Student Health Center Research Articles

University Support and Prevention Needs for Sexual Harassment: What Do European Students and Doctoral Students Ask For?

AbstractThis study explores experiences of and reflections on sexual harassment in academia among students and doctoral students from Belgium, Croatia, Germany, and Sweden. Prevalence studies show that sexual harassment is a common occurrence and has negative consequences not only on mental health in general but also on academic performance. However, little is known about what kinds of support and prevention are needed. Therefore, the aim of this study has been to develop in-depth knowledge about students’ and doctoral students’ reflections on how victims of sexual harassment in academia should be supported, and how sexual harassment in academia could be prevented. To achieve this aim, 54 individual interviews, and 6 focus group interviews with 18 participants, were conducted between 2020 and 2022 with a total of 72 participants at the bachelors, masters, doctoral level or state exam level. Based on a thematic analysis three themes emerged: (a) Information on sexual harassment, (b) Prerequisites for reporting and intervening, and (c) Support as a preventive activity. The results show an urgent need for information, since this is perceived as lacking by students and doctoral students, and suggested strategies for information provision are presented. Further, there are challenges related to reporting, and ignorance about how to intervene when sexual harassment is witnessed. Professional support is described as important, along with support from peers, mentors, family, and friends. These findings are relevant for researchers and for clinicians at university student health centres, to develop relevant preventive and supportive interventions in the context of academia.

Travel Health-Related Preparation Practices of Institutions of Higher Education and Occurrence of Health-Related Events among Undergraduate Students Studying Abroad, 2018-2021.

Knowledge of specific health-related events encountered by students studying abroad and the availability and use of pre-travel healthcare for these students is lacking. Anonymous web-based questionnaires were sent to study abroad offices, student health centers, and undergraduate students after studying abroad at eight institutions of higher education in the United States and Ireland from 2018-2021. Analyses were descriptive; relative risks and 95% confidence intervals were calculated for health-related events. One study abroad office required a pre-travel consultation. All student health centers had pre-travel counseling available. Among 686 students, there were 307 infectious and 1,588 non-infectious health-related issues; 12 students (2%) were hospitalized. Duration of travel and timing of a pre-travel consultation impacted the risk of health-related events. Certain mental health conditions were associated with increased risk of alcohol and drug use. Future studies should address the optimal timing and best practices to optimize health for students studying abroad.

The experiences and perceptions of campus resource utilization by college students with childhood domestic violence exposure histories

Objective: The purpose of this study was to examine the campus resource utilization experiences of university students with childhood domestic violence exposure (CDV) histories. Participants: 368 students attending a large, flagship, land-grant, predominantly White university in the Southeastern United States. Methods: Participants completed a web-based survey with variables including CDV, campus resource utilization and perceptions of said resources, and participant resource suggestions. Results: Most students utilized at least one health-related campus resource, with the student health and counseling centers being the most common and helpful. Suggested areas for institutional and service provider growth include enhanced advertisement and accessibility for existing resources and added support groups. Conclusions: College campuses provide unique opportunities to support young adults with CDV histories. Tailoring programming to students with CDV histories has the potential to improve student’s success in and beyond college.

Satisfaction of Students Regarding Communication with Healthcare Providers at College Health Services

This quantitative descriptive study focuses on how satisfied college students are with communication from medical professionals at Atharva Business College in Nepal. The study was conducted from April 2023 to June 2023. The study includes 89 students, mostly female, aged 18 to 29, who received medical assistance at the on-campus Student Health Centre. Participants completed a questionnaire survey to score their satisfaction with several aspects of provider communication. The results show a high overall acceptance rate, with specific areas such as the greeting process, respectful treatment, and interest in patients' suggestions garnering positive comments. Most participants reported that they had excellent communication about their health problems, were involved in decision-making, and understood medical information. The findings highlight the importance of excellent provider communication in improving patient outcomes and satisfaction in a campus healthcare setting.

Online Scan of Campus Health Resources and HPV Vaccination Information on College and University Websites in the State of Oregon.

This study is the first to report the results of a scan of the official webpages of all public and private colleges and universities in the state of Oregon, including but not limited to student health services webpages and student handbooks, to identify available services, policies, and educational information on HPV vaccination. The purpose is to describe vaccination services (with a focus on the HPV vaccine), prevention efforts, and institutional policies on vaccination on college and university websites in Oregon. An online scan was conducted from September to November 2020 to collect and describe data from college/university websites across Oregon. Colleges/universities were obtained from the National Center for Education Statistics website. The final sample included 48 colleges/universities. Twenty colleges/universities have a health center with 11 providing the HPV vaccine on campus: most are large public universities and non-religious private colleges. A few religious private universities and one community college offer the vaccine on campus. More than half (n = 26) of Oregon colleges/universities had a webpage specifically designated for immunization information, but only 11 mentioned the HPV vaccine on their immunization webpage. Twelve colleges/universities recommend, and none require the vaccine. Information on HPV vaccination services and education was limited on college/university websites, especially on community college and religious private university websites. Most colleges/universities with a student health center recommend and offer the HPV vaccine on campus. College/university websites may be a low-cost and effective medium to increase HPV vaccination awareness, encourage immunizations, and prevent HPV-associated cancers.

Using Unannounced Standardized Patients to Assess Clinician Telehealth and Communication Skills at an Urban Student Health Center

PurposeAs the COVID-19 pandemic forced most colleges and universities to go online, student health centers rapidly shifted to telehealth platforms without frameworks for virtual care provision. An urban student health center implemented a needs assessment involving unannounced standardized patients (USPs) to evaluate the integration of a new telehealth workflow and clinicians' virtual communication skills. MethodsFrom April to May 2021, USPs conducted two video visits with 12 primary care and four women's health clinicians (N = 16 clinicians; 32 visits). Cases included (1) a 21-year-old female presenting for birth control with a positive Patient Health Questionaire-9 and (2) a 21-year-old male, who vapes regularly, with questions regarding safe sex with men. Clinicians were evaluated using a checklist completed by the USP immediately following the visit and a systematic chart review of the electronic health record. ResultsUSP feedback indicates most clinicians received high ratings for general communication skills but may benefit from educational intervention in several key telemedicine skills. Clinicians struggled with using nonverbal signals to enrich communication (47% well done), acknowledging emotions (34% well done), and using video for information gathering (34% well done). Low rates of standard screenings (e.g., 63% administered the PHQ-2, <50% asked about alcohol use) suggested protocols for in-person care were not easily incorporated into telehealth practices, and clinicians may benefit from enhanced care team support. Performance reports were shared with clinicians and leadership postvisit. DiscussionResults suggest project design and implementation is scalable and feasible for use at other institutions, offering a structured methodology that can improve general student health care.

Student Health Services at Historically Black Colleges and Universities and Predominantly Black Institutions in the United States.

Student health services are associated with improved health outcomes and academic success, particularly among under-resourced college populations. This study compared student health services at Historically Black Colleges and Universities (HBCUs) and Predominantly Black Institutions (PBIs) and identified factors associated with the availability of comprehensive health services (CHS). We conducted a secondary analysis of 2022 data from the Integrated Postsecondary Education Data System (IPEDS), the Minority Serving Institutions (MSIs) Directory, and the websites of HBCUs and PBIs (n=167). Bivariate and multivariate logistic regression analyses were undertaken to identify institutional variables associated with providing CHS. Institutional variables included college type (public vs. private), MSI category (HBCU vs. PBI), undergraduate enrollment, location, and proportion of Pell grant recipients. Approximately 13% of HBCUs and 26% of PBIs offered no student health services; 65% of HBCUs and 39% of PBIs offered on-campus CHS with prescribing providers. Four-year HBCUs were five times more likely than 4-year PBIs to have CHS (p=0.014). Institutions with more Pell Grant recipients were less likely to offer CHS. Access to health care is an important social determinant of health, academic persistence, and achievement for college students. HBCUs were significantly more likely than PBIs to offer CHS. HBCUs are more likely than PBIs to have resources from federal funding, donors, and endowments that may support the development of student health centers and services. Increased funding for PBI health centers could improve access and promote health equity among the most vulnerable student populations.

Embedding Counselors in Student Health Centers: Exploring Challenges to Implementing the Primary Care Behavioral Health Model

ABSTRACT Embedding counselors in various campus locations has been one strategy to address the student mental health crisis. The aim of this study was to evaluate challenges to implementing the primary care behavioral health (PCBH) model, in which behavioral health counselors (BHCs) are embedded within the college health center, and to explore characteristics associated with differing levels of PCBH fidelity. Seventy-one BHCs working in college health centers completed the online fidelity survey. Most respondent scores denoted moderate or strong fidelity to the PCBH model. Psychologists showed better adherence to autonomous clinical aspects of PCBH while social workers/counselors showed better adherence to collaborative aspects of PCBH. Overall findings suggest fidelity to PCBH by BHCs in college health is driven by independent clinical activity more than interdisciplinary collaboration. Strategies for developing and evaluating a PCBH program that complements the specialty mental health services offered through counseling centers are discussed.

“I Wasn't Expecting That Question”: Responses to Requests for Abortion Referral at College Student Health Centers

BackgroundWomen 18–24 years of age have the highest proportion of unintended pregnancies of any age group, and thus represent a significant population in need of abortion services. Prior research indicated that only half of college student health centers provide appropriate abortion referrals. Our objective was to better understand the referral experience and barriers to abortion referral at college student health centers. ProceduresWe conducted a “secret caller” study at all 4-year colleges in Pennsylvania between June 2017 and April 2018, using a structured script requesting abortion referral. Calls were transcribed, coded using an iteratively developed codebook, and analyzed for themes related to barriers and facilitators of abortion referral. Main FindingsA total of 202 completed transcripts were reviewed. Themes that emerged were knowledge, experience, and comfort with abortion referral; support, empathy, and reassurance; coercion; misleading language; questioning the caller's autonomy; and institutional policy against referral. Most staff lacked knowledge and comfort with abortion referral. Although some staff members made supportive statements toward the caller, others used coercive language to try to dissuade the caller from an abortion. Many staff cited religious institutional policies against abortion referral and expressed a range of feelings about such policies. ConclusionsAbortion referrals at student health centers lack consistency. Staff members frequently did not have the knowledge needed to provide appropriate abortion referrals, used coercive language in responding to requests for referrals, and perpetuated abortion stigma. Some health staff used coercive or evasive language that further stigmatized the caller's request for an abortion referral. College health centers should improve training and resources around abortion referral to ensure they are delivering appropriate, high-quality care.

The misgendering and deadnaming survey: An innovative, co-designed campus change project to catalyze improvement

Misgendering and deadnaming can have a negative impact on the experiences and wellbeing of transgender, non-binary, and gender expansive (TGNB) students in higher education. As a part of a larger effort to reimagine and redesign the pursuit of TGNB student health equity, the LGBTQ + Center and Student Health Center at New York University (the team) partnered to address misgendering and deadnaming as one of many barriers to the wellbeing and thriving of TGNB students at the university. Through this partnership, the team created the Misgendering and Deadnaming Survey—a brief, weekly survey of cohorts of TGNB students conducted every semester for a two-year period. The tool enabled the institution to assess if change efforts yielded improvement and provided close-to-real-time feedback that allowed the team to identify and address root causes of misgendering and deadnaming, including biases, via the reporting of individual incidents and tracking of trends over time. In addition to an overview of the survey tool for those interested in replicating it at their institution, this report concludes by offering lessons learned in the development and implementation of this innovative, co-designed campus change project to catalyze improvement toward reducing misgendering and deadnaming and improving the campus conditions for TGNB college students to thrive.

Environmental surface monitoring as a noninvasive method for SARS-CoV-2 surveillance in community settings: Lessons from a university campus study

Environmental testing of high-touch objects is a potential noninvasive approach for monitoring population-level trends of SARS-CoV-2 and other respiratory viruses within a defined setting. We aimed to determine the association between SARS-CoV-2 contamination on high-touch environmental surfaces, community level case incidence, and university student health data. Environmental swabs were collected from January 2022 to November 2022 from high-touch objects and surfaces from five locations on a large university campus in Florida, USA. RT-qPCR was used to detect and quantify viral RNA, and a subset of positive samples was analyzed by viral genome sequencing to identify circulating lineages. During the study period, we detected SARS-CoV-2 viral RNA on 90.7 % of 162 tested samples. Levels of environmental viral RNA correlated with trends in community-level activity and case reports from the student health center. A significant positive correlation was observed between the estimated viral gene copy number in environmental samples and the weekly confirmed cases at the university. Viral sequencing data from environmental samples identified lineages concurrently circulating in the local community and state based on genomic surveillance data. Further, we detected emerging variants in environmental samples prior to their identification by clinical genomic surveillance. Our results demonstrate the utility of viral monitoring on high-touch environmental surfaces for SARS-CoV-2 surveillance at a community level. In communities with delayed or limited testing facilities, immediate environmental surface testing may considerably inform epidemic dynamics.

Access to on-campus contraception on college and university campuses in North Carolina

Background and ObjectiveUnintended pregnancies occur more frequently in college students and negatively affect health outcomes and educational attainment. This study examined access to on-campus contraceptives at all 4-year colleges and universities in North Carolina (NC). MethodsThis institutional review board-exempt study evaluated availability of on-campus contraceptives including condoms; hormonal contraceptives including pills, patches, and vaginal rings; medroxyprogesterone injections; implants; intrauterine devices; and emergency contraception via website review. Institutions were stratified by characteristics including size, location, type (e.g., public, private, religious affiliation, historically black colleges and universities, women’s colleges), and presence of a student health pharmacy. Comparisons were made using chi-square test or Fisher’s exact test. ResultsFifty-four 4-year colleges and universities were identified. A plurality or the majority of schools were considered small (41%) and urban (48%) and had a religious affiliation (61%). Thirty-three percent of colleges and universities had an on-campus pharmacy. The most frequent contraceptives offered were condoms (43%), oral contraceptives (33%), and medroxyprogesterone injections (22%). Emergency contraception was available at approximately one-third of colleges and universities. Six percent of institutions provided a full range of contraceptive methods. Contraceptives were offered more frequently at large, public, urban institutions, whereas religious institutions and smaller institutions were less likely to offer contraceptives. ConclusionAccess to on-campus contraception for college students in NC is lacking, and the vast majority of institutions did not provide a full range of contraceptives. Policy measures, such as enhancing reproductive health services at student health centers or increasing contraception availability directly through pharmacies, are needed to improve access for college students.

Use of Patient-Reported Symptom Data in Clinical Decision Rules for Predicting Influenza in a Telemedicine Setting.

Increased use of telemedicine could potentially streamline influenza diagnosis and reduce transmission. However, telemedicine diagnoses are dependent on accurate symptom reporting by patients. If patients disagree with clinicians on symptoms, previously derived diagnostic rules may be inaccurate. We performed a secondary data analysis of a prospective, nonrandomized cohort study at a university student health center. Patients who reported an upper respiratory complaint were required to report symptoms, and their clinician was required to report the same list of symptoms. We examined the performance of 5 previously developed clinical decision rules (CDRs) for influenza on both symptom reports. These predictions were compared against PCR diagnoses. We analyzed the agreement between symptom reports, and we built new predictive models using both sets of data. CDR performance was always lower for the patient-reported symptom data, compared with clinician-reported symptom data. CDRs often resulted in different predictions for the same individual, driven by disagreement in symptom reporting. We were able to fit new models to the patient-reported data, which performed slightly worse than previously derived CDRs. These models and models built on clinician-reported data both suffered from calibration issues. Patients and clinicians frequently disagree about symptom presence, which leads to reduced accuracy when CDRs built with clinician data are applied to patient-reported symptoms. Predictive models using patient-reported symptom data performed worse than models using clinician-reported data and prior results in the literature. However, the differences are minor, and developing new models with more data may be possible.

Individual Difference Correlates of Being Sexually Unrestricted Yet Declining an HIV Test

Which individual differences accurately predict one’s decision to get tested for human immunodeficiency virus (HIV), and do individuals who have regular short-term sex get tested at higher rates? Two studies—one lab study (total valid N = 69, with n = 20 who were tested) and one involving a student health center (valid N = 250, n = 4 who were tested)—involved participants (total valid N = 319, with n = 24 who got tested) taking a number of personality and individual difference measures, including the dark triad (Machiavellianism, narcissism, and psychopathy). Then, in both studies, participants had the opportunity to actually get tested for HIV. After analyzing data from Study 1, for Study 2 we preregistered the prediction that narcissistic participants would tend to (a) show disinclination to get tested for HIV, and (b) show proclivity for unrestricted short-term sexual behavior, manifesting in (c) a significant difference between these two correlations. As predicted, such a difference in correlations was evident for narcissism as well as psychopathy (the latter, however, was not predicted), suggesting that such individuals are not likely to seek HIV diagnostic information, but are taking more sexual risks. A research synthesis was consistent with these ideas (although controlling for demographic factors diminished the effects). Narcissistic and psychopathic individuals may be undetected hubs in the network of sexually active individuals with HIV. These results are silent on whether the typical HIV patient is narcissistic or psychopathic; the results merely implicate narcissistic and psychopathic traits in the spread of the virus.

Embedding a Dedicated Sexual Health Clinic in a University's Health Services Expands Sexually Transmitted Infection Screening Options.

The primary objectives of this study were to assess utilization of sexual health services at a university's student health and wellness center and to determine whether the presence of a dedicated sexual health clinic (SHC) was associated with different utilization patterns for sexual health services when compared with primary care clinics. This was a retrospective chart review of patients presenting to the University of Alabama at Birmingham's Student Health and Wellness Center for sexual health services between January 2015 and June 2019. Utilization of sexual health services, specifically sexually transmitted infection (STI) testing, was compared between the dedicated SHC and primary care clinics. A total of 3081 cases were included. There were statistically significant differences in the proportion of male individuals and populations more burdened by STI tested for STI in the SHC (i.e., persons who identify as Black and younger female individual). We also observed a higher percentage of positive gonorrhea and chlamydia test results and a greater likelihood of extragenital screening in men who have sex with men in the SHC. The dedicated SHC within the University of Alabama at Birmingham's Student Health and Wellness Center was associated with an increase in STI screenings. There was a significant difference between the demographics of those presenting to the SHC versus primary care clinics, proportionally more diagnoses of gonorrhea and chlamydia, and, for men who have sex with men, more extragenital screenings performed in the SHC. These findings suggest that there may be a benefit of an embedded SHC in college and university health and wellness centers.

Poorer decision making among college students during the COVID-19 pandemic: Evidence for “pandemic-brain”

Objective Did living through the COVID-19 pandemic cause healthy college students to experience “pandemic-brain,” a phenomenon characterized by difficulties with various cognitive abilities? Did students shift from deliberative to more impulsive decision making? Participants We compared a pre-pandemic sample of 722 undergraduate students to 161 undergraduate students recruited in Fall 2020, during the COVID-19 pandemic. Method We compared scores on the Adult Decision Making Competence scale among participants who completed the task pre-pandemic or across two time points in Fall 2020, during the pandemic. Results Decision making was less consistent and more reliant on gain/loss framing during the pandemic compared to pre-pandemic, but college students were no less confident in their decisions. No significant changes in decision making occurred during the pandemic. Conclusions These decision making changes could increase the risk of making an impulsive choice with negative health consequences affecting demands on student health centers and imperiling learning environments.

Decreasing reproductive and abortion care barriers: findings on the student health center's role from a student survey

BackgroundCollege-aged young adults in the US have low utilization and high need for reproductive healthcare. Multiple barriers to reproductive care exist. University Student Health Centers (SHCs) provide varying degrees of reproductive products and services. Recently, California legislated that public university SHCs add medication abortion to their care.MethodsTo examine existing attitudes and barriers to reproductive healthcare for public university students, we conducted an anonymous online survey at a large, diverse, urban coastal California State University. Students were asked about numerous barriers accessing reproductive services in general and at the SHC, which we categorized into three groups: stigma, access and system. Respondents were also asked about knowledge and preferences for accessing and recommending various services. To understand the extent to which inequities exist, we compared differences across racialized/ethnic identity, gender identity, anticipated degree, and living distance from campus using chi-squared tests.ResultsThe majority of survey (n = 273) respondents experienced stigma and access barriers in general healthcare settings which made obtaining reproductive healthcare for themselves or their partners difficult (stigma barriers 55%; 95% CI 49%–61%; access barriers 68%; 95% CI 62–73%). Notably, students reported statistically significant lower rates of access barriers at the SHC, 50%, than in general reproductive healthcare settings, 68%. There were limited differences by student demographics. Students also reported a high willingness to use or recommend the SHC for pregnancy tests (73%; 95% CI 67–78%), emergency contraception pills (72%; 95% CI 66–78%) and medication abortion (60%; 95% CI 54–66%). Students were less likely to know where to access medication abortion compared to other services, suggesting unmet need.ConclusionsOur study provides evidence that students face barriers accessing reproductive healthcare and that SHCs are a trusted and accessible source of this care. SHCs have a key role in increasing health, academic and gender equity in the post-Roe era. Attention and financial support must be paid to SHCs to ensure success as state legislatures mandate them to expand reproductive and abortion care access.

SARS-CoV-2 raw wastewater surveillance from student residences on an urban university campus.

The COVID-19 pandemic brought about an urgent need to monitor the community prevalence of infection and detect the presence of SARS-CoV-2. Testing individual people is the most reliable method to measure the spread of the virus in any given community, but it is also the most expensive and time-consuming. Wastewater-based epidemiology (WBE) has been used since the 1960s when scientists implemented monitoring to measure the effectiveness of the Polio vaccine. Since then, WBE has been used to monitor populations for various pathogens, drugs, and pollutants. In August 2020, the University of Tennessee-Knoxville implemented a SARS-CoV-2 surveillance program that began with raw wastewater surveillance of the student residence buildings on campus, the results of which were shared with another lab group on campus that oversaw the pooled saliva testing of students. Sample collection began at 8 am, and the final RT-qPCR results were obtained by midnight. The previous day's results were presented to the campus administrators and the Student Health Center at 8 am the following morning. The buildings surveyed included all campus dormitories, fraternities, and sororities, 46 buildings in all representing an on-campus community of over 8,000 students. The WBE surveillance relied upon early morning "grab" samples and 24-h composite sampling. Because we only had three Hach AS950 Portable Peristaltic Sampler units, we reserved 24-h composite sampling for the dormitories with the highest population of students. Samples were pasteurized, and heavy sediment was centrifuged and filtered out, followed by a virus concentration step before RNA extraction. Each sample was tested by RT-qPCR for the presence of SARS-CoV-2, using the CDC primers for N Capsid targets N1 and N3. The subsequent pooled saliva tests from sections of each building allowed lower costs and minimized the total number of individual verification tests that needed to be analyzed by the Student Health Center. Our WBE results matched the trend of the on-campus cases reported by the student health center. The highest concentration of genomic copies detected in one sample was 5.06 × 107 copies/L. Raw wastewater-based epidemiology is an efficient, economical, fast, and non-invasive method to monitor a large community for a single pathogen or multiple pathogen targets.

Derivation and validation of clinical prediction rules for diagnosis of infectious mononucleosis: a prospective cohort study

ObjectivesInfectious mononucleosis (IM) is a clinical syndrome that is characterised by lymphadenopathy, fever and sore throat. Although generally not considered a serious illness, IM can lead to significant loss of...

Providers’ shared decision-making as a predictor of healthcare outcomes for college-aged adults managing upper respiratory tract infections

ObjectivesStrategies that assist patients with upper respiratory tract infections (URTIs) to endorse non-antibiotic treatments are vital to curbing antibiotic resistance. This study examines the potential of shared decision-making (SDM) for improving stewardship-relevant outcomes and investigates patient affect as a mechanism that explains the beneficial impact of perceived SDM. MethodPatients (N = 433) seeking care for URTIs at a university student health center and not prescribed antibiotics completed a pre-visit questionnaire and two surveys one day and 14 days post-visit. The day-one survey assessed perceived SDM, affect, and immediate stewardship-relevant outcomes, and the day-14 survey assessed long-term stewardship-relevant outcomes. ResultsPerceived SDM was negatively associated with negative affect and positively associated with positive affect, favorable perceptions of non-antibiotic treatments and providers, and self-efficacy to manage symptoms and obtain follow-up care. Patient affect and day-one outcomes were mediators between perceived SDM and retrospective self-efficacy two weeks post-visit. ConclusionThe study illustrated the beneficial influence of patient perceived SDM on antibiotic stewardship in both short and long terms and elucidated the mechanisms through which the influence occurs. Practice implicationsSDM can be an effective strategy for primary care providers to improve patients’ outcomes with URTI visits without prescribing unwarranted antibiotics.