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High rates of sexually transmitted infections and unplanned pregnancy continue to plague young adults in the USA with low condom use a contributing factor. To better understand condom acquisition, errors, and breakage among US cisgender college students, a survey was conducted across six structurally diverse institutions of higher education in 2019-2020 prior to the COVID-19 pandemic. Students who had used external condoms in the last year (N = 1584) were asked about specific on- and off-campus locations of condom acquisition and practices related to condom use. Findings indicate that students most frequently acquired condoms off-campus with location differences between genders and relationship status. Condom errors were common, with no consistent patterns related to gender, but unpartnered students were more likely than those in relationships to experience condom errors. Multivariate logistic regression indicated that relationship status, applying condom on wrong side, adding condom after sex started, removing condom during sex, condom slipping off, and problems with fit were predictors for condom breakage. The study results provide guidance for healthcare and sexuality education professionals working with college students to better address the differing needs of college students regarding condom acquisition and correct condom use.

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OBJECTIVE: The relationship between postsecondary students' health and academic outcomes may have important implications for their collegiate experience and their future prospects. Yet a comprehensive summary of the evidence examining this potential connection does not presently exist. Seeking to fill this gap, this study reviewed the extant literature on postsecondary students' academic outcomes and health across multiple domains. METHODS: Using an established methodological framework, a scoping review was conducted to identify and summarize the attributes of all peer-reviewed research performed in the U.S. and published between 2008 and 2019 that examined the relationship between postsecondary students' health and academic outcomes. RESULTS: The search strategy resulted in 12,488 articles. After deduplication, initial screening, and full review of relevant articles to determine eligibility, 264 articles were included in the final review. The most frequently examined health domains were mental health and substance use. Grade point average (GPA) was the most common academic measure investigated. Most studies took place at single institutions among undergraduate students, and several studies focused on specific student sub-populations. Almost all study results indicated that healthier behavior or optimal health status was associated with better academic outcomes or did not negatively impact academic success. CONCLUSIONS: This study serves as a first step in understanding the scope of existing research examining the connection between postsecondary students' health and academic outcomes. A substantial literature base was found; however, several gaps were identified including the need for more cohort studies, national studies, examination of graduate students, and a focus on academic outcomes beyond GPA.

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PURPOSE: College students' academic achievement has crucial implications for their future success. Students' health may be a key determinant of academic performance, but more research is needed to understand this relationship. DESIGN/SETTING/SUBJECTS: Secondary analysis of the American College Health Association-National College Health Assessment III pre-COVID-19 Spring 2020 dataset. N = 39 146 undergraduates at 75 higher education institutions (14% mean response rate, comparable with other large-scale national college health surveys). MEASURES: Self-reported grade point average (GPA) and 33 health behaviors in the categories of dietary behavior, physical activity, sedentary behavior, substance use, sexual risk behavior, violence-related behavior, mental health, and sleep behavior. ANALYSIS: Weighted cross-tabulations examining the association between GPA and health behaviors; multinomial logistic regressions assessing if behaviors predicted GPA, controlling for year, sex/gender, and race/ethnicity. Individual GPA categories were also compared to a D/F referent group. RESULTS: There were gradient trends across GPA categories for A through D/F (18 behaviors) or A through C (12 behaviors) (P < .001). Each health behavior predicted GPA differences (P < .001), except heroin use (P = .052). The A GPA group was significantly different from the D/F GPA group for 27 behaviors (P < .001). In general, protective behaviors corresponded with higher GPAs and most risk behaviors were associated with lower GPAs. CONCLUSIONS: There is a link between numerous health behaviors and academic performance. Stakeholders invested in college students' health and academics should engage in mutually beneficial strategies to safeguard students' current and future well-being and success.

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BACKGROUND: Condom distribution programs are a structural-level intervention implemented on college campuses to reduce sexually transmitted infections and unplanned pregnancies. Understanding students' beliefs about these programs and attitudes that can affect condom use is critical. METHODS: Students at 6 different universities (n = 2809) completed items related to beliefs about campus condom distribution programs and their personal condom embarrassment and condom self-efficacy levels. Surveys were completed both in classroom and online. T Tests and analysis of variance were used to examine differences based on demographics. Logistic regression was used to examine predictors of condom use. RESULTS: College students support the distribution of condoms on campus (97.4%) but express moderate levels of embarrassment in condom acquisition and possession (mean, 19.37). Lower rates of embarrassment were reported for condom negotiation (mean, 9.13) and actual condom use (mean, 8.48). Lower overall rates of embarrassment were reported by condom users, men and individuals in relationships compared with noncondom users, women, and single individuals. Heterosexual students were more embarrassed than bisexual students about acquiring condoms and negotiating condom use. Condom users, men, and individuals in relationships had higher rates of condom self-efficacy compared with nonusers, women, and single students. There were no differences in self-efficacy based on sexual orientation. Embarrassment about acquiring and actual use of condoms, condom self-efficacy and demographics were all significant predictors of condom use. CONCLUSIONS: Campus condom distribution programs are supported by college students. Interventions to address embarrassment and increase condom self-efficacy need to be tailored to different students based on gender, experience with condoms, and relationship status.

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Sexual assault in higher education is a continuing concern. At the same time, college students are engaging in a range of consensual sexual behaviors that could appear to be sexual violence. Sexuality education on college campuses should address the spectrum of sexual behaviors and college health professionals and administrators need to be able to distinguish consensual rough sex from sexual violence. Common consent negotiations in BDSM (bondage and discipline, dominance and submission, sadism and masochism) contexts may serve as an appropriate model for acquiring consent. This viewpoint article aims to (1) review the increased participation of college students in diverse sexual behaviors, and (2) introduce the consent process of BDSM as a framework for college health professionals to discuss consent for other sexual behaviors.

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Faculty can play a critical role in supporting college health professionals' efforts to enhance student health and well-being. However, many college health practitioners have expressed concerns about how to effectively engage faculty. This article, written by current faculty who are all former college health professionals, aims to bridge this gap. We propose that some difficulties in working with faculty could be improved by having a more nuanced understanding of faculty roles and expectations, and through identifying ways to leverage faculty duties for mutually beneficial partnerships. First, we describe characteristic faculty responsibilities based on position and institutional type. Next, we provide ideas for potential collaborative opportunities. Then we offer recommended approaches for how to engage faculty and sustain these relationships. We hope these insights will help to strengthen the needed connection between faculty and college health professionals in order to best meet the needs of college students.

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OBJECTIVE: This case study describes the simultaneous establishment of a campus garden and food pantry at an urban, Hispanic-serving institution. Lessons learned and implications for practice are discussed. Participants: Students, staff, and faculty established a campus garden (February 2016) and food pantry (March 2017). Methods: University administration approved funds to establish both a campus garden and food pantry after adequate student and academic support was provided. Results: Both the campus garden and food pantry aligned with campus initiatives for student success and sustainability. The food pantry had adequate staffing and local partnerships that aided in its success, while the student-led garden struggled with student-turn over, limited financial support, and lack of regulatory guidance that has slowed progress to address food security. Conclusions: Institutions considering these strategies to address food insecurity would benefit from university financial support based on student-relevant data, dedicated staff, students, and faculty, and collaboration with local organizations.

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Objective: To provide an overview of college health centers' practices surrounding education, counseling and referral after a patient receives a positive pregnancy test. Participants: College health centers that participated in the annual ACHA Pap Test and STI Survey years 2008 to 2014. Methods: Descriptive analyses for items regarding all-options and limited counseling/education and types of referrals (adoption, abortion and prenatal care) provided to students. Chi-square statistics were calculated to examine trends over time and differences between demographic characteristics. Results: There were no significant differences across time but there were significant differences between regions of the US and if the institution was faith-based, though few had strong association values. Conclusions: The results indicate most college health centers are following best practices regarding counseling and education for a positive pregnancy test result. Understanding limitations for those institutions not in compliance require further exploration.

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Objective: To examine changes in diagnoses/treatment for 12 mental health (MH) conditions, previous use of campus MH services, and willingness to seek MH services in the future. Participants: ACHA-NCHA II participants from 2009 to 2015 (n = 454,029). Methods: Hierarchical binary logistic regression with step 1 controlling for demographics and step 2 considering time. Results: Time was significant except for bipolar disorder, bulimia, and schizophrenia with increases for all conditions except substance abuse. Anxiety (OR = 1.68), panic attacks (OR = 1.61), and ADHD (OR = 1.40) had the highest odd ratios. Use of MH services at current institution (OR = 1.30) and willingness to utilize services in the future (OR = 1.37) also increased over time. Conclusions: Based on a national sample, self-reported diagnoses/treatment of several MH conditions are increasing among college students. This examination of a variety of MH issues can aid college health professionals to engage institutional stakeholders regarding the resources needed to support college students' MH.

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OBJECTIVE: To examine characteristics of college students who have previously received mental health (MH) services on campus and are willing to seek help again in the future. PARTICIPANTS: Spring 2015 ACHA-NCHA II (N = 12,501) undergraduate respondents who had previously used MH services on their current campus. METHODS: Binary logistic regression with willingness to seek MH services in the future as the dependent variable. RESULTS: Among students who had already utilized campus MH services, significant predictors for future help-seeking were: female, white, gay/lesbian, those not working for pay, having the college/university health insurance plan, and not currently/previously serving in the military (p < .05). CONCLUSIONS: The predictors for willingness to use services in the future were consistent with the existing literature related to initial use. Colleges and universities need to consider factors that influence openness to MH services after a previous experience in addition to initiating care. Implications for college MH professionals are provided.

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Adolescents and young adults are disproportionately affected by sexually transmitted diseases (STDs). This study examined the association of GYT: Get Yourself Tested (GYT), a sexual health social marketing campaign, with several sexual health behaviors on a nationally representative sample of high school (HS) and college students ( n = 2,329) recruited through an online panel survey. Behaviors examined were STD testing, HIV testing, and whether students had communication with health care providers and their romantic partners about STDs and STD testing. Rao-Scott chi-square tests and multivariable logistic regression models were conducted. The results indicated college students were more aware of GYT than HS students. Awareness of GYT was significantly associated with STD testing ( p < .05), HIV testing ( p < .01), and talking with romantic partners ( p < .01) for college students but only with STD testing ( p < .05) and talking to a provider ( p < .05) for HS students. The differences between HS and college students provide insight for those developing and implementing interventions across such a broad age range of youth.

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OBJECTIVE: To examine college student health centers' (SHCs) practices related to sexually transmitted disease (STD) screening and treatment over a 5-year period. PARTICIPANTS: College SHCs that completed the ACHA Pap and STI Survey between 2010 and 2014. METHODS: Chi-square tests were conducted with Cramer's V providing a measure of association. RESULTS: Chlamydia screening of women under 25 years of age was a well-established practice. Almost one-third of SHCs did not report screening practices of men who have sex with men (MSM) consistent with current chlamydia and gonorrhea guidelines; however, there was improvement over time. Few college SHCs utilized expedited partner therapy (EPT), though fewer had blanket restrictions prohibiting its use in 2014 compared to 2010. CONCLUSIONS: Over the 5-year period, more SHCs followed current best practices. Improvement in compliance with guidelines related to MSM STD screening as well as increased usage of EPT is needed to best address the needs of the diverse college student population.

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OBJECTIVE: To conduct a trend analysis of Pap test practices, Pap test results and related women's services and guidelines of college health centers. PARTICIPANTS: College health centers who participated in the annual ACHA Pap Test and STI (sexually transmitted infection) Survey years 2004-2014 (n ranged from 127 to 181 depending on year). METHODS: Descriptive analyses are presented with ANOVAs (Analysis of Variance) and chi-square tests calculated to examine trends over time. RESULTS: The number of Pap tests significantly decreased over time; however, the percentage of normal and HSIL (high-grade squamous intraepithelial lesion) results did not vary. Availability of conventional cytology slides and cryotherapy were significantly associated with year. Over time, college health centers' guidelines related to initiation of Pap testing evolved to consistently conform to national recommendations for cervical screening. CONCLUSIONS: The results indicate most college health centers are following the current national guidelines regarding Pap testing for young adult women.

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Many college students today are no longer using the terms straight, gay, lesbian, bisexual, or transgender to self-identify their sexual orientation or gender identity. This commentary explores research related to fluidity of sexual identities, emerging sexual identities used by college students, and how these identities interact with the health and well-being of the student. Additionally, the authors discuss strategies to help college health professionals provide a sensitive environment and clinical experience for students whose sexual identity is fluid.

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OBJECTIVE: To examine whether 6 institutional characteristics were associated with health behavior and outcomes among college students. METHODS: Chisquare statistics and ANOVAs were used to determine relationships between institutional characteristics and health issues among undergraduate participants (N = 81,242) for the spring 2011 American College Health Association-National College Health Assessment II. RESULTS: Most institutional characteristics were significantly associated with all health issues. However, Cramer's V and eta 2 were frequently weak. Relationships between institutional characteristics and health outcomes were complex with few clear patterns. CONCLUSIONS: This exploratory study provides insight into environmental influences specific to college health. Future research should consider individual student differences and campus offerings to improve understanding of how the environment affects college student health.

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OBJECTIVE: To conduct a confirmatory factor analysis on the 17-item Sexual Health Survey (SHS), a comprehensive instrument designed to be used with college students. PARTICIPANTS: College students (N = 515) aged 18 to 26 years enrolled at a Midwest public university October 2009. METHODS: Confirmatory factor analysis with maximum likelihood estimation was performed to test the stability of the constructs. RESULTS: All factor loadings were significant (p < .001), ranging from .55 to .99 (standardized). The range of squared multiple correlations of items was .31 to .98, and the intercorrelations among the 5 factors were from -.03 to .52. These small to moderate levels of intercorrelation support discriminant validity of 5 constructs. CONCLUSIONS: This study supports the 5-factor version of the 17-item SHS as a viable scale that can measure sexual health overall and 5 distinct areas. College health professionals should consider use of this scale for assessment purposes and evaluation of programmatic efforts.

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OBJECTIVE: To examine the impact of work and volunteer hours on 4 health issues among undergraduate college students. PARTICIPANTS: Full-time undergraduate students (N = 70,068) enrolled at 129 institutions who participated in the Spring 2011 American College Health Association-National College Health Assessment II survey. METHODS: Multiple linear regression and binary logistic regression were used to examine work and volunteer hour impact on depression, feelings of being overwhelmed, sleep, and physical activity. RESULTS: The impact of work and volunteer hours was inconsistent among the health outcomes. Increased work hours tended to negatively affect sleep and increase feelings of being overwhelmed. Students who volunteered were more likely to meet physical activity guidelines, and those who volunteered 1 to 9 hours per week reported less depression. CONCLUSIONS: College health professionals should consider integrating discussion of students' employment and volunteering and their intersection with health outcomes into clinical visits, programming, and other services.

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Many studies have examined differences in sexual behavior based on sexual orientation with results often indicating that those with same-sex partners engage in higher risk sexual behavior than people with opposite sex partners. However, few of these studies were large, national sample studies that also include those identifying as unsure. To address that gap, this study examined the relationship of sexual orientation and sexual health outcomes in a national sample of U.S. college students. The Fall 2009 American College Health Association-National College Health Assessment was used to examine sexual health related responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 25,553). Responses related to sexual behavior, safer sex behaviors, prevention and screening behaviors, and diagnosis of sexual health related conditions were examined. The findings indicated that sexual orientation was significantly associated with engaging in sexual behavior in the last 30 days. Sexual orientation was also significantly associated with the number of sexual partners in the previous 12 months, with unsure men having significantly more partners than gay, bisexual and heterosexual men and heterosexual men having significantly less partners than gay, bisexual and unsure men. Bisexual women had significantly more partners than females reporting other sexual orientations. Results examining the associations between sexual orientation and safer sex, prevention behaviors, and screening behaviors were mixed. Implications for practice, including specific programmatic ideas, were discussed.

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This study examined the relationships of mental health issues and sexual orientation in a national sample of college students. Using the Fall 2009 American College Health Association-National College Health Assessment, responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 27,454) relating to mental health issues and impact of these issues on academics were examined. The findings indicate that gay, lesbian, bisexual, and unsure students consistently reported higher levels of mental health issues and a more frequent impact on academics because of these issues than heterosexual students. Bisexuals frequently reported higher levels than students identifying as gay, lesbian, and unsure.

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