Care of the College Student

 

Approximately 19 million students attend college in the United States. Although they are generally healthy, about 20% of youth have special health care needs, including asthma, diabetes mellitus, and learning, mental health, and substance use disorders. Physicians can facilitate the transition of a youth to an adult model of health care by using structured processes to orient the youth to self-care before entry into college. Stimulant medications are effective for treatment of students with attention-deficit/hyperactivity disorder, but physicians should monitor for signs of drug diversion. Learning disorders may manifest with emotional or physical symptoms and are managed in a multidisciplinary fashion. Depression, anxiety, sleep problems, and posttraumatic stress and eating disorders are common in this population and can affect school performance. Screening and/or interventions for obesity, depression, anxiety, violence, nicotine use, and substance use are effective. Immunizations for influenza, human papillomavirus, meningococcus, and pertussis are crucial in this high-risk population. Lesbian, bisexual, gay, transgender, and queer students have unique health care needs.

Approximately 19 million full- and part-time students were enrolled in U.S. colleges in 2018.1  Although they are generally healthy, many of these individuals have special health care needs such as asthma, diabetes mellitus, mental health concerns, and learning disorders. Understanding and managing the needs of this dynamic population involve addressing the unique psychosocial stressors related to this life transition that manifest before and while attending college. Common self-reported medical conditions among college students are presented in Table 1.2

WHAT'S NEW ON THIS TOPIC

Care of the College Student

About 20% of college students have special health care needs, including asthma, diabetes mellitus, learning disorders, mental health concerns, and substance use problems.

Approximately 72% of college students and recent graduates indicate that finding health care coverage remains difficult, and 1.6 million students remain uninsured.

An estimated 13.3% of college students reported seriously considering suicide, and 2.4% reported attempting suicide in the past 12 months.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Structured, coordinated transition from a childhood model of care to an adult model of care promotes health care adherence and appropriate use of ambulatory services.6

C

Consistent, moderate-quality, patient-oriented public health study

Cognitive behavior therapy and stimulant medications are effective for treatment of students with attention-deficit/hyperactivity disorder, but physicians should monitor for signs of drug diversion in those taking stimulants.15,21

B

Consistent, good-quality, patient-oriented evidence

Educational accommodations during classroom examinations are commonly encouraged for people who have attention-deficit/hyperactivity disorder or learning disorders.21,22

C

Usual practice and expert opinion

Tobacco use screening and cessation interventions are recommended in college students.36

B

Inconsistent, patient-oriented evidence

Alcohol use and misuse counseling is recommended in college students.37

B

Inconsistent, patient-oriented evidence


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Structured, coordinated transition from a childhood model of care to an adult model of care promotes health care adherence and appropriate use of ambulatory services.6

C

Consistent, moderate-quality, patient-oriented public health study

Cognitive behavior therapy and stimulant medications are effective for treatment of students with attention-deficit/hyperactivity disorder, but physicians should monitor for signs of drug diversion in those taking stimulants.15,21

B

Consistent, good-quality, patient-oriented evidence

Educational accommodations during classroom examinations are commonly encouraged for people who have attention-deficit/hyperactivity disorder or learning disorders.21,22

C

Usual practice and expert opinion

Tobacco use screening and cessation interventions are recommended in college students.36

B

Inconsistent, patient-oriented evidence

Alcohol use and misuse counseling is recommended in college students.37

B

Inconsistent, patient-oriented evidence


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT

The Authors

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BRIAN K. UNWIN, MD, is section chief for geriatrics and palliative medicine at Carilion Clinic and a professor of Medicine and Family and Community Medicine at the Virginia Tech-Carilion School of Medicine, Roanoke....

JEFFREY GOODIE, PhD, CAPT, USPHS, is a board-certified clinical health psychologist and a professor in the Departments of Medical and Clinical Psychology and Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md.

BRIAN V. REAMY, MD, is the senior associate dean for Academic and Faculty Affairs and a professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.

JEFFREY D. QUINLAN, MD, is a professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.

Address correspondence to Brian K. Unwin, MD, Carilion Center for Healthy Aging, 2001 Crystal Spring Ave., Suite 302, Roanoke, VA 24014 (email: bkunwin@carilionclinic.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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