Health Association-National College Research Articles

Examining the Risks of Multiple Types of Interpersonal Victimization for Transgender and Gender Non-Conforming College Students.

Recent research has shown that transgender and gender non-conforming (TGNC) individuals are at risk of experiencing interpersonal violence, yet there may be differences within this group and across victimization types. The current study examined rates of seven types of interpersonal victimization based on six gender identities (cisgender women, cisgender men, trans women, trans men, nonbinary, and another identity) among a national study of college students. Data from the Spring 2021 American College Health Association's National College Health Assessment III (ACHA-NCHA III), a national-level study of U.S. college students, were used. We examined the association between gender identity and seven types of interpersonal violence victimization (violent victimization, sexual victimization, intimate partner violence victimization, stalking, bullying, microaggression, and discrimination) that occurred within the past 12 months. Logistic regression analyses were performed to examine if, when controlling for competing factors, gender identity was associated with an increase in the expected odds of victimization for each victimization type. Analyses revealed that TGNC college students reported experiencing a greater amount of all seven types of victimization compared to cisgender college students. These findings corroborate previous research indicating that rates of interpersonal violence are higher among TGNC college students compared to those who identify as cisgender, even after controlling for sexual orientation, related demographic factors, and substance use. Findings from the current study suggest that there are differences within individuals who identify as TGNC in terms of their risk for interpersonal victimization and that rates differ across victimization types. More work is needed to provide tailored prevention programming for TGNC college students.

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.

Intersectionality of demographic characteristics in self-reported anorexia nervosa, bulimia nervosa, and probable eating disorders among college students.

To investigate associations between identity intersectionality, with a primary focus on minority identity, and probable eating disorders (EDs) within the US college student population. Data consisting of n = 414,299 college students' responses to the American College Health Association's National College Health Assessment between fall 2015 and spring 2019 were utilized for this study. Overall and stratified adjusted odds ratios (aORs) were used to assess the association between different facets of identity (i.e., race/ethnicity, gender identity, and sexual orientation) and probable EDs. Among all, in our analytic sample, 7.15% reported a probable ED. Interactions between all three identity variables were significant, and thus stratified odds ratios were evaluated. Transgender men were significantly more likely to report probable ED than cisgender male peers within the following racial/ethnic groups: non-Hispanic White (aOR: 3.33; 95% CI: 2.79, 3.96; p < .0001), non-Hispanic Black (aOR: 3.29; 95% CI: 1.72, 6.28; p = .0003), Hispanic (aOR: 2.31; 95% CI: 1.55, 3.43; p < .0001), Asian or Pacific Islander (aOR: 2.19; 95% CI: 1.45, 3.30; p = .0002), Biracial or Multicultural (aOR: 3.36; 95% CI: 2.17, 5.22; p < .0001), and other (aOR: 4.19; 95% CI: 2.25, 7.79; p < .0001). This study underscores the importance of increasing our understanding of interactions between marginalized identities and the ways in which minority identity informs ED risk. The impact of multiple marginalized identities on ED outcomes is not well understood. Our study expands on previous ACHA-NCHA studies by addressing identity intersectionality, looking at more than one identity at a time (i.e., specifically race/ethnicity, gender identity, and sexual orientation). Our results contribute unique risk profiles for students who identify with multiple marginalized groups. Further, they indicate that that these associations vary based on the compounded effect of the demographic factors considered.

Victimization, Disability Status, and Fear Among U.S. College Students.

Levels of fear of crime are high in the United States, though they differ across groups. Researchers have identified characteristics associated with high levels of fear of crime, often noting that those most fearful also have vulnerabilities that increase their risk of experiencing victimization. Thus, having a vulnerability and experiencing victimization may exacerbate fear of crime. One such characteristic that may impact fear of crime is having a disability. The current study uses data from the American College Health Association's National College Health Assessment Spring 2021 survey to investigate how disability interacts with victimization to impact fear of crime among college students. To do so, assessments of personal safety in multiple contexts are used: at night, during the day, on campus, and in the community. Results show that disability increases the odds of feeling unsafe across contexts, as does having a history of victimization. Nonetheless, disability does not significantly interact with victimization. It may be that having a disability is such a strong risk factor for feeling unsafe that being a victim does not significantly further increase this assessment. Institutions of higher learning should use their offices of accommodation as well as victim services to assist students in reducing their feelings of being unsafe.

Polyvictimization and Academic Performance: Findings From a National-Level Study of College Students.

Research on polyvictimization (i.e., experiencing multiple types of victimization) suggests that its effects are diverse and may be more severe than the effects of single-type victimization. Few studies have focused on polyvictimization among college students and how its experience may shape academic life. Thus, this study examines how polyvictimization (i.e., sexual, violent, and stalking-in the last 12 months) among college students relates to academic performance. Participants (N = 67,972) were drawn from the Spring 2019 administration of the American College Health Association's National College Health Assessment II. Findings show that polyvictims' grade point averages are lower than nonpolyvictims and polyvictims have higher odds of having their academic performance suffer connected to a variety of factors (mental health, physical health, and substance use). Students who experienced three types of victimization (compared to fewer) had the highest odds of having their academic performance harmed. These findings suggest extra attention be paid to polyvictimization as it relates to factors that shape academic performance.

Psychological Well-Being in Asian and Asian American University Students: Impacts of Discrimination During the COVID-19 Pandemic

PurposeThe aim of this study is to determine what modifiable behavioral and sociological factors were predictive of psychological distress and suicide risk in Asian and Asian American students, the ethnic group with the highest unmet mental health need in collegiate populations. We also compared these relationships in Fall 2019 to Fall 2020 to better understand how the impact of these factors changed during the COVID-19 pandemic and concurrent increase in Anti-Asian discrimination. MethodsWe used factor analysis to extract a wide range of predictor variables from the Fall 2019 and Fall 2020 American College Health Association's National College Health Assessment III. Next, we used structural equation modeling to identify significant drivers of psychological distress (Kessler-6 scale) and suicidality (Suicide Behavior Questionnaire-Revised scale) in Asian and Asian American students (n = 4,681 in 2019 and 1,672 in 2020). ResultsWhen compared to 2019, experiencing discrimination in 2020 had a substantially larger effect on both psychological distress and suicidality among Asian and Asian American university students. Loneliness and depression were also significant drivers of negative mental health outcomes both years, and their effect magnitudes remained largely unchanged. Being well rested had a protective effect against psychological distress both years. DiscussionDuring the COVID-19 pandemic, discrimination was an important driver of psychological distress and suicidality in Asian and Asian American students. These findings suggest that organizations should enhance culturally competent mental healthcare services, while also working at the systems level to reduce bias and discrimination.

Does College Matter? Exploring College-Level Factors Related to Victimization Risk for U.S. and Canadian College Students.

Research shows that U.S. college students are at risk for a variety of victimization types. College students in Canada also experience similar types of victimization compared to U.S students, yet recent research shows that Canadian students are at a greater risk than U.S. college students of being victimized. Little is known, however, as to whether college-level factors influence victimization risk and how these risks may be different for U.S. and Canadian college students. Using the American College Health Association's National College Health Assessment data (ACHA-NCHA II), the current study builds upon past research by exploring the role of both individual and school characteristics and whether they are similarly related to risk of victimization in the two populations. The findings show that Canadian students are at higher risk for victimization and that some school-level factors play a role in predicting this risk for all students, with some variation in ones that matter for each country.

The relationship between family-based adverse childhood experiences and substance use behaviors among a diverse sample of college students

IntroductionResearch suggests that college students are an especially vulnerable subset of the population for substance use and misuse. However, despite evidence of the high prevalence of adverse childhood experiences (ACE) among students and the link between family-based ACE and substance use among older adults, this relationship remains understudied in college populations. Moreover, whether ACE represents a shared risk across substance use behaviors and ethnic groups is unknown. MethodsData are student responses (n=2953) on the 2015 American College Health Association's National College Health Assessment II (ACHA-NCHA II) administered at one of the largest, most diverse public universities in California. Multivariable logistic and negative binomial regression models tested the association between individual and accumulated ACE and past 30-day alcohol, tobacco, marijuana, and illicit drug use, past 12-month prescription medication misuse and polysubstance use. ResultsBetween 50% and 75% of students involved in substance use were ACE exposed. There was a significant dose-response relationship between ACE and substance use and polysubstance use. Although accumulated ACE increased risk for substance use, there was considerable ethnic variability in these associations. ConclusionsThe graded effects of ACE for substance use underscore the link between family-based stressors and these behaviors in emergent adult college students. Our findings make a compelling case for investing in health initiatives that prioritize ACE screening and access to trauma-informed care in campus communities. Continued research with college populations is needed to replicate findings and clarify the role of ethnicity and culture in trauma response and help seeking behaviors.

Mental health and substance use of sexual minority college athletes

ABSTRACTObjective: Assess the mental health and substance use of sexual minority collegiate student-athletes in the United States, as compared with heterosexual college students and heterosexual student-athletes. Participants: Undergraduate students (N = 196,872) who completed the American College Health Association's National College Health Assessment (Fall 2008–Fall 2012 administrations). Methods: Written cross-sectional survey. Results: Sexual minority student-athletes had a higher risk of experiencing mental health difficulties than their heterosexual athlete peers. There were no significant differences in mental health between sexual minority male athletes and nonathletes. Sexual minority female athletes appeared to fare better than nonathlete peers. Substance use was greater among sexual minority students (athlete and nonathlete) and was mediated by mental health. Conclusions: Participation in athletics does not appear to be associated with an elevated risk of negative mental health outcomes for sexual minority participants; however, there are disparities in mental health outcomes by sexual orientation regardless of athletics participation.

Utilization and limitations of the American College Health Association's National College Health Assessment instrument: A systematic review

ABSTRACTObjective: To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II. Participants and Methods: The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument use, limitations, and data analyses. Results: The search resulted in 72 articles for inclusion. Researchers used the instrument to either conduct a primary investigation or utilize reference group data for secondary analysis. Researchers used many data analyses, statistical tests, techniques, and methods. Limitations of the instrument were consistently mentioned by researchers. Conclusions: Results indicate limitations in the NCHA. To ensure college health professionals are gaining the best information possible regarding students on their campuses, specific improvements to the NCHA are recommended.

Association of Stress, General Health, and Alcohol Use with Poor Sleep Quality among U.S. College Students

Background: Poor sleep among college students is a major, growing problem associated with lower academic performance, higher rates of health and emotional problems, and development of chronic sleep disorders. Purpose: Though previous studies have focused on individual colleges, our study purpose was to reveal the association of behaviors and function to sleep quality in a large sample of students from across the United States. Methods: We analyzed data from the Fall 2009 American College Health Association's National College Health Assessment–II survey using descriptive statistics, independent sample t tests, chi-square tests, and logistic regression to find a representative, matched sample of 14 870 college students, both with and without a sleep problem, measured by daytime sleepiness. Results: Our correlational analysis revealed that sleep quality decreased with increasing levels of stress or alcohol/cigarette use and with decreasing levels of general health (all Ps < .001). Discussion: College interventions should include efforts to address sleep quality to improve students' academic performance and long-term quality of life, especially for students experiencing substantial stress or poor general health. Translation to Health Education Practice: Educators, advisors, and leaders should incorporate sleep quality improvements into their services and programs for all students, especially students in at-risk groups.

Abstract A01: Cancer-risk behavior clustering involving physical activity, tobacco and alcohol use by race, ethnicity and socioeconomic status among U.S. college students

Abstract Background: Health disparities in the U.S. are disproportionately found among racial and ethnic minorities and populations of lower socioeconomic status. Cancer is one of six primary health concerns identified by the NIH in which ethnic and racial minorities experience a higher risk of disease and mortality rates when compared to Caucasians. In large part, this could be due to demonstrated ethnic, racial and socioeconomic differences in cancer-related behavioral risk factors like unhealthy diet and overweight, physical inactivity, tobacco use and alcohol consumption. For example, dietary practices influence the risk of cancer, and epidemiologic studies show that ethnic and racial minorities, particularly of lower SES, often maintain poorer diet and nutrition, with a growing body of evidence implicating environmental factors such as limited access to affordable healthy foods and targeted marketing of high-calorie foods and beverages to these populations. Many cancer-related deaths are preventable through modifying unhealthy behavior. This study aims to understand how cancer-risk behaviors, including physical activity, diet, body-mass and tobacco/alcohol use, cluster as a function of race, ethnicity and socioeconomic status in a large sample of young adults enrolled U.S. colleges and universities. Methodology: Using the American College Health Association's National College Health Survey Fall 2010 dataset, latent class analysis (LCA) was used to examine clustering of alcohol binge drinking, tobacco use, poor diet (insufficient fruit/vegetable consumption), and physical inactivity. The identified clusters were examined by students' socioeconomic status as measured Findings: Among 30,093 college students surveyed, there were high rates of tobacco use (24%), alcohol binge drinking (33%), physical inactivity (64%), and unhealthy diet (95%). Results of the LCA of behavior clustering by socioeconomic status will be presented, with a focus on alcohol binge drinking and tobacco use. Conclusions: Most U.S. students smoke and binge drink at high rates and do not meet current guideline recommendations for physical activity and fruit/vegetable consumption. Interventions focused on modifying multiple risk behaviors in college student populations could have a much larger effect on cancer prevention than interventions targeting any single behavior. Findings should provide valuable information about the extent to which multiple health behavior interventions should be tailored by racial/ethnic background and socioeconomic status. Citation Format: Christina Czart Ciecierski, Joseph Kang, Brian Hitsman. Cancer-risk behavior clustering involving physical activity, tobacco and alcohol use by race, ethnicity and socioeconomic status among U.S. college students. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A01. doi:10.1158/1538-7755.DISP13-A01

Sexual orientation and disordered eating behaviors among self-identified male and female college students

This study compared the risk of a) clinically diagnosed eating disorders, and b) disordered eating behaviors, separately among three groups of United States college students, controlling for known covariates. These groups included college students self-identifying as: 1) gay/lesbian; 2) bisexual; and, 3) unsure, with self-identified heterosexuals as the reference. Data from the American College Health Association's National College Health Assessment II (2008–2009) were utilized (N=110,412). Adjusted logistic regression analyses, stratified by self-reported gender, examined the effect of self-identified sexual identity on clinical eating disorder diagnosis and disordered eating behaviors. Covariates included self-reported binge drinking (past 2weeks), stress (last 12months), smoking (past 30days), depression (past 12months), fraternity/sorority membership, college athletics participations, and race. Additional logistic regression sub-analyses examined sexual minorities only, with gay/lesbian as the referent. Gay, unsure, or bisexual men were at significantly increased odds to report both clinical eating disorders and disordered eating behaviors when compared to heterosexual men in both the unadjusted and adjusted models (p<.002). All sexual minority men and women were significantly more likely to report dieting to lose weight compared to heterosexual men and women (p<.002). Targeted disordered eating and eating disorder prevention efforts are needed for those who are sexual minorities, particularly for sexual minority men.

Associations between Healthy Lifestyle Behaviors and Academic Performance in U.S. Undergraduates: A Secondary Analysis of the American College Health Association's National College Health Assessment II

To examine associations between academic performance and moderate-vigorous physical activity, strength training, fruit and vegetable intake, and sleep. Cross-sectional observational study. Forty U.S. colleges and universities participating in the Fall 2008 National College Health Assessment-II (NCHA-II) (median response, 27%). A total of 16,095 undergraduate students (18-24 years; 70.3% female). Self-reported lifestyle variables from the NCHA-II questions were dichotomized as meeting or not meeting public health recommendations. Grade average ranged from 1.00 to 4.00 points. Linear regression, adjusting for sociodemographic and health-related variables. The prevalence of meeting public health recommendations was as follows: moderate-vigorous physical activity, 41.9%; strength training, 32.4%; fruit and vegetable intake, 4.6%; and sleep, 23.6 %. Grade average was higher in students meeting moderate-vigorous physical activity, fruit and vegetable intake, and sleep recommendations (p ≤ .019). If moderate-vigorous physical activity was met, grade average was higher by .03 points, .15 points higher when meeting fruit and vegetable intake recommendations, and .06 points higher for sleep. There was no significant change in grade average in those meeting strength-training recommendations. College students who adhere to public health recommendations for lifestyle behaviors have modestly higher grade averages after adjusting for sociodemographic and negative health behaviors.

A Comparison of Lesbian, Bisexual, and Heterosexual Female College Undergraduate Students on Selected Reproductive Health Screenings and Sexual Behaviors

BackgroundThe purpose of this study was to compare lesbian, bisexual, and heterosexual college undergraduate women on selected reproductive health screenings. Associations between sexual orientation and preventive health screenings and sexual behaviors were made to determine if differences existed between the groups. MethodsThe study was a secondary analysis of three semesters of the American College Health Association's National College Health Assessment-II. FindingsBisexuals were 1.1 times as likely as heterosexuals to have a gynecological examination and perform a breast self-examination (BSE), and 1.5 times as likely to have an HIV test. Bisexuals also were 1.5 times as likely as lesbians to have a gynecological examination, 1.2 times as likely to perform BSE, and 1.4 times as likely to have an HIV test. Lesbians were 0.70 times as likely as heterosexuals to have a gynecological examination, but no different in BSE or HIV testing. Bisexuals were more likely to have anal intercourse than heterosexuals or lesbians (p < .001). Bisexuals were less likely to use condoms than heterosexuals for vaginal intercourse but more likely to use them for anal intercourse (p < .001). Most of the women (90%) used no barrier protection for oral sex. Bivariate tests found associations between sexual orientation and each of the preventive screenings and that those with more partners screened more frequently. ConclusionsHealth educators should attend to the unique needs of each sexual orientation group when presenting sexual health information to college women. Health care providers should undergo diversity and sensitivity training to work more effectively with these groups.

Gender Differences in the Associations Among Body Mass Index, Weight Loss, Exercise, and Drinking Among College Students

Objective: To explore gender differences regarding weight management behaviors of college drinkers. Participants: Nationally representative sample of college students from the fall 2008 American College Health Association's National College Health Assessment II (N = 26,062 students). Methods: Structural equation modeling was used to examine potential gender differences in associations among exercise, weight loss behaviors, and alcohol use. Results: Critical ratio tests revealed that associations between exercise and weight loss behaviors were more strongly correlated among females as compared with males. For females, there was a small negative association between exercise and drinking behaviors; in contrast, for males, there was a positive relationship between exercise and alcohol use. Weight loss behaviors were positively associated with drinking for both female and male students; however, the association was significantly stronger for females. Conclusions: This investigation furthers previous research on drunkorexia and also sheds additional light on the gender-based differences in weight management behaviors of drinkers.

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.

Health‐related barriers to learning among graduate students

PurposeThe purpose of this paper is to report the perceived impact of various health concerns on the academic performance of health sciences graduate students.Design/methodology/approachThe American College Health Association's National College Health Assessment (ACHA‐NCHA), a 58‐item anonymous survey, was distributed to all graduate health science students during a five‐week period in the spring semester.FindingsStudents (n=1,355) were most likely to report a negative perceived academic impact related to psychosocial concerns such as stress, depression/anxiety, and relationship problems. The students' most pressing felt concerns were upper respiratory infections, stress, concerns about troubled loved ones and sleep difficulties. Clinical graduate students (n=712) were significantly more likely to report negative academic impacts related to upper respiratory infections (p=0.001), concern about a troubled friend or family member (p=0.001), sleep difficulties (p=0.005), relationship difficulties (p=0.030), and internet use/computer games (p=0.015) than non‐clinical graduate students. However, the magnitude of those differences was small.Practical implicationsThis paper adds to one's knowledge of student health concerns, which may help to address health‐related barriers to learning.Originality/valueThis paper presents findings that further explicate the reciprocal relationship between student health and learning by suggesting methodology to identify priority health issues among a graduate student population. Findings from this study of over 20 different health concerns indicate that the priority health concerns of graduate health science students are primarily psychological and psychosocial health issues.

Do “Clicker” Educational Sessions Enhance the Effectiveness of a Social Norms Marketing Campaign?

Objective: Social norms campaigns are a cost-effective way to reduce high-risk drinking on college campuses. This study compares effectiveness of a “standard” social norms media (SNM) campaign for those with and without exposure to additional educational sessions using audience response technology (“clickers”). Methods: American College Health Association's National College Health Assessment questions are used to evaluate actual and perceived use. Additional survey questions assess individual exposure to the interventions. Results: The authors find “clicker” technology to be more effective than social norms poster media alone in reducing misperceptions of normative alcohol use for those students who attended clicker sessions. Conclusion: Poster SNM campaigns may be most effective when supported by group “clicker” heath-related sessions.