Association-National College Health Assessment Research Articles

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).

Perceived campus safety as a mediator of the link between gender and mental health in a national U.S. college sample

ABSTRACTMen and women tend to have different mental health outcomes. The purpose of this study is to examine the reason for gender differences in college students’ mental health. We examined perceived campus safety as an explanation for the relationship between gender and mental health in college students. According to the social structure and psychological distress paradigm, women are objectively disadvantaged, which creates a sense of powerlessness and causes distress. We hypothesized that perceived campus safety would mediate the relationships between gender and psychological distress as well as gender and sleep disturbances. To test these hypotheses, we examined data from the Spring 2010 American College Health Association National College Health Assessment II (ACHA-NCHA II) survey (N = 95,712) using multilevel structural equation modeling. Results confirmed that perceived campus safety partially mediated the relationship between gender and psychological distress as well as gender and sleep disturbances when controlling for victimization and general health. Women reported that they felt less safe than men on campus and experienced more psychological distress and sleep disturbances. The results of this study suggest that campus administrators could promote student well-being by addressing women’s safety concerns.

Sociodemographic factors associated with recent alcohol use among college students

ABSTRACTAlcohol use among college students continues to be a major public health problem in the United States. Therefore, the purpose of this paper is to examine factors associated with recent alcohol use among college students. Participants completed the American College Health Association National College Health Assessment in their classrooms. The university wellness center recruited participants. Findings indicated 76.0% of participants reported using alcohol in the past 30 days. Recent alcohol use was associated with multiple factors including grade level, sorority/fraternity status, been emotionally abused, mental health problems, and other drug use. College health professionals may use study findings to develop and implement harm reduction and alcohol prevention programming for students.

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.

Calculating the contribution of sleep problems to undergraduates' academic success

ObjectivesThe objective of this study is to determine to what degree sleep disturbances predict academic success, relative to other known risk factors for decreased academic performance. MethodsWe performed regression analyses on data from the Spring 2009 American College Health Association National College Health Assessment II dataset (n=55,322 students) to isolate the relative contribution of the frequency of sleep problems in the previous week to GPA and the likelihood of withdrawing from a course. In our estimations, we also controlled for other factors that influence academic success such as demographic and academic variables, drug and alcohol use, perceived stress, and employment hours. ResultsSleep disturbances were found to be a significant independent predictor of academic problems; on average, each additional day per week that a student experienced sleep problems raised the probability of dropping a course by 10% and lowered the cumulative GPA by 0.02. Factors such as stress, binge drinking, marijuana and other illicit drug use, which typically receive more attention by university administrators, had similar or relatively smaller negative associations with academic success as compared to disturbed sleep. Approximately three quarters of students surveyed reported never receiving information about sleep from their university. ConclusionsSleep education represents an underutilized opportunity for universities to maximize retention rates and academic success.

Smoking, health and academic outcomes: evidence from a limited smoking campus policy.

Although there is substantial literature on the impact of smoking laws, the number of studies that investigate the impact of such policies on college campuses is sparse. Using a rich data set from various waves of the American College Health Association National College Health Assessment survey for a mid-sized public university in the southern United States, we investigate a possible causal link between a limited smoking policy and smoking behaviours, health and academic outcomes among college students. We employ propensity score matching methods to control for endogeneity of unobservable characteristics. Our results show a significant reduction in the propensity to smoke cigarettes and cigars following the introduction of the policy. Further, we find that the policy has increased academic outcomes; however, it has no significant effect on student health. These findings have important policy implications for schools that are considering instituting comprehensive smoking bans on college.

Transgender college students: Academic resilience and striving to cope in the face of marginalized health

ABSTRACTObjective: To examine health behavior and outcome disparities between transgender, female, and male participants in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 32,964 undergraduate and graduate students responding to the Fall 2013 American College Health Association–National College Health Assessment; 65.8% were female, 0.4% were transgender, 67.9% were white, and 90.4% were heterosexual. Results: Transgender students reported more mental health diagnoses, trauma, and suicidality; experienced more violence and less safety, reported more sex partners and sexually transmitted infections (STIs); higher rates of illicit and nonprescription substance use and binge drinking use while engaging in less harm reduction behavior; and reported more barriers to academic success. Conclusions: There is an established need for college clinicians and health educators to reduce these disparate outcomes once students arrive on campus through professional training and culturally competent campus prevention and intervention efforts to promote health equity.

Abusive Relationship and Its Associated Factors Between Deployed and Un-Deployed Veterans in College.

This study is to examine the effect of student veteran status on abusive relationships, namely, emotional, physical, and sexual abuse. In addition, this study divided student veterans into two groups, deployed and un-deployed veterans, to see whether two groups demonstrate different results on abusive relationships. Logistic regression models were employed as a statistical strategy using the 2011-2014 American College Health Association National College Health Assessment II (ACHA-NCHA-II) data. The results found that deployed veterans were more likely to experience physical abuse, while un-deployed veterans were more likely to experience emotional abuse. Student veterans did not show any significant relationship with sexual abuse regardless deployment experience. It would be appropriate to consider the results of this study to address abusive relationships among student veterans, which help them to not only adjust college life but also succeed in careers and have healthy family relationships.

Association Between Nonmedical Use of Prescription Drugs and Sleep Quality in a Large College Student Sample

ABSTRACT Objective/Background: Poor sleep and nonmedical use (NMU) of prescription drugs (NMUPD) are both common among college students. Since lack of sleep adversely influences academic performance, this study examined the association between NMUPD and subjective sleep quality among college students. Participants: Students who completed the American College Health Association–National College Health Assessment data (Fall 2010, Spring 2011; N = 135,874). Methods: Associations were examined between NMUPD in four classes over the past 12 months (antidepressant, painkillers, sedatives, and stimulants), and five aspects of sleep quality (Enough Sleep, Early Awakening, Daytime Sleepiness, Difficulty Falling Asleep, and Problem With Daytime Sleepiness) in the past seven days. Results: Any NMUPD (at least one class), NMU of stimulants specifically, and NMU of painkillers specifically were associated with getting fewer days of Enough Sleep (OR: 0.86, 0.93, and 0.84 respectively), more days of Early Awakening (OR: 1.28, 1.10, and 1.28 respectively), Daytime Sleepiness (OR: 1.23, 1.13, and 1.16 respectively), and Difficulty Falling Asleep (OR:1.32, 1.10, and 1.27 respectively; p < .0001, each). NMU of sedatives was significantly associated with having Problem With Daytime Sleepiness (OR: 1.10), more days of Early Awakening (OR: 1.12), and Difficulty Falling Asleep (OR: 1.17; p < .0001). Conclusions: NMUPD is associated with poor sleep among college students. Therefore, behavioral medicine screening and treatment of this vulnerable population should consider sleep health, NMUPD, and the potential that these problems may be comorbid.

Emotional Abuse: Correlates to Abuse Among College Students

ABSTRACTEmotional abuse, also known as psychological maltreatment, is a significant health problem. Long-term outcomes of emotional abuse are quite negative and include physical and mental health disorders. The present study examined emotional abuse and correlates to such abuse among college students. The American College Health Association–National College Health Assessment II was completed by study participants at one urban, Midwestern university. A total of 777 students participated in the survey. Greater than one in 10 (10.7%) students reported being emotionally abused in the past year. The final logistic regression model found being female, being an older student, recent marijuana use, and being so depressed it was difficult to function were significant predictors of emotional abuse. Study findings suggest it may be important to screen high-risk students for emotional abuse as part of mental health treatment or other medical screenings. Given that one in 10 students experienced past year emotional abuse, it may also be crucial to raise awareness of emotional abuse on college campuses.

Health behaviors of culturally diverse inner-city community college students

ABSTRACTObjective: To determine the prevalence of risk behaviors related to cigarette use, alcohol use, nutrition, physical fitness, and sexual behavior. Participants: Participants were 1,075 students attending an urban community college during the Spring 2012 semester. Methods: Data were collected in randomly selected classes using the American College Health Association National College Health Assessment II (ACHA-NCHA II) paper survey and analyzed using Statistical Package for the Social Sciences (SPSS) version 22 for frequencies and chi-square test of independence. Results: The sample population reported poor diet, low rates of physical activity, high rates of overweight/obesity, low rates of condom use for vaginal sex, multiple sexual partners, and unintentional pregnancy. Protective health behaviors included low rates of cigarette smoking and alcohol use, high rates of condoms use for anal sex, and high rates of human immunodeficiency virus (HIV) testing. Conclusion: Students are at high risk for health problems related to poor diet, lack of exercise, and risky sexual behaviors. Additional research is recommended to determine the most effective intervention strategies.

The Theory of Planned Behavior as it predicts potential intention to seek mental health services for depression among college students

ABSTRACTBackground: Between 9.5% and 31.3% of college students suffer from depression (American college health association national college health assessment II: reference group executive summary spring 2013. Amer. Coll. Health Assoc. 2013; Eagan K, Stolzenberg EB, Ramirez JJ, Aragon, MC, Suchard, RS, Hurtado S. The American freshman: national norms fall 2014. Higher Educ. Res. Inst.; 2015). Universities need to understand the factors that relate to care-seeking behavior. Objective: Across 3 studies, to relate attitudes, social norms, and perceived behavioral control to intention to seek mental health services, and to investigate barriers to care-seeking. Participants: University college students (N = 845, 64% female, 26% male, and 10% unspecified). Methods: New measures were created in Studies 1 and 2, and were examined using structural equation modeling in Study 3. Results: Partially consistent with the Theory of Planned Behavior (Ajzen, I, Fishbein, M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980), a model with an excellent fit revealed that more positive attitudes about care and higher perceived behavioral control directly predicted higher intention to seek mental health services. Conclusions: Educating college students about mental health disorders and treatments, enhancing knowledge about available services, and addressing limited access to long-term care might improve treatment rates for students suffering from depression.

Depression, anxiety, and tobacco use: Overlapping impediments to sleep in a national sample of college students

ABSTRACTObjectives: To examine how tobacco use and depression/anxiety disorders are related to disturbed sleep in college students. Participants: 85,138 undergraduate respondents (66.3% female, 74.5% white, non-Hispanic, ages 18–25) from the Spring 2011 American College Health Association–National College Health Assessment II database. Methods: Multivariate analyses of tobacco use (none, intermediate, daily) and mental health (diagnosed and/or symptomatic depression or anxiety) were used to predict sleep disturbance. Results: Daily tobacco use was associated with more sleep problems than binge drinking, illegal drug use, obesity, gender, and working >20 hours/week. Students with depression or anxiety reported more sleep disturbances than individuals without either disorder, and tobacco use in this population was associated with the most sleep problems. Conclusions: Tobacco use and depression/anxiety disorders are both independently associated with more sleep problems in college students. Students with depression and/or anxiety are more likely to be daily tobacco users, which likely exacerbates their sleep problems.

Victimization and suicidality among female college students

ABSTRACTObjective: To investigate the predictive role of victimization in suicidality among college women. Participants: Female respondents to the American College Health Association National College Health Assessment II (N = 258). Methods: Multivariate logistic regression analyses examined the relationship between victimization and suicidality. Results: Emotional victimization (odds ratio [OR] = 11.79, 95% confidence interval [CI] = 2.43, 57.19, p < .01), physical victimization (OR = 6.10, 95% CI = 1.49, 25.08, p < .05), and sexual victimization (OR = 7.53, 95% CI = 2.06, 27.50, p < .01) were all significantly associated with an increased odds of suicidality even after considering the role of depression, anxiety, and stress. Conclusions: Victimization is a significant and independent predictor of suicidality among college women. Controlling for relevant psychological health–related variables, college women who reported any of the 3 types of victimization had more than 8 times the odds of suicidality compared with nonvictims.

Hookah and Cigarette Smoking Among African American College Students: Implications for Campus Risk Reduction And Health Promotion Efforts

ABSTRACTObjective: To identify individual and institutional risks and protections for hookah and cigarette smoking among African American (AA) college students. Participants: AA college students (N = 1,402; mean age = 20, range = 18–24 years; 75% female) who completed the Fall 2012 American College Health Association–National College Health Assessment II. Methods: Respondents were stratified into 4 mutually exclusive groups by last-30-day smoking status: cigarette-only use (5.1%), hookah-only use (5.9%), dual use (2.4%), and nonuse (86.6%). Multinomial logistic regression models identified the relative odds of exclusive and dual hookah and cigarette smoking. Results: Current hookah and cigarette smoking rates were comparably low. Age, gender identity, current substance use, interest in tobacco use information, and student population prevailed as risks and protections for hookah and cigarette smoking. Conclusions: Campus health promotion campaigns may need to tailor messages to AA students, particularly those who use substances, to underscore the health risks of hookah and cigarette smoking.

Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students

PurposeThis study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors in transgender and cisgender college students. MethodsData came from 289,024 students from 223 U.S. universities participating in the American College Health Association–National College Health Assessment II (median age, 20 years). Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were compared among transgender students (n = 479) and cisgender sexual minority (SM) male (n = 5,977) and female (n = 9,445), unsure male (n = 1,662) and female (n = 3,395), and heterosexual male (n = 91,599) and female (n = 176,467) students using chi-square tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates. ResultsRates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were highest among transgender students and lowest among cisgender heterosexual men. Compared to cisgender heterosexual women, transgender students had greater odds of past-year SR-ED diagnosis (odds ratio [OR], 4.62; 95% confidence interval [CI], 3.41–6.26) and past-month use of diet pills (OR, 2.05; 95% CI, 1.48–2.83) and vomiting or laxatives (OR, 2.46; 95% CI, 1.83–3.30). Although cisgender SM men and unsure men and women also had elevated rates of SR-ED diagnosis than heterosexual women, the magnitudes of these associations were lower than those for transgender individuals (ORs; 1.40–1.54). ConclusionsTransgender and cisgender SM young adults have elevated rates of compensatory behavior and SR-ED diagnosis. Appropriate interventions for these populations are urgently needed.

Mediating Effects of Stress, Weight-Related Issues, and Depression on Suicidality in College Students

Objective: Through a holistic health lens, the current study examines the effects of weight-related issues and stress on suicidality while controlling for depressive symptoms in college students. Participants: In total, 872 undergraduate and graduate students at DePaul University completed the American College Health Association–National College Health Assessment II Web-based survey in Spring 2010. Methods: Measures of suicidality, depression, weight-related issues, and life stressors were assessed, along with gender differences. Results: Females reported experiencing more weight loss attempts and total stressors than males. Weight-related issues and stress both significantly predicted depressive symptoms in a path analysis; depressive symptoms, in turn, significantly predicted suicidality. Gender differences were found; depressive symptoms mediate the relation between stress and suicidal behavior for females but not for males. Implications: This investigation furthers previous research on suicidality in college students and suggests that all-inclusive interventions that address weight-related issues and stress may help reduce depressive symptoms, which then may reduce suicidal behavior.

Mental Health Symptoms Among Student Service Members/Veterans and Civilian College Students

Objective: The aim of this study was to investigate if and to what extent student service members/veterans differ from civilian college students in the prevalence of self-reported symptoms of poor mental health. Participants: The Fall 2011 implementation of the American College Health Association–National College Health Assessment included 27,774 respondents from 44 colleges and universities. Methods: Participants were matched using propensity scores, and the prevalence of symptoms was compared using logistic regression and zero-inflated negative binomial regression models. Results: The odds of feeling overwhelmed in the last 12 months were significantly lower among student service members/veterans with a history of hazardous duty (odd ratio [OR] = 0.46, adjusted p value <.05) compared with civilian students. Military service, with and without hazardous duty deployment, was not a significant predictor of the total number of symptoms of poor mental health. Conclusions: Current student service members/veterans may not be disproportionately affected by poor psychological functioning.

Impediments to Academic Performance of Bisexual College Students

Objective: To investigate health-related impediments to academic success for bisexual college students. Participants: Respondents to the Fall 2011 American College Health Association–National College Health Assessment II (ACHA-NCHA II) survey who self-identified as bisexual, heterosexual, gay, or lesbian. Methods: Secondary analyses of the ACHA-NCHA II data were conducted to compare the experiences of bisexual students with both each other (bisexual men and bisexual women) and those of their nonbisexual counterparts (heterosexual and gay/lesbian students). Results: Bisexual college students are a large and distinct sexual minority group. On all measures with the exception of discrimination, bisexual college students reported the strongest threats to academic success of all sexual orientations. Conclusions: Given the unique impediments for bisexual students, college health professionals should consider specifically addressing needs for bisexual students, bisexual women in particular.

Community College Student Mental Health

This study explores community college student mental health by comparing the responses of California community college and traditional university students on the American College Health Association–National College Health Assessment II (ACHA-NCHA II). Using MANOVA, we compared community college and traditional university students, examining overall group differences on four multicomponent questions; pairwise comparisons also were used to examine individual survey items. This study found significant differences in reported mental health issues and needs between the students. More specifically, a pattern of difference in psychological concerns, available resources, and resource utilization emerged, with community college students having more severe psychological concerns and less institutional mental health resources than traditional university students. Findings suggest that both community colleges and traditional universities would benefit from increased mental health resources, though community colleges are particularly in need.