Beyond alphabet soup: helping college health professionals understand sexual fluidity

ABSTRACT

Many college students today are no longer using the terms straight, gay, lesbian, bisexual, or transgender to self-identify their sexual orientation or gender identity. This commentary explores research related to fluidity of sexual identities, emerging sexual identities used by college students, and how these identities interact with the health and well-being of the student. Additionally, the authors discuss strategies to help college health professionals provide a sensitive environment and clinical experience for students whose sexual identity is fluid.     

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.     

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.     

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.     

Are Peer Educators Really Peers?

Objective, Participants, and Methods: To determine whether peer educators are considered peers by their audiences, the authors compared 28 peer educators and 28 college students on their personal qualities using self-report surveys. Results: Students who wanted to become peer educators reported higher self-esteem, greater leadership skills, and fewer risky health behaviors than did demographically similar college students. However, peer educators appeared similar to their colleagues in terms of personal values and personality temperament. Conclusions: Although peer educators are natural leaders with strong self-esteem and more healthy behaviors, they appear to be quite similar to their audiences in regard to values and temperaments, making them successful role models and arguably true peers.     

What do urban college students really think about health insurance? A qualitative study

Abstract

Objective: To determine barriers and opportunities to health insurance enrollment among an undergraduate students at a large urban university. Participants: Participants were 31 college students enrolled in 4-year and community colleges in the City University of New York (CUNY), and six health services and insurance enrollment specialists who facilitate and assist in the health insurance enrollment process for CUNY students. Methods: Focus groups were conducted with students and in-depth interviews with key informants in May 2017. Results: The research revealed important insights into how students perceive and value insurance and yielded recommendations for the university to improve enrollment of its students. Conclusions: Many colleges can increase student enrollment in health insurance by informing and educating students about the process. Improving enrollment processes can increase insurance rates and improve student population health.     

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.     

Premature Return to School following a Psychotic Episode

Abstract

A college mental health service professional often finds that a student who has had an episode of psychiatric illness is eager to return to fulltime status before he or she seems ready for this undertaking. The mental health professional may advise that the student stay out of school for a longer period, but often this advice is rejected.

Approaches to dealing with the problem of return to school following an academic leave prompted by a psychotic episode include the requirement that the student maintain a minimum time out of school and be in treatment during the attempt to return to academic life. The assessment of a student's psychological status at the time of a proposed return often raises the problem of dual agency. Although the college mental health professional is apt to place a high value on maximizing the student's chances of having things work out to his or her liking, the administrator to whom the mental health professional is ultimately responsible is probably inclined to place the needs and well-being of the campus community above those of the student seeking to return.

While the proposed return of a student to academic work following a psychotic episode poses many difficult questions, considerable experience is available to aid in the task of those charged with making this decision. The authors propose two helpful approaches.     

Social network analysis for assessing college-aged adults' health: A systematic review

Objective: Social network analysis (SNA) is a useful, emerging method for studying health. College students are especially prone to social influence when it comes to health. This review aimed to identify network variables related to college student health and determine how SNA was used in the literature. Participants: A systematic review of relevant literature was conducted in October 2015. Methods: Studies employing egocentric or whole network analysis to study college student health were included. We used Garrard's Matrix Method to extract data from reviewed articles (n = 15). Results: Drinking, smoking, aggression, homesickness, and stress were predicted by network variables in the reviewed literature. Methodological inconsistencies concerning boundary specification, data collection, nomination limits, and statistical analyses were revealed across studies. Conclusions: Results show the consistent relationship between network variables and college health outcomes, justifying further use of SNA to research college health. Suggestions and considerations for future use of SNA are provided.     

Waterpipe Smoking Among College Students in the United States: A Review of the Literature

Abstract

Objective: To review the literature on college student waterpipe use with a focus on undergraduates in the United States. Participants: Undergraduate students. Methods: Studies were accessed using the databases PubMed, MEDLINE, PsycINFO, and Academic Search Premier. Searches included combinations of the following keywords: “waterpipe,” “hookah,” “shisha,” “nargila,” “argileh,” “hubble bubble,” “college,” “university,” and “student.” Results: Results demonstrate that approximately 1 in 5 American college students report past-year waterpipe use. Results also suggest that there are a number of established correlates of waterpipe smoking, including male gender, Arab ethnicity, cigarette smoking, and the belief that waterpipe smoking is less harmful than cigarette smoking. Conclusions: Despite its harmful health effects, waterpipe smoking is quite common among college students. Future research with better methodologies and theoretical frameworks are needed to advance the field.     

Flourishing: Exploring Predictors of Mental Health Within the College Environment

Abstract

Objective: To explore the predictive factors of student mental health within the college environment. Participants: Students enrolled at 7 unique universities during years 2008 (n = 1,161) and 2009 (n = 1,459). Methods: Participants completed survey measures of mental health, consequences of alcohol use, and engagement in the college environment. Results: In addition to replicating previous findings related to Keyes’ Mental Health Continuum, multiple regression analysis revealed several predictors of college student mental health, including supportive college environments, students’ sense of belonging, professional confidence, and civic engagement. However, multiple measures of engaged learning were not found to predict mental health. Conclusions: Results suggest that supportive college environments foster student flourishing. Implications for promoting mental health across campus are discussed. Future research should build on exploratory findings and test confirmatory models to better understand relationships between the college environment and student flourishing.     

Undergraduate students survey their peers on mental health: Perspectives and strategies for improving college counseling center outreach

Abstract

Objective: The purpose of the study was to examine student perspectives about college mental health including the primary mental health issues affecting students, common college student stressors, student awareness of campus mental health resources, and mental health topics students want more information about. Participants: Participants were 822 undergraduate and graduate students enrolled in a private university. The study was conducted during September 2016. Methods: As part of a public health course in program planning, undergraduate students surveyed their peers about their experience with mental health and mental health resources. Results: Stress was perceived as the largest mental health issue. Students most wanted more information about school/work/life balance followed by stress management. Electronic newsletters, social media, and on-campus seminars were the top strategies that students suggested as ways to reach them. Conclusions: The results provide student perspectives on mental health that may be useful in developing effective outreach efforts.     

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.     

Herpes: Coping and Caring—A Total College Health Program

Abstract

This article seeks to assist college health nurses in developing appropriate protocols for patient care. In addition, the authors outline factors influencing protocol content, design, and development and describe steps in creating individualized protocols by practice setting. To provide college health nurses with a basic understanding of protocols, the authors offer definitions and examples of appropriate and inappropriate use, and show how protocols can influence the delivery of patient care. Although protocols may provide college health nurses with directives for managing specific health problems, they require a sophisticated level of judgment and skill in their implementation.     

Evaluating the design and implementation fidelity of an adapted Plan-Do-Study-Act approach to improve health system performance in a Nigerian state

BackgroundThe Plan-Do-Study-Act (PDSA) cycle is fundamental to many quality improvement (QI) models. For the approach to be effective in the real-world, variants must align with standard elements of the PDSA. This study evaluates the alignment between theory, design and implementation fidelity of a PDSA variant adapted for Nigeria’s health system performance improvement.MethodsAn iterative consensus building approach was used to develop a scorecard evaluating new conceptual indices of design and implementation fidelity of QI interventions (design and implementation index, defects and gaps) based on Taylor’s theoretical framework.ResultsDesign (adaptation) scores were optimal across all standard features indicating that design was well adapted to the typical PDSA. Conversely, implementation fidelity scores were only optimal with two standard features: prediction-based test of change and the use of data over time. The other features, use of multiple iterative cycles and documentation had implementation gaps of 17 % and 50 % respectively.ConclusionThis study demonstrates how both adaptation and implementation fidelity are important for success of QI interventions. It also presents an approach for evaluating other QI models using Taylor’s PDSA assessment framework as a guide, which might serve to strengthen the theory behind future QI models and provide guidance on their appropriate use.     

Health Services Utilization Among Graduate Students: Patterns of Use,Access, and Satisfaction

Abstract

Utilization of health services by graduate students has been a neglected area of college health research. This paper describes the access problems and utilization patterns of a systematic random sample of the graduate student population at the University of Mississippi.

Survey methodology was used to assess sociodemographic, health status, and attitudinal characteristics of the study sample. In addition to type and number of visits for various health services, other utilization-related items included access to and satisfaction with care, and information received about these health services.

The results indicated that graduate students and their dependents were reliant to a large degree on local health care. Inadequacy of information was viewed as a major problem relating to access. Satisfaction with care appeared to be a function of the quality of care received.     

Mental health literacy,stigma, and help-seeking behaviors among male college students

Objective: Mental health literacy (MHL) is low in college-aged men potentially resulting in impaired mental wellbeing. This study assessed MHL, psychosocial determinants, and help-seeking behaviors among male university students. Participants: Male undergraduate and graduate students were surveyed in Spring 2017 (n = 1,242) at a large southeastern university in the United States. Methods: Preexisting validated scales for MHL, psychosocial determinants, and help-seeking intention were used in measurement and demographic variables were collected. T-tests and one-way ANOVA were performed to measure differences between groups. Results: Participants showed low scores for all constructs with statistically significant differences between undergraduate and graduate students, as well as between races and major classifications. Undergraduate men had moderate MHL and low intentions to seek professional care. Conclusions: Interventions focusing on increasing mental health knowledge and improving beliefs can improve MHL among male college students. Further, interventions should be tailored for racial groups and major classifications.     

Does the Andersen Behavioral Model of Health Services Use predict college students’ use of on-campus mental health services?

Abstract

Objective: 10–50% of college students meet the diagnostic criteria for one or more mental illnesses; unfortunately, less than half seek treatment. This study assessed the predictive power of specific variables on students’ use of on-campus mental health resources using the American College Health Association’s National College Health Assessment (ACHA-NCHA) II. Participants: Respondents included undergraduate and graduate students ages 18–35?years (n?=?96,121). Methods: We analyzed data from the ACHA-NCHA II Fall 2014 and Spring 2015. Andersen’s Behavioral Model of Health Services Use enabled selection of predisposing, enabling, and need predictor variables; these were analyzed individually and collectively. Results: Predisposing, enabling, and need variables accounted for 9%, 2.3%, and 17% of the overall variance. Significant variables associated with a student’s decision to access on-campus mental health services accounted for 23% of variance total. Conclusions: This insight could allow universities to better recognize students at-risk for needing but not accessing mental health services.