of Planned Behavior

Abstract

Objective: To test the applicability of the Theory of Planned Behavior (TPB) in college students who have not previously received the A/H1N1 vaccine. Participants: Undergraduate communication students at a metropolitan southern university. Methods: In January–March 2010, students from voluntarily participating communication classes completed a hardcopy survey assessing TPB and clinically significant constructs. Hierarchical regression equations predicted variance in vaccine intentions of students who had not received a flu shot (N = 198; 70% Caucasian). Results: The TPB model explained 51.7% (p < .001) of variance in vaccine intentions. Controlling for side effects, self-efficacy and perceived comparative susceptibility predicted intentions when entered in the first block, whereas attitudes, subjective norms, and perceived behavioral control significantly contribute when entered in the second block. Conclusions: For students who have not previously received a flu vaccine, vaccine communication should utilize self-efficacy and perceived comparative susceptibility to employ the TPB to promote vaccine intentions.     

Safety of a meningococcal group B vaccine used in response to two university outbreaks

Objective: To assess the safety of meningococcal group B (MenB)-4C vaccine. Participants: Undergraduates, dormitory residents, and persons with high-risk medical conditions received the MenB-4C vaccine two-dose series during mass vaccination clinics from 12/2013 through 11/2014. Methods: Adverse events (AEs) were identified by 15 minutes of observation postvaccination, spontaneous reports, surveys, and hospital surveillance. Causality was assessed for serious adverse events (SAEs). Results: 16,974 persons received 31,313 MenB-4C doses. The incidence of syncope during the 15-minutes post-dose 1 was 0.88/1000 persons. 2% of participants spontaneously reported an AE (most common were arm pain and fever). 3 SAEs were suspected of being caused by the vaccine, including one case of anaphylaxis. Conclusions: Most AEs reported were nonserious and consistent with previous clinical trial findings. Measures to prevent injury from syncope and to treat anaphylaxis should be available wherever vaccines are administered. Our safety evaluation supports the use of MenB-4C in response to outbreaks.     

“This is not a drill”: Activation of a student-led influenza vaccination point of dispensing

Objective: To describe activation of a Point of dispensing (POD) in response to an influenza outbreak, highlighting the use of a student-led model. Participants: Faculty, staff, and students of Harris College of Nursing and Health Sciences, Texas Christian University (TCU), as well as those located in its primary building. Methods: In response to an August 2017 influenza outbreak, a vaccination clinic was conducted for a target population through POD activation. The larger campus community was served through provision of additional doses by the Texas Christian University Health Center and the annual October student-led vaccination clinic. Results: Eleven additional cases were diagnosed after vaccinations began. Conclusions: One hundred percent of the targeted population was vaccinated (n = 824), with an additional 127 participants vaccinated (others working in the building where POD held also vaccinated). This was the first time POD activation had occurred on campus in response to an outbreak.     

Lifetime exposure to abuse,current stressors,and health in federally qualified health center patients

ABSTRACT

Purpose: The purpose of this study was to examine the impacts of lifetime exposure to abuse and current stressors on health, an integrative concept of physical, mental and social health, among patients of a Federally Qualified Health Center.

Method: The sample included 1,055 patients (male: N = 346; female: N = 709) who were at least 18 years of age and completed an assessment on their first visit between January 2015 and March 2017 at a Federally Qualified Health Center. The assessment contained subscales of the DUKE Health Profile measuring physical, mental, and social health; four questions assessing lifetime exposure to abuse; and a relational and socioeconomic stressor checklist.

Results: Results from structural equation modeling analyses showed that for both male and female groups, lifetime exposure to abuse, relational stressors and socioeconomic-related stressors were strongly associated with health. In the male group, socioeconomic-related stressors were the strongest predictor of health, while in the female group, lifetime exposure to abuse was the strongest predictor of health.

Conclusions: Understanding the relationships between health and the combined factors of a lifetime exposure to abuse, relational stressors, and socioeconomic stressors can provide insight to patient care professionals who treat patients in lower income, underserved communities. Ecological Systems Theory provides a framework to plan interventions or to prevent potential negative outcomes associated with these stressors.     

Meningococcal serogroup B outbreak response University of Wisconsin-Madison

A meningococcal serogroup B (MenB) outbreak at a large public university prompted an emergency response to immunize undergraduates. Objective: To report on a successful meningococcal serogroup B (MenB) vaccine clinic response at a large public university. Methods: We assembled the team leaders to write this case report. Results: Activation of the emergency plan and points of dispensing required cooperation of many units on campus under the leadership of university health officials with support from Centers for Disease Control and Prevention, state division of public health and the city-county health department. Significant efforts to provide consistent messages to students and parents regarding the outbreak and the availability of the MenB vaccines were made. Volunteers were recruited to staff the clinics alongside university healthcare providers. Over 22,000 doses of vaccine were administered. Conclusion: We report our experience and lessons learned which may be helpful to universities in preventing and responding to disease outbreaks.     

High-Risk Sexual Behavior Among Students of a Minority-Serving University in a Community With a High HIV/AIDS Prevalence

Objective: The authors used a stratified cluster sampling design to inform campus sexually transmitted diseases prevention programs. Participants and Methods: They conducted a cross-sectional study of students (N = 1,130) at a large, urban, minority-serving university in South Florida using the 2004 National College Health Assessment Survey instrument. Results: Of the 1,130 participants, 14.0% reported risky sexual behavior (having more than 1 sexual partner in 1 year and not using a condom the last time they had vaginal intercourse), and 11.9% reported consistent risky sexual behavior (having more than 1 partner in 1 year and not using condoms most or all of the time during the past 30 days). In multivariable analysis, past-month alcohol use had the strongest independent association with both risky and consistent risky sexual behavior. Illicit drug use was marginally significant in both models. Conclusions: Administrators should address the use of alcohol and other drugs on campus in planning interventions to promote safe sexual behavior.     

College Students and the Diagnosis of Attention Deficit Hyperactivity Disorder

Abstract

Background: When H1N1 emerged in 2009, institutions of higher education were immediately faced with questions about how best to protect their community from the virus, yet limited information existed to help predict student preventive behaviors. Methods: The authors surveyed students at a large urban university in November 2009 to better understand how students perceived their susceptibility to and the severity of H1N1, which preventive behaviors they engaged in, and if policies impacted their preventive health decisions. Results: Preventive health behavior messaging had a mixed impact on students. Students made simple behavior changes to protect themselves from H1N1, especially if they perceived a high personal risk of contracting H1N1. Although policies were instituted to enable students to avoid classes when ill, almost no student self-isolated for the entire duration of their illness. Conclusions: These findings can help inform future decision making in a university setting to best influence preventive health behaviors.     

An Infection Control Program for a 2009 Influenza A H1N1 Outbreak in a University-Based Summer Camp

Abstract

Objectives: Describe two 2009-H1N1 influenza outbreaks in university-based summer camps and the implementation of an infection control program. Participants: 7,906 campers across 73 residential camps from May 21–August 2, 2009. Methods: Influenza-like-illness (ILI) was defined as fever with cough and/or sore throat. Influenza A was identified using PCR or rapid-antigen testing. We implemented an infection control program consisting of education, hand hygiene, disinfection, symptom screening, and ILI case management. Results: An initial ILI cluster involved 60 cases across 3 camps from June 17–July 2. Academic Camp-1 had the most cases (n = 45, 14.9% attack rate); influenza A was identified in 84% of those tested. Despite implementation of an infection control program, a second ILI cluster began on July 12 in Academic Camp-2 (n = 47, 15.0% attack rate). Conclusions: ILI can spread rapidly in a university-based residential camp. Infection control is an important aspect of the medical response but is challenging to implement.     

Varicella immunization requirements for US colleges: 2014–2015 academic year

ABSTRACT

Objective: To obtain information on varicella prematriculation requirements in US colleges for undergraduate students during the 2014–2015 academic year. Participants: Health care professionals and member schools of the American College Health Association (ACHA). Methods: An electronic survey was sent to ACHA members regarding school characteristics and whether schools had policies in place requiring that students show proof of 2 doses of varicella vaccination for school attendance. Results: Only 27% (101/370) of schools had a varicella prematriculation requirement for undergraduate students. Only 68% of schools always enforced this requirement. Private schools, 4-year schools, northeastern schools, those with <5,000 students, and schools located in a state with a 2-dose varicella vaccine mandate were significantly more likely to have a varicella prematriculation requirement. Conclusions: A small proportion of US colleges have a varicella prematriculation requirement for varicella immunity. College vaccination requirements are an important tool for controlling varicella in these settings.     

VIDEO REVIEW

Abstract

THE NEUROBIOLOGY OF ALCOHOLISM: SIMPLIFIED. A presentation of the Betty Ford Center at Eisenhower. Produced by Annenberg Center for Health Sciences, Rancho Mirage, CA. Reviewed by Ted R. Watkins.     

GotFlu Channel: An Online Syndromic Surveillance Tool Supporting College Health Practice and Public Health Work

Abstract

Objective: Develop a tool to ease the burden of H1N1 influenza on a campus clinic by promoting self-care, generating medical notes, and identifying vulnerable students. Participants: Students at Brock University, a mid-sized urban campus; Brock's Student Health Services; and Niagara Public Health. Methods: Students accessed a controlled portal of Brock's Web site and self-identified onset/offset of influenza-like symptoms. Daily sign-in numbers were monitored and nonidentifiable aggregate data transferred to the local public health unit. Results: There was concordance among the number of college students signing in, local school absenteeism rates, and local rates of laboratory-confirmed influenza. Many visits to the campus health clinic were averted, 1,432 students used the tool. Conclusion: The online, real-time surveillance tool was effective in monitoring influenza activity on campus, providing timely health advice, decreasing unnecessary visits to the campus medical clinic, and assisting local public health in surveillance activities.     

The College Mental Health Center: A Report After Ten Years

Abstract

The College Center is a unique mental health facility providing care for thousands of students from many colleges in the Greater Boston area. The authors report on data collected during the 1975–76, 1976–77 school years regarding patient variables such as: gender, year in school, academic major, presenting problem, and others. The center's handling of these patients is reported in terms of diagnoses, treatment recommendations, and numbers of visits. Several commonly held staff assumptions and hypotheses are tested, and from the data available in this study, are not generally confirmed. The impressions, however, of a more recent decrease in antisocial acting out behavior and drug abuse (other than alcohol) and an increase in patients presenting with more classical neurotic and adjustment symptoms are confirmed.     

An Evaluation of Behavioral Health Compliance and Microbial Risk Factors on Student Populations Within a High-Density Campus

Abstract

Objective: The aim of this Canadian study was to assess student behavioral response to disease transmission risk, while identifying high microbial deposition/transmission sites. Participants: A student survey was conducted during October 2009. Methods: The methods included a survey of students to assess use of health services, vaccination compliance, and hygiene along with a microbial analysis of potential transmission sites targeting specific residence buildings on campus. Results: Results indicated that most students maintained that they were worried about H1N1 and reported making changes in hygienic behavior, with the majority not planning to be vaccinated. The microbial analysis indicated contamination of fomites in co-ed residences to be higher than either male or female student residences. Conclusions: A consideration of physical space along with behavioral factors is required in order to properly assess risk pathways in the establishment of an evidence-based infection control plan for universities and their contiguous communities.     

Systematically collected information at encounters with HIV-positive students: A review of 10 years of electronic medical records

Abstract

Objective: The objective of this study was to examine clinical and epidemiological information collected by Student Health Center (SHC) providers on HIV-positive students, and benchmark this information against Infectious Disease Society of America guidelines. Participants: Students who utilized the SHC and had an ICD-9 code indicating positive HIV status between 2005 and 2015 (3?=?7). Methods: In June 2016, we accessed the free-form provider notes of the SHC’s electronic medical records to identify specific, recorded epidemiological and clinical information. Results: Seven unique students sought care at the SHC during the study period. Current sexual risk taking and other known behavioral risk factors were absent from all records, along with CD4 count and viral load. ART status was only available for one patient, and he was not on ART. The information collected failed to meet IDSA benchmarks. Conclusion: Clinically- and epidemiologically-relevant information is not systematically collected from HIV-positive students at SHCs.     

Building a health communication brand for University of Texas System tobacco control

Objective: Despite declining cigarette smoking rates in the US, there is a continued need for tobacco prevention education campaigns to reach young adults. Recognizing the need for improved tobacco control messaging, the University of Texas (UT) System engaged The University of Texas at Austin Center for Health Communication to develop a brand and message that would strengthen tobacco control efforts at its 14 institutions. Methods: This article describes the iterative process involved in creating a brand for tobacco control, including an environmental scan, identifying potential message themes, and creating and refining logos. Results: This article highlights the process of developing a system-wide tobacco control brand. Specifically, the process included coordinating an interdisciplinary team with content and design experts, and presenting ideas to stakeholders for serial feedback and refinement, among others. Conclusions: Ultimately, this project offers a model for other systems of higher education interested in pursuing similar initiatives.     

Participation by Health Professional Students in Tuberculin Screening

Abstract

The author reports on a study of the liquid nitrogen treatment of warts at the Rutgers University Student Health Center. He demonstrates that liquid nitrogen therapy is a safe, effective treatment method, appropriate for use by nurses and other primary providers in a college health setting.     

Utilization and limitations of the American College Health Association's National College Health Assessment instrument: A systematic review

ABSTRACT

Objective: To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II. Participants and Methods: The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument use, limitations, and data analyses. Results: The search resulted in 72 articles for inclusion. Researchers used the instrument to either conduct a primary investigation or utilize reference group data for secondary analysis. Researchers used many data analyses, statistical tests, techniques, and methods. Limitations of the instrument were consistently mentioned by researchers. Conclusions: Results indicate limitations in the NCHA. To ensure college health professionals are gaining the best information possible regarding students on their campuses, specific improvements to the NCHA are recommended.