The impact of a health education intervention on health behaviors and mental health among Chinese college students

Abstract

Objective: This study aimed to assess the impact of a health education intervention on health behaviors, self-efficacy, and well-being among college students. Participants: Between March and October 2016, a total of 532 undergraduates participated. Methods: A theory-based intervention was conducted at Wuhan University, China. Participants were assigned to a control or intervention group (IG). The IG attended a 7-week health education class on knowledge, attitude, and practice of health behaviors. Results: Participants in the IG, compared with those in the control group (CG), reported significantly increased prevalence of high physical activity and regular breakfast, as well as lower screen time, sugar beverage intake, and Internet addiction tendency. Furthermore, intervention students improved in health behavior scores (p?=?0.040), compared with the CG, while the changes in subjective well-being and self-efficacy remained similar between the two groups. Conclusions: Health education may promote health behaviors among Chinese college students.     

Diagnostic sequence of cocaine use disorder in relation to other mental health conditions among college students

Abstract

Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among college students to inform treatment of cocaine use disorder (CUD). Method: Using electronic medical records from the psychiatric clinic at the student health care center of a large, public university from 2005 to 2015, patients diagnosed with CUD were identified. Their top mental health conditions were identified and assessed to see whether the first diagnosis of these conditions was made (1) before, (2) at the same time as, or (3) after the first diagnosis of CUD. Results: Among the 50 CUD patients, their most common mental health comorbidities were alcohol use disorder, anxiety, depression, and cannabis use disorder. Anxiety and depression were likely to be diagnosed before CUD; alcohol and cannabis use disorders were likely to be diagnosed concurrently with CUD. Conclusion: Diagnostic sequencing can be used to inform screening, workup, and treatment for patients with CUD.     

Health insurance literacy: A mixed methods study of college students

Objective: This study examines the health insurance literacy, or the ability to use health insurance effectively, of college students. Participants: A total of 455 students from a large, public university completed an online questionnaire in November 2016. Methods: A questionnaire examined students’ knowledge of commonly encountered health insurance terms and ability to apply that knowledge to determine cost-sharing in a clinical setting. Results: The majority of students were able to correctly identify the most commonly encountered terms, but could not identify terms related to plan types and options. Eighty-eight percent of students could not determine their cost-sharing for two presented scenarios. Approximately half of the students indicated they had been confused about their health insurance plan, with one-quarter of students stopping or delaying medical care due to confusion. Conclusions: Outreach and education for students should target specific deficits in knowledge such as those identified in this study.     

An examination of ecological predictors of health literacy in black college students

Objective: Health literacy is a determinant of health, but disparities in health literacy persist. This study examined the influence of ecological factors on college students’ health literacy. Participants: During January 2016 a nonrandom sample of black undergraduate students (n = 298) aged 18–24 were recruited from enrollment lists at two urban universities in the Southeastern United States. Methods: Information on health literacy as well as numerous intrapersonal, social, and cultural-environment factors was obtained using an electronic questionnaire and then statistically modeled. Results: Ecological factors accounted for 28.7% of the variance in health literacy. In particular, reappraisal (B = 0.323, p < .001), suppression (B = ?0.289, p < .001), campus health education (B = 0.192, p < .05), campus tobacco culture (B = ?0.174, p < .05), and perceived norms (B = ?0.153, p < .05) directly predicted health literacy. Conclusions: Although intrapersonal factors influence health literacy, the sociocultural environment of college can also foster or hinder college students’ health literacy.     

Exploring college students’ sexual and reproductive health literacy

Abstract

Objective: To assess college students’ sexual and reproductive health (SRH) literacy experiences, specific to contraception use and STI prevention. Participants: In Spring 2015, participants (n?=?43) from a large institution participated in six focus groups (two male and four females groups). Methods: Focus groups were guided by the health literacy domains (access; understand; appraise; apply); data were analyzed in MaxQDA using the constant comparative method. Results: The Internet was the most commonly accessed source for SRH information. Participants discussed facilitators (eg, use of visuals) and barriers (eg, medical jargon) to understanding information; and personal lifestyle, advice from family/friends, symptoms, and sexual partners as appraisal factors. Participants applied information by communicating with friends/providers and seeking healthcare. However, findings were not linear nor mutually exclusive, representing the interaction of health literacy skills. Conclusion: Findings suggest that a patient-centered intervention capitalizing on technology and trusted individuals (providers/peer educators) may facilitate college students’ SRH literacy.     

Microaggressions,perceptions of campus climate,mental health,and alcohol use among first-year college students of color

Depressive and anxiety symptoms are increasingly common, and problematic alcohol use remains prevalent in college. To expand on prior research on mostly white samples, we surveyed first-year students of color from our predominately white university (Southeastern US) to identify risk factors for mental health symptoms and potentially co-occurring problematic alcohol use. Results showed significant associations between microaggressions and poor campus climate (hypothetical predictors) with depressive, anxiety, somatic symptoms (hypothetical outcomes) that were indirectly linked through perceived stress, poor sleep, and academic burnout (hypothetical mediators). Poor campus climate, academic burnout, and using alcohol to cope were the most relevant to alcohol use disorder symptoms. Results support efforts to address and reduce racial microaggressions and promote a positive campus climate for all.     

HIV knowledge mediates the relationship between HIV testing history and stigma in college students

ABSTRACT

Objective: HIV-related stigma is one of the strongest barriers to prevention and treatment. HIV prevalence in U.S. college students is estimated around 0.02%, but is thought to be drastically underreported. We examined the influence of HIV knowledge on the relationship between HIV testing history and stigma in college students. Participants: A random sample of 2343 students, over the age of 18, attending a large university in the southeastern United States completed the survey in January 2016. Methods: A mediation model was constructed in regression framework to explore the relationship between HIV testing history, knowledge, and stigma. Results: HIV testing history was associated with higher knowledge scores (a path: B = 4.08, p < .001) and higher knowledge scores were associated with lower stigma (b path: B = .01, p < .001). These results suggest that HIV knowledge partially mediates the relation between HIV testing history and stigma in college students. Conclusions: HIV testing history may decrease stigma by increasing knowledge. Results can be used to inform college health promotion practice on developing programs and services.     

The understudied half of undergraduates: Risky sexual behaviors among community college students

Abstract

Objective: This study examines the prevalence and risk factors associated with risky sexual behaviors in community college students. Participants: A diverse sample of 18–19-year-old community college students (N?=?264). Methods: Baseline data from an online prevention program administered in 2015. Results: Community college students in this sample disproportionately experienced sexual assault and were unlikely to test for STIs. Higher intentions to engage in risky sexual behaviors were associated with gender and sexual experience, but also with having lower intentions to communicate with a sexual partner about pregnancy and STIs, and having higher gender norm endorsement. Conclusions: Older adolescents attending community colleges may be at high risk for poor sexual health outcomes, and appropriate theory-based education should be tailored to meet the needs of these underserved students.     

Examining the efficacy of an mHealth media literacy education program for sexual health promotion in older adolescents attending community college

Objective: To determine the feasibility of a mobile health (mHealth), media literacy education program, Media Aware, for improving sexual health outcomes in older adolescent community college students. Participants: 184 community college students (ages 18–19) participated in the study from April–December 2015. Methods: Eight community college campuses were randomly assigned to either the intervention or a wait-list control group. Student participants from each campus completed web-based pretest and posttest questionnaires. Intervention group students received Media Aware in between questionnaires. Results: Several intervention effects of the Media Aware program were significant, including reducing older adolescents' self-reported risky sexual behaviors; positively affecting knowledge, attitudes, normative beliefs, and intentions related to sexual health; and increasing media skepticism. Some gender differences in the findings were revealed. Conclusions: The results from this study suggest that Media Aware is a promising means of delivering comprehensive sexual health education to older adolescents attending community college.     

Eating disorders and academic performance among college students

Abstract

Objective: There is a paucity of research exploring eating disorders (EDs) and academic performance (AP). This study aimed to understand the effect of ED treatment on AP, hypothesizing that students receiving treatment for EDs would have a higher GPA. Participants: The Spring 2010 – Spring 2011 National College Health Assessment data (N?=?231,586) was utilized. Methods: Ordinal logistic regressions, controlling for key confounders, analyzed the association between those diagnosed with anorexia or bulimia and GPA. Results: Students diagnosed with anorexia or bulimia and treated with medication and psychotherapy were respectively 1.49 (1.24, 1.80; p?<?.0001) or 1.35 (1.13, 1.61; p?=?.0009) times more likely to have a higher GPA (p?<?.0001) compared to students without EDs. Conclusion: Findings expand the literature on EDs and AP among college students. Additional research is needed to determine whether the combination of medication and psychotherapy is the most effective way to improve AP among students with EDs.     

Promoting healthy transition to college through mindfulness training with first-year college students: Pilot randomized controlled trial

Objective: Given the importance of developmental transitions on young adults' lives and the high rates of mental health issues among U.S. college students, first-year college students can be particularly vulnerable to stress and adversity. This pilot study evaluated the effectiveness and feasibility of mindfulness training aiming to promote first-year college students' health and wellbeing. Participants: 109 freshmen were recruited from residential halls (50% Caucasian, 66% female). Data collection was completed in November 2014. Methods: A randomized control trial was conducted utilizing the Learning to BREATHE (L2B) program, a universal mindfulness program adapted to match the developmental tasks of college transition. Results: Participation in the pilot intervention was associated with significant increase in students' life satisfaction, and significant decrease in depression and anxiety. Marginally significant decrease was found for sleep issues and alcohol consequences. Conclusions: Mindfulness-based programs may be an effective strategy to enhance a healthy transition into college.     

Beliefs underlying stress reduction and depression help-seeking among college students: An elicitation study

Objective: This study illustrates how a theory-based approach can identify college students’ beliefs about stress reduction activities and help-seeking for depression. These beliefs are the basis for intervention design. Participants: A sample of 53 undergraduate students at a public university in the Midwest participated in this research during March 2016. Methods: An open-ended belief elicitation survey was administered online. Beliefs were identified through qualitative thematic analyses. Results: Exercise was students’ most preferred stress reduction activity. Beliefs about exercise emphasized physical benefits yet also not having time for exercise. Beliefs about help-seeking for depression emphasized treatment efficacy, support from others, stigma, and time constraints. Conclusions: Whereas beliefs about positive outcomes inform educational and motivational messages, beliefs about time constraints underscore the need to also consider structural factors that can help students find time to attend to their well-being.     

A multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students

Objective: This study investigated associations between adverse childhood experiences (ACE) prior to age 18 years and multiple health behaviors (eg, cigarette and other substance use) and outcomes (eg, obesity, depression) for a large college sample. Participants: 2,969 college students from seven universities in the state of Georgia were included in the analysis. Methods: Web-based surveys were completed by students (45–60 minutes) during the spring semester, 2015. Results: Findings indicate that more ACEs are associated with higher levels of depressive symptoms, ADHD symptoms, cigarette use, alcohol use, marijuana use, and BMI, in addition to lower levels of fruit and vegetable intake, and sleep. Conclusion: ACEs may carry forward in the lifespan to influence a range of unhealthy outcomes among college students. College intervention programs may benefit by recognizing the pervasiveness of ACEs and their associations with health behaviors and outcomes, and include interventions across more than one health behavior.     

Help Seeking and Treatment Use Among Suicidal College Students

Abstract

Objectives: Many suicidal college students do not receive mental health treatment, and the reasons for this are not fully understood. This study examines how attitudes, beliefs, and social network factors relate to help seeking among suicidal students. Participants: A random sample of 8,487 undergraduate and graduate students from 15 US universities participated. Methods: A Web-based survey administered in spring 2009 examined correlates of mental health service utilization among students reporting serious thoughts of suicide in the previous year (n = 543). Results: Correlates of treatment use included perceived need, beliefs that treatment is effective, contact with service users, lower personal stigma, higher perceived stigma, fewer positive relationships, and sexual minority or Caucasian identity. Conclusions: Help seeking among suicidal students is associated with a range of personal and social network factors. Campus strategies to enhance help seeking should be tailored to address identified facilitators and barriers to treatment use among target populations.     

Variability in measures of health and health behavior among emerging adults 1 year after high school according to college status

Objective: To examine changes in health behaviors among US emerging adults 1 year after high school. Participants: The national sample of participants (N = 1,927), including those attending 4-year college/university (n = 884), 2-year colleges/technical schools (n = 588), and no college (n = 455), participated in annual spring surveys 2013–2014. Methods: Health behaviors were assessed the last year of high school and first year of college; differences by college status controlling for previous-year values were estimated using regression analyses. Results: Relative to 4-year college attendees, those attending technical school/community college were less likely to binge drink (odds ratio [OR] = 0.57, confidence interval [CI] = 0.38–0.86) but more likely to speed (OR = 1.26, CI = 1.0–2.84), consume sodas (OR = 1.57, CI = 1.0–2.47), and report lower family satisfaction (p < .01), with marginally more physical and depressive symptoms. College nonattendees reported more DWI (driving while intoxicated; OR = 1.60, CI = 1.05–2.47), soda drinking (OR = 2.51, CI = 1.76–3.59), oversleeping (OR = 4.78, CI = 3.65–8.63), and less family satisfaction (p < .04). Conclusions: Health risk behaviors among emerging adults varied by college status.     

The Theory of Planned Behavior as it predicts potential intention to seek mental health services for depression among college students

ABSTRACT

Background: Between 9.5% and 31.3% of college students suffer from depression (American college health association national college health assessment II: reference group executive summary spring 2013. Amer. Coll. Health Assoc. 2013; Eagan K, Stolzenberg EB, Ramirez JJ, Aragon, MC, Suchard, RS, Hurtado S. The American freshman: national norms fall 2014. Higher Educ. Res. Inst.; 2015). Universities need to understand the factors that relate to care-seeking behavior. Objective: Across 3 studies, to relate attitudes, social norms, and perceived behavioral control to intention to seek mental health services, and to investigate barriers to care-seeking. Participants: University college students (N = 845, 64% female, 26% male, and 10% unspecified). Methods: New measures were created in Studies 1 and 2, and were examined using structural equation modeling in Study 3. Results: Partially consistent with the Theory of Planned Behavior (Ajzen, I, Fishbein, M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980), a model with an excellent fit revealed that more positive attitudes about care and higher perceived behavioral control directly predicted higher intention to seek mental health services. Conclusions: Educating college students about mental health disorders and treatments, enhancing knowledge about available services, and addressing limited access to long-term care might improve treatment rates for students suffering from depression.     

Oral health among student veterans: Effects on mental and physical health

Abstract

Objective: The purpose of this study was to explore differences in oral health among students by military service status in postsecondary settings. Participants: Secondary data were obtained from the American College Health Association’s 2011–2014 National College Health Assessment II. Method: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results: Service member and veteran students are at greater risk for neglecting health behaviors associated with positive oral health, including that they were less likely to get dental exams and that those who deployed in the past were the least likely to be practicing good oral health. Conclusions: The results suggest that improving oral health will contribute to improving health and mental health outcomes in this population, and provide important information for health specialists working with service members and veterans on college campuses.