American College Health Association-National College Health Assessment Research Articles

Exploring the cardiovascular health behaviors of college students and the areas that need increased public health efforts.

Cardiovascular disease (CVD) is a leading cause of death worldwide among adults. Traditionally, the disease has been considered as a condition affecting older adults. However, its risk factors (e.g., poor diet, sedentary behavior, inadequate sleep, and obesity) are increasingly being identified in younger populations. There is a need to increase the evidence of CVD risk factors in this population to further support preventive programs in this demographic. This study investigates the prevalence of CVD risk factors in young adult, college students. Data was used from the American College Health Association's National College Health Assessment (ACHA-NCHA) II-C. The sample included data from 426,259 students, ages 18-25. Data was reviewed on race, nutrition, physical activity, tobacco use, sleep, weight, and history of chronic disease. Descriptive statistics were utilized to examine the prevalence of CVD risk factors. There was a notable prevalence of CVD risk factors, such as insufficient nutrition, obesity, insufficient physical activity, and inadequate sleep, among college students. CVD-related risk factors are on the rise within this demographic. There is a pressing need for the expansion of public health initiatives aimed at enhancing CVD awareness and prevention among college students.

Suicidal ideation in the context of alcohol use among college students: differences across sexual orientation and gender identity.

There is a dearth of research on suicidal ideation (SI) that occurs specifically in the context of drinking alcohol. Alcohol use and binge drinking are both elevated among college students, among whom sexual and gender minority (SGM) students are at particular risk for SI. This manuscript examines alcohol use, SI, and SI specifically in the context of alcohol use among a large sample of undergraduate students and examines differences across sexual and gender minority groups. Data were drawn from ~ 300,000 students who completed the American College Health Association National College Health Assessment (ACHA-NCHA) between Spring 2019 and Fall 2022. Participants reported identity variables and information about drinking behaviors and suicidal ideation over the past year. Multilevel models were used for all analyses. Risky drinking behaviors and higher blood alcohol content during the last episode of social drinking were associated with higher odds of SI while drinking. Rates of risky drinking behaviors, SI, and SI while drinking were elevated among SGM students with SGM men and nonbinary students reporting the highest rates across groups. SI while drinking, which is seldom assessed in measures of either measures of suicidal thoughts or alcohol use behavior, is an important construct for further research to improve our understanding of high risk states for suicide. Given elevated rates of alcohol use and SI among college students, providing education and resources to reduce SI while drinking is a critical target for universities, particularly to reduce risk among vulnerable SGM students.

Creation of a sexual risk index from the American College Health Association-National College Health Assessment (ACHA-NCHA) III to compare nontraditional and traditional student sexual risk

Objective To examine the utility of a novel sexual risk index (SRI) to better use National College Health Assessment (NCHA) sexual health-related questions. Methods The first phase included discussions, testing, and recoding of the initial set of items. In the second phase, a correlation analysis was run; items were systematically removed to achieve a Cronbach’s alpha of .714. Results All currently enrolled students in Spring 2020 at medium-sized, 4-year public university in Florida were recruited (n = 4,850) for the NCHA. Of the 441 total respondents, 223 students were included in the SRI analyses. Most had very low SRI scores, indicating few sexual risks. Nontraditional students were half as likely to experience academic challenges as compared to traditional students (TS; OR = .487, p = .033), while increasing SRI scores (OR = 1.182, p = .022) and decreasing GPA scores (OR = −1.975, p < .001) were associated with an increased likelihood of self-reporting academic challenges. Conclusions Results suggest high utility and reliability of the SRI. The use of the SRI provides a better overall picture of sexual risk-taking through a score rather than comparison of individual NCHA items.

Investigation into the relationships between Greek life, experiences of violence, and suicidal thoughts and behaviors among undergraduate students

Introduction: This study aims to examine how involvement in Greek life impacts the relationships between violence and STBs. Methods: This study utilizes data from the American College Health Association-National College Health Assessment (ACHA-NCHA) waves IIb, IIc, and III. Analyses examine the moderating effect of involvement in Greek life on the relationship between violence and presence of STBs in the past year. Results: Main effects revealed consistent patterns across violence types, STBs and waves, with Greek life membership associated with increased odds of experiencing violence and associated with decreased odds of suicidal ideation. The relationship between violence and suicide attempts was stronger for those involved in Greek life. Discussion: Greek life may be an institution where targeted interventions for suicide and violence may be effective. It may be important to identify additional avenues to reduce STBs that are not associated with increased experiences of violence.

Physical activity is inversely associated with overall cancer risk among college students in the United States: Results from the National College Health Assessment.

To our knowledge, this is the first epidemiologic study to examine the association between physical activity (PA) and cancer using data from the American College Health Association-National College Health Assessment (ACHA-NCHA). The goal of the study was to understand the dose-response relation between PA and cancer, as well as the associations between meeting US PA guidelines and overall cancer risk in US college students. The ACHA-NCHA provided self-reported information on demographic characteristics, PA, body mass index, smoking status, and overall cancer during 2019-2022 (n = 293,682; 0.08% cancer cases). To illustrate the dose-response relationship, a restricted cubic spline logistic regression analysis was used to evaluate the association of overall cancer with moderate-to-vigorous PA (MVPA) on a continuous basis. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals for the associations between meeting the three U.S. PA guidelines and overall cancer risk. The cubic spline observed that MVPA was inversely associated with the odds of overall cancer risk after adjusting for covariates; a one hour/week increase in moderate and vigorous PA was associated with a 1% and 5% reduced overall cancer risk, respectively. Multivariable-adjusted logistic regression analyses showed that meeting the US guidelines for aerobic PA for adults (≥150 minutes/week of moderate aerobic PA or ≥75 minutes of vigorous PA) (OR: 0.85), for PA for adults (≥2 days of muscle strengthening activity in addition to aerobic MVPA) (OR: 0.90), and for highly active adults (≥2 days of muscle strengthening activity and ≥300 minutes/week of aerobic moderate PA or 150 minutes/week of vigorous PA) (OR: 0.89) were statistically significant and inversely associated with cancer risk. MVPA, especially meeting US guidelines, may be inversely associated with overall cancer among college students in the US. To reduce cancer risks, multilevel interventions to promote US physical activity guidelines among college students are warranted.

Racial and Ethnic Disparities in Weight Loss Behaviors Among US College Students.

Weight loss behaviors are prevalent among college students and are associated with adverse physical and psychological outcomes, such as an elevated risk of developing an eating disorder. While cross-ethnic differences have been reported, no consistent pattern has emerged. The purpose of this study was to examine racial and ethnic differences in weight loss behaviors among female and male college students. The American College Health Association-National College Health Assessment (ACHA-NCHA) II-C survey data from the collection periods from 2015 to 2019 was used. A total of 426,425 students participated in the survey. Most participants were White (60%) and female (68.5%). Information on students' age, body mass index (BMI), and self-rated health was also collected. Logistic regression analyses were performed to determine cross-ethnic differences in weight loss methods among female and male students. Students' weight loss behaviors were assessed and included dieting, exercising, vomiting or taking laxatives, and the use of diet pills in the past 30 days. More than half of the participants attempted to lose weight through exercise (53.5%), and 40.3% of students dieted to lose weight in the past month. Purging and the use of diet pills were endorsed by 2.9% and 2.8% of the participants, respectively. With few exceptions, male students from racial and ethnic minority backgrounds were more likely to engage in extreme weight control practices (ie, vomiting or taking laxatives, taking diet pills) than White male students, while female students from racial and ethnic minority backgrounds were less likely to use diet and exercise as weight loss methods than White female students. For all outcomes, Biracial/Multiracial and Hispanic/Latino male students were more likely to attempt weight loss than White male students. Biracial/Multiracial female students more frequently endorsed extreme weight control behaviors than White female students. The results of the present study add to the growing body of literature on the relationship between race and ethnicity and weight loss behaviors. The findings indicate the need for tailored educational and intervention programs on college campuses.

Prevalence and Correlates of Prescription Stimulant Misuse Among US College Students: Results From a National Survey.

Objective: There is a high prevalence of prescription stimulant misuse (PSM) among college students in the United States (US). Preventing and identifying PSM requires an understanding of risk factors and correlates, but large-scale surveys regarding this issue have been lacking. We present the largest multi-institution study to date on the correlates of PSM among US college students. Methods: We performed a secondary analysis of the 2017 American College Health Association–National College Health Assessment (ACHA-NCHA), an annual national survey on the demographics, health, and academic experiences of US college students. Logistic regression models examined associations between past-year PSM in 40,645 undergraduate college students and hypothesized risk factors. Results: PSM was reported in 8% of college students. PSM was associated with past-year diagnosis or treatment of depression (adjusted odds ratio = 1.16; 99% CI, 1.01–1.33), anorexia (AOR = 1.44; 99% CI, 1.02–2.03), attention-deficit/hyperactivity disorder (AOR = 1.66; 99% CI, 1.41–1.95), and substance use disorder/other addiction (AOR = 1.79; 99% CI, 1.30–2.46). The odds of PSM were 5.5 times higher for students who endorsed past-month use of “Legal drugs” and 8 times higher for students who endorsed past-month use of “Illegal drugs” than for those who did not. Other factors associated with PSM included academic difficulty, daytime sleepiness, fraternity or sorority involvement, White race, and cis-male gender. Conclusions: This study identifies many potential risk factors for PSM among US undergraduate college students. Targeted outreach, prevention, and clinical management are discussed. As the COVID-19 pandemic has exacerbated psychiatric distress, sleep difficulties, substance use, and attentional challenges among college students, this study may serve as a baseline for future studies examining the impact of COVID-19 on PSM among college students.

Abstract 13059: Associations of Tobacco, Nicotine, and Cannabis Use With Covid-19 and Other Respiratory Infections—Results From the American College Health Association-National College Health Assessment (ACHA-NCHA)

Background: Tobacco use is the single most preventable cause of cardiovascular disease mortality and morbidity. However, evidence on associations of tobacco/nicotine and cannabis use and COVID-19 infection and severity among youth is limited. It is also unclear if associations between tobacco and cannabis use with COVID-19 are similar to other acute respiratory infections (ARIs). Methods: We used data from Fall-2020 and Spring-2021 ACHA-NCHA surveys. Multivariable multinomial and binary logistic regression models were used to estimate the odds of COVID-19 infection/severity and other ARIs by tobacco/nicotine product or cannabis use within last 3 months. Results: Of 69,868 students ages 18-24, 70% were female, 0.7% with COVID-19 confirmed-severe, 5% confirmed-moderate, 8% confirmed-mild/asymptomatic, 23% with any ARIs, 18% using any tobacco/nicotine products, and 16% using cannabis. With multiple adjustments, users of only e-cigarettes, only other tobacco products, or dual/poly products (vs. non-users) were nearly 2 times more likely to have COVID-19 (vs. confirmed-negative). A similar pattern of associations was observed for tobacco/nicotine product use and ARIs. Cannabis use had no association with COVID-19 infection, but cannabis users had 8% higher odds of ARIs than non-users. Of 9,380 COVID-19 confirmed students, no association of tobacco/nicotine product use with COVID-19 severity was observed, but cannabis users had 17% higher odds of severe/moderate (vs. mild/asymptomatic) symptoms than non-users. Conclusion: Aong US college students, e-cigarette or dual/poly-product users are more likely to have COVID-19 and other acute respiratory infections. Cannabis users were more likely to have more severe COVID-19 symptoms than non-users; they were also more likely to have other acute respiratory infections.

Testing positive, losing a loved one, and financial hardship: Real-world impacts of COVID-19 on US college student distress

BackgroundThe COVID-19 pandemic has taken a particularly heavy toll on U.S. college students. In addition to facing academic-related stress and social pressures, these individuals are now increasingly susceptible to experiences such as contracting the virus, losing loved ones to COVID-19, or facing financial hardship due to the pandemic. The effects of such personal, pandemic-related experiences on young adult mental health — and the inherent racial disparities within these outcomes — remain largely understudied. MethodsWe analyzed 65,568 undergraduate students from the Spring 2021 American College Health Association-National College Health Assessment (ACHA-NCHA). ResultsThe rates of the aforementioned COVID-19-related stressors were unevenly distributed across racial groups. A logistic regression analysis to identify predictors of moderate and serious psychological distress revealed that participants who had experienced the death of a loved one had 1.14 times greater odds of developing psychological distress (p < 0.0001). Those who experienced financial hardship had an odds ratio of 1.78 (p < 0.0001). Surprisingly, testing positive for COVID-19 was associated with an odds ratio of 0.82 of psychological distress (p < 0.0001). LimitationsSelf-reported measures are susceptible to recall bias and misinterpretation. Exposure and outcome variables were measured simultaneously in this cross-sectional study which limits inference on causality. ConclusionsFinancial burdens and bereavement are especially impactful stressors among college students during the pandemic, whereas contracting COVID-19 seemingly exhibits less impact on distress levels. When addressing student wellbeing, institutions should consider prioritizing the implementation of resources to support individuals affected by pandemic-related financial and familial losses.

Associations between discrimination and adverse mental health symptoms and disorder diagnoses among college students in the United States

BackgroundMental health disorders are prevalent among college students in the US. Perceived discrimination is a known risk factor for adverse mental health and is widespread on college campuses. MethodsWe estimated the association between perceived discrimination and mental health among US college students using the American College Health Association–National College Health Assessment (ACHA-NCHA), a large national cross-sectional survey of college students. Results7.9% of students reported experiences of discrimination, and that discrimination was more common among minority students. Perceived discrimination was associated with 86 excess cases of students reporting being too depressed to function per 1000 students, and 27 excess cases of students reporting seriously considering suicide per 1000 students. Students who experienced discrimination had a 37% increase in the number of mental health symptoms (IRR 1.37 [95% CI 1.35, 1.39], P < .0001) compared to non-discriminated students, and a 94% increase in the number of mental health diagnoses (IRR 1.94 [95% CI 1.89, 1.99], P < .0001). Discrimination was positively associated with all mental health symptoms and diagnoses. This pattern was largely held across sub-analyses by race/ethnicity, gender, and sexual orientation, but with varying magnitudes. LimitationsInability to distinguish between the forms of discrimination experienced, whether involving gender, sexual orientation, or race/ethnicity. ConclusionsConsequences of perceived discrimination are of clinical relevance for healthcare providers in general and mental health providers in particular. This study confirms the association between perceived discrimination and adverse mental health in college students. Efforts to reduce discrimination and bias in college campuses may improve the mental health of students.

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.

Binge drinking and sexual risk behavior among US sexual and gender minority college students.

Binge drinking and sexual risk behaviors have historically been associated with lesbian, gay, bisexual, and transgender (LGBT) adults; however, few studies have described this association among broader sexual and gender minority (SGM) students, who often identify outside of LGBT (e.g., asexual, queer). This study examined the relationship between binge drinking and sexual risk behaviors among SGM versus non-SGM college students. A retrospective analysis was conducted with cross-sectional data from the Spring 2017 American College Health Association-National College Health Assessment (ACHA-NCHA) survey among US undergraduates (n = 47,821) across 92 institutions. Binge drinking was measured as more than five drinks consumed the last time the student socialized; sexual risk behavior was measured as the number of sexual partners in the past 12 months. Numerous undergraduates nationally identify as SGM (19.9%), with bisexual (32.7%), other SGM (26.1%), and asexual (25.4%) students comprising the largest subgroups. Prevalent among both SGM (28.1%) and non-SGM (29.6%) students, binge drinking had a significant main effect on the number of sexual partners. A significant interaction effect was observed between SGM identity and binge drinking on the number of sexual partners, such that this association was stronger in SGM versus non-SGM students. This effect remained significant across multiple SGM subgroups. SGM students are more prevalent and diverse than previously reported. While prevalent overall, binge drinking may be uniquely sexualized among SGM students. In the first large-scale study assessing drinking among disaggregated SGM college students, data suggest tailoring alcohol interventions to SGM students, particularly those identifying outside of LGBT.

Preexisting Depression and Daytime Sleepiness in Women and Men

ABSTRACT Background: Sleep problems can persist following the treatment of depression and remission of symptoms. The extent to which having a previous history of depression may be associated with current daytime sleepiness is largely unknown. Methods: Data were obtained from the spring 2017 American College Health Association-National College Health Assessment (ACHA-NCHA) survey (92 institutions) which assessed self-reported health in U.S. college students (n = 41,670). Among the sample, 93.5% were 18–24 year of age, and 69.6% women. Logistic regression estimated the association between reported prior lifetime diagnosis of depression and daytime sleepiness from the past 7 days, while adjusting for depressive symptoms and antidepressant use from the past year. Unadjusted and adjusted logistic regression models stratified by gender were performed. Results: Among those who reported problems with sleepiness, 31.6% women and 19.4% men had a preexisting depression diagnosis. Individuals with preexisting depression were more likely than those without this diagnosis to report sleepiness problems (women: OR = 1.4, CI = 1.3–1.6, p < .001; men: OR = 1.2, CI = 1.0–1.4, p < .01). However, this association differed significantly by gender, with women with a preexisting depression diagnosis having a 13.0% greater likelihood of sleepiness compared to men. Conclusions: Those with a preexisting depression diagnosis, and specifically women, may be at risk for daytime sleepiness even in the absence of current depressive mood-related symptoms. Given that many individuals are at risk for daytime sleepiness, mental health initiatives, including those on college campuses, should incorporate sleep hygiene within their programming.

Asian international students’ help-seeking intentions and behavior in American Postsecondary Institutions

While the number of Asian international students has increased in postsecondary institutions in the United States over the last two decades, unlike their American peers, these students were reported to have more severe mental health issues with less help-seeking intentions and behavior. This study drew the national data collected by American College Health Association-National College Health Assessment (ACHA-NCHA) from 2011 to 2014 to examine how various factors were associated with help-seeking intentions and behavior among Asian International Students (AIS) in the U.S. After case-wise deletion of missing data, the dataset used in regression analyses included 97,259 college students, including 2999 AISs, who were randomly drawn within the 62 participated postsecondary institutions. The study performed a series of logistic regression with complex survey design that controlled for institutional clustering effects to analyze the relationship between various factors and AISs’ help-seeking intentions and behavior. The results showed that AIS utilized significantly less services and were less willing to seek mental health services than not only American domestic students but also other international students. Variables related to institutional characteristics, demographic information, academic status, and health conditions were found to significantly influence AISs’ help-seeking intentions and behavior. College mental health professionals and university stakeholders need to pay more attention to the mental health needs of AIS. Implications for college mental health professionals and university stakeholders are discussed.

Stress, stressors, and substance use: Differential risk for hookah use among African American college students

Using differential, multivariable risk models, we assessed the contribution of substance use and stress/traumatic events to hookah use among African American college students (n = 1,402) using data from the Fall 2012 American College Health Association-National College Health Assessment (ACHA-NCHA) II. Lifetime hookah use was 24.8%, with 34.2% of lifetime users having done so in the past 30 days. Compared to nonusers, hookah users had significantly higher use rates of alcohol, marijuana, other tobacco, and other drugs. Furthermore, hookah use was more likely among those with cumulative stress, yet less likely among older students. An implication is that prevention messages may need to be tailored for African American college students and particularly target younger students, substance users, and those with cumulative stress. These findings also inform policy discussions regarding hookah use on college campuses.

The risk factors of abusive relationships for nontraditional students

Objective: To examine the effect of nontraditional student status on abusive relationships, namely emotional, physical, and sexual abuse. Participants: The 2011–2014 American College Health Association National College Health Assessment (ACHA-NCHA) II data (N = 102,563) were utilized for the analysis. Methods: Logistic regression models were employed as the outcome variables were dichotomous. Results: Non-traditional students compared to traditional ones indeed had higher odds ratios of having abusive relationships. Nontraditional students compared to traditional students, however, were more likely to experience emotional and physical abuse, but not sexual abuse. Conclusions: The prevention programs and policies related to abusive relationships need to be address differently based on the results of this study, which is also essential for nontraditional students to adjust and succeed in higher education and further their careers.

The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use.

The college years represent a period of increased vulnerability for a wide range of mental health (MH) challenges. The onset of common psychiatric conditions occurs during this period of development. Increases in depression, anxiety, and suicidality among U.S. college students have been observed. This study identified prevalence and correlates of MH diagnoses and suicidality in a recent sample of U.S. college students. The Spring 2015 American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed MH diagnoses and suicidality from U.S. undergraduate students (n=67,308) across 108 institutions. Stress was strongly associated with a greater likelihood of suicide attempts and MH diagnoses, even among students reporting 1-2 stressful events (OR [odds ratio] range 1.6-2.6, CI [confidence interval]=1.2-3.2). Bisexual students were more likely to report MH diagnoses and suicidality, compared to heterosexual and gay/lesbian students (OR range 1.5-3.9, CI=1.8-4.3), with over half engaging in suicidal ideation and self-harm, and over a quarter reporting suicide attempts. Transgender students reported a higher rate of MH diagnoses and suicidality relative to females (OR range 1.9-2.4, CI=1.1-3.4). Racial/ethnic minority students were generally less likely to report MH diagnoses relative to Whites, although the likelihood for suicidality was mixed. The high rate of multiple stress exposures among the U.S. college population and the high impacts of stress on MH and suicidality point to an urgent need for service utilization strategies, especially among racial/ethnic, sexual, or gender minorities. Campuses must consider student experiences to mitigate stress during this developmental period.

Trends in long-acting reversible contraceptive (LARC) use, LARC use predictors, and dual-method use among a national sample of college women

ABSTRACTObjective: Assess long-acting reversible contraceptive (LARC) and other contraceptive use trends, identify LARC use predictors, and examine dual method use. Participants: Women in the American College Health Association-National College Health Assessment (ACHA-NCHA) II, aged 18–24 years, who reported having vaginal sex (N = 37,899). Methods: Secondary analyses of Fall 2011–2014 ACHA-NCHA II data. Results: Statistically significant increases in LARC usage and, specifically, implant usage, were found. Characteristics associated with LARC use included age, race/ethnicity, relationship status, and school type. Students reporting LARC use had lower odds of condom usage compared with non-LARC hormonal method users. Conclusion: This analysis of LARC predictors and dual LARC/condom use has implications for research and health promotion efforts. Findings suggest that college health services are well positioned to meet the sexual and reproductive health needs of diverse populations of students. College health professionals should elicit students' individual and/or relationship priorities to tailor messaging/services offered for pregnancy/STI prevention.

Comparing Mental Health Issues Among Undergraduate and Graduate Students

Background: Stress and other mental health issues can negatively impact the health and academic performance of college students. Purpose: Examine relationships among stress, mental health, and academic classification in a national sample of college students. Methods: Analyses utilized secondary data from 27 387 college students responding to the Fall 2009 American College Health Association-National College Health Assessment (ACHA-NCHA) II. Results: In general, undergraduates reported significantly higher rates of feelings and behaviors related to poor mental health and negative effects on academic performance than graduate students. Graduate students and undergraduate students reported significantly different levels of stress. χ2(4) = 54.34, Cramer's V = .045, p = .001. Graduate students (74.0%) were also more likely to seek mental health care services in the future than undergraduates (64.8%), χ2(1) = 101.12, Cramer's V = .061, p = .001. Translation to Health Education Practice: Stress and mental health differences exist between undergraduate and graduate students. For universities, understanding such differences is critical to the delivery of effective health education programs.

Sexual and Reproductive Health Behaviors of California Community College Students

Objective: To explore the sexual and reproductive health behaviors of students from 13 community college campuses in California. Participants: Heterosexual college students, ages 18 to 24, who have had sexual intercourse (N = 4,487). Methods: The American College Health Association's National College Health Assessment (ACHA-NCHA) survey was administered in class to randomly selected classrooms at 12 institutions and electronically to randomly selected e-mails of students at 1 institution from March through April 2007. Results: This sample of community college students reported higher rates of risky sexual behaviors, unintended pregnancy, emergency contraception, and sexually transmitted diseases, and lower rates of human immunodeficiency virus (HIV) testing, than the overall ACHA-NCHA reference group. Those who had been tested for HIV reported more sexual partners, and lower rates of condom use. Conclusions: The data provide justification for broader educational programs and access to family planning services, condoms, and HIV testing on community college campuses.