College students are a sizeable and diverse group of people. In 1995, one quarter of people in the United States between 18 and 24 years of age were either full- or part-time college students, making colleges and universities an important setting for addressing common health issues for young adults. In 2004, nearly 14 million students will enroll in the 3,600+ undergraduate colleges and universities in the United States; just over half (57%) of those will be women. According to the National Center for Education Statistics (NCES), approximately one third of undergraduates are nonwhite and only half are of traditional college age (18-24 years). The National Center for Education Statistics recently noted that “more than a quarter (27%) of undergraduates had dependents, 13% were single parents, and 80% were employed, including 39% who were employed full time.” According to self-reports, about 1 in 10 college students have some kind of disability. Approximately 3.5 million college students in the United States do not have health insurance. These individuals may face substantial barriers in seeking access to health care. It is for these reasons that college students represent a little discussed but important and distinct health population in our country.
To better understand the prevalence of health-risk behaviors among college students, the Centers for Disease Control (CDC) sponsored the 1995 National College Health Risk Behavior Survey (NCHRBS), which was conducted with 4,609 U.S. undergraduates (age 18 and older) at 2- and 4-year institutions across the nation. The purpose of the NCHRBS was to monitor six areas identified as priority health risk factors: behaviors that contribute to unintentional and intentional injury; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including HIV; unhealthy dietary behaviors; and physical inactivity. The results of the NCHRBS are summarized below, followed by some discussion of health resources available to students.
Alcohol consumption is a significant public health problem among college students. Episodic heavy drinking is more prevalent among college students than among their peers of the same age who do not attend college. Alcohol use in this manner is strongly linked with serious injury and injury-related deaths, particularly involving motor vehicle accidents. Alcohol use among college students is also related to unsafe sexual behavior, violence, and academic problems. One third (34.5%) of students reported episodic heavy drinking during the 30 days preceding the survey and 27.4% reported drinking and driving during the month prior to the survey.
Tobacco use. The health effects of tobacco use are the single most preventable cause of death in the United States. Nevertheless, more than one quarter (29%) of college students reported currently smoking cigarettes. Although fewer college students (16.5%) are frequent cigarette smokers, it is clear that even modest levels of tobacco use may place students at risk for long-term addiction and associated health problems.
Illicit drug use. Nationwide, 48.7% of college students reported using marijuana at some point during their lifetime (i.e., “lifetime use”), while only 11.6% of women college students reported current marijuana use. While 14.4% of college students had used some form of cocaine during their lifetime, fewer than 1 in 100 students reported cocaine use during the 30 days prior to the NCHRBS. Lifetime inhalant abuse (e.g., sniffing glue, breathing the contents of aerosol spray cans, or inhaling any paints or sprays to get high) was reported by 7% of undergraduate women. Nationwide, 20.5% of college students reported lifetime use of “other illegal drugs,” such as LSD, PCP, “ecstasy,” mushrooms (i.e., hallucinogens), speed, ice, or heroin. Among women, white students (22.2%) were significantly more likely than black (4.5%) and Hispanic (14.1%) students to have ever used other illegal drugs. However, only 1.6% of women reported current “other illegal drug” use. White (1.8%) and Hispanic (2.1%) women were significantly more likely than black women (0.1%) to report current use of “other illegal drugs.” Current combination of illegal drugs and alcohol was reported by 6.8% of female college students, with white female students (8.3%) being significantly more likely than black female students (1.9%) to report current combined illegal drug and alcohol use.
STDs and unintended pregnancies pose a significant risk for many college students. STDs of particular importance for college students include HIV/AIDS, chlamydia, genital warts/HPV/condyloma, hepatitis B and C, herpes, gonorrhea, trichomoniasis, pubic lice, syphilis, urinary tract infections (UTIs), and yeast infections. Nationwide, only 38.8% of college students had ever had a blood test for HIV. Rates of unintended pregnancy among persons aged 15-24 years are higher than for any other age group. In 1988, almost two thirds of births to females aged 15-24 years were unintended. The NCHRBS indicates that of students who had had sexual intercourse during the 3 months preceding the survey, only 29.6% had used a condom at the last sexual intercourse and 34.5% had used birth control pills. Increased use of both condoms and effective methods of contraception among college students is necessary to decrease rates of STD and unintended pregnancy. Many STDs have no or minimal symptoms or might be mistaken for other common ailments (e.g., a yeast infection), but can lead to serious health problems, such as infertility or a compromised immune system, or even death if untreated. Consistent condom use is very important in preventing most STDs, but does not guarantee protection. Routine testing to facilitate early diagnosis and treatment of STDs is critical, not only for the infected person, but to avoid transmission to others.
Mental health issues, many of which were not directly assessed by the NCHRBS, are common problems on college campuses, including depression, anxiety, gender identity issues, and eating disorders. For instance, 10.3% of college students nationwide had seriously considered attempting suicide during the 12 months preceding the NCHRBS. Some psychiatric disorders appear for the first time during the college years, such as schizophrenia, which is characterized by auditory and/or visual hallucinations, unusual beliefs, disordered thoughts, social withdrawal, and diminished relatedness.
Unhealthy diet and physical inactivity. Approximately one in five (20.5%) college students was overweight based on their body mass index (BMI). Survey results indicated that 73.7% of students had failed to eat five or more servings of fruits and vegetables during the day preceding the survey, 21.8% had eaten three or more high-fat foods during the day preceding the survey, and few students had engaged in vigorous (37.6%) or moderate (19.5%) physical activity at recommended levels. Men (26.6%) were significantly more likely than women (10.3%) to have participated on a college or university sports teams (intramural or extramural).
Gender-specific health risks. The NCHRBS found there were several health risks that were significantly different for college men and women. For example, men were more likely than women to report the following negative health behaviors: rarely or never wearing safety belts when riding in or driving a car; drinking alcohol and driving a car or other vehicle; drinking alcohol while boating or swimming; carrying a weapon or gun; physical fighting; current smokeless tobacco use; current tobacco use; current alcohol use; current, frequent alcohol use; current episodic heavy drinking; current marijuana use; lifetime inhalant use; lifetime illegal steroid use; current other illegal drug use; current combined illegal drug and alcohol use; initiating alcohol use, marijuana use, and sexual intercourse at age less than 13 years; having six or more sex partners during their lifetime; alcohol and drug use at last sexual intercourse; and eating more than two servings of foods typically high in fat content.
Sexual assault is another serious concern among college students, particularly among young women. The Sexual Experiences Survey conducted during 1984-1985 indicated that 15% of females reported having been raped and an additional 12% reported that someone had attempted to rape them since age 14. According to self-reports, one in five female college students had been forced to have sexual intercourse during her lifetime. This finding was confirmed by the NCHRBS, with women students more likely than male students to report ever being forced to have sexual intercourse against their will.
In terms of other risk behaviors and negative health issues, women more commonly indicated not using a condom at last sexual intercourse or using condoms inconsistently. They had a more pronounced pattern of thinking they were overweight, attempting weight loss through dieting, excessive exercise, vomiting, taking laxatives, or taking diet pills. The majority of women students indicated that they had not participated in vigorous physical activity or strengthening exercises on a consistent basis, and fewer women than men proportionately participate on a college sports team.
Student health resources are available to help college students protect and maintain their mental, physical, and emotional well-being. College students face major developmental challenges in each of these domains, often while under considerable pressure from a variety of sources: academic, economic, self-imposed, peer, familial, or social stress. Student Health Centers, available on most campuses, are an excellent resource to help students successfully navigate these obstacles while usually providing clear privacy protections for student-patients. While resource issues appear to be common on college campuses, many have special programs to address specialized mental, physical, and emotional health care needs of college students.
Medical services offered by student health centers commonly include contraceptive information, prescription, and follow-up; pregnancy testing, counseling and referrals; annual gynecological exams; STD testing, diagnosis, and treatment; primary care services and referrals; preventive health checkups; and mental health counseling. Many provide some services for free and offer low-cost insurance plans that enable students to gain access to their full range of services. While many programs currently exist that are aimed at helping colleges and universities address health-risk behaviors among their students by increasing access to health-related information, education, and services, there is still room for improvement. Many cities and towns in which colleges are located also offer Rape Crisis Centers and hotlines available to those who have experienced sexual assault. Some of these centers are run in collaboration with local universities to facilitate student access, and the contact information for counselors and hotline volunteers is often listed in school directories.
Many student health centers take a “wellness” approach which looks beyond an absence of sickness to emphasize optimal physical, mental, and emotional well-being. These centers have programs to educate students about a preventive way of living that focuses on personal responsibility for making the lifestyle choices and self-care decisions that will improve quality of life. This includes educating and improving college students’ choices about nutrition, physical activity, stress management, responsible sexual behavior, and leading a balanced lifestyle. Wellness is a positive, day-to-day approach to a long, healthful, active life.
See Also: Acquired immunodeficiency syndrome, Alcohol use, Cannabis, Chlamydia, Condoms, Health insurance, Rape, Reproductive technologies, Safer sex, Sexually transmitted diseases, Smoking, Substance use, Teen pregnancy, Tobacco
- Division of Adolescent and School Health National Center for Chronic Disease Prevention and Health Promotion. (1997). Youth risk behavior surveillance: National College Health Risk Behavior Survey—United States, 1995. CDCMMWR Surveillance Summary, 46(SS-6), 1—54.
- Roberts, L. W., Warner, T., Lyketsos, C., Frank, E., Ganzini, L., Carter, D. D., et al. (2000). Caring for medical students as patients: Access to services and care-seeking practices of 1027 students at nine medical schools. Academic Medicine, 75(3), 272—277.
- Roberts, L. W., Warner, T., Lyketsos, C., Frank, E., Ganzini, L., Carter, D. D., et al. (2001). Perceptions of academic vulnerability associated with personal illness: A study of 1027 students at nine medical schools. Comprehensive Psychiatry, 42(1), 1—15.