Discrepancies in prevalence estimates of suicidal ideation and attempts in 18- to 22-year-old US college students: a comparison of three surveys.

PURPOSE: Suicidal thoughts and behaviors (STB) have been increasing among US college students. Accurate measurement of STB is key to understanding trends and guiding suicide prevention efforts. We aimed to compare the prevalence estimates of STB among college students from two campus-based surveys (the National College Health Assessment [NCHA] and the Healthy Minds Study [HMS]) and one general population study (the National Survey on Drug Use and Health [NSDUH]). METHODS: Estimates were generated from the three surveys for past year suicidal ideation (PYSI) and past year suicide attempts (PYSA) among 18- to 22-year-old full-time college students. Data were combined from each survey to develop bivariate and multivariate regression models for odds of PYSI and PYSA. RESULTS: Estimates for PYSI varied between the three surveys: 34.3% for NCHA, 15.0% for HMS, and 10.7% for NSDUH. Estimates for PYSA were 2.6% for NCHA, 1.6% for HMS, and 1.7% for NSDUH. After adjusting for demographic and educational characteristics, odds of PYSI remained significantly lower for HMS participants (aOR 0.31, 95% CI 0.29-0.33) and NSDUH participants (aOR 0.19, 95% CI 0.19-0.30) compared to NCHA participants. The odds of PYSA for HMS participants were lower than those for NCHA participants (aOR 0.63, 95% CI 0.54-0.73). CONCLUSION: Estimates of PYSI and PYSA vary between leading sources of data on college student mental health. The differences are likely related to question wording, survey implementation, as well as institutional and individual representation. Accounting for these differences when interpreting estimates of STB can help guide suicide prevention efforts.

Associations between college/university campus characteristics and student body mass index.

BACKGROUND: Campus environments are associated with undergraduate weight. However, few studies have examined campus type and geographic location in relation to student weight. This article aimed to identify college/university students with elevated BMIs by campus type and region. METHODS: Linear mixed effects regression models were fit to data from the American College Health Association-National College Health Assessment II. Analyses tested associations between campus type/region and student self-reported BMI. RESULTS: The sample included 404,987 students from 445 schools with mean BMI 24.9 ± 5.8. Across all school types/regions, BMI confidence intervals included overweight values. Two-year and public school students had higher BMIs compared to four-year and private school students, respectively. Students in the Midwest had higher BMIs compared to students in the Northeast. In the South only, Minority Serving Institution (MSI) students had higher BMIs compared to non-MSI students. CONCLUSION: Healthy weight maintenance programs should be made available to undergraduate students.

An Investigation of COVID-19 Outcomes and College Student Demographics: Results from a National Sample.

PURPOSE: To assess the effects of COVID-19 on college students and any differential outcomes across collegiate sub-populations towards the beginning of the pandemic. DESIGN: Cross-sectional survey. SETTING: Fall 2020 American College Health Association-National College Health Assessment. SUBJECTS: N = 13 373 undergraduate/graduate/professional students; 22 colleges/universities. MEASURES: Six COVID-19 outcomes; 10 demographics. ANALYSIS: Campus-specific weights for student enrollment/sex distribution. Cross-tabulations/Pearson χ2 test; Cramer's V/effect size; Bonferroni multiple testing correction (P < .0009). RESULTS: 5.6% of students had been diagnosed with COVID-19. Compared to counterparts within each demographic category, rates were significantly higher among many BIPOC student groups (e.g., Native Hawaiian/Other Pacific Islander: 15.0%); cisgender women (5.9%) and men (5.6%); heterosexuals (6.1%); undergraduates (6.3%); and sorority/fraternity members (13.7%). Due to COVID-19, 8.8% of students had lost a loved one; 14.6% had a loved one with long term effects from COVID; 38.6% had increased stress; 61.4% had more financial concerns; and 52.7% had more difficulty accessing mental healthcare. Students identifying as BIPOC; cisgender women and transgender/gender non-conforming (TGNC); queer-spectrum; undergraduate; first-generation; having a disability; and taking courses online were significantly more affected by most of these outcomes (all comparisons P < .0009). CONCLUSIONS: Students were widely impacted by COVID-19 with substantive differences across sub-populations. Future research should examine trends over time and explore ways to reduce health disparities.

Health-Related Behaviors and Academic Achievement Among College Students.

PURPOSE: College students' academic achievement has crucial implications for their future success. Students' health may be a key determinant of academic performance, but more research is needed to understand this relationship. DESIGN/SETTING/SUBJECTS: Secondary analysis of the American College Health Association-National College Health Assessment III pre-COVID-19 Spring 2020 dataset. N = 39 146 undergraduates at 75 higher education institutions (14% mean response rate, comparable with other large-scale national college health surveys). MEASURES: Self-reported grade point average (GPA) and 33 health behaviors in the categories of dietary behavior, physical activity, sedentary behavior, substance use, sexual risk behavior, violence-related behavior, mental health, and sleep behavior. ANALYSIS: Weighted cross-tabulations examining the association between GPA and health behaviors; multinomial logistic regressions assessing if behaviors predicted GPA, controlling for year, sex/gender, and race/ethnicity. Individual GPA categories were also compared to a D/F referent group. RESULTS: There were gradient trends across GPA categories for A through D/F (18 behaviors) or A through C (12 behaviors) (P < .001). Each health behavior predicted GPA differences (P < .001), except heroin use (P = .052). The A GPA group was significantly different from the D/F GPA group for 27 behaviors (P < .001). In general, protective behaviors corresponded with higher GPAs and most risk behaviors were associated with lower GPAs. CONCLUSIONS: There is a link between numerous health behaviors and academic performance. Stakeholders invested in college students' health and academics should engage in mutually beneficial strategies to safeguard students' current and future well-being and success.

Waterpipe smoking among U.S. university students.

INTRODUCTION: While cigarette use is declining, smoking tobacco with a waterpipe is an emerging trend. We aimed to determine the prevalence of waterpipe use in a large diverse sample of U.S. university students and to assess the association of waterpipe use with individual and institution-related characteristics. METHODS: We assessed students from 152 U.S. universities participating in the National College Health Assessment during 2008-2009. We used multivariable regression models to determine independent associations between individual and institutional characteristics and waterpipe tobacco use in the past 30 days and ever. RESULTS: Of 105,012 respondents included in the analysis, most were female (65.7%), White (71.2%), and attending public (59.7%) nonreligious (83.1%) institutions. Mean age was 22.1 years. A total of 32,013 (30.5%) reported ever using a waterpipe to smoke tobacco. Rates for current tobacco use were 8.4% for waterpipes, 16.8% for cigarettes, 7.4% for cigars (including cigarillos), and 3.5% for smokeless tobacco. Of current waterpipe users, 51.4% were not current cigarette smokers. Although current waterpipe use was reported across all individual and institutional characteristics, fully adjusted multivariable models showed that it was most strongly associated with younger age, male gender, White race, fraternity/sorority membership, and nonreligious institutions in large cities in the western United States. CONCLUSIONS: After cigarettes, waterpipe use was the most common form of tobacco use among university students. Because waterpipe use affects groups with a wide variety of individual and institutional characteristics, it should be included with other forms of tobacco in efforts related to tobacco surveillance and intervention.

Determinants of perceived health in university employees.

Objective: Employee health plays an important role in overall campus health and wellbeing. Therefore, this research explored the physical, mental, and environmental determinants of perceived health in employees of higher education. Participants: 422 full-time employees from one university took the American College Health Association National Faculty and Staff Health Assessment (NFSHA) online in April 2021. Methods: A cross-sectional correlational design was used to explore which physical, mental, and environmental health factors influenced perceived health of employees. Results: Sleep, body mass index (BMI), flourishing, and the extent to which employees felt the university cared about their health and wellbeing were the four significant factors that increased the odds of employees reporting higher levels of perceived health. Conclusions: Using Bandura's reciprocal determinism as a theoretical lens, these results reinforce that behaviors, personal attributes, and the environment are interdependent and influence perceived health in this sample of university employees.

Associations Between College/University Physical Activity Requirements and Student Physical Activity.

Background: Most U.S. college students do not meet physical activity guidelines. Physical activity requirements (PAR) are a proposed solution for increasing undergraduate physical activity. Purpose: To determine whether college/university PAR are associated with undergraduates' self-reported physical activity. Methods: Undergraduate students (N = 383,632) attending colleges and universities taking part in the American College Health Association-National College Health Assessment II survey (2015-2019) self-reported physical activity and demographics. Using websites and course catalogs, researchers coded schools to indicate binary PAR status. Bayesian Hierarchical Logistic Regression was used to determine the percentage of students meeting physical activity guidelines; interactions between PAR status and student characteristics (sex, BMI) were examined. Results: PAR status was positively associated with percent of students meeting physical activity guidelines (PAR: 43.3%, without: 40.5%; difference score 95% Highest Density Interval [HDI; 1.0, 4.5]). A greater percentage of students attending schools with PAR, versus without, met physical activity guidelines across all categories of sex and weight. However, the positive relationship between PAR status and physical activity was stronger among male students (PAR: 46.7%, without: 43.2%; 95% HDI [1.6, 5.4]) compared to female students (PAR: 39.9%, without: 37.9%; 95% HCI [0.2, 3.8]), and among students with underweight (PAR: 39.2%, without: 35.5%; 95% HDI [1.2, 6.3]) or obesity (PAR: 37.1%, without: 33.7%; 95% HDI [1.4, 5.3]) compared to normal weight (PAR: 49.3%, without: 47.4%; 95% HDI [0.1, 3.7]) or overweight (PAR: 47.5%, without: 45.5%; 95% HDI [0.1, 4.0]). Conclusions: PAR are associated with meeting physical activity guidelines, particularly among college/university students with underweight or obesity.

The development of the American College Health Association-National College Health Assessment III: An improved tool to assess and enhance the health and well-being of college students.

This article describes the development of the American College Health Association-National College Health Assessment III (ACHA-NCHA III), a widely used comprehensive survey that assesses college students' health behaviors and outcomes at the institutional and national levels. Only the second major revision since the ACHA-NCHA was established in 2000, the ACHA-NCHA III launched in Fall of 2019. Background on the purpose and history of the ACHA-NCHA will first be provided. Then the systematic steps taken to create a new and enhanced version of the survey will be recounted. An overview of the final ACHA-NCHA III instrument will be given, and future directions for the survey post-implementation will be discussed.

Prevalence of Physical Activity Requirements Among US Colleges/Universities Participating in the American College Health Association-National College Health Assessment II.

Physical activity requirements (PAR; ie, courses required for graduation) have been proposed as a policy solution for increasing undergraduate physical activity. This study aimed to report prevalence of PAR among US colleges/universities participating in the American College Health Association-National College Health Assessment (ACHA-NCHA) and to understand whether these requirements were associated with campus characteristics. Data from the American College Health Association-National College Health Assessment II serial cross-sectional survey (2015-2019) were merged with researcher coded variables (2019): binary PAR status, nature of PAR (activity-based, conceptual, or combination), and number of courses required to fulfill the PAR. Logistic regression determined whether campus characteristics were associated with PAR in 2019. Nonparametric tests examined differences in nature and number of PAR courses. Of 379 schools, 59 (15.6%) had PAR, with 36 (61.0%) having activity-based PAR and 23 (39.0%) having a combination. Compared to public and four-year schools, private (OR=3.47 [1.77, 6.80]) and two-year schools (OR=6.55 [2.21, 19.45]) had significantly increased odds of having PAR. Private schools required significantly more PAR courses compared to public schools (2.42 vs. 1.73, P=.005). PAR were less prevalent in this sample than reported historically, indicating need for campus leadership attention to this issue. Research is needed to understand what barriers exist to implementing and maintaining PAR on college/university campuses, particularly among public and four-year schools. Understanding health promotion practices among ACHA member schools, which have made leadership commitments to promote student health, can provide greater knowledge of PAR barriers and best practices in schools across the United States and globally.

Integrated primary care behavioral health services in college health: Results from a national survey of health center administrators.

OBJECTIVE: The present study investigates the organization of primary care behavioral health within student health centers and assesses the relationship between organizational structure and practice integration among physical and mental health services. Methods: We collaborated with the American College Health Association to distribute a 54 item survey to representatives of each ACHA member institution. Results: A total of 189 (26.3%) surveys were obtained and included 86 (46%) integrated (health/counseling) centers and 101 (54%) nonintegrated centers. Significant differences in levels of practice integration were noted between these two groups. Significant correlations were found between levels of practice integration and the presence of behavioral health staff. Conclusions: The organization and delivery of physical and behavioral healthcare services for students is considerably integrated and collaborative. Adding behavioral health clinicians to the primary care college health setting increases integrated care practice without embarking on full administrative integration of physical and mental health services.

More Than Inconvenienced: The Unique Needs of U.S. College Students During the COVID-19 Pandemic.

U.S. college students are a distinct population facing major challenges due to the COVID-19 pandemic. Before the pandemic, students were already experiencing substantial mental health concerns, putting both their health and academic success in jeopardy. College students now face increasing housing and food insecurity, financial hardships, a lack of social connectedness and sense of belonging, uncertainty about the future, and access issues that impede their academic performance and well-being. There is also reason to believe that COVID-19 is exacerbating inequalities for students of color and low-income students. We provide several recommendations for institutions of higher education to mitigate these obstacles, including engaging in data-driven decision making, delivering clear and informative messaging to students, prioritizing and expanding student support services, and using an equity framework to guide all processes.

Sexual and substance use behaviors of college students with disabilities.

OBJECTIVES: To identify the substance use and the sexual behaviors of college students with disabilities. METHODS: A secondary data analysis was conducted of the spring 2009 administration of the ACHA-NCHA II. RESULTS: College students with disabilities tended to be 24 or more years old; of an ethnic minority; and bisexual, gay, or lesbian. They consistently reported engaging in both substance use and sexual risk behaviors more than those of students without disabilities. CONCLUSIONS: Substance use and sexuality programs on college campuses should be physically, socially, and intellectually accessible for students with disabilities while considering their multiple identities. Efforts should be made to recruit or target these students for such programming.

The State of the union: sexual health disparities in a national sample of US college students.

OBJECTIVE: To examine sexual health disparities between blacks and whites in a national sample of US college students. PARTICIPANTS AND METHOD SUMMARY: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18-24; M = 20.1) responding to the Spring 2007 American College Health Association-National College Health Assessment; 64% were female and 94.7% were white. RESULTS: Whites reported more experience in oral and anal sex, were less likely to use condoms for oral, anal, and vaginal sex, and less likely to have been tested for HIV (human immunodeficiency virus) compared with blacks. However, blacks reported more sex partners, lower use of hormonal contraceptives, and higher rates of adverse sexual health outcomes, such as sexually transmitted infections (STIs) and unintended pregnancy. Sexual behaviors and outcomes also varied across gender. CONCLUSIONS: This study highlights a need to increase access to hormonal contraceptives and early STI screening/treatment among blacks, improve HIV testing among whites, and increase condom use promotion for all students.