Predictors of Student Health Care Utilization Patterns

Abstract

In recent years, interest has been renewed concerning student utilization and nonutilization of university and college health services. A study was conducted at James Madison University to examine for prediction purposes: (a) student utilization patterns; (b) knowledge of available services; and (c) attitudes toward the student health service. Questionnaires were sent to a 10% random sample of the student population. Employing multiple regression analysis, the predictive value of the independent variables of knowledge, attitudes, convenience, and sociodemographic data were evaluated for the three criterion (dependent) variables related to utilization and non-utilization of health services. These had been identified as (1) frequency of use, (2) number of different types of use, and (3) user-nonuser. Results of the analysis indicated that certain predictor variables could predict to an extent the utilization and nonutilization patterns of students. The implications of these findings as well as their reflections on previous studies are discussed.     

Prevention Efforts Underlying Decreases in Binge Drinking at Institutions of Higher Education

Abstract

Analyses of 94 Fund for the Improvement of Post-Secondary Education (FIPSE)-sponsored drug-prevention programs and their outcomes used the Core Survey to identify 34 institutions where college students' binge drinking increased (M = 5.44%) and 60 institutions where it decreased (M = -4.59%) during 2 years of program operation. The authors used an inductively derived taxonomy of prevention program elements, student variables, student substance use, use-related variables, and institutional variables to compare the 2 groups of institutions. Only prevention program elements discriminated between groups. Factor analysis of discriminating elements identified 8 prevention factors that improved base-rate prediction of institutional decrease in binge drinking by 28.1%. Factor synthesis yielded a 3-construct binge-drinking prevention model based on student participation and involvement strategies, educational and informational processes, and campus regulatory and physical change efforts. This model improved base-rate prediction of decreased binge drinking by 33.2%.     

Abortion,Limited Medical Resources,and the Meaning of Health Care

Abstract

Although accidents are the leading cause of death among college students, literature about developing student health safety programs is limited. In this article, we present preliminary recommendations based on literature review, epidemiologic data, and Nominal Group Process (NGP) activities, for developing university student safety programs. Our recommendations include appointing a coordinator to oversee all on-campus safety activities, providing for university-wide education programs dealing with alcohol and drug use, promoting personal safety efforts in areas such as family violence and rape prevention, and encouraging students to use safe transportation alternatives.     

Growth Promotion Activities in Rural Areas: Do They Make a Difference?1

Abstract Can leaders in small towns and surrounding areas actually influence local economic and demographic growth? Competing views but few studies of this issue characterize recent debates about the effects of “growth machines” in local areas. This paper uses alternative indicators of growth during the 1980s for a sample of local areas in rural Pennsylvania to examine the effects of development efforts, controlling ecological and structural characteristics. The analysis considers local participation in state programs and maintenance of a favorable business climate as well as measures of local growth promotion for business and industry, recreation and tourism, development of forest products, and services development. Hierarchical regressions, taking account of the statistically dominant effects of ecological and structural variables, show that local efforts can influence local growth.     

College Time: Implications for Student Mental Health Services

Abstract

Time conditions on campus are in many ways extreme and contribute to the distinctiveness and stress of the college or university experience. This paper studies college time by examining the variables of duration, change, and degree of structure across the perspectives of the overall college career, the course of a single semester, and day to day student life. The most salient features that are identified are the interruptions in the college experience caused by vacations and leaves from campus, the extent and pace of change both over the college career and over the semester, and the lack of a set time structure in daily student life. These and other time features, it is proposed, have a dual effect on student mental health services, influencing the content and timing of students' issues in psychotherapy and the nature of the psychotherapy that mental health offices provide. In light of the special features of college time, recommendations are offered regarding waiting lists, duration of therapy, distribution of sessions, scheduling of sessions, and time-based evaluations and interventions.

“Primary Plague Pneumonia Contracted from a Domestic Cat at South Lake Tahoe, Calif,” S. Benson Werner, et al. Primary plague pneumonia occurred in a 47-year-old South Lake Tahoe woman shortly after face-to-face exposure to her plague pneumonia-infected cat. Both died. Field investigation revealed a recent plague epizootic in squirrels and chipmunks around the patient's home. Control measures included active surveillance and chemoprophylaxis of 197 contacts to the victim, a community alert on methods of self- and pet-protection, and application of insecticide to reduce rodent flea populations. No secondary cases occurred. (Journal of the American Medical Association 1984;251:929–931.)     

Civic engagement among student veterans

Abstract

Objective: The purpose of this study was to assess participation rates in civic volunteering among service member and veteran students. Participants: Data for the present cross-sectional study were obtained from the American College Health Association’s (ACHA) 2011–2014 National College Health Assessment II (NCHA). Methods: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with either Fisher’s exact test or maximum likelihood multiple logistic regression. Results: Service member and veteran students were more likely to engage in volunteerism than their non-veteran counterparts. Additionally, student veterans and non-veteran students reported that engagement in volunteer efforts both reduces their feelings of depression and increases their use of mental health services. Conclusion: The findings of this research suggest that the promotion of civic engagement and participation in volunteerism for service member and veteran students on college campuses might contribute to successful reintegration outcomes.     

Student Bodies,Past and Present

Abstract

This article examines how the field of college health has evolved over time to address the needs of an increasingly diverse student population. The central argument is that college and university health programs developed in conjunction with shifting standards of medical care and public health practices in the United States. The author reviews the role of college health programs as public health agencies for campus communities, and describes contemporary public health challenges facing college campuses. She shows how the history of college health is intertwined with the history of diversity in higher education. In particular, the author outlines how the growth of health services made higher education accessible to women, racial minorities, veterans, and persons with disabilities.     

On the Integration of Science and Practice in College Health

Abstract

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an “all or nothing” proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.     

Student healthcare needs, attitudes, and behavior: marketing implications for college health centers

This article presents the findings of a 1987 cross-institutional study of the healthcare needs, attitudes, and behavior of college students, based on a comprehensive survey of 1,050 students at three different institutions. The paper focuses on student health concerns, use of facilities, and healthcare knowledge and outlook. For each of these topics, the authors present their findings and discuss the marketing implications of these findings for college health centers. In order to increase utilization rates, match services with student needs, and make maximum use of resources, the authors suggest that college health centers may need to develop and promote programs and services that better address student healthcare concerns; investigate media alternatives and effectiveness; develop aggressive promotion messages; consider joint interinstitutional development of healthcare advertising; and train and develop staff through internal marketing seminars.     

Prevention efforts underlying decreases in binge drinking at institutions of higher education

Analyses of 94 Fund for the Improvement of Post-Secondary Education (FIPSE)-sponsored drug-prevention programs and their outcomes used the Core Survey to identify 34 institutions where college students' binge drinking increased (M = 5.44%) and 60 institutions where it decreased (M = -4.59%) during 2 years of program operation. The authors used an inductively derived taxonomy of prevention program elements, student variables, student substance use, use-related variables, and institutional variables to compare the 2 groups of institutions. Only prevention program elements discriminated between groups. Factor analysis of discriminating elements identified 8 prevention factors that improved base-rate prediction of institutional decrease in binge drinking by 28.1%. Factor synthesis yielded a 3-construct binge-drinking prevention model based on student participation and involvement strategies, educational and informational processes, and campus regulatory and physical change efforts. This model improved base-rate prediction of decreased binge drinking by 33.2%.     

Student health insurance programs at collegiate institutions: a national survey

Increasing health care costs are forcing collegiate institutions to find more economical ways to meet the health care needs of students. Student health insurance programs are a major component in meeting these needs. This national survey reports the extent to which student health insurance programs are offered or administered by 2-year and 4-year colleges, universities, and professional and graduate schools in both the public and private sectors. The study finds that most programs are optional, open to all registered students regardless of age or credit load, with dependent coverage options usually available. Reported enrollment levels suggest that less than 20% of the students participate at a majority of the institutions surveyed. Concern about group health insurance at the collegiate level reflects national concern over the large number of Americans who currently lack health coverage.     

Health promotion and disease prevention: a look at demand management programs

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.     

One Hundred Years of College Mental Health

Abstract

Although the first student health service is credited to Amherst College in 1861, almost 50 years passed before Princeton University established the first mental health service in 1910. At that time, a psychiatrist was hired to help with student personality development. Although other schools subsequently established such services, the first 50 years of college mental health were marked by a series of national conferences. At the American Student Health Association's annual meeting in 1920, “mental hygiene” was identified as critical for college campuses to assist students to reach their highest potential. However, it took another 40 years before mental health and psychological counseling services became common on college and university campuses. The American College Health Association formed a Mental Health Section to serve mental health professionals in 1957, and most colleges and universities have now developed mental health and counseling programs commensurate with the size of their student bodies.     

Gender,academic performance and university athletes

This paper investigates gender differences in academic performance among university athletes at an NCAA Division I school. Using regression analysis, the findings suggest that background scholastic achievement variables and race influence university academic performance for student athletes, but sport participation measures and race are negatively related to university academic performance for males only. The consequences of inequalities between men's and women's athletic programs are explored. Implications for academic programs are discussed.     

The Status of Nutrition Education in ACHA College and University Health Centers

Abstract

An assessment of the prevalence and scope of nutrition services offered through 208 randomly selected American College Health Association member student health centers revealed that 79% of the 160 respondents provided some type of nutrition education for students. One-to-one counseling, available at 96% of the institutions, was the most common approach. The larger the school's enrollment, the more likely it was to provide programs in nutrition. All of the institutions with student populations of more than 35,000 offered some type of nutrition service, as did 52% of the 19 schools with enrollments between 2,000 and 5,000. Health educators, nurses, doctors, dietitians, and trained peer educators provided the services, with registered dietitians the most common providers and often coordinators of the programs. Costs to students for nutrition interventions were nominal; weightmanagement programs were the most expensive and showed the greatest variation in content.     

The History of College Health Nursing

Abstract

Almost from the beginning of formal college health programs in the second half of the 19th century, college health nurses were there to care for students in college and university settings. By the end of the 20th century, the role of college health nurses had evolved with the nursing field in general, but with enough unique features for the American Nurses’ Credentialing Center to recognize college health nursing as a professional subspecialty and administer the first College Health Nurse Certification examinations. In addition, new nurse practitioner programs provided practicing nurses with more independence, and their duties continued to expand beyond care of the sick to include health promotion, administrative, and teaching activities. As a result of these changes, college health nurses now play a larger role in the life of students and promoting a healthy campus community than ever before in the history of college health.     

Marketing Postsecondary Health Services

Abstract

This article reviews the major elements of marketing as applied to college and university health service programs. Changes in the health care industry, institutional debate about the advisability of institutionally based health centers, and the erroneous equation of promotion as marketing are reviewed. The necessity for research data to determine campus health program offerings is articulated as the most important aspect of successful marketing programs for health services. Types of segmentation for user groups are detailed, as well as the basic elements of an environmental analysis. The four fundamental aspects of health care marketing are discussed: the need to define the “core of service” for the health center; the issues associated with the access corridor to care; the task of refining communication channels; and the difficulty of measuring the effect of price on service usage rates. For marketing efforts to have a positive effect, colleges and universities must have an institutional commitment to health services. The article concludes by noting that marketing is a major management task.     

Self-leadership and stress among college students: Examining the moderating role of coping skills††

Abstract

Objective: Stress remains a major health concern among college students today. Consequently, research on student stress is imperative, from both an organizational and an individual perspective. This research study explores the moderating role of coping skills on the relationship between self-leadership and stress among college students. Participants: Data from 643 full-time undergraduate students attending a 4-year public university in the mid-Atlantic region were collected in February 2017 and analyzed using a moderated regression model. Results: The results indicate self-leadership practices do reduce student stress levels and that this relationship is moderated by student coping skills. Conclusion: The findings from this study deepen our understanding of how self-leadership practices may decrease student stress and showcases self-leadership as an effective tool for reducing college student stress.     

A survey of substance abuse prevention efforts at Virginia's colleges and universities

The extremes of college student substance use and the negative consequences students face as a result of such use are of great public health concern. Although a multitude of campus-based substance abuse prevention efforts have appeared in literature, a clear picture of the programs and policies currently in use at colleges and universities is not readily available. This research was undertaken to detail both the efforts aimed at general student samples and those targeting at-risk (eg, Greeks, student athletes) and historically underserved (eg, ethnic minorities, students with disabilities) student groups at colleges and universities in the Commonwealth of Virginia. While a variety of efforts were being made, there was a reliance on program orientations with limited scientific support. Four-year institutions used a wider array of outlets for their prevention messages. Targeted programs for at-risk groups were common but were largely unavailable specifically for ethnic minority students and students with disabilities.