U.S. postsecondary students' health and academic outcomes: A comprehensive scoping review.

OBJECTIVE: The relationship between postsecondary students' health and academic outcomes may have important implications for their collegiate experience and their future prospects. Yet a comprehensive summary of the evidence examining this potential connection does not presently exist. Seeking to fill this gap, this study reviewed the extant literature on postsecondary students' academic outcomes and health across multiple domains. METHODS: Using an established methodological framework, a scoping review was conducted to identify and summarize the attributes of all peer-reviewed research performed in the U.S. and published between 2008 and 2019 that examined the relationship between postsecondary students' health and academic outcomes. RESULTS: The search strategy resulted in 12,488 articles. After deduplication, initial screening, and full review of relevant articles to determine eligibility, 264 articles were included in the final review. The most frequently examined health domains were mental health and substance use. Grade point average (GPA) was the most common academic measure investigated. Most studies took place at single institutions among undergraduate students, and several studies focused on specific student sub-populations. Almost all study results indicated that healthier behavior or optimal health status was associated with better academic outcomes or did not negatively impact academic success. CONCLUSIONS: This study serves as a first step in understanding the scope of existing research examining the connection between postsecondary students' health and academic outcomes. A substantial literature base was found; however, several gaps were identified including the need for more cohort studies, national studies, examination of graduate students, and a focus on academic outcomes beyond GPA.

A Comparison of Food Insecurity Prevalence among Students Attending Minority-Serving Compared with Predominantly White Institutions in Prephase, Earlier, and Later Phases of the COVID-19 Pandemic.

BACKGROUND: College students have a high prevalence of food insecurity, and descriptive reports suggest even higher rates at minority-serving institutions than those at predominantly White institutions. These institutional inequities in food insecurity among college students based on minority designation may have shifted owing to the COVID-19 pandemic. OBJECTIVES: We aimed to compare the prevalence of food insecurity between students at minority-serving and predominantly White institutions during 3 phases: prepandemic [Fall 2019-Spring 2020 (February 2020)], earlier pandemic (Fall 2020-Spring 2021), and later pandemic (Fall 2021-Spring 2022). METHODS: Our study included repeated cross-sectional samples from the American College Health Association-National College Health Assessment III (N = 287,221 students, 354 institutions). We performed multivariable Poisson regression with cluster-robust SEs to estimate associations between institutional minority designation and food insecurity, with 1 model for each pandemic phase. RESULTS: Students attending minority-serving compared with predominantly White institutions had a higher prevalence of food insecurity overall (42% compared with 37%) and within each pandemic phase. After adjusting for sociodemographic and institutional characteristics, students at minority-serving institutions had 23% higher food insecurity prevalence during the prepandemic phase than students at predominantly White institutions (95% confidence interval: 1.14, 1.32). Associations were null for earlier and later pandemic phases. CONCLUSIONS: Lower institutional inequities in food insecurity after the onset of the pandemic may reflect more students returning home as well as an increase in social safety net programs. Regardless of cause, the high prevalence of food insecurity among students, especially at minority serving institutions, underscores the importance of addressing food insecurity at postsecondary campuses.

Health screenings in college health centers: Variations in practice.

Objective: The purpose of this study was to examine the routine screening of female students in college health centers for six priority health-related behaviors and experiences (tobacco use, alcohol use, eating disorders [EDs], obesity, anxiety and depression, intimate partner violence/sexual violence [IPV/SV]), and to identify variations in practice. Participants: A nationally representative sample of 1,221 healthcare providers (HCPs), including nurse practitioners, physicians, and physician assistants, from 471 U.S. college health centers. Methods: HCPs completed surveys (on-line or paper) and reported on routine screening of female college students. Results: HCPs reported consistently high rates (75-85%) of screening for tobacco use, alcohol use, and anxiety/depression. Rates of screening for IPV/SV, obesity and EDs were much lower. Nurse practitioners reported the highest IPV/SV screening rates. Conclusions: College health centers present unique opportunities for screening, case-finding and intervening to reduce long-term sequelae. Providers are well-positioned to lead initiatives to improve screening practices.

Universal Sexual Violence Intervention Effects in a Cluster-Randomized Trial: Moderation by Sexual Orientation.

Sexual minority (e.g., gay/lesbian, bisexual, and queer) students are more likely than their heterosexual peers to experience sexual violence (SV) during college. Interventions that prevent SV and improve SV care-seeking behaviors for sexual minority students are lacking. Giving Information for Trauma Support and Safety (GIFTSS) is an evidence-based universal SV intervention implemented by providers during college health and counseling visits. Compared to controls, GIFTSS participants reported greater self-efficacy to use SV harm reduction strategies and SV disclosure during clinical visits. However, GIFTSS' effectiveness for sexual minority participants is unknown. The current study examines whether sexual orientation moderates GIFTSS' effects on numerous SV-related outcomes (i.e., to test whether intervention effects at 4 and 12 months differed based on sexual orientation). Across 28 college campuses in Pennsylvania and West Virginia, 2,291 students participated in a two-arm cluster-randomized controlled trial. We used mixed models with two- and three-way interaction terms to test whether sexual orientation modified GIFTSS' effects at 4- and 12-month follow-up on participants': SV recognition; knowledge of and self-efficacy to enact SV harm reduction strategies; intentions to intervene; knowledge of and self-efficacy to use SV-related services; SV disclosure during visits; and recent SV exposure. Overall, 22.1% of participants were sexual minorities (n = 507). Sexual orientation moderated GIFTSS effectiveness as indicated by significant three-way interaction (p = .01) at 12-month follow-up, and knowledge of SV services decreased for heterosexual participants (ß = -.23) but increased for sexual minority participants (ß = .23). Our study indicates that universal provider-based education may promote greater knowledge of SV services among sexual minority than heterosexual participants, and population-specific interventions are needed that reduce sexual minority students' SV exposure, service utilization, and other critical aspects of SV prevention on university campuses.Clinical Trial Registration: Registry name: College Health Center-based Alcohol and Sexual Violence Intervention (GIFTSS), Registration number: NCT02355470, Web link: https://clinicaltrials.gov/ct2/show/NCT02355470, Deidentified individual participant data will not be made available.

Demographic, substance use, and mental well-being correlates of high-intensity drinking among college students and non-college young adults: implications for intervention.

OBJECTIVE: To assess demographic, substance use, and mental wellbeing factors associated with high-intensity drinking (HID; 10+ drinks on one occasion) among college- and non-college young adults, to inform prevention and intervention efforts. PARTICIPANTS: A total of 1,430 young adults (819 in college and 611 not attending college) in a Midwestern state who reported trying alcohol at least once. METHODS: Participants were recruited via social media between November 2019 and February 2020 to complete a web-based survey assessing demographics, substance use, and mental well-being. Logistic regression was conducted to assess relationships between these measures and HID among (1) college students and (2) non-college young adults. RESULTS: About 14.0% of participants reported past-month HID. Among both college- and non-college young adults, men, those who perceived slight or no risk of harm from binge drinking, and those who used alcohol and marijuana simultaneously in the past year had greater odds of reporting past-month HID. Among students, past-year prescription drug misuse was also associated with HID. CONCLUSIONS: High intensity-drinking is concerning given potential adverse consequences. Campus programming should address norms that may promote such drinking and other high-risk substance use associated with HID.

Impact of a College Sexual Violence Prevention Program on Condom Use: A Mediation Analysis.

College-age students are disproportionately impacted by sexually transmitted infections. Campus programs that reduce sexual violence have received recent investment, are increasingly common, and may offer a platform to increase condom use, but this has not yet been investigated. We explore this novel question through a secondary analysis of a randomized control trial of RealConsent, a web-based, sexual assault program for college women, on three college campuses. By estimating single and multiple-mediator models we examine the relationships between study assignment, the hypothesized mediators: self-efficacy to discuss safer sex, and clarity and assertiveness in sexual communication, and consistent condom use at follow-up. In the single mediator models, self-efficacy for safer sex communication (aOR: 1.11, 95% CI: 1.03-1.19, p = .004), assertiveness in sexual communication (aOR: 1.06, 95% CI: 1.02-1.11, p =.004), and clarity in sexual communication (aOR: 1.03, 95% CI: 1.00-1.05, p = .026) demonstrated significant direct effects on condom use. No statistically significant relationships between RealConsent and the mediators, nor indirect effects were found. In the multimediator model, there were no statistically significant associations identified. Self-efficacy, assertiveness, and clarity in communication about sex may have a positive impact on condom use but we did not find evidence that RealConsent impacted these mediators and thus no mediated effect was identified. Additional research is needed to develop and assess college-based sexual violence prevention programs that include an additional focus on skills specifically related to condom negotiation and use to understand if these widespread programs offer an efficient and effective platform to reduce the impact of sexually transmitted infections (STIs) among this high-risk population.

Gender-Based Heat Map Images of Campus Walking Settings: A Reflection of Lived Experience.

Fear of crime can influence our view of and experience with the world around us. This can be problematic for individuals seeking physical activity, including from walk commuting. Prior work shows fear is especially evident among women, who report fear of rape and sexual abuse by men as a primary concern. We present the results of a cross-sectional survey (n = 571) where participants were shown images from college campus (n = 4 campuses) depicting different lighting (daytime, nighttime), and entrapment levels (high, low; i.e., able to easily escape if needed, with high entrapment being difficult and low being easy), and using the Qualtrics heat map tool, selected features that stood out to them most. Data were segregated by gender and analyzed to determine similarity of heat maps for the same base image. Heat map images were analyzed using canonical correlation (Rc) to determine the relationship between the two groups; dispersion testing to decipher spatial uniformity within the images; the Structural Similarity Index (SSIM) to characterize the nature of image patterns differences; and, the Breslow-Day Test to specify pattern locations within images. Several heat map images are also presented in the results. Overall, female and male participants appear to "see" different things when imagining walk-commuting (as seen by poor Rc values) and the nature of what they were looking at were different (as seen by poor SSIM values). Female participants tended to focus on areas outside the walking path, such as bushes and dark areas, whereas men's focus was on the path ahead [χ2(1) = 4.29, p = 0.04]. Furthermore, women were more likely to select areas outside the walking path during high entrapment settings [χ2(1) = 15.49, p < 0.001] and at nighttime [χ2(1) = 4.98, p = 0.02]. Our study demonstrates point-of-view differences in female-male walking space assessments. Viewing walking safety through the lens of lived experience could be productive for holistic community walking safety.

Implementation of a Prospective Index-Cluster Sampling Strategy for the Detection of Presymptomatic Viral Respiratory Infection in Undergraduate Students.

Background: Index-cluster studies may help characterize the spread of communicable infections in the presymptomatic state. We describe a prospective index-cluster sampling strategy (ICSS) to detect presymptomatic respiratory viral illness and its implementation in a college population. Methods: We enrolled an annual cohort of first-year undergraduates who completed daily electronic symptom diaries to identify index cases (ICs) with respiratory illness. Investigators then selected 5-10 potentially exposed, asymptomatic close contacts (CCs) who were geographically co-located to follow for infections. Symptoms and nasopharyngeal samples were collected for 5 days. Logistic regression model-based predictions for proportions of self-reported illness were compared graphically for the whole cohort sampling group and the CC group. Results: We enrolled 1379 participants between 2009 and 2015, including 288 ICs and 882 CCs. The median number of CCs per IC was 6 (interquartile range, 3-8). Among the 882 CCs, 111 (13%) developed acute respiratory illnesses. Viral etiology testing in 246 ICs (85%) and 719 CCs (82%) identified a pathogen in 57% of ICs and 15% of CCs. Among those with detectable virus, rhinovirus was the most common (IC: 18%; CC: 6%) followed by coxsackievirus/echovirus (IC: 11%; CC: 4%). Among 106 CCs with a detected virus, only 18% had the same virus as their associated IC. Graphically, CCs did not have a higher frequency of self-reported illness relative to the whole cohort sampling group. Conclusions: Establishing clusters by geographic proximity did not enrich for cases of viral transmission, suggesting that ICSS may be a less effective strategy to detect spread of respiratory infection.

Just in case: undergraduate students identifying and mitigating barriers to their sexual and reproductive health needs.

BACKGROUND: Many U.S. colleges and universities offer access to a healthcare center that provides sexual and reproductive health (SRH) resources, services, and products. The importance of health centers in college and university settings in reducing sexual health disparities in student populations cannot be stressed enough. This article evaluates a student-led, mutual-aid, grassroots health promotion strategy for students with limited access to healthcare services, supplies, and tools via an anonymous and discrete distribution of SRH resources without charge. METHODS: In partnership with faculty, undergraduate students worked to address their school's unmet SRH needs by increasing on-campus access to comprehensive, evidence-based, and sex-positive resources. Referred to as Just in Case, this student-led, grassroots health promotion program provided students with supply kits containing contraceptives, sexual health wellness products, basic hygiene supplies, and education materials. Students were surveyed in a pre- (n = 95) post- (n = 73) pilot study to identify contraception acquisition barriers, discern perceptions of on-campus SRH resources, and elucidate trends in this program's use and impact. Chi-square tests of independence were used to compare survey group responses, and association rule mining was employed in tandem to identify SRH items that students requested. RESULTS: Students identified cost and privacy as significant barriers to acquiring sexual health products on campus. Of the 182 Just in Case supply kits requested by students during the 2022-2023 academic year, condoms were requested most frequently in 75% of fulfilled kits, while emergency contraception and pregnancy tests were asked most often in 61% of kits. 50% of students reported access to contraceptives on campus before this program's implementation, growing to 75% (p < 0.001) 1 year later post-implementation. Similar jumps were observed for reported access to sexual health education (30 to 73%, p < 0.001) and services (36 to 73%, p < 0.001). CONCLUSION: A student-led SRH supply and resource delivery strategy may immediately reduce SRH inequities and decrease barriers to contraceptive use for students with limited access to on-site SRH product availability.

Identifying Barriers to Basic Needs, Academic Success, and the Vaccination Pattern among College Students during the COVID-19 Pandemic.

College students face significant challenges during large-scale disease outbreaks that potentially compromise their basic needs, vaccine confidence, and academic success. Using a cross-sectional design and convenience sampling, we examined the impact of COVID-19 among college students (N = 828). The survey was administered using the Qualtrics survey platform to collect data on multiple demographic and health behaviors of students in the summer semester (2021). Our study demonstrated that the most common financial shock experienced by the study participants was job loss, with less remarkable changes in food and housing insecurities. Academically, students had the most difficulty learning online compared to other modalities (face-to-face, Hyflex, etc.) and struggled with staying motivated. They also struggled with group work and finding appropriate learning spaces. However, many did not use university support systems such as career and tutoring services. Exploring the COVID-19 vaccination attitudes, we found that only age, ethnicity, classification, and health insurance status were associated with getting vaccinated (p < 0.05). When the learning environment was assessed for various modalities, only college attendance was significantly associated (p < 0.05) with the accessible platforms (online, Hyflex, face-to-face, and others); however, nearly 40% of students reported difficulty learning on an online learning platform compared other categories that had much lower proportions. Our findings underscore an immediate need for universities to take measures to improve their preparedness and response strategies to mitigate the negative effects of future large-scale public health emergencies among students.

Screening Utility of the PHQ-2 and PHQ-9 for Depression in College Students: Relationships with Substantive Scales of the MMPI-3.

We investigated the validity and screening effectiveness of the PHQ-2 and PHQ-9 scores in 229 college students in a cross-sectional design. PHQ associations with Minnesota Multiphasic Personality Inventory-3 internalizing scales suggest PHQ scores are effective screening tools for college students and may aid in effective triage and service needs.

Exploring college students' flourishing: The interplay of demographic characteristics, time allocation in daily activities and responsibilities, and sense of belonging.

The purpose of this study is to investigate how college students' flourishing relates to their demographic characteristics, students allocating time in daily activities and responsibilities, and sense of belonging to the university. The total sample for this study includes 553 undergraduate students, of which 69% identified as female, 24% as male, 7% as non-binary, 29% as underrepresented minority (URM) students, and 38% as first-generation students. Method. The study utilized the ACHA-NCHA III survey data from a large public 4-year university. The researchers conducted an exploratory factor analysis to identify prominent components, resulting in seven constructed variables to measure students' level of involvement in managing roles related to their academic, extracurricular, and personal life. The researchers then used multiple regression models to examine the relationship between student flourishing outcomes and students' time allocation in fixed roles (as a student, caretaker, and employee) and other activities, and their sense of belonging to the university. The results showed that college students who assume additional roles besides being a student, who spend more time engaging in prosocial activities while balancing socializing, and have a strong sense of belonging, also have a higher level of flourishing. Conversely, media consumption was negatively associated with students' flourishing.

Teach, Learn, Do, Repeat: Service Learning Curriculum that Drives Public Health Education while Improving Community Health Outcomes.

The integration of service learning into public health curriculum allows students to apply and ultimately better understand often abstract but important theoretical concepts. We provide lessons learned and practical advice on how to plan and implement an experiential learning project over a two-semester period for upper level undergraduate public health students. Through application of program planning pedagogy, students obtained real-world experience while simultaneously improving mental health for college students. We also discuss how experiential curriculum also provides faculty the opportunity to engage with community stakeholders and organizations to build sustainable partnerships that positively impact students and the community at large.

Assessing the Impact of a Health Education Intervention for Post-secondary International Students in Canada.

Objective The objective is to determine the impact of a health education intervention on self-rated health knowledge, levels of stress and anxiety, and ability to find and access school resources for international students studying at a Canadian University and College. Participants and setting This is a pre- and post-intervention survey. Undergraduate and graduate international students on the shared campus of Durham College and Ontario Tech University in Oshawa, Ontario were included. Interventions  International students participating in this study received two structured visits, scheduled two weeks apart. At the start of the first visit, students completed a baseline survey which included questions on self-rated health knowledge, stress levels, and ability to access school resources. At this visit, students received 30 minutes of structured health education from a registered nurse on the topics of sexual health and adult immunizations.  At the second visit, students received 30 minutes of structured teaching from the registered nurse on the topics of mental health, COVID-19, and campus resources. Upon the completion of this teaching, students completed a post-intervention survey with the same questions as the pre-survey, to gauge for changes related to the intervention. Results T-values were calculated for each survey item from the pre and post-survey. These t-values were used as the outcome measure to determine changes in health knowledge, stress levels, and ability to access resources following the intervention. In total, there were 202 participants. Statistical analysis showed significant t-values for all survey items in the pre- and post-analysis. Following the education intervention, the highest t-values were noted in self-rated sexual health knowledge (t-value 16.80, p < 0.001), ability to find and access school resources (t-value 16.14, p < 0.001), and current level of stress/anxiety in regard to being in a new country (t-value 14.04, p < 0.001). Conclusion Following a structured health education intervention, international students reported significant increases in self-rated health knowledge for specific topics, ability to find and access school resources, ability to get help for a mental health issue, and significant decreases in self-rated stress/anxiety. These results can support further exploration of health education in international student populations to ensure these students are adequately informed and supported when arriving in a new country.

"I See a lot of Crazy Things and I Don't Know What to Believe": Lessons Learned about Health Literacy and Strategies for Communicating with Vaccine-Hesitant College Students.

Throughout the COVID-19 pandemic, the American College Health Association (ACHA) has partnered with CommunicateHealth (CH) to develop COVID-19 mitigation resources for colleges and universities. In 2021, the CH team conducted a series of applied research activities to gain a nuanced understanding of factors that shape perceptions of risk and drive vaccine hesitancy among campus audiences-especially college students who are emerging adults (approximately ages 18 to 22). Based on our findings, CH and ACHA identified key traits of vaccine-hesitant college students and implications for future vaccine communication campaigns. First, vaccine-hesitant students are more likely to ask "why" and "how" questions such as "Why do I need to get vaccinated?" and "How was the vaccine developed and tested?". Secondly, these students want to have open, authentic dialogue rather than simply accepting health recommendations from a trusted source. Finally, the CH team noted that vaccine-hesitant students were not highly motivated by their own personal risk of getting sick from COVID-19; concern about spreading COVID-19 to others was a much stronger motivating factor. Leveraging these insights, CH and ACHA developed strategies to apply health literacy principles to reach vaccine-hesitant college students with the right information at the right time-and to leverage relevant motivators and overcome barriers to vaccination. By implementing these strategies, CH and ACHA developed clear and empowering educational materials about COVID-19 vaccination tailored to the unique information needs of vaccine-hesitant students.

White paper: Gender affirming care in college health.

College health services are uniquely situated to reduce barriers that have historically made it difficult for Transgender and Gender Diverse (TGD) people to access care. The Big 10 Gender Care Coalition recognizes the importance of providing gender-affirming care and presents recommendations for integrative, inclusive college health services.

I'll be there for you: The effects of exercise engagement on social support provision within undergraduate students' personal networks.

Objective: To use social network analysis to examine exercise participation relative to health and wellness support provision within students' networks. Participants: 513 undergraduates from a large private university completed online surveys. Methods: Multilevel modeling assessed exercise engagement at the individual and dyadic level and support provision from network members. Results: More support was perceived by first and second-year students and individuals who reported more exercise engagement. Significant others, roommates, siblings, female network members, and those who exercised often provided greater support. Greater support was reported when both the participant and their social tie were involved in the campus group-exercise program. Conclusion: This study suggests individual and dyadic-level exercise was related to undergraduates feeling more supported. Findings support campus group exercise programs as opportunities to create reciprocal supportive ties for college students. Future research could further explore ways exercise and social support, particularly in group settings, affect health and well-being.

A case series measuring campus and clinic level factors during implementation of a sexual violence prevention intervention in campus health and counseling centers: does environment matter?

OBJECTIVE: This study examined campus and clinic factors that may influence likelihood of implementing sexual violence (SV) prevention for college students seeking care in campus health and counseling centers. METHODS: Campus-, clinic-, and student-level data were collected from both intervention and control campuses as part of a 28-campus cluster randomized controlled trial. A case series exploratory data analysis assessed differences in the implementation of an SV prevention intervention by campus characteristics. RESULTS: All large schools were in the top quartile for reporting positive prevention policies regarding SV. At the clinic level, the presence of SV protocols and procedures varied widely with no clear correlation with school size. Students at intervention schools where providers received instruction and tools to facilitate these discussions reported more discussions with providers about SV. Only school size appeared to be associated with positive SV policies on campus and student-reported receipt of SV prevention intervention. Large schools performed well on campus-level policies, yet students reported some of the lowest levels of intervention receipt in the clinics at these larger schools. IMPLICATIONS: Consistency between campus and clinic environments and implementation of the intervention was not observed. Our findings suggest that high performance regarding SV policy and prevention on a campus do not necessarily translate to implementation of appropriate SV prevention and care for students seeking care on campus, including assessments, resources, referrals, and services. TRIAL REGISTRATION: NCT registration: NCT02355470.

The Moby Bookmobile: Providing Health Education Materials in Wyoming Indian Country.

The COVID-19 pandemic made it difficult for Native American populations to access health information. Through funding from the Network of The National Library of Medicine Region 4, a community library was able to enhance their native and nonnative health collections for distribution on the Wind River Reservation in Central Wyoming. The book mobile was originally funded by the Wyoming State Library through American Rescue Plan Act of 2021 funding to increase literacy efforts during the pandemic. Materials were distributed at multiple locations throughout the reservation and individuals indicated they appreciated the materials being provided. This program was successful in distributing health information to an underserved priority population within the United States. Hopefully, similar programs would be successful in enhancing health education programs with other priority populations in both the United States and the world.

Exploring What Influences Heterosexual College Men and the Practice of Safe Sex: The Power of Stigma and Community.

The college student population is among the highest risk group for contracting sexually transmitted infections (STIs) such as gonorrhea, chlamydia, and HIV. Safe sex practices, which are intended to mitigate risks associated with sexually transmitted infections, are often negated in the population of heterosexual college students. Historically, research on safe sex practices has shown that the burden of behavior change and the focus on educational efforts historically fall onto the female population. There is little published on how safe sex education for males impacts attitudes and behaviors towards safe sex practices. This community-based participatory research (CBPR) project explored heterosexual college male attitudes and behaviors about safe sex responsibilities with the goal of creating effective health promotion messages to increase safer sex. The research team comprised almost entirely of undergraduate male students, which strengthened the design and translation of results to practice. A mixed methods design was employed utilizing both focus groups and surveys as data collection (n=121). Results showed that young men are still prioritizing pregnancy prevention over disease contraction and/or testing, and relying on female partners to initiate safe sex. Implications for health promotion practice efforts on college campuses include: male-led peer education programming and support and messaging around screening and prevention of STIs.