Campus Life Poses a Unique Set of Health Risks

If you’re one of the 15 million young men and women who attend college each year, the years in academe are probably among the happiest and healthiest in your life. And why not? You still have all your hair, as well as all your marbles. Your abs are flat, your skin taut. On top of that, your resumes are too short to contain any major life derailments.

That said, it’s never all rosy behind those ivy-covered walls. In fact, college can be a time of increased risk. You might become a binge drinker, for instance, which raises the odds that you’ll have unwanted sex, get pregnant or acquire a sexually transmitted disease. You might develop eating problems--ingesting too much or too little. Even cancer can rear its ugly head at this tender age. And, despite all the good stuff that college offers, academic and relationship pressures may make you seriously depressed, even suicidal.

So here’s a primer to help college students start the year on the right note, avoid the major pitfalls and emerge from college not only educated but also relatively unscathed.

Confidentiality. Many college health services are sensitive to privacy issues. But you should still ask under what circumstances your medical records might be revealed and what services may show up on your term bill (which most parents see). You should also request that counseling records be stored separately from medical records. If you want to be tested for AIDS, pregnancy or other sensitive conditions, see if you can get anonymous, not merely confidential, testing.

Sex. First and foremost, you always have a right to say no. If you’re unsure about what you want, consider saying yes to some things and no to intercourse. “The most important thing, for women,” says Janet Lever, a sociologist who studies sexuality at Cal State L.A., “is that we know a lot of men are willing to say ‘I love you’ when it’s not true, to have sex.” A man who really cares, she adds, “will stay until the relationship has deepened and you are ready.”

Despite all the warnings, sexually transmitted diseases remain a serious health problem. A study published this year by the Baltimore-based American College Health Assn. (which surveyed 16,000 students from non-randomly selected schools) showed that 1% reported having had genital herpes in the past year; 1.4% said they’d been infected with the human papilloma virus (which causes cervical cancer) and nearly 1% had had chlamydia. In addition, 0.4% said that at some point they had been diagnosed with HIV, and 0.8% said they had been infected with the hepatitis B or C virus. (Hepatitis C is usually spread by contact with blood but can be sexually transmitted.)

Sexual victimization is also still a problem. A study published in December 2000 by the U.S. Department of Justice found that 1.7% of college women have been raped. The American College Health Assn. study found a slightly higher rate, 2.2%.

The good news is that, overall, abortions are down among young women. The bad is that many college women still don’t know about emergency contraception, notes Dr. Lawrence Neinstein, director of University Park Health Center at USC.

So here’s the deal: There are now two brands of “morning after pills”--Preven and Plan B--on the market. You can get a prescription from your doctor, fill it and keep the pills in your purse. Or you can get a supply of standard birth control pills that, if taken in special doses, can also be used as emergency contraception. Emergency contraception pills work up to 72 hours after unprotected sex and act by blocking ovulation, not by triggering abortion (as the “abortion pill,” RU-486, does).

Mental health. If you’re feeling anxious, depressed or suicidal, take heart. You are far from alone, and treatments are highly effective. Nationally, 23 million Americans suffer anxiety, and 18 million, depression. The recent college health survey showed that a third of students felt hopeless at least three times during the previous school year, 76% felt overwhelmed, and 22% felt so depressed they couldn’t function.

Compared with younger adolescents, college students are actually less likely to be suicidal, says Neinstein of USC. Even so, 1995 government data shows that more than 11% of 18- to 24-year-olds have seriously considered suicide, and nearly 8% had made a suicide plan.

So it’s crucial to remember that there are effective treatments for anxiety and depression, including psychotherapy and drugs, among them antidepressants such as Prozac, Zoloft or Paxil that combat anxiety and depression. If these drugs don’t help, see a psychopharmacologist, because other drugs might.

The message is simple: If you have felt very down for several weeks, have lost interest in regular activities, have persistent sleep or appetite disturbances, can’t concentrate, have diminished energy or have suicidal thoughts, go to your student health center and ask about professional help. Some health services now also offer stress management programs.

Alcohol, tobacco and other drugs. Moderate alcohol consumption--one drink a day for women, two for men--can actually be healthful: It may lower your risk of heart disease by 40%.

But binge (also called high-risk) drinking can be disastrous. Half of college men and 40% of college women are binge drinkers, notes social psychologist Henry Wechsler, director of college alcohol studies at the Harvard School of Public Health. Binge drinking is defined as five drinks in a row for men, four for women.

The Harvard studies show that binge drinkers are 10 times more likely than moderate drinkers to have unplanned or unprotected sex, to cause personal injury and property damage, to miss classes and to have interpersonal problems. A 1999 study of UCLA students showed that 31% of binge drinkers (but only 7% of moderate drinkers) had sex they regretted; 3% of binge drinkers were assaulted or raped (versus 0% of moderate drinkers).

As for tobacco, the Harvard studies show that smoking among young people has risen dramatically between 1993 and 1997, yet only 56% of college health services offer smoking cessation programs. Chewing--and spitting--tobacco is also a major health concern. This disgusting, addictive habit can cause cancer, as well as mouth sores, bad breath and ruined teeth.

The use of marijuana and other illicit drugs is also on the rise on campuses, and 90% of students who use marijuana also use other illicit drugs, smoke cigarettes or engage in binge drinking, the Harvard data show.

The bottom line? If you’re concerned about your own or a friend’s drinking, smoking, or other substance abuse, get help from the health service. You can also insist on living in a substance-free dorm.

Skin. Acne is one of the biggest health concerns of college students. It’s caused by clogged pores, bacteria and hormones, in particular, DHEA, which signals the sebaceous glands at the base of hair follicles to pump out oil, and androgens, or male hormones, which rev up this process. Over-the-counter remedies often help, says Dr. Robert Stern, chairman of dermatology at Beth Israel Deaconess Medical Center in Boston. For stubborn cases, see a dermatologist for topical or oral antibiotics or other prescription drugs such as Retin-A or Differin. For women, birth control pills may also help. If all else fails, there’s Accutane, but it’s toxic to fetuses, so women must practice birth control to take it.

Tattoos, or more specifically, getting rid of them, are a growing problem. An estimated 18% of college students now get tattoos. Dermatologists can remove them with lasers, but it’s painful and expensive. If you get a tattoo, make sure your tattoo artist uses sterile needles, and remember that some pigments may not be approved for skin contact, much less injection. Never get tattooed while drunk. And get a small tattoo to start with--on an area of the body where it will only be seen when you choose.

Skin cancer, which can be highly curable, strikes 1 million Americans a year. Don’t be one of them: Wear sunscreen (SPF of 15 or more), and keep an eye on suspicious moles.

Sleep. An estimated 30 to 60 million Americans have chronic insomnia, and millions more, probably including you, are too busy to get enough sleep. In fact, one study showed that only 10% of college students got enough sleep to feel rested on all seven nights of the previous week, and 12% didn’t get enough sleep on any night! Sleep deprivation can be even worse for graduate students who study until the wee hours and get up early with their young children, says Dr. David Rosenthal of Harvard, director of Harvard University Health Services.

Sleep loss doesn’t usually cause long-term medical problems, but it can adversely affect physical and intellectual performance, and mood. If you can’t sleep, one solution is to not try too hard--that can make things worse. Don’t drink alcohol, water or smoke cigarettes near bedtime or have caffeinated drinks after midafternoon. If you have a chronic sleep problem, talk to a doctor at the health service about short-term use of sleeping pills.

Repetitive strain injuries. Prevention is the key here, so if you need help setting up your computer properly, call the campus tech services folks. Early signs of RSI include favoring an injured hand, dialing the phone with your nondominant hand, using your forearm or foot to open doors, dropping things and having trouble brushing your teeth.

Cancer. Testicular cancer is relatively rare--this year, 7,200 men are expected to get it and 400 will die--but it tends to strike males between 15 and 35. If it’s caught early, the cure rate is close to 100%. To do a testicular self-exam (once a month) use both hands and gently roll each testicle between the thumbs and fingers. A normal testicle is oval, somewhat firm and free of lumps. If you find an area of firmness, go to the health services center immediately. For college-age women, the big risk is the sexually spread human papilloma virus. It causes 99% of all cases of cervical cancer, which will strike 12,900 women this year and kill 4,400. (Be aware: HPV can be spread by any genital or digital contact, not just intercourse.)

A majority of college-age women are at least transiently infected with HPV. You should get an annual Pap test, preferably a sensitive one called ThinPrep, says Dr. Diane McGrory of Gynecology Partners in Weston. While you’re at it, ask if your doctor can automatically order your cervical sample to be tested for HPV if the Pap test comes back atypical. If the HPV test is negative, you should get a repeat Pap test in six months. If it’s positive, you may need a colposcopy--a microscopic exam of the cervix.

Shots. You’re not a kid anymore, but you still need vaccinations. The federal Centers for Disease Control and Prevention says people age 18 to 24 should be vaccinated against tetanus, diphtheria, measles, mumps and rubella. (Make sure you get all the necessary doses; some vaccines take more than one shot.) State requirements vary, but hepatitis B vaccination is also a good idea, especially if you’re working in a health sciences lab or have multiple sex partners. You may also want to make sure you are immune to chickenpox and polio, and, if you’re living in close quarters, ask about vaccines against meningococcus and possibly flu.

Eating problems. Roughly 8% of college students (most of them, women) have some degree of anorexia nervosa (in which sufferers fear weight gain yet are underweight) or bulimia (binge eating followed by purging). Another 2% are binge eaters who don’t purge, says Dr. David Herzog, director of the eating disorders unit at Massachusetts General Hospital. Cognitive-behavioral therapy, which teaches you to alter negative thoughts and behaviors, can help. So do antidepressant drugs, once you’ve regained normal weight. Obesity and just being overweight, though not psychiatric disorders, are also big problems, including on campuses. In fact, 12% of people age 18 to 29 are obese. Many colleges have nutritionists and support groups for overeaters.

Avoidable injuries. College campuses may look idyllic, but one recent study of 15,000 undergrads showed that 3.5% had working firearms. That’s bad enough in itself, but combined with alcohol abuse, it can be truly dangerous. If you’re concerned, talk to your dean.

It’s easier to prevent another potentially serious problem: head injury. More than one-third of students in another study said they never wear a helmet while biking. That’s dumb. Why spend four years in college pouring facts into your brain, then wreck it in a bike accident?

The bottom line in all this, of course, is knowing where the dangers lie--and taking simple steps to avoid them so that you graduate not just smarter, but safe.

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Judy Foreman writes a syndicated column on health issues. She is a fellow in medical ethics at Harvard Medical School. Her column appears occasionally in Health.