A model for HIV risk reduction and prevention among African American college students

Training African American student leaders as peer educator-mentors to reach African American students in the traditional workshop setting as well as in informal, one-to-one occasions is an effective method of managing students' risks of human immunodeficiency virus (HIV) infection. The Ujima project, developed and implemented by Syracuse University Health Services, trained educator-mentors to provide first-year African American students with correct information about HIV risk reduction and how to build life skills associated with prevention that enhance self-esteem and provide ongoing social support on formal and informal occasions in a culturally sensitive manner. These strategies were successful in changing knowledge, attitudes, and behaviors necessary for HIV prevention among African American college students.

Intervention in hypercholesterolemic college students: a pilot study

PURPOSE

Since atherosclerosis begins in childhood and cholesterol levels can track from adolescence to adulthood, early intervention to lower elevated levels may be important. Our objective was to test the effectiveness of a health education intervention in hypercholesterolemic college students.

METHODS

Thirty-nine university students with plasma low-density lipoprotein cholesterol (LDL-C) levels > or = 75th percentile (2.84 mmol/L, 110 mg/dL) were randomized into two study groups. The control group (n = 19) attended a lecture and viewed a brief video on diet and cholesterol. The intervention group (n = 20) participated in 7 weekly sessions on nutrition and behavior modification. At baseline and 8 weeks later, all subjects completed standardized tests assessing knowledge and attitudes regarding cholesterol, saturated fat, fiber, and heart-healthy lifestyles. Lipid profiles were analyzed at baseline, 8 weeks, and 8 months after study initiation.

RESULTS

The groups did not differ at baseline in terms of knowledge, attitudes or lipid profiles. At the 8-week post-test, the intervention group's knowledge was superior to that of the control group (p = < 0.001). Both groups showed improvement in their attitude toward a heart-healthy diet. At the 8-week follow-up, the intervention group lowered their mean plasma LDL-C by 0.21 mmol/L (8 mg/dL) whereas the control group's level fell by an average of 0.05 mmol/L (3 mg/dL) (p = 0.40). At the 8-month follow-up, LDL-C levels increased from baseline in both groups, but the control group levels rose significantly more than the intervention group (0.34 mmol/L vs. 0.05 mmol/L, p = 0.045). Students whose baseline LDL-C was > or = 95% (3.36 mmol/L, 130 mg/dL) benefitted more from the intervention than those with levels > or = 75% but < 95%.

CONCLUSIONS

We conclude that a 7-week intervention results in significant improvement in nutritional knowledge and protects hyperlipidemic college students with levels > or = 95% from significant increases in LDL-C.

The student health center as multicultural catalyst

Stanford's student health center participated with underrepresented students in observing Black Liberation Month; Bisexual, Gay, and Lesbian Awareness Days; and Cinco de Mayo, the commemoration of a Mexican Army defeat of the French in 1862. For minority students on a campus where a majority of the students and faculty are White, the health center's involvement in these events was viewed as an affirmation and acceptance of worth of these diverse student groups. The outreach effort exposed health center caregivers to the cultures of the three groups when staff members attended the special activities, interacted with the celebrants, and became more sensitized to their needs.

Very brief psychological interventions with university students

Annual college mental health service statistics reveal that 50% to 60% of all students served are seen for very brief psychological interventions--5 or fewer sessions. A substantial portion of the students benefit from these very brief contacts. The authors review the selection criteria for student and therapist that make very brief intervention possible. The student must be motivated for and seek a brief encounter and must enter the therapeutic relationship with the capacity for trust already in place and the professional qualifications of the therapist already established. The problem presented should be sufficiently clear and manageable to be resolved, or to begin being resolved, in a few sessions. Finally, the student must have the capacity for rapid insight and learning. The therapist brings to the relationship a belief in the value of very limited sessions, the capacity to develop a positive relationship quickly, and the ability to determine when it is appropriate to work in such a short time frame and to use the time most effectively. Four ways that students may benefit from very brief psychological interventions include (1) psychodynamic therapy, (2) crisis intervention, (3) mental health consultation, and (4) managed referral. Case illustrations and clinical methods are presented.

Student healthcare delivery and financing programs: adapting to healthcare reform

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an "all or nothing" proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.

Nursing diagnosis as a framework for college health nursing protocols

Standardized nursing protocols in college health must facilitate cost-effective student healthcare, allow nurses to function within the legislated scope of practice of their state, and still address the health needs of the patient population. Nursing diagnosis provides the framework for a protocol model that does all of this, as well as providing professional growth opportunities for college health nurses and nursing.

Suicide attempts and threats on one college campus: policy and practice

Because of a university policy requiring a mental health evaluation of every student who is cause for worry with respect to his or her own safety, the counseling center at the College of William and Mary has been able to examine almost all situations in which students are suicidal or thought to be suicidal. Over the course of 1 calendar year, counseling center clinicians recorded data on every case of students who attempted or threatened suicide or were otherwise of concern to residence life staff or faculty or administrators because of a perceived potential for suicidality. Sixty such situations, including 11 suicide attempts and 14 threats, arose. No completed suicides were recorded. The rate of suicide attempts was 14.5 per 10,000 students, and the rate of suicide threats was 18.4 per 10,000 students, a total of 32.9 cases per 10,000 students. Findings by race, gender, and class are outlined, although low base rates did not yield adequate statistical power to make comparisons practical within these groupings. The most prevalent risk factor found in suicide attempters was work or school failure; for suicide threateners, it was difficulty in a relationship; and for those found to be nonsuicidal, the major problem was social isolation. Follow-up therapy was the most frequently used intervention for attempts and threats, whereas instructions for using the emergency on-call system was the most used option in the otherwise worrisome cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The condom race

The condom race is a hands-on activity that can help teach young people condom use as part of safer sex practices. Although it is well documented that students know about condom use, they often do not do what they know they should. One possible explanation for this is that the students may lack the skills and confidence they need to have when they use condoms. The condom race offers students a chance to gain skills and confidence in a humorous, nonthreatening way. During the exercise, which is based on the concept of a relay race, students touch, feel, and practice putting condoms on penis models. After participating in the activity, students reported increased confidence in their ability to use, discuss, and carry condoms. The condom race is a quick, amusing, and easy activity.

Prematriculation immunization requirements of American colleges and universities

The authors surveyed a stratified sample of 880 colleges and universities in the United States to assess the status and characteristics of their prematriculation immunization requirements (PIRs). On the basis of a 90% return (796 responses), they estimated that 55% of US colleges and universities had implemented a PIR at the time of the survey. Among schools with PIRs, measles vaccine was almost universally required, with 74% requiring two doses, mumps vaccine was required by 70%, and rubella vaccine by 92%. Hepatitis B vaccine was rarely required and was usually recommended only for students in health-profession programs. The strongest determinant of having a PIR was the presence of a state law or regents' policy. PIRs implemented under the aegis of a state law were, on average, less comprehensive but better enforced. Other factors associated with the implementation of a PIR included membership in the American College Health Association (ACHA), the presence of a student health clinic, and availability of record-keeping personnel.

Research in college health. 4: Analyzing and communicating results

The final article in this series on research in college health deals with the analysis and communication of research data. The authors introduce descriptive and inferential statistics and summarize the applicability of different types of statistical analysis to college health research. Two major means of conveying results, conference presentations and journal articles, are also described and some guidelines for the effective communication of findings are offered.

Protocols for college health nurses: alive and well in the 1990s

This article seeks to assist college health nurses in developing appropriate protocols for patient care. In addition, the authors outline factors influencing protocol content, design, and development and describe steps in creating individualized protocols by practice setting. To provide college health nurses with a basic understanding of protocols, the authors offer definitions and examples of appropriate and inappropriate use, and show how protocols can influence the delivery of patient care. Although protocols may provide college health nurses with directives for managing specific health problems, they require a sophisticated level of judgment and skill in their implementation.

Complex issues for sexual assault peer education programs

Peer education programs dealing with sexual assault are important for starting dialogue and improving students' awareness. If a peer education effort is to be effective, the college or university must have written policies condemning sexual assault, investigative and reporting procedures, and comprehensive sexual education and information programs. Experience at Brown University revealed the necessity of providing peer educators with opportunities during initial training for open and honest dialogue on the politics of campus rape, facing issues of power and dominance, women's dress as a factor in rape, and the distinction between victim and survivor. These discussions can be strained and frustrating, but they are a necessary step in resolving conflict among the peer educators and helping them provide a consistent message.

Establishing a student health all-appointment system: making the transition from a walk-in approach

The authors offer a process for critically evaluating a walk-in system for patient and care provider satisfaction, for developing goals for a new patient flow system, and for designing and implementing an appointment system at a student health center. Their suggestions are based on their recent experience in making the transition from a walk-in approach to an all-appointment system in the general medicine division of the university's student health service. They give specifics of the appointment system established at their facility, including an explanation of the weekly appointment schedule, the monthly duty schedule, and a strong triage system. Key areas for consideration in converting to an all-appointment system, such as reeducational techniques for various staffing responsibilities and strategies for marketing a new system to patients, are outlined in detail.

College students' views of excessive drinking and the university's role

Views of college students (N = 133) regarding excessive drinking were explored in terms of the amount of drinking which constitutes a drinking problem, the behaviors that indicate a student has been drinking excessively, and university alcohol policies that students would endorse. Students accepted levels of drinking by peers that markedly exceed definitions of excessive drinking by experts. A sizable minority of students refuse to label very dangerous behaviors associated with excessive drinking as indicating a drinking problem. The views of male and female students differed only marginally. Since students seem to define excessive drinking in ways that differ from professionals, it is suggested that student affairs personnel need to plan programs that recognize the students' views, otherwise students may continue to believe that while excessive drinking is bad, their level of drinking cannot lead to any problems.

Healthy dating: a mixed-gender date rape workshop

College communities are increasingly being called upon to institute date rape prevention programs. This article describes a mixed-gender workshop sponsored by a university's Program for Rape Education and Prevention that was given to more than 1,400 undergraduate students in more than 80 presentations. In order to guide modifications of the workshop, formative evaluation data collected from 330 male (mean age 20.3 years) and 314 female (mean age 20.5 years) university students were collected. Results were largely positive. Despite the sensitive nature of the topic, only 10.2% of the men and 8.2% of the women reported being uncomfortable discussing date rape in mixed-gender groups. Furthermore, students were virtually unanimous in their agreement that date rape is a topic worthy of a workshop.

Identification of campaign recruitment strategies for a stepped smoking cessation intervention for a college campus

A rapproachement of the Stepped Approach Model of health care delivery and Ajzen's Theory of Planned Behavior was used to identify campaign recruitment strategies for a stepped smoking cessation intervention for a college campus. The study examines outcome expectancies, outcome evaluations, and interest in participating in smoking cessation programs presented in graduated steps of intervention intensity. Telephone surveys were conducted with a probability sample of 191 student smokers. A significant negative trend indicates that the steps are ordered cost-effectively. Scheffé a posteriori tests also reveal that interest in Step 1 (pamphlets and brochures) was significantly higher than interest in any other step, including those representing traditional health care services (i.e., groups and individual treatments). The two strongest predictors of interest in each step were attitudes about participation and control beliefs; normative expectations about program participation discriminated between respondents with high or low interest in Steps 2 through 5. It was concluded that attitudes and control beliefs should be the focus of initial program promotion for college smoking cessation campaigns. Emphasis on attitudes, control beliefs, and especially perceived norms could be helpful in advancing unsuccessful participants to the next more intensive program in a stepped intervention.