Trends in College Student-Athlete Mental Health in the National College Health Assessment (NCHA), 2011–2019

ABSTRACT Context: Recently the athletic training community has paid increased attention to college student-athlete mental health, treatment-seeking, and impacts on athletic and academic performance. Ongoing efforts to better-educate and equip athletic trainers to help student-athletes in this regard should result in improved mental health-related outcomes. Objective: Examine changes in student-athlete mental health over the past decade compared to non-athlete students. Design: Cross-sectional study. Setting: United States colleges and universities. Patients or Other Participants: Varsity athletes (n=54,479) and non-athlete students (n=448,301) who completed the National College Health Assessment (NCHA) between 2011 and 2019. Main Outcome Measures: Survey responses (self-report) to questions in five mental health-related domains: symptoms, diagnoses, treatment-seeking, institutional information distribution, and academic impacts. Results: Student-athletes consistently reported significantly lower symptom and diagnose rates than non-athletes, except for attempted suicide, substance abuse, and eating disorders. Diagnoses increased over time in both groups, but remained lower in athletes. Treatment-seeking and openness to future treatment increased over time in both groups, but remained lower in athletes. Student-athletes received more information on stress reduction, substance abuse, eating disorders, and handling distress/violence than non-athletes. Both groups received information more frequently over time. Athletes reported lower academic impacts, especially for depression and anxiety, but impacts grew over time in both groups. Impacts of injuries and extracurricular activities on academic performance were higher in athletes than in non-athletes. Conclusions: Athletes reported overall lower levels of symptoms, diagnoses, and academic impacts than non-athletes. While non-athlete rates climbed over the past decade, athletes' rates broadly remained flat or climbed less rapidly. Increasingly positive attitudes toward treatment are encouraging, but the deficit relative to non-athletes remains. Ongoing efforts of athletic trainers to educate athletes and guide them to mental health resources are needed in order to continue (or, better yet, accelerate) the observed positive trends in information dissemination and treatment-seeking.

U.S. and Canadian College Students’ Fear of Crime: A Comparative Investigation of Fear of Crime and Its Correlates

Being fearful of crime is, unfortunately, a common experience. Research shows that many factors influence a person’s fear of crime, demonstrating that certain groups are generally more fearful than others. Even though they are typically young, college students express being fearful of crime on and off campus. What has yet to be investigated is whether college students who attend school in the United States are fearful at similar levels to their Canadian counterparts. Further, the correlates of fear of crime may also be different. To explore these issues, data from the American College Health Association’s National College Health Assessment II survey of U.S. and Canadian college students are used. Results show that Canadian college students generally perceive their safety as being higher than U.S. college students, even though they face elevated victimization risks. Further, some correlates of fear of crime differ for U.S. and Canadian college students. These findings suggest the need for additional cross-national comparative work to see if patterns generalize across contexts.

College Student Aerobic and Muscle-Strengthening Activity: The Intersection of Gender and Sexual Orientation Among United States Students

The purpose of the study was to examine differences in aerobic and muscle-strengthening activity participation based on the intersection of gender and sexual orientation among cisgender college students. Data from the American College Health Association National College Health Assessment collected between Fall 2015 and Fall 2018 were analyzed. Differences from the population average for meeting aerobic and muscle-strengthening activity (separately) recommendations were computed for each gender and sexual orientation intersection. The likelihood of meeting aerobic and muscle-strengthening activity (separately) recommendations were calculated using a series of logistic regression analyses to determine odds ratios controlling for age, year of enrollment, race/ethnicity, and health status. Overall, more men and those identifying as straight met activity (aerobic and muscle-strengthening) recommendations. Asexual and straight women were less likely to meet activity recommendations compared to men, and bisexual and questioning women were less likely to meet muscle-strengthening recommendations compared to men. Bisexual, pansexual, and questioning individuals were less likely to meet activity recommendations compared to straight individuals among both genders, as were queer and gay men and women who identified as pansexual or another identity. Men who identified as pansexual or another identity, as well as lesbian and queer women were less likely to meet muscle-strengthening recommendations compared to straight individuals. In summary, findings demonstrate that aerobic and muscle-strengthening activity participation disparities are evident based on the intersection of gender and sexual orientation. The intersection of socio-demographic characteristics should be considered by researchers and physical activity promoters in order to better understand and address disparities.

Does College Matter? Exploring College-Level Factors Related to Victimization Risk for U.S. and Canadian College Students

Research shows that U.S. college students are at risk for a variety of victimization types. College students in Canada also experience similar types of victimization compared to U.S students, yet recent research shows that Canadian students are at a greater risk than U.S. college students of being victimized. Little is known, however, as to whether college-level factors influence victimization risk and how these risks may be different for U.S. and Canadian college students. Using the American College Health Association’s National College Health Assessment data (ACHA-NCHA II), the current study builds upon past research by exploring the role of both individual and school characteristics and whether they are similarly related to risk of victimization in the two populations. The findings show that Canadian students are at higher risk for victimization and that some school-level factors play a role in predicting this risk for all students, with some variation in ones that matter for each country.

Two-Year Update on ACHA-NCHA II Results Following the Implementation of a Sexual Assault Violence Prevention and Awareness Campaign at a State-Supported Regional University

Objective: We measured progress on seven (7) objectives from Topic Area: Injury and Violence Prevention of the Healthy Campus 2020 campaign at our university. We assessed execution of a Sexual Assault Violence Prevention and Awareness campaign one-year post implementation. Participants and Methods: One thousand and fifty-two students at our University completed the American College Health Association-National College Health Assessment II Survey. Results: From 2.8-11% of students reported emotionally, physically, and sexually abusive intimate relationships, and non-consensual touching and penetration. Conclusions: Our University is committed to supporting and maintaining an educational environment free from all forms of violence and will continue to offer educational sessions and outreach efforts.

0553 Hallucinogen Use Among College and University Students: Associations with Insufficient Sleep and Insomnia

Introduction Previous studies have shown that poor sleep is associated with alcohol use, smoking, and other substance use, especially among young adults. Yet, very little is known about hallucinogen use. Methods Data from the 2011-2014 National College Health Assessment were used (N=113,749), representing a wide range of students across the US. Hallucinogen use was reported as “never,” “past,” and “present” (reflecting use in the past 30 days). Students also self-reported nights/week they did not get enough sleep to feel rested (insufficient sleep), as well as nights/week they had difficulty falling asleep (initial insomnia). Responses for both were categorized as 0, 1-2, 3-4, 5-6, or 7 nights/week. Multinomial logistic regressions examined hallucinogen use as outcome (past or present vs never) and sleep as predictor, with adjustment for covariates (age, sex, race/ethnicity, and survey year) and mental health (past 30 days depression/anxiety). Results Hallucinogen use was infrequently reported, with 4.8% (N=5,493) reporting past use and 0.98% (N=1,119) reporting present use. In adjusted analyses, increase likelihood of past use was associated with insufficient sleep on 1-2 (RRR=1.28, p=0.001), 3-4 (RRR=1.37, p<0.0005), 5-6 (RRR=1.30, p<0.0005), and 7 (RRR=1.34, p<0.0005) nights per week, as well as 1-2 (RRR=1.30, p<0.0005), 3-4 (RRR=1.52, p<0.0005), 5-6 (RRR=1.58, p<0.0005), and 7 (RRR=1.49, p<0.0005) nights per week of initial insomnia. Present use was associated with 1-2 (RRR=1.44, p<0.0005), 3-4 (RRR=1.76, p<0.0005), 5-6 (RRR=2.05, p<0.0005), and 7 (RRR=1.83, p<0.0005) nights per week of initial insomnia. When mental health was entered into the model, results were maintained. Conclusion Past use of hallucinogens was associated with insufficient sleep as well as insomnia. Present use was also associated with insomnia. When mental health was included in models, all results were maintained. It is not clear whether hallucinogen use leads to, or is predicted by, sleep difficulties. Support Dr. Grandner is supported by R01MD011600

National College Health Assessment II: propriedades psicométricas e concordância dos formatos impresso e on-line

Os objetivos do estudo foram: (a) identificar e comparar as propriedades psicométricas da versão brasileira do questionário National College Health Assessment II (NCHA IIc) nos formatos impresso e on-line; e (b) verificar a capacidade de concordância entre os dados levantados por ambos os formatos. Ambos os formatos do questionário foram preenchidos por 371 estudantes universitários voluntários. Para identificar as propriedades psicométricas foi calculado coeficiente alfa de Cronbach (consistência interna) e realizada análise fatorial confirmatória e de multigrupo. A concordância entre os modelos foi medida por meio do percentual de concordância, estatística Kappa e coeficiente intraclasse. Os resultados do estudo indicam que a versão brasileira on-line do NCHA IIc forneceu dados de qualidade semelhante ao formato impresso tradicional, com vantagens logísticas e de custos substanciais, possibilitando, desse modo, sua aplicação em estudos futuros com finalidade de analisar condutas de proteção e risco para saúde de estudantes universitários no Brasil.

Sex and Racial/Ethnic Differences in Suicidal Consideration and Suicide Attempts among US College Students, 2011-2015

Objectives: In this study, we examined sex and racial/ethnic differences in the prevalence and predictors of suicide consideration and attempts among US college students. Methods: We used multivariable logistic regression to investigate suicide consideration and attempts by sex and race/ethnicity among students (N = 319,342) who completed the American College Health Association-National College Health Assessment from fall 2011 to spring 2015. Results: Overall, the prevalence of suicide consideration and attempts was higher in spring 2015 than fall 2011 (p < .05). Men had higher odds of suicide consideration and attempts than women (p < .001). Blacks, Hispanics, and Asians had higher odds of suicide consideration and attempts compared with Whites (p < .001). Weight-related problems (unhealthy weight, body weight overestimation, and lack of physical activity), sleep problems (insufficient sleep and sleep difficulties), and lower levels of academic performance were associated with both suicide consideration and attempts (p < .05). Conclusions: Our findings indicate a need for sex- and race/ethnicity-specific suicide prevention strategies for college students, specifically men and racial/ethnic minority groups. Furthermore, appropriate weight and sleep management could be considered to help prevent suicide among US college students.

The prevalence of distress, depression, anxiety, and substance use issues among Indigenous post-secondary students in Canada

This study aimed to estimate the prevalence of mental illness and substance use among Indigenous students attending Canadian post-secondary institutions. We obtained data from the National College Health Assessment - American College Health Association Spring 2013 survey, which includes 34,039 participants in 32 post-secondary institutions across Canada. We calculated prevalence estimates with 95% confidence intervals (CI). We compared Indigenous and non-Indigenous students using age- and sex-adjusted prevalence ratios (PR) obtained from Poisson regression models. Of the total sample, 1,110 (3.3%) post-secondary students self-identified as Indigenous. Within the past 12 months, Indigenous students had higher odds of intentionally injuring themselves (PR = 1.53, 95% CI = 1.27–1.84), seriously considering suicide (PR = 1.32, 95% CI = 1.12–1.56), attempting suicide (PR = 1.74, 95% CI = 1.16–2.62), or having been diagnosed with depression (PR = 1.26, 95% CI = 1.08–1.47) or anxiety (PR = 1.18, 95% CI = 1.02–1.35) when compared with non-Indigenous students. Indigenous students also had higher odds of having a lifetime diagnosis of depression (PR = 1.31, 95% CI = 1.17–1.47) when compared with non-Indigenous students. Indigenous students were more likely to report binging on alcohol (PR = 1.10, 95% CI = 1.02–1.19), using marijuana (PR = 1.21, 95% CI = 1.06–1.37), and using other recreational drugs (PR = 1.32, 95% CI = 1.06–1.63) compared to non-Indigenous students. This study demonstrates that Indigenous students at post-secondary institutions across Canada experience higher prevalence of mental health and related issues compared to the non-Indigenous student population. This information highlights the need to assess the utilization and ensure the appropriate provision of mental health and wellness resources to support Indigenous students attending post-secondary institutions.