Impediments to Health Care for the Foreign Student

Abstract

Today's college students occupy a “window” between older adults, whose need for hepatitis B vaccination is minimal, and younger people who receive the vaccine as part of their childhood immunization series. However, because of the high-risk activities that are often part of student behavior, college students are among the individuals who are at the highest risk for this disease; 75% of all reported hepatitis B cases occur in persons between the ages of 15 and 39 years. It is therefore imperative that college health professionals take seriously their responsibility to educate students about issues related to hepatitis B and make available programs that enable the students to receive immunizations. This article briefly describes a successful hepatitis B education and immunization program at an institution that has no mandatory prematriculation immunization requirements.     

The cost effectiveness of hepatitis immunization for US college students

Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to consider infection risks and disease progression and then compared the cost of vaccination with economic, longevity, and quality of life benefits. Immunization of 100,000 students would prevent 1,403 acute cases of hepatitis A, 929 cases of hepatitis B, and 144 cases of chronic hepatitis B. Hepatitis B vaccination would cost the health system $7,600 per quality-adjusted life year (QALY) gained but would reduce societal costs by 6%. Hepatitis A/B vaccination would cost the health system dollar 8,500 per QALY but would reduce societal costs by 12%. Until childhood and adolescent vaccination can produce immune cohorts of young adults, college-based hepatitis immunization can reduce disease transmission in a cost-effective manner.     

The Cost Effectiveness of Hepatitis Immunization for US College Students

Abstract

Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to consider infection risks and disease progression and then compared the cost of vaccination with economic, longevity, and quality of life benefits. Immunization of 100,000 students would prevent 1,403 acute cases of hepatitis A, 929 cases of hepatitis B, and 144 cases of chronic hepatitis B. Hepatitis B vaccination would cost the health system $7,600 per quality-adjusted life year (QALY) gained but would reduce societal costs by 6%. Hepatitis A/B vaccination would cost the health system $8,500 per QALY but would reduce societal costs by 12%. Until childhood and adolescent vaccination can produce immune cohorts of young adults, college-based hepatitis immunization can reduce disease transmission in a cost-effective manner.     

Contagious diseases in competitive sport: what are the risks?

Great concern is often expressed over the possibility of contagion among athletes in competitive sports, particularly sports with much person-to-person contact. Human immunodeficiency virus (HIV) is only the most notorious of infectious agents; potentially, other viruses, bacteria, and even fungi may be involved. Because of the concern, however, special attention is paid to HIV and hepatitis B infections. For most of the infections considered, the athlete is more at risk during activities off the playing field than while competing. Inclusion of immunizations against measles and hepatitis B among prematriculation immunization requirements (PIRs) for colleges and universities would eliminate these two diseases from the list of dangers to college athletes and all students. Education, rather than regulations, should remain the cornerstone in considering the risks to athletes from contagious diseases.     

Measles and Rubella on College Campuses: The Need to Act

Abstract

The lack of immunization requirements at the nation's colleges and universities threatens the maintenance of the interruption of indigenous measles in the United States. The high susceptibility rates in some college populations coupled with the high mobility of college students who may travel to countries where measles is endemic or epidemic increases the potential for measles outbreaks.

Preventing measles in college-age populations is particularly important because the disease can be more serious in adults. In view of the importance of preventing measles in college students, the Immunization Practices Advisory Committee (ACIP) of the U.S. Public Health Service has recommended that officials strongly consider immunization requirements for college entry.

The ultimate goal of rubella immunization is the protection of a future fetus against damage from intrauterine infection. Although rubella cases are reported routinely on college campuses, most colleges make no effort at controlling these outbreaks or instituting immunization requirements. The ACIP strongly urges educational institutions to require proof of immunity to rubella for registration or employment.     

Backlash against the inclusion of students with learning disabilities in higher education: Implications for transition from post-secondary environments to work

Individuals with learning disabilities (LD), the largest group of people with disabilities in the United States, are attending college in greater numbers than ever before. Post-secondary training is critical for individuals with LD to make successful transitions into a changing and ever more demanding world of work. Research indicating that college faculty are willing to provide requested accommodations to students with LD suggests that they are increasingly likely to experience successful post-secondary outcomes, and therefore improve their vocational prospects. However, college students with LD and the accommodations they receive have recently garnered some highly critical press. These portrayals may portend problems in higher education for students with LD, who must self-identify and make specific accommodation requests to faculty in order to receive the instruction and testing environments that they require to succeed. Efforts to ensure that the LD label is not ubiquitously applied and that college faculty attempt to separate the idea of merit from achievement and implement instructional practices to better meet the educational needs of students with and without LD are recommended.     

Using nursing students to enhance one college's immunization program.

In New York State, all college students who were born on or after January 1, 1957, are required to show proof of immunity against measles, mumps, and rubella (MMR) before the 1st day of classes. Colleges have established immunization programs so that those students who do not have the required proof can be given the necessary injections. Often, our health service office does not have enough staff to administer the MMR shots during the registration period, resulting in long lines of students waiting to be immunized. In this article, the authors describe how one college used nursing students to assist with and enhance its immunization program. The 45 nursing students who participated in this project administered 694 injections over a 5-day period, They received credit from the nursing department for clinical time and all of the participants agree that the project was a success.     

Knowledge about hepatitis B and predictors of hepatitis B vaccination among Vietnamese American college students.

Asian American college students are at high risk for hepatitis B virus (HBV). PARTICIPANTS AND METHODS: Vietnamese American students completed a questionnaire assessing HBV knowledge and attitudes. The authors performed statistical analyses to examine the relationship between HBV knowledge and participant characteristics. They also performed logistic regression to identify predictors of vaccination. Participants' mean age was 22.2 years, and almost 50% were born in the United States. RESULTS: Only 29.9% knew that Asian Americans are at high risk for HBV. Participants who had undergone screening or vaccination or had a family member with HBV or liver disease had significantly higher levels of HBV knowledge. Less acculturated students were less likely to have received vaccination. Those with higher levels of knowledge were more likely to have received the vaccine. CONCLUSIONS: HBV educational programs targeting young Asian American individuals are needed, with emphasis on reaching less acculturated individuals. Institutions of higher education are important locales to coordinate HBV efforts for young Asian Americans.     

Using Nursing Students to Enhance One College's Immunization Program

Abstract

In New York State, all college students who were born on or after January 1, 1957, are required to show proof of immunity against measles, mumps, and rubella (MMR) before the 1st day of classes. Colleges have established immunization programs so that those students who do not have the required proof can be given the necessary injections. Often, our health service office does not have enough staff to administer the MMR shots during the registration period, resulting in long lines of students waiting to be immunized. In this article, the authors describe how one college used nursing students to assist with and enhance its immunization program. The 45 nursing students who participated in this project administered 694 injections over a 5-day period, They received credit from the nursing department for clinical time and all of the participants agree that the project was a success.     

US college students' reports of receiving health information on college campuses

Institutions of higher education are in a unique position to promote healthy behaviors by providing health education to students, but little information exists about the proportion of students reached by such efforts. The authors used data from a nationally representative sample of college students to describe the extent to which students reported receiving health information from their colleges and universities, to examine the characteristics of students who received such information, and to determine specific sources of health information. Approximately three quarters of college students reported they received information on at least one health topic, and 6% received information on all of the topics examined. Those who reported receiving health information from their colleges or universities were likely to be "traditional" college students. To achieve relevant national health objectives, health educators must increase the proportion of students they reach and the number of health topics they cover.     

Healthcare providers' treatment of college smokers

About 28% of college students smoke tobacco, and many will continue smoking into adulthood. Although little is known about how to help college students quit smoking, 1 promising strategy is healthcare providers' advice. To estimate their life-time receipt of brief advice and to identify characteristics that predict who may receive that advice, 348 college students completed a survey about their smoking and related practices. Seventy-seven percent of the smokers (73% of the students) were asked about smoking. Of those smokers, 57% were advised to quit, 22% were given advice about quitting, 5% were helped with setting a quit date, and 4% were offered follow-up. Occasional smokers were less likely than daily smokers to be advised to quit. Although 36.2% of the smokers did not report their smoking accurately, smokers who were accurate were more likely to be advised to quit and to be given advice about quitting.     

Effects of Parental Divorce on Children's Financial Support for College Students

No-fault divorce laws, and the lowering of the age of minority from 21 to 18 years have combined to have unintended negative impact on the children of divorce. Previous research has shown that children whose parents are divorced are at increased risk for emotional problems and a reduced standard of living. This study was conducted to learn more about the effects of parental divorce on a young person's access to a college education. A questionnaire was developed to learn how students pay for college, and what non-financial support they receive from parents. The questionnaire was administered to a randomly selected sample 9 of 19 students at a state university. Findings indicated that young people whose parents were divorced received higher Pell grants, were more likely to provide more of their own necessities, and were more likely to repay their college loans themselves. Further, young people whose parents were divorced were much more likely to have their material and fnancial needs met by their custodial parents rather than their noncustodial parents. Implications are that young people with divorced parents may have less financial support for college from their family, and the support they receive is much more likely to come from their custodial than noncustodial parent. Changes in child support laws and financial aid policies are recommended.     

Knowledge About Hepatitis B and Predictors of Hepatitis B Vaccination Among Vietnamese American College Students

Asian American college students are at high risk for hepatitis B virus (HBV). Participants and Methods: Vietnamese American students completed a questionnaire assessing HBV knowledge and attitudes. The authors performed statistical analyses to examine the relationship between HBV knowledge and participant characteristics. They also performed logistic regression to identify predictors of vaccination. Participants' mean age was 22.2 years, and almost 50% were born in the United States. Results: Only 29.9% knew that Asian Americans are at high risk for HBV. Participants who had undergone screening or vaccination or had a family member with HBV or liver disease had significantly higher levels of HBV knowledge. Less acculturated students were less likely to have received vaccination. Those with higher levels of knowledge were more likely to have received the vaccine. Conclusions: HBV educational programs targeting young Asian American individuals are needed, with emphasis on reaching less acculturated individuals. Institutions of higher education are important locales to coordinate HBV efforts for young Asian Americans.     

Negative consequences of alcohol use among college students: victims or victimizers?

Focusing on reciprocity between primary and secondary consequences resulting from alcohol use among college students, this study hypothesizes that college students should not be dichotomously viewed as those who generate alcohol-related negative consequences and those who suffer from the consequences generated by fellow students; instead, since students usually live closely together and most of them use alcohol, they constantly affect one another with consequences of their alcohol use. Five colleges in New York State were randomly selected for the study. The telephone interview method was employed to survey college students during the spring semester of 1998. Within each participating college, students were randomly selected through the use of complete student telephone directories provided by the college administration. A total of 813 students were interviewed. Findings indicate that negative consequences of alcohol use among college students may be understood more in a form of group process than in separate individual circumstances. Through association and interaction with other alcohol users, students are frequently victimizing fellow students and being victimized by others in terms of alcohol-related consequences; the severity of alcohol-related hazard for students, thus, tends to be twice as severe as that for individuals who are not in a college environment.     

College Prevention: A View of Present (and Future) Web-Based Approaches

College campuses in the United States may be the most electronically "wired" environments on earth. College students use the Internet not only to write term papers and receive correspondence but also to report (and keep track of) friends' personal status, download music, view classroom lectures, and receive emergency messages. In fact, college students spend considerably more time online than the average person. In a recent survey of U.S. college students (Jones et al. 2009), nearly all respondents (94 percent) stated that they spent at least 1 hour on the Internet each day, with the main tasks including social communication, entertainment, and class work. In keeping with this trend, Web-based programs that address alcohol consumption among college students have become widely available in the United States. This sidebar provides an overview of currently available programs as well as of the advantages and disadvantages of this approach and the future outlook of Web-based programs.     

Life change and spirituality among a college student cohort

OBJECTIVE: Because college marks a time when life-change is typically high, the authors designed this study to determine whether life-change was related to degree of spirituality, the "directing" component of health, among a college student cohort. PARTICIPANTS AND METHODS: The sample group, consisting of 180 northeastern US undergraduate college students, completed the 48-item Life Attitude Profile-Revised (LAP-R) and the Schedule of Recent Experience (SRE) in the fall semester of 2004. RESULTS: Findings indicate that college students who reported experiencing higher levels of life change, both positive and negative, also scored lower on spirituality. Nevertheless, these students had scores indicative of a higher desire to find spirituality, even though their motivation to do so was low. CONCLUSIONS: Although life changes among college students likely will remain high, lower spirituality can be enhanced; therefore, interested health educators are encouraged to help students increase their degree of spirituality.     

Evaluation of a measure of incidental legal risk behaviors in college students who use alcohol

The purpose of this study was to develop a new measure of incidental behaviors that put college students at increased risk of legal consequences while using alcohol, the Legal Risk Behaviors while using Alcohol (LRBA) scale. Two hundred and twenty one college students who used alcohol were recruited to complete an online study about their use of alcohol, specific behaviors engaged in while using alcohol, and associated consequences. Analyses revealed that the 19-item LRBA consisted of three factors--"Risky Behaviors," "Protective Behaviors," and "Private Settings." Analyses suggested that the LRBA had adequate test-retest reliability and internal consistency. Initial results indicate that the LRBA may be a useful measure to help us better understand what behaviors college student engage in that increase their risk for experiencing a legal encounter.     

The effect of a college sexual assault prevention program on first-year students' victimization rates

OBJECTIVE: Although a variety of sexual assault prevention programs are currently available to college health professionals, there is a dearth of information about the effect of these programs on sexual assault victimization rates. PARTICIPANTS: The authors evaluated the efficacy of a sexual assault prevention program for first-year students at a college in the Northeast (N = 1,982). METHODS: They used a retrospective cohort design and assessed the prevalence of sexual assault victimization among students exposed to the sexual assault prevention program and students 1 year their senior who were not exposed. RESULTS: Students who had no exposure were more likely to report that they were sexually assaulted during their first year of college (odds ratio = 1.74, 95% confidence interval [1.32-2.29]). Results suggest that the program was effective for males and females, but not for students with a prior history of sexual assault victimization. Gay, lesbian, and bisexual students were at increased risk for victimization as compared with heterosexual students, and students who drank alcohol or engaged in binge drinking were at increased risk as compared with alcohol abstinent students. CONCLUSIONS: Findings suggest that this program had a positive effect on victimization rates for certain sub-groups of students.     

The Interactive Relationship Between Class Identity and the College Experience: The Case of Lower Income Students

To probe the role that college context plays in influencing the class-based aspects of identity for lower income students, we interviewed 30 lower income students, 15 from an elite college and 15 from a state college. Significant disparities of wealth between students at the elite college heightened awareness of class, and led to feelings of intimidation, discomfort, inadequacy, deficiency, exclusion, and powerlessness among lower income students, feelings that were less prevalent among state college students. Students at both colleges acquired new forms of cultural capital and coped with class-based discontinuities between who they were before college and who they were becoming, but these issues became heightened for the elite college students.     

Predictors of meningococcal vaccination among university students

Invasive disease secondary to Neisseria meningitidis is a rare but devastating illness among university students. The Advisory Committee on Immunization Practices recommends educating college freshmen about meningococcal disease and vaccinating all college freshmen who live in residence halls. We conducted this survey to gain a better understanding of current immunization rates and factors associated with vaccination.