University Health Research Articles

Correlates of pre-exposure prophylaxis (PrEP) use among college students in the United States

Introduction HIV rates in the US continue to be high despite the availability of effective prevention medication such as pre-exposure prophylaxis (PrEP). Little is known about how undergraduate college students engaging with campus healthcare services use PrEP. This study of a national sample of undergraduate college students explored the sociodemographic and behavioral factors associated with PrEP use. Methods Data were collected as part of the National College Health Assessment (NCHA). Logistic regression models were used to estimate the likelihood of PrEP use. Results PrEP use was low (3.0%) and was associated with recent anal sex and identifying as men or transwomen. Being unsure about one’s HIV testing history was associated with higher odds of PrEP use, a potential concern considering how crucial HIV testing is to PrEP adherence. Discussion College students may benefit from more explicit discussions around HIV tests and the results of those tests as well as targeted messaging campaigns around PrEP.

Undergraduate health science students’ knowledge, attitudes, practices, and perceived barriers towards research at Kuwait university: a cross-sectional study

Abstract Introduction Research is the most reliable strategy to advance scientific understanding and enhance multiple healthcare services1. Integrating undergraduate health science students into research at an early stage is an important step towards improving critical thinking and problem-based solving, which in return enhances patient health outcomes2. Aim The aim of this study was to assess undergraduate health science students’ knowledge, attitudes, practices and perceived barriers towards research at Kuwait University. Methods A cross-sectional study was conducted among undergraduate health science students from the Colleges of Pharmacy, Medicine, Allied Health, Dentistry, and Public Health at Kuwait University. A self-administered online questionnaire consisting of five sections was used. The first section included questions to assess the demographic characteristics. The second section aimed to assess the knowledge of undergraduate students regarding basic research (score = low ≤3, moderate 4-5, high >5). The third section assessed attitude toward research by a five-point Likert scale (score = negative 31-75, neutral 76-110, positive 111-155). The fourth section of the questionnaire aimed to assess the perception of the barriers toward research practice (score = low 0-50, moderate 51-75, high 76-100). Finally, a section with eight questions on research practices. The questionnaire was distributed through online educational and social media platforms, such as WhatsApp and Microsoft Teams. Students from any academic year and who were enrolled as health science students at the time of the study were eligible to participate. The questionnaire was pilot tested prior to distribution. The recommended sample size was calculated using Raosoft (344 students)3. Ethical approval was received from The Health Sciences Ethical Committee, Kuwait University (reference: VDR/EC-393). Results A total of 364 undergraduate medicine, dentistry, pharmacy, allied health and public health students participated in the study. The participants were from different academic stages, ranging from first-year to seventh-year. The results showed that the students possessed moderate knowledge levels, with a median of 3 out of 8 according to the scoring system of the study. Most students had neutral attitudes (N=253; 69.5%) and moderate levels of perceived barriers (N=200; 54.9%). Medical and pharmacy students had significantly higher knowledge levels compared to the others (p<0.001; Kruskal-Wallis). The majority of students agreed that the lack of time is a barrier towards conducting research (N=237; 65.1%). Almost one half of the study participants took part in research projects (N=175; 48.1%) and a promising number of students had publications or poster presentations (N=67; 18.4%). Discussion/Conclusion The results suggest that undergraduate health science students at Kuwait University possess moderate research knowledge and have neutral attitudes towards research. Time constraints were the most frequently reported barrier to participation. While nearly half of the students participated in research projects, implementing mandatory research projects and providing research methodology workshops could significantly enhance student knowledge, attitudes, and future research engagement. A key limitation in this study is that observed relationships may not reflect long-term shifts in knowledge, attitudes, or practices. The study was also conducted in one university (Kuwait University), therefore the findings and results cannot be generalized to other undergraduate students.

Relapsed AML in a Patient Presenting to a College Health Center: A Case Report

Acute myelogenous leukemia (AML) represents nearly 40% of all cancers affecting the adolescent and young adult (AYA) population. Although overall survival has improved, cure rates for AYAs lag behind younger leukemia patients. The primary care provider (PCP), including the college health provider, is a crucial member of the medical team for children and AYA cancer survivors. In the college setting, the PCP plays a key role in close monitoring for relapse and late effects. This case highlights the presentation of a college student to their university's health center for complaints later found to be due to relapsed leukemia. The PCP must distinguish the unique needs of AYA cancer survivors to provide early recognition and referral to treatment for concerns.

Health-care utilisation and associated economic burden in Major Depressive Disorder and Treatment-Resistant Depression in a longitudinal population-based cohort study of 110.000 patients

Major depressive disorder (MDD), and particularly treatment-resistant depression (TRD), lead to high levels of health-care use and disease burden. The aim of this study was to evaluate and compare the health-care resource utilisation and associated costs in these patient groups. It was a population-wide, retrospective analysis of NHS health-care electronic records in northwest London using the Discover-NOW platform, one of the largest interlinked datasets in Europe hosted by Imperial College Health Partners, which contains coded emergency and routine, primary and secondary, physical and mental health data, covering a population of more than 2.5 million. Eligible patients were adults with a diagnosis of MDD who had been prescribed at least one antidepressant between 2015 and 2020. A total of 110,406 patients were included, 101,333 [92%] with MDD and 9,073 [8%] with TRD. Mean duration of depression was 52.8 (SD 41.7) months for MDD and 70.8 (SD 37.8) months for TRD (p<0.0001). Patients with TRD had significantly higher risks of both psychiatric and somatic comorbidities such as anxiety, asthma, and alcohol misuse (all p<0.0001). They also demonstrated increased primary care and emergency attendance rates, more frequent and longer hospitalizations, and on average 1.5 times greater total healthcare costs compared to MDD patients. Primary care visits represented the largest proportion overall (TRD mean 162 [SD 96] vs. MDD 108 [90] visits per patient, p<0.0001; cost per patient £17,348 [SD £33,040] vs. £12,011 [£25,588], p<0.0001) during the study period. In secondary care, accident and emergency visits accounted for the highest use (TRD mean 5.5 [10.6] vs. MDD 3.54 [SD 6.0] visits per patient, p<0.0001) while non-elective hospitalisations incurred the highest costs (mean £2,518 [£8,064] vs. £1,909 [SD £6,807], p<0.0001). Demand increased with the duration of depression and the number of lines of treatment. The study highlights the substantial clinical and economic burden associated with MDD and especially TRD across different care settings.

Impact of the COVID-19 pandemic on university students’ psychological distress, well-being, and utilization of mental health services in the United States: populations at greatest risk

IntroductionThe COVID-19 pandemic led to major disruptions in the lives of university students, which is a population that is already at a greater risk of mental health concerns. Little is known about how the pandemic impacted distress and mental health services utilization among university students across the United States.MethodsUsing survey data from the National College Health Assessment, both before the COVID-19 pandemic (pre-March 2020, n = 88,986) and during the pandemic (Spring 2021, n = 96,489), the present study examined mental health symptoms and utilization of mental health services among undergraduate students attending four-year universities in the United States.ResultsThere were notable increases in measures of psychological distress and reductions in well-being from before the pandemic to during the pandemic. However, overall utilization rates of mental health services slightly decreased from pre-pandemic to during the pandemic. Predictors of severe psychological distress included those who experienced loneliness, COVID-19 related stressors, and loss of a loved one from COVID-19. COVID-related stressors and loneliness were associated with higher utilization rates of mental health services, while well-being and resilience were associated with lower utilization rates.DiscussionAnalyses revealed that several demographic groups were at an elevated risk for severe psychological distress, including non-binary, female, and sexual minority students, and especially those who identify as both non-binary and non-heterosexual. Results indicated that students of color, especially female students of color, were less likely to receive mental health services. Future research is needed to increase our understanding of the barriers to mental health service use among high-risk university students.

Eating habits of students of health colleges and non-health colleges at the Northern Border University in the Kingdom of Saudi Arabia.

Eating habits are important determinants of health. Young adults who have recently transitioned to university life experience stress and lack of time, which are major risk factors for poor eating habits. This study's objectives were to identify and compare eating habits between students at health and non-health colleges at Northern Border University (NBU), Saudi Arabia and to determine the relationship between students' eating habits and their sociodemographic, lifestyle, and psychological factors. This comparative cross-section study was conducted on 480 students equally from health and non-health colleges at NBU from March to April 2023. A pre-designed electronic questionnaire was used to collect data on students' sociodemographic characteristics, eating habits, and diet-related psychological factors. Statistical analyses were carried out using STATA/SE version 11.2 for Windows. Unhealthy eating habits were reported by 44.6% and 41.3% of students at health and non-health colleges, respectively. Most students had irregular meals, skipped breakfast, ate fast food frequently, and consumed insufficient amounts of vegetables, fruits, and water. Parental separation, living away from family predisposed to unhealthy eating habits. Being 21-23 years old, playing sports, and high body mass index were linked to healthy eating habits. Psychological factors such as overeating until the stomach hurts and eating to feel happy were associated with unhealthy eating habits. Unhealthy eating habits were prevalent among students at NBU irrespective of the type of study. Thus, implementing initiatives to promote nutrition and healthy eating habits within the university environment is crucial for health promotion and well-being among students.

The Urgent Need for Disaster Education as a Core Competency in Accredited Schools and Colleges of Public Health by the Council on Education for Public Health.

Public Health is essential to disaster preparedness, mitigation, response, and recovery. This has never been more evident than during the COVID-19 pandemic when public health was the disaster response lead. However, students are graduating from accredited schools and colleges of public health with limited or no education in disaster management. This is a crisis unto itself, and it is incumbent upon The Council on Education for Public Health (CEPH) to take immediate action. Public health preparedness should be recognized as a core element in public health curricula, and practical experiences, such as drills and simulations, are necessary to equip students with the confidence and competencies needed in high-stress situations. The need for such preparedness education extends beyond the COVID-19 pandemic. It is a crucial step for creating a resilient and competent public health workforce capable of safeguarding community health in the face of complex and emerging challenges.

Institutional Examples of Applying the SHAPE Appropriate Instructional Practice Guidelines for Higher Education Physical Activity Programs

This educational brief provides examples of applications of the recently updated Society of Health and Physical Educators (SHAPE) Appropriate Instructional Practice Guidelines for Higher Education Physical Activity Programs across several institutions (SHAPE America, 2022). Research has shown that movement and physical activity are essential for managing physical and mental health; therefore, the current low level of physical activity among college students is concerning (American College Health Association, 2024; Rodríguez-Romo et al., 2022). Academic instructional physical activity programs (IPAPs) provide students with quality learning environments that promote and support opportunities for lifelong physical activity and movement. Empowering physical activity instructors with appropriate instructional practices increases the likelihood of positive experiences for both students and instructors. The intent of this brief is to demonstrate how SHAPE IPAP Guidelines are incorporated in universities today. The institutional examples can serve as models to facilitate discussions within other colleges and universities. The information provided will assist program administrators and faculty in developing, better aligning, and supporting their respective IPAP with teaching, administrative, and instructional practices as identified in the SHAPE IPAP Guidelines document.

Alcohol misuse among university students before and during COVID-19: The role of mental health

Objective: Examine predictors of alcohol misuse among university students amid the COVID-19 pandemic. Participants: University students who completed the National College Health Assessment III before, during, and after the pandemic lockdown. Methods: Using multivariable logistic regression, we examined associations between psychological functioning, time spent with family and friends, and problematic alcohol use. Results: Alcohol use decreased, and psychological functioning was poorest one year after COVID-19-related university closures. While indicators of psychological functioning started to improve in the second year after the school closures, alcohol use started to increase. Overall stress, spending more time with friends, and fraternity/sorority residence significantly predicted moderate to high risk for alcohol dependence and binge drinking two years post-pandemic. Severe psychological distress (OR= 1.36, CI = 1.22, 1.52, p < 0.001) predicted moderate to high risk for alcohol dependence but not binge drinking. Conclusion: Innovative mental health interventions are needed to reduce alcohol misuse among university students.

Flourishing levels among health and non-health profession students in Saudi Arabian colleges

ObjectivesThis study aimed to evaluate the levels of flourishing among university students, compare these levels between students in health-related and non-health-related colleges, and identify factors that predict flourishing.MethodsA cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University, Saudi Arabia, involving 1,148 students from the first to fourth year across both academic sectors. Data were collected utilizing the self-reported Global Flourishing Study Questionnaire (GFS) during the period from September 2023 to June 2024. Multistage sampling techniques were employed to ensure a representative sample, with data collection facilitated through a self-administered electronic link on QuestionPro resulting in a response rate of 51.7%. Data analysis was performed using SPSS version 22, incorporating descriptive statistics, t-tests, ANOVA, and regression analysis to identify predictors of flourishing. The reliability and validity of the questionnaire were assessed using Cronbach’s alpha and Pearson’s correlation analysis.ResultsThe study included nearly equal proportions of students from health (51.0%) and nonhealth (49.0%) colleges. The average flourishing score was 85.6 (SD=18.6), with a slight increase in health colleges (85.7) compared with non-health colleges (85.4). Factors that significantly affected flourishing included gender, employment status, exercise frequency, experiences of abuse, and income. In the multiple regression analysis, well-being emerged as the strongest predictor, followed by external factors, disposition, and behavior. Gender exhibited a positive association with flourishing, whereas religion had a negative influence. Furthermore, employment and higher income levels were found to positively contribute to flourishing.ConclusionThis study revealed elevated levels of flourishing among university students in Saudi Arabia, with a notable average score of 85.6. Although the differences between students enrolled in health-related and non-health-related colleges were minimal, significant predictors of flourishing were identified, including well-being, external factors, disposition and behavior, gender, religious affiliation, employment status, income, frequency of exercise, and experience of abuse. These findings underscore the complexity of flourishing and highlight the necessity of considering a range of sociodemographic and lifestyle factors to promote student well-being.

Perceived Health Risks Associated with Smartphone Use Among Health College Students at Qassim University in Saudi Arabia

Background Smartphones have evolved into a fusion of traditional personal digital assistants and cellular phones, integrating mobile communication capabilities with features parallel to those of a handheld computer. Objective This study aimed to assess the health risks associated with smartphone use and the prevalence and nature of observed health issues among health college students at Qassim University in Saudi Arabia. Methods Employing a descriptive cross-sectional research design, this study surveyed a convenience sample of 511 health college students at Qassim University. The data collection instrument comprised two sections: Section 1 assessed sociodemographic, academic, and health-related information, while Section 2 evaluated the health risks as perceived by students. Results The majority of the participants were women (71%) and were studying nursing (26%). A significant proportion (39.9%) reported blurred vision, while 38.6% indicated a lack of adequate sleep. Notably, no significant association was observed between the health complaints and sociodemographic information. The analysis also revealed no significant relationship between health complaints and smartphone usage patterns. Conclusion The findings highlight a critical need for further research to investigate the factors contributing to the effect of smartphone use on the physiological well-being of university students. Such research is essential for developing targeted interventions to mitigate the associated health risks.

Impact of self-restraint by COVID-19 pandemic on mental health in college students-COVID-19 Longitudinal survey of the 2nd and 3rd waves

[Purpose] The purpose of this study was to investigate the effects of the COVID-19 pandemic on mental health in students at university. [Method] 1880 students from university were surveyed. Survey period: July-August 2020 Demographic factors were used department, grade, gender, age. Mental health factors (PHQ-9 Japanese version, GAD-7 Japanese version, IES-R) were used. Decreased motivation to learn, loneliness: Japanese version UCLA loneliness scale was used. [Results] As a result of the survey, in (July-August), 737 patients (123 males and 614 females) were recovered (recovery rate 40.9%). As a result, in terms of gender difference, males had a higher total of "loneliness" than females and had a higher total of PTSD and "invasive symptoms". Students whose parents corresponded to corona had high "anxiety" and "depression". Students who felt rumors had high scores for "PTSD," "depression," "anxiety," and "loneliness." Students "seeking support" also scored higher on PTSD, depression, anxiety, and loneliness. Those who were "not very careful" about infection control were more likely to be depressed than those who were "careful", and those who were "quite careful" were less motivated to learn. Family structure and parental profession have no effect. In addition, the relationship between each psychiatric symptom (PTSD, depression, anxiety disorder) and "loneliness" and "motivation to learn" was examined using covariance structure analysis. When the model was examined, the models of "loneliness" ⇒ "decreased learning motivation" ⇒ "PTSD" ⇒ "depression" and "anxiety" were verified. In other words, it was shown that it is important to deal with "loneliness" to improve mental health and learning motivation during the COVID 19 pandemic. [Conclusion] At the time of the COVID-19 pandemic, college students may be high-risk persons with mental health problems.

Evaluation of TikTok social media posts on side effect information for popular weight loss medications

AbstractIntroductionThe prevalence of overweight and obesity is increasing in America, contributing to various health risks. Glucagon‐like peptide‐1 (GLP‐1) and gastric inhibitory peptide (GIP) receptor agonists have bloomed in popularity due to their efficacy and United States Food and Drug Administration (FDA) approval for weight loss, igniting popularity on social media. This study focuses on the role of TikTok™ (ByteDance, Haidian, Beijing, China), a popular social media platform, in disseminating understandable and actionable information about the side effects of weight loss medications.MethodsThe study analyzed the top 50 TikTok videos for each of the following hashtags: #ozempicsideeffects, #semaglutidesideeffects, #mounjarosideeffects, and #wegovysideeffects. Videos were evaluated based on their understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT) for audio‐visual (AV) products. PEMAT‐AV scores and popularity of videos were compared between hashtags utilizing one‐way analysis of variance (ANOVA). An alpha of 0.05 was used, with Bonferroni correction.ResultsA total of 165 videos were reviewed for PEMAT‐AV understandability and actionability scores. The total visibility of the videos reached over 19.4 million views. A majority of the videos were personal experiences (89%), with only 5% being health care education videos. The average understandability and actionability scores for all videos were 43% and 20%, respectfully. The data presented a difference between searched hashtags for both evaluation scores, p‐values of &lt;0.001 and 0.093, respectively.ConclusionTikTok videos covering weight loss medication side effects have poor understandability and actionability scores. This study highlights the opportunity for more educational videos produced by health care professionals on TikTok, and a potential need for health care organizations and/or colleges of pharmacy to provide education to health care providers on how to create quality content for medication education on social media‐based platforms. Further research is needed to evaluate the credibility of content.

Knowledge And Attitude Regarding Rabies Prevention Among Adults Residing Under The Field Areas Of Medical College Health Unit, Pangappara

ABSTRACT Rabies has been one among the most dreaded diseases to man since antiquity. The present study was intended to assess the knowledge and attitude regarding rabies prevention among adults residing under the field areas of Medical College Health Unit, Pangappara. The objectives of the study were to assess the knowledge and attitude regarding rabies prevention, to assess the practice regarding rabies prevention, to find out the correlation between knowledge and attitude and to find out the association between knowledge of adults regarding rabies prevention with sociodemographic variables. The research approach adopted for the study was quantitative and the data was collected from 408 participants. The study design was cross sectional design and participants were selected using cluster sampling technique. Socio demographic data and the knowledge were assessed using an interview schedule, attitude and practice were assessed using a five point Likert scale and a checklist respectively. Data analysis was carried out using both descriptive and inferential statistics. The results showed that 47.1% had good knowledge,28.4% had average knowledge and 24.5% had poor knowledge regarding rabies prevention and 38% of adults had positive attitude,36% had uncertain attitude and 26% had negative attitude towards rabies prevention,45.9% reported good practice after an animal bite. The study revealed that there was a moderate positive correlation between knowledge and attitude (r = 0.443 and p &lt; 0.05) and there was a significant association between knowledge of adults regarding rabies prevention with age, socio economic status and adults participation status in rabies prevention campaign. The study concludes the necessity for preventing the mortality by dog mediated Rabies.

Suicidal Thoughts and Behaviors Among Autistic Transgender or Gender-Nonconforming US College Students

Suicide risk is a global public health crisis, with suicide ranking as a consistent leading cause of death among adults in the US. Autistic individuals and transgender or gender-nonconforming (TGNC) individuals represent populations with notably elevated rates of suicidal thoughts and behaviors (STBs). To characterize suicidal thoughts and behaviors among TGNC and autistic individuals, using a large, nationally representative sample. This study is a secondary analysis of cross-sectional data from students at colleges and universities throughout the US who participated in the American College Health Association National College Health Assessment from 2019 to 2023. Autistic and TGNC identities were self-reported by participants. The frequency of intersectionality of autism and TGNC identities and whether those who had intersectional marginalized identities had increased likelihood of STBs were examined. STBs were self-reported by participants. A series of moderated regression analyses were performed to examine how the interaction between autism and possessing a marginalized gender identity (ie, TGNC status) was associated with STBs. The sample included 41 507 college students with a mean (SD) age of 23.35 (6.83) years. A total of 2410 participants (5.81%) identified as being TGNC. Overall, 326 TGNC participants (13.53%) also identified as autistic, whereas 625 of those who identified as cisgender (1.58%) also identified as autistic. Gender identity and autism were associated with greater odds of STBs. For suicidal ideation, gender identity had an odds ratio (OR) of 3.34 (95% CI, 2.99-3.73), and autism had an OR of 2.06 (95% CI, 1.76-2.42). For suicide attempts, gender identity had an OR of 2.74 (95% CI, 2.13-3.52), and autism had an OR of 2.39 (95% CI, 1.62-3.52). A significant interaction existed for attempts (OR, 0.51; 95% CI, 0.27-0.97); nonautistic cisgender individuals had the lowest attempt rate. This cross-sectional study addresses the dearth of information on how intersectionality in gender and autism status impacts the risk of STBs, and the results confirm the elevated risk of STBs among TGNC and autistic populations. Interventions are needed to support college students with these identities.

Food for Thought: Mental Health, Psychological Well-Being, Social Engagement and Campus Service Utilization of Students Experiencing Food Insecurity at a Large Atlantic Canadian University

ABSTRACT The aims of this study were to determine the prevalence and associated mental health characteristics of food insecure (FI) students at an Atlantic Canadian University. Based on data from the National College Health Assessment-third revision (NCHA-III, 2023) (N = 1694; mean age = 26.6; 63.2% female), FI prevalence was 46.6%, with higher rates for male, international, and undergraduate students, and those from low-income families. Food Insecure students were more likely to report “serious” psychological distress, a state of ’languishing,’ a greater frequency of all forms of suicidality, and use of the university’s food bank and mental health services. Concomitant social issues were also more likely for FI students in terms of lacking companionship, feeling left out and isolated from others, experiencing problems/challenges with family and peers, and indicating less agreement that they belonged at their university, and that their health/well-being was a priority on campus. Recommendations on how institutions can address the issue are considered.

National recommendations for the management of children and young people with IgA vasculitis: a best available evidence, group agreement-based approach

ObjectiveIgA vasculitis (IgAV) is the most frequently experienced subtype of vasculitis seen in children. Most children fully recover, however, complications including chronic kidney disease are recognised. The aim of this...

Assessing the effectiveness of flipped classroom teaching–learning method among undergraduate medical students at gondar university, college of medicine and health sciences: an interventional study

IntroductionThe flipped classroom teaching–learning method has been increasingly adopted in higher education to enhance student-centered learning. Despite its growing popularity, limited evidence exists regarding its effectiveness in medical education in Ethiopia. This study aimed to assess the impact of the flipped classroom method on academic performance, student engagement, and satisfaction among undergraduate medical students at Gondar University, College of Medicine and Health Science.MethodsA quasi-experimental study was conducted involving 100 s-year undergraduate medical students, divided into two groups: the flipped classroom group (n = 50) and the traditional lecture-based group (n = 50). The flipped classroom group received online instructional materials before class, while classroom sessions focused on interactive activities. The traditional lecture-based group attended conventional lectures followed by homework assignments. Data were collected using pre- and post-intervention tests to measure academic performance, the Student Engagement Scale to gauge engagement, and a validated questionnaire to assess student satisfaction. Data were analyzed using Statistical Package for the Social Sciences version 25, with descriptive statistics, paired t-tests, independent t-tests, and Chi-square tests employed to interpret the findings.ResultsThe flipped classroom group demonstrated a significant improvement in academic performance, with mean pre-test and post-test scores of 65.2 ± 8.1 and 78.6 ± 6.9, respectively. In contrast, the traditional lecture-based group had pre-test and post-test mean scores of 62.8 ± 7.5 and 74.2 ± 8.3, respectively. Additionally, the flipped classroom group showed higher levels of student engagement mean scores of 4.5 ± 0.8 and satisfaction mean scores of 4.2 ± 0.7 compared to the traditional lecture-based group, which had engagement mean scores of 3.8 ± 0.6 and satisfaction mean scores of 3.9 ± 0.5. Chi-square tests showed a statistically significant association between the teaching method and both pass/fail rates and participation in activities, but not a significant association with gender distribution.ConclusionThe flipped classroom approach proves to be a superior teaching method, promoting better academic outcomes and greater student engagement and satisfaction. This study adds to the growing body of evidence advocating for the implementation of flipped classrooms in medical education.Trial registrationNot applicable.

Methodology for assessing health risk behaviours among undergraduates in Sri Lanka: a literature review

It is imperative to learn more about the distinctive Health-Risk-Behaviours (HRB) that are culturally acceptable in the lower-resource settings. Therefore, the objective of this review is to identify tools measuring HRBs among undergraduates in Sri Lankan context. A literature review was conducted both manually and electronically through Google Scholar and Hinari and PubMed databases. Self-administered Questionnaires were used in National Surveys and individual studies. Youth-Risk Behaviour-Surveillance-System was the most commonly used comprehensive HRB assessment tool. The National College Health Risk Behaviour Survey, National College Health Assessment were other widely used instruments. There are few validated tools and multiple short scales or items combined like Health-Promotion-Lifestyle[1]Profile, Health-Behaviour-Questionnaire or Inventory, DOSPERT scale, Adolescent-Health-Attitude and Behaviour[1]Survey, Healthy-Lifestyle-Scale, Health-Behaviour-Scale and Health-Behaviour-Checklist. Objective methods for assessing high-risk behaviors (HRBs) include measures of personality and aggression, which have been used to critically quantify violence and accidental injury, as well as biochemical tests for alcohol, nicotine, and other drug use, mechanical or computer sensors, and biological tests such as urinary cultures for sexual risk behaviours. These tools had focused only on specific aspects of HRBs among undergraduates in Western countries and were not comprehensive assessments of HRBs of undergraduates in lower-resource settings. It was evident that there has been a deficit of choices for the adaptation of an HRB tool for undergraduates in lower-resource-settings and a new tool to be developed for Sri Lankan context.

Lifestyle behaviors and mental health outcomes in sexual and gender minority graduate students

Objective There are well-documented health disparities among sexual and/or gender minority (LGBTQ+) individuals generally, but there is limited research investigating the disparities in health-related lifestyle factors and mental health among LGBTQ+ graduate students, which is a group that may be especially vulnerable. Participants This project was a secondary analysis of data from the American College Health Association’s National College Health Assessment’s (NCHA) Fall 2019 wave, which included 7,766 graduate students. Methods Students self-reported engagement in health-related lifestyle factors and psychological distress. Welch’s independent samples t-tests were used to compare differences in psychological distress and lifestyle behaviors and multiple linear regression models were used to test lifestyle factors as predictors of LGBTQ+ psychological distress. Results LGBTQ+ graduate students reported worse lifestyle profiles compared to their peers and greater psychological distress. Sleep quality had the strongest association with psychological distress among LGBTQ+ graduate students. Conclusions These findings have important implications for policies and interventions to improve health and decrease suffering in LGBTQ+ graduate students.