Screening and Brief Intervention for Tobacco Use by Student Health Providers on College Campuses

Abstract

Objective: This study assessed college students’ reports of tobacco screening and brief intervention by student health center providers. Participants: Participants were 3,800 students from 8 universities in North Carolina. Methods: Web-based survey of a stratified random sample of undergraduates. Results: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. Conclusions: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.     

Web-assisted instruction for changing social cognitive variables related to physical activity

The authors examined the efficacy of Web-assisted instruction for promoting the use of social cognitive theory (SCT) strategies related to physical activity. They recruited college students attending health courses. The authors created 3 groups (Web-assisted, comparison, and control) based on the course structure. The Web-assisted group received information on exercise and fitness and a Web-based program (treatment, n = 127); 7 sections received the same exercise and fitness information as the treatment condition, but no Web-based program (comparison, n = 118); and 6 sections received information in unrelated areas (control, n = 178). The Web-based program consisted of 9 Web assignments (1 per week) that targeted key SCT variables. Satisfaction with the Web-based program was high. Use of self-regulation strategies was significantly higher at posttest in the treatment group than it was in the other groups. Knowledge concerning the skills taught by the Web assignments was significantly greater in the treatment group than it was in the comparison group. The results of this study demonstrate that a Web-based instructional program has a positive impact on knowledge and skills related to SCT strategies for changing physical activity behavior.     

Internet use among community college students: implications in designing healthcare interventions

The Internet has become a commonly used venue for seeking healthcare information. Young adults search the Internet for health information more than any other group, yet little is known about use patterns among community college students. The authors surveyed a diverse community college to assess students' use of the Internet for health-related information. More than 80% had home Internet access, regardless of race or gender. Men and women searched for health information in almost equal numbers. Most students were interested in searching for diet/nutrition topics, and least interested in smoking information. Although the digital divide appears to be closing, varying levels of interest in a variety of important health topics remain. Understanding these differences could guide the design of more effective Web-based health interventions.     

Web-Assisted Instruction for Changing Social Cognitive Variables Related to Physical Activity

The authors examined the efficacy of Web-assisted instruction for promoting the use of social cognitive theory (SCT) strategies related to physical activity. They recruited college students attending health courses. The authors created 3 groups (Web-assisted, comparison, and control) based on the course structure. The Web-assisted group received information on exercise and fitness and a Web-based program (treatment, n = 127); 7 sections received the same exercise and fitness information as the treatment condition, but no Web-based program (comparison, n = 118); and 6 sections received information in unrelated areas (control, n = 178). The Web-based program consisted of 9 Web assignments (1 per week) that targeted key SCT variables. Satisfaction with the Web-based program was high. Use of self-regulation strategies was significantly higher at posttest in the treatment group than it was in the other groups. Knowledge concerning the skills taught by the Web assignments was significantly greater in the treatment group than it was in the comparison group. The results of this study demonstrate that a Web-based instructional program has a positive impact on knowledge and skills related to SCT strategies for changing physical activity behavior.     

College health services in California.

College health services are an underrecognized segment of California's health delivery system. Higher education institutions in California vary in their arrangements for the provision of health services. Some of the smaller institutions provide nurse triage, first aid, and referral only, whereas other institutions provide 24-hour-per-day/7-day-per-week comprehensive ambulatory and inpatient services. More than 200 full-time equivalent physicians are employed in college health services in California. Patient profiles served by college health services targeted the traditional college student age range. Some institutions, however, have expanded their services to include nonstudent university employees and their dependents. Comparing numbers of outpatient visits and professional staffing requirements to student enrollment showed significant variability between institutions, depending upon the scope of services provided (basic, intermediate, comprehensive) and the type of student population (residential, commuter, mixed).     

Quality Improvement in Patient Distribution at a Major University Student Health Center

Abstract

Healthcare in a major university setting poses unusual challenges and great opportunities. Two traditionally challenging areas in patient distribution are the initial intake of allergy/immunization patients and the triage of outpatients in the general medical clinic. The authors describe the use of the FOCUS-PDCA quality improvement (QI) problem-solving process for each situation. After identifying major problems, the health center established cross-functional teams of experts representing the allergy/immunization and general medical clinics. The teams analyzed the problems with a flow chart and undertook studies to further elucidate causes and potential solutions. They listed potential solutions in order of priority and submitted them to the student health center director for review and initiation. Each team then used the PDCA (plan-do-check-act) cycle to put approved solutions into effect. Permanent improvements made in each area resulted in a more effective and efficient patient distribution system, favorable staff comment, and greater patient satisfaction.     

Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis

Abstract

Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between January and April 2006. Methods: A standardized 2-tiered screening approach for an inception cohort of students utilizing primary services. Primary care providers were trained to triage students with depressive symptoms. Results: Six percent of participants had clinically significant depressive symptoms (CSD). Severe depressive symptoms were found in less than 1.0% of participants. Male rates of severe depressive symptoms were more than double that of females. Only 35.7% of untreated depressed participants started treatment within 30 days following identification. Conclusions: Systematic primary care depression screening in a college health center is a promising approach to identify untreated students with depression. More study is needed to improve rates of treatment engagement.     

Quality improvement in patient distribution at a major university student health center

Healthcare in a major university setting poses unusual challenges and great opportunities. Two traditionally challenging areas in patient distribution are the initial intake of allergy/immunization patients and the triage of outpatients in the general medical clinic. The authors describe the use of the FOCUS-PDCA quality improvement (QI) problem-solving process for each situation. After identifying major problems, the health center established cross-functional teams of experts representing the allergy/immunization and general medical clinics. The teams analyzed the problems with a flow chart and undertook studies to further elucidate causes and potential solutions. They listed potential solutions in order of priority and submitted them to the student health center director for review and initiation. Each team then used the PDCA (plan-do-check-act) cycle to put approved solutions into effect. Permanent improvements made in each area resulted in a more effective and efficient patient distribution system, favorable staff comment, and greater patient satisfaction.     

Student assistance program: a new approach for student success in addressing behavioral health and life events

College health centers, whether large or small, often find it challenging to provide counseling and supportive services for all students (including remotely located students) 24 hours a day, 7 days a week. Student assistance programs (SAPs) are services provided to students through a contractual arrangement to the university or college as a part of student services. The goal is to address psychosocial concerns that may interfere with academic performance within the realm of short-term counseling. These services range from traditional behavioral health concerns about stress and depressive reactions to how to find child care with foreign-speaking services. In this article, the authors describe a method to provide such short-term counseling to a 2,200-student health-science campus. They present data from 1 year of service as well as the benefits and limitations.     

Student Assistance Program: A New Approach for Student Success in Addressing Behavioral Health and Life Events

College health centers, whether large or small, often find it challenging to provide counseling and supportive services for all students (including remotely located students) 24 hours a day, 7 days a week. Student assistance programs (SAPs) are services provided to students through a contractual arrangement to the university or college as a part of student services. The goal is to address psychosocial concerns that may interfere with academic performance within the realm of short-term counseling. These services range from traditional behavioral health concerns about stress and depressive reactions to how to find child care with foreign-speaking services. In this article, the authors describe a method to provide such short-term counseling to a 2,200-student health-science campus. They present data from 1 year of service as well as the benefits and limitations.     

Date fighting experiences among college students: are they associated with other health-risk behaviors?

OBJECTIVE: The authors examined the clustering of health-risk behaviors among college students who reported date fight involvement. PARTICIPANTS AND METHODS: The authors administered a Web-based survey to a stratified random sample of 3,920 college students from 10 universities in North Carolina. RESULTS: Among men, 5.6% reported date fight victimization, and 1% reported date fight perpetration. Victimization among men was associated with (1) first drink at age 15 years or younger, (2) a recent threat of violence by someone who had been drinking, (3) smoking, (4) amphetamine use, and (5) older age. Among women, 6.7% reported date fight victimization, which was associated with (1) older age, (2) assault from a student who had been drinking, (3) sex with 2 or more persons, (4) consumption of alcohol in high school, (5) illegal drug use, (6) nonsexual assault requiring medical treatment, and (7) living off campus. Of the women, 4.2% reported date fight perpetration, which was associated with (1) minority race/ethnicity, (2) older age, (3) frequency of sexual intercourse, and (4) alcohol and marijuana use. CONCLUSIONS: Date fight experiences were associated with multiple health-risk behaviors among this sample of college students.     

Alcohol Use in Students Seeking Primary Care Treatment at University Health Services

Abstract

Objective: Given the high rate of at-risk drinking in college students, the authors examined drinking behaviors and associated factors in students being seen in student health services for primary care visits from October 30, 2004, to February 15, 2007. Methods: Analyses were based on a Health Screening Survey completed by 10,234 college students seeking general medical treatment. Results: Alcohol use was similar to other studies with 57% (n = 5,840) meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking. Twenty-six percent of the students reported smoking at least once in the last 3 months. Risk factors for at-risk drinking included young age, white males, drinking at a fraternity/sorority house, and use of tobacco. Conclusions: These findings support the widespread implementation of alcohol screening and intervention in university health services.     

Predictors of smoking and smokeless tobacco use in college students: a preliminary study using web-based survey methodology

Cigarette smoking and smokeless tobacco (SLT) use are associated with numerous health hazards and economic costs, and rates of tobacco use have recently increased among young adults. In this study, the authors compared predictors of smoking and SLT use among college students (N = 21,410) from 13 Texas universities using a Web-based survey. Results revealed that sex, belonging to a fraternity or sorority, participation in intercollegiate sports, peer influences, and ethnicity predicted smoking and SLT use. Although common factors predicted both lifetime and current smoking and SLT use, patterns of prediction differed across dependent variables. The authors discuss implications for developing tobacco prevention programs targeting specific risk factors salient to the young adult population.     

Evidence for significant polydrug use among ecstasy-using college students

Ecstasy (MDMA) has been added to the spectrum of illicit drugs used by college students. In this study, the authors estimated the prevalence of ecstasy use within a large college student sample and investigated the polydrug-use history of those ecstasy users. They administered an anonymous questionnaire to college students (N = 1,206) in classrooms at a large university in the mid-Atlantic United States. The overall student response rate was 91%. Nine percent of the sample reported lifetime ecstasy use. Because 98% of ecstasy users had used marijuana, the authors compared polydrug use between ecstasy users and individuals who had used marijuana but not ecstasy. Ecstasy users, as compared with these marijuana users, were significantly more likely to have used inhalants (38% vs. 10%), LSD (38% vs. 5%), cocaine (46% vs 2%), and heroin (17% vs 1%) in the past year. Significant polydrug use among college student ecstasy users has important implications for their substance abuse treatment.     

Exploring the Climate for Overweight and Obese Students in a Student Health Setting

Attitudes and beliefs of health care providers, in conjunction with a nonthreatening physical environment, are important components in establishing a constructive and supportive climate for care of overweight and obese students. Objective: The authors explored providers' attitudes about obesity and assessed the physical environment in a student health clinic to identify areas that may be detrimental to the care of overweight and obese students. Participants: Eighteen direct care providers participated in the project. Methods: The authors conducted focus groups with direct care providers and assessed their experiences and perceived challenges in working with overweight and obese students. The authors also conducted a walk-through assessment of the physical environment. Results: Direct care providers expressed discomfort in deciding how and when to discuss weight with students. The authors found that elements of the physical environment could present barriers to care for overweight and obese students. Conclusions: The authors make recommendations for improving the health care climate for overweight and obese students.     

Coping with Competitors Coast to Coast

Abstract. Ecstasy (MDMA) has been added to the spectrum of illicit drugs used by college students. In this study, the authors estimated the prevalence of ecstasy use within a large college student sample and investigated the polydrug-use history of those ecstasy users. They administered an anonymous questionnaire to college students (N = 1,206) in classrooms at a large university in the mid-Atlantic United States. The overall student response rate was 91%. Nine percent of the sample reported lifetime ecstasy use. Because 98% of ecstasy users had used marijuana, the authors compared polydrug use between ecstasy users and individuals who had used marijuana but not ecstasy. Ecstasy users, as compared with these marijuana users, were significantly more likely to have used inhalants (38% vs. 10%), LSD (38% vs. 5%), cocaine (46% vs 2%), and heroin (17% vs 1%) in the past year. Significant polydrug use among college student ecstasy users has important implications for their substance abuse treatment.     

Self-Reported Incidence of Physical Violence in College Students

Abstract

A survey of a college student population indicates that physical abuse is prevalent in our society. The self-reported data were found to be similar to that occurring in the literature on parent-reported child abuse, documenting that approximately one-third of college students had a history of moderate abuse and 5 to 10% had a history of a severe abuse during their developmental years. Through an awareness of its high prevalence, the health care provider will question a history of physical violence when evaluating a student with a medical or psychosocial complaint and appropriately plan a management program including therapeutic counseling to decrease the effect of the prior or current physical abuse.     

Patient Rights: An Advocate's Perspective

Abstract

The current growing concern about patients' rights and the delivery of student health care precipitates an environment of fear, distrust, and uneasiness within university health services. This paper addresses several selected clinical, ethical, and legal issues which have come into conflict during recent years. Our examination surveys ethical and legal principles of confidentiality, defines areas in which breaches are most likely to occur, and suggests ways of preventing breaches of confidence between students and health services.

While the fundamental ethical principle underlying confidentiality is the individual's right of privacy, many issues of confidentiality are extremely difficult to resolve. University health services have expanded the concept of health care to encompass all the conditions — medical, emotional, social, economic and environmental — which affect the health of students. As a result, health service administrators should be fully aware of the laws and associated legal complexities in their own state which affect confidentiality. Furthermore, student health physicians, and particularly mental health therapists must be sensitive to needs for protecting the privacy of students.

Legal principles of confidentiality discussed in this paper with respect to specific problem situations which might arise in a student health center include: 1) right to privacy; 2) privileged communications; 3) releasing information from the medical record; 4) releasing information to the student; and 5) treating minors without parental consent. Finally, in addition to the responsibilities which must be assumed by the health professional, certain student responsibilities in the selection and utilization of health professionals are recommended.     

Some data on the establishment of student families: the social-hygiene and demographic aspects

Some social, demographic, and health aspects of family formation among students aged 20-24 in the USSR are discussed. Trends in the incidence of student marriages are examined with respect to age at marriage, number and timing of births, pregnancy outcome, use of medical facilities, child care arrangements, and reasons for delaying pregnancy. Data are from a survey of 643 married students interviewed in 1978 and 1979.