Association-National College Health Assessment Research Articles

Suicidal ideation, suicide attempt, and self-injury among American Indian, Alaskan Native, and Native Hawaiian college students in the United States from 2015 to 2019.

Suicide is a major driver of mortality among college students and is the leading cause of death among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) young adults. Data on suicidal ideation, suicide attempt, and self-injury among AI/AN/NH college students (n = 8103) were analyzed via multivariable logistic regressions employing the American College Health Association National College Health Assessment survey from 2015 to 2019. Adjusted odds ratios (aORs) were used to assess how opioid misuse may act as a risk or protective factor for suicidality and self-injury. Between 2015 and 2019, suicidal ideation was the most prevalent dimension of suicidality affecting AI/AN/NH college students (ranges from 12.69% to 18.35%), followed by self-injury (7.83%-11.41%) and suicide attempt (2.40%-4.10%). AI/AN/NH college students who reported opioid misuse were significantly more likely to experience suicidal ideation (aOR: 1.417; 95% confidence interval [CI]: 1.154-1.740) and self-injury (aOR: 1.684; 95% CI: 1.341-2.116) than those who did not engage in such behavior. We identified opioid misuse as a potential risk factor for suicidal ideation and intentional self-injury among populations of AI/AN/NH college students. Programs seeking to reduce suicide prevalence among Indigenous college students may benefit from the inclusion of evidence-based interventions that prevent and treat issues related to opioid use.

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

BackgroundCollege 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. ObjectivesWe 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). MethodsOur 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. ResultsStudents 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. ConclusionsLower 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.

Photoprotective measures among adolescents stratified by region: An analysis utilizing the National College Health Assessment.

Exposure to sunlight has been shown to cause pigmentary alterations, photoaging and photocarcinogenesis. Understanding photoprotective patterns in adolescent populations is beneficial to public health initiatives. We utilized data provided by the American College Health Association's National College Health Assessment to evaluate photoprotective behaviors among adolescent populations. Behavioral questions related to photoprotection were analyzed from the American College Health Association (ACHA) National College Health Assessment (NCHA) (Version III). When comparing races, Black/African American respondents had the lowest association of practicing photoprotective behaviors in comparison to white respondents (p < .05). When comparing US geographic regions, the south had the lowest association of photoprotective measures (p < .05). The response rate of each institution varied, although there was still a large quantity of respondents. Finally, we cannot discern the specific reasoning for adolescent populations not using sunscreen. These data identify demographics where efforts to enhance education on photoprotective behaviors, specifically among skin of color and southern population, to support public health initiatives.

Understanding ADHD in AAPI College Students: Prevalence, Comorbidities, Impairments, and Treatment Utilization

Objective: Asian American and Pacific Islander (AAPI) students with ADHD may face increased risk for college maladjustment due to cultural factors and a tendency to delay treatment. This is the first study to examine ADHD prevalence, ADHD-related impairments and comorbidities, and ADHD treatment utilization in AAPI college students. Method: AAPI, White, Hispanic, and Black undergraduates (n = 258,005) from the American College Health Association—National College Health Assessment II survey were included in the study. Results: AAPI students had lower ADHD prevalence rates than White and Black students, and similar prevalence to Hispanic students. AAPI students with ADHD had significantly higher risk for comorbidities and social and academic impairments, compared to White students with ADHD. Approximately half of AAPI students with ADHD did not utilize treatment despite experiencing psychiatric comorbidities and functional impairments. Conclusion: AAPI college students with ADHD are underutilizing treatment despite elevated psychiatric comorbidities and functional impairment.

Evaluation of food security status, psychological well-being, and stress on BMI and diet-related behaviors among a sample of college students

ObjectivesThe purpose of this study was to evaluate food insecurity on body mass index (BMI) and diet-related behaviors among college students and whether psychological well-being (PWB) and stress levels mediate this relationship. Study designThis was a cross-sectional study. MethodsData from 1439 students from the American College Health Association National College Health Assessment III (Fall 2020) were used. Food security status was evaluated by the USDA Six-Item Short Form. PWB was measured using the Diener Flourishing Scale. Diet-related behaviors included the average servings of fruits, vegetables, and sugar-sweetened beverages consumed per day. Stress was measured by self-reported levels. Regression model analysis evaluated the influence of food security status, PWB, and stress levels on BMI. PWB and stress were also tested as mediators in the relationship between food insecurity and BMI. ResultsAmong our sample of college students, 44.54% (n = 641) were food insecure, and 55.46% (n = 798) were food secure. Multiple regression analysis showed that higher food insecurity, older age, full-time enrollment status, and fifth-year student status were positively associated with a higher BMI score (P < 0.05). Results from mediation models revealed that PWB, but not stress, mediated the relationship between food security and BMI among Black/African American students. Regarding diet-related behaviors, high stress levels mediated the relationship between food insecurity and sugar-sweetened beverage intake among students. ConclusionsFood insecurity appears to influence BMI in college students. This relationship seems to be mediated by disrupted PWB and a higher intake of sugar-sweetened beverages due to stress.

Negative impact of chronic pandemic-specific financial stress on food security among college students

Since the pandemic started, food insecurity has become a more serious issue for U.S. college students. The study goals were to evaluate whether pandemic-specific stress contributes to current food insecurity (as of February–March of 2022) and to determine which student characteristics are associated with food insecurity. We used the 2022 Spring American College Health Association—National College Health Assessment data (n = 620) collected at a public university. We estimated two multiple logistic regression models. The odds of having very low food security (OR = 8.65, 95% CI = 4.84:15.43) and low food security (OR = 2.87, 95% CI = 1.66:4.96) were significantly higher among students whose financial situation had become a lot more stressful as a result of the pandemic (relative to the other students). Sexual and gender minority, relationship, and current tobacco use statuses were associated with very low food security. There is a need for continued efforts to decrease the negative impact of the pandemic on students’ food security.

Correlates of COVID-19 vaccine uptake among U.S. College students

Hesitance toward COVID-19 vaccination has greatly decreased over the course of the pandemic in the U.S. However, some populations have lower vaccination rates than the general population. This study was conducted to identify correlates of being fully vaccinated (i.e., having received all doses required to be fully vaccinated) among college students using students’ responses to the 2022 Spring American College Health Association—National College Health Assessment. The surveys were administered in March of 2022. The sample (n = 617) included 18-to-30-year-old students. Firth logistic regression models were performed that controlled for age, sex assigned at birth, and food security (at a 5% significance level). The model-assisted results indicated that being a member of sexual and gender minority communities, being a graduate student, and being concerned about someone close getting COVID-19 were positively associated with being fully vaccinated, while current use of any tobacco product and current use of e-cigarettes were negatively associated with being fully vaccinated (all p-values < 0.05). In addition, the percentage of fully vaccinated students was higher among transgender/gender non-binary students (95%) than among cisgender men and women (85–87%), and among sexual minority groups (93–97%) than among heterosexual/straight students (82%). Among the racial/ethnic groups considered, the percentage of fully vaccinated students was lowest among non-Hispanic Black/African American students (77%), but the racial/ethnic differences were not statistically significant (at 5% level). The study points to a critical need for development and implementation of tailored vaccination campaigns to help students from diverse communities, including tobacco users, make informed decisions and become fully vaccinated.

Sexual Assault, Mental Health, and Alcohol Use in College Women: The Role of Resilience and Campus Belonging.

Understanding the mental health outcomes of sexual assault among college women is a public health priority. Although research has identified risk factors for the development of mental health problems following an assault, few studies have utilized a strengths-based approach to identify personal and social resources that may mediate the sexual assault-mental health link. Prior studies allude to the role of resilience and perceived campus belonging in explaining the relationship between sexual assault and mental health. This study represents the first application of the stress process model using a large sample of college women to examine (a) the association between sexual assault and mental health (i.e., psychological distress, suicidality, self-harm) and alcohol use problems and (b) the role of resilience and perceived campus belonging as partial mediators of these associations. Data were collected as part of the Spring 2021 American College Health Association National College Health Assessment (ACHA-NCHA; n = 31,328, Mean age = 20.26, SD = 1.64, 58.8% White), a cross-sectional, online survey that samples college students from 143 self-selected United States colleges. To test our primary hypothesis, a structural regression model was conducted, which included a latent sexual assault predictor, manifest resilience and campus belonging mediators, a latent mental health outcome, and a manifest alcohol use problems outcome. Mental health and alcohol use problems were positively associated with sexual assault and negatively associated with resilience and campus belonging. Resilience partially mediated the association between sexual assault and mental health. Campus belonging partially mediated the association between sexual assault, mental health, and alcohol use problems. This model explained 23.2% of the variance in mental health and 5.9% of the variance in alcohol use. Resilience and campus belonging may represent modifiable factors that can be targeted in trauma-focused interventions in efforts to improve victimized college women's mental health.

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.

Association Between College Course Delivery Model and Rates of Psychological Distress During the COVID-19 Pandemic

College students in the US have been heavily affected by the COVID-19 pandemic. In addition to increased rates of depression and anxiety, college students have faced unprecedented stressors, such as geographic relocation and abrupt conversion from in-person classes to online classes. To study the association between course delivery model and psychological distress among US college students. This cross-sectional analysis used national data from the American College Health Association-National College Health Assessment III data set. Data were gathered from a web-based survey administered from January to early June 2021 to full-time US college students attending 4-year programs. Course delivery model was self-reported. Psychological distress was measured using the Kessler Screening Scale for Psychological Distress. This study evaluated 59 250 full-time undergraduate students (68.1% women; 51.5% White students; mean [SD] age, 21.2 [4.3] years); 3.5% attended fully in-person classes, 61.2% attended fully online classes, and 35.3% attended a mixed format of in-person and online classes. Students who attended classes fully online reported higher levels of psychological distress than those who attended a mix of online and in-person classes (b = 0.76 [99% CI, 0.64-0.88]; P < .001). This association remained significant after controlling for geographic region, year in school, gender, race and ethnicity, food security, current anxiety and/or depressive disorders, COVID-19 concerns, and residence (living on campus, off campus with family, or other off-campus arrangements) (b = 0.18 [99% CI, 0.04-0.31]; P = .001), as well as time spent socializing with friends (b = 0.13 [99% CI, 0.002-0.26]; P = .009). The findings of this study suggest that mental health professionals may wish to consider the association of course delivery models with mental health outcomes when working with college students. Colleges should be aware of the mental health burden associated with attending fully online classes and consider possible in-person components and supports for students.

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.

College Student Aerobic and Muscle-Strengthening Activity: The Intersection of Gender and Sexual Orientation Among United States Students

The purpose of the study was to examine differences in aerobic and muscle-strengthening activity participation based on the intersection of gender and sexual orientation among cisgender college students. Data from the American College Health Association National College Health Assessment collected between Fall 2015 and Fall 2018 were analyzed. Differences from the population average for meeting aerobic and muscle-strengthening activity (separately) recommendations were computed for each gender and sexual orientation intersection. The likelihood of meeting aerobic and muscle-strengthening activity (separately) recommendations were calculated using a series of logistic regression analyses to determine odds ratios controlling for age, year of enrollment, race/ethnicity, and health status. Overall, more men and those identifying as straight met activity (aerobic and muscle-strengthening) recommendations. Asexual and straight women were less likely to meet activity recommendations compared to men, and bisexual and questioning women were less likely to meet muscle-strengthening recommendations compared to men. Bisexual, pansexual, and questioning individuals were less likely to meet activity recommendations compared to straight individuals among both genders, as were queer and gay men and women who identified as pansexual or another identity. Men who identified as pansexual or another identity, as well as lesbian and queer women were less likely to meet muscle-strengthening recommendations compared to straight individuals. In summary, findings demonstrate that aerobic and muscle-strengthening activity participation disparities are evident based on the intersection of gender and sexual orientation. The intersection of socio-demographic characteristics should be considered by researchers and physical activity promoters in order to better understand and address disparities.

Fraternity and sorority membership and risky sexual behavior

Objectives: To determine the impact of fraternity and sorority membership on condom use during sex. Methods: Utilizing data from The American College Health Association (ACHA) National College Health Assessment from 2016-2018, we estimated a linear probability, logistic, and instrumental variable model to determine the relationship between fraternity and sorority membership and the frequency of condom use during sex. Results: Compared to non-fraternity members, fraternity members experience an increase in sex without a condom for both oral sex (13.5%, 95% ci= 0.048, 0.221) and anal sex (28.5%, 95% ci= 0.174, 0.396). Compared to non-sorority members, sorority members are more likely to engage in oral sex without a condom. This result is not robust to single sorority members. Conclusions: Fraternity membership increases the probability of risky oral and anal sex. Policy Implications: The reduced use of condoms has implications on sexual health including an increased risk of contracting or spreading sexually transmitted infections.

College student aerobic and muscle-strengthening activity: the intersection of gender and race/ethnicity among United States students

Objective To adopt an intersectional approach to examine differences in aerobic and muscle-strengthening participation based on the intersection of gender and race/ethnicity among college students. Methods: Data from the American College Health Association (ACHA) National College Health Assessment collected between 2015 and 2018 were analyzed. Differences in the prevalence of meeting activity recommendations based on the intersection of gender and race/ethnicity were computed and displayed graphically. Odds of meeting activity recommendations were determined by calculating odds ratios controlling for age, year of enrollment, sexual orientation, and health status. Results: Aerobic and muscle-strengthening activity differed significantly between races within genders, and between genders within races. With minor exceptions, men were more likely to meet aerobic and muscle-strengthening activity recommendations than women of the same race/ethnicity. Disparities based on race varied considerably between genders. Conclusions: The intersection of gender and race/ethnicity should be considered when examining and addressing physical activity disparities.

Sexual Violence and Mental Health Among College Students in the Era of #MeToo

Sexual violence is a prevalent public health issue among college students and associated with adverse mental health outcomes. Modern social movements that bring awareness to sexual violence, such as #MeToo, have facilitated institutional coverage of the issue. A cross-sectional survey, the American College Health Association National College Health Assessment IIc was administered in Spring 2017 (n = 54,497) and Spring 2018 (n = 50,770) across universities (n = 83) in the United States. Data analyses utilized descriptive, bivariate, and multivariate methods. Relationships between sexual violence and seven mental outcomes, anorexia, anxiety, bulimia, depression, insomnia, stress level, and suicide, were assessed and compared across time periods. Logistic regression indicated that sexual violence was significantly associated with all mental health outcomes and that the measures of association for anxiety and suicide ideation decreased significantly from the year 2017 to 2018. Results confirm the adverse effect of sexual violence on mental health among college students. Possible implications of these findings include the role of social movements in dismantling stigma and mitigating the mental health impact of sexual violence.

Looking forward to student-athlete mental health: Racial/ethnic trends from 2010 to 2015

Objective This study examined trends in functionally impairing depression, significant anxiety, suicidal ideation, and suicide attempts among college student-athletes across time, racial/ethnic group, and student-athlete standing. Participants The sample consisted of 39,840 White, Black, Hispanic/Latinx, Asian/Pacific Islander, Native American, and Multiracial students who reported participating in “varsity” level college athletics in the past 12 months during the Spring 2010-2015 administrations of the American College of Health Association National College Health Assessment II. Methods Chi-square and difference in proportion tests compared mental health rates across time, racial/ethnic groups, and student-athlete status (student-athlete versus non-athlete). Results Findings suggested a lack of differences in mental health rates between 2010 and 2015, with the exception of a higher rate of anxiety for White student-athletes in 2015. Racial/ethnic comparisons pointed to relatively consistent heightened risks for depression and suicide concerns among Asian/Pacific Islander and Multiracial student-athletes compared to White student-athletes. Student-athlete status appeared most consistently to benefit White student-athletes, whereas there was evidence of potential liability of student-athlete status for Asian/Pacific Islander student-athletes. Conclusions Results make the case for adopting a racially/ethnically aware cultural lens when conceptualizing mental health risk and resilience among student-athletes.

Assessing Marijuana Use, Anxiety, and Academic Performance Among College Students

This article examines the relationship between marijuana use and anxiety symptoms among college students, with a secondary focus on marijuana use and grade point average (GPA). A secondary analysis was conducted on data obtained from the American College Health Association–National College Health Assessment. Results indicated that marijuana use was negatively associated with GPA among students with current anxiety and no formal treatment. The relationships between these variables may be more complex than previously thought.

Associations between marijuana use patterns and recreational legislation changes in a large Colorado college student sample

Background: Many states in the U.S. have changed how they regulated medicinal and/or recreational marijuana. Understanding the impact of these policy changes on marijuana use and perceptions of acceptability and safety of use is needed. The current study examined perceptions and patterns of marijuana use among college students, a population at increased risk for initiation and heavy use.Method: Data include Colorado university students and national sample averages. We used repeated cross-sectional analyses to examine responses to the American College Health Association National College Health Assessment and added marijuana measures. We examined differences in use and norms pre- to post-legalization among Colorado college students. Colorado data were also compared to national summary statistics.Results: Social norms, use initiation, and use recency and frequency in Colorado increased significantly across changes in recreational legislation. Descriptive norms and rates of ever users in Colorado increased faster than national averages.Conclusions: Results suggest recreational legalization increases how quickly social norms become more approving. As marijuana policy continues to change, implementing social norms interventions alongside legislative changes may offset increases in risk for use initiation and frequency by countering increased social norms favorable to use.

Club and Intramural Sports Participation and College Student Academic Success

The purpose of this investigation was to determine the relationship between university club and intramural sports participation and student grades via the American College Health Association National College Health Assessment (NCHA) survey, while controlling for confounding variables. Data were obtained from the NCHA for the fall 2008, spring 2009, fall 2009, and fall 2010 time periods. The original sample included 178,091 respondents. After inclusion and exclusion criteria, the final analytic sample included 85,316 respondents. Multinomial logistic regression was used to evaluate the role of participation in club and/or intramural sports on self-reported grade averages. Analyses were adjusted for significant covariates that have been identified as potentially impacting academic success. In general, sport participants were more likely to report higher grade averages than nonparticipants. The strongest relationships were found for participants of club sports. Future research should investigate relationships between club and intramural sports and other indicators of academic success.

Mental health symptoms and treatment utilization among trauma-exposed college students.

Universities have demonstrated growing awareness of students impacted by interpersonal violence (e.g., sexual and physical assault) and veterans/service-members with combat-related trauma because of their sizable presence on campuses and unique vulnerabilities. This study sought to describe impacts of these two forms of trauma exposure on students' mental health and academic functioning and to compare mental health service utilization among students based on their experiences of trauma exposure. To acquire a large, national sample of college students, we examined archival data from the Fall 2015 American College Health Association National College Health Assessment, a yearly, web-based survey which represented a sample of 19,861 students from 40 institutions. Twenty percent of the students had experienced interpersonal victimization in the last 12 months, combat exposure, or both. Compared with other groups, interpersonal violence survivors reported the most negative impacts on mental health and interference with academic performance. Service utilization rates among trauma-exposed students ranged from 52% to 84%, and students who had experienced recent interpersonal violence were the most likely to have received services. With a national sample, this study confirms that trauma-exposed students report poor mental health. Service utilization is high among this population, but campus-based mental health services appear to remain underutilized. Outreach efforts by student life professionals and campus clinicians targeting demographic subgroups could enhance utilization and accessibility of campus resources. (PsycINFO Database Record (c) 2019 APA, all rights reserved).