Adolescent Health Care: A Practical Guide

Chapter 84

Overview of Health Issues for College Students

Lawrence S. Neinstein

Paula L. Swinford

James A. H. Farrow

More than 17.6 million students were enrolled in 2006 in the nation's 4,392 colleges and universities with an anticipated 19.5 million by 2014. Almost two thirds (63%) of these students are in the 14- to 24-year-old age-group. College students of traditional age (18–24 years) compromise a unique population with specific health-related assets and vulnerabilities, whereas the college campus is a unique health environment that creates both risks and opportunities (Keeling, 2002). This makes colleges and universities, collectively referred to as Institutions of Higher Education (IHEs), critical settings for preventing or reducing health-risk behaviors and enhancing well-being among many young adults.

College health has as its mission the enhancement of the health of college students in support of advancing student academic success and the learning environment. IHEs provide a variety of services including the provision of health care to approximately 10 million adolescents, young adults, and adults in the United States. Nationally, there are approximately 1,600 colleges or universities that provide some level of services to advance the health of students (Patrick, 1988). Most common are medical or clinical services directed by a physician, nurse, nurse practitioner, or administrator. More than 150 of these institutions maintain an ambulatory health care center accredited by either the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). However, what specific services are offered varies widely in the United States, ranging from part-time nurses providing triage and referral to comprehensive ambulatory health care centers, and even public health, counseling, education, prevention services, and sometimes disability and recreational services. There are approximately 10 million students making as many as 30 million visits to these services per year at an approximate cost of $1.4 billion dollars. Approximately 5% to 25% of these visits were made to counseling services.

While it is beyond the scope of this book to offer a comprehensive review of the history and scope of college health, this chapter provides an overview of the following:

  • The philosophy of a model college health program
  • Demographics of the student population
  • Demographics of IHEs in the United States
  • Statistics regarding morbidity, mortality, and the health status in this student population
  • Information for providers when their patients start attending college
  • Information for parents when their children start attending college
  • Web-based resources for college students, parents, and health care professionals

Issues of college health may also be important to pediatricians and other health care professionals serving adolescents and young adults, for the following reasons:

  1. Health care providers often perform precollege examinations or provide care during college years.
  2. Health care providers may communicate with college health professionals regarding health care needs of a student while at school.
  3. Employment and career opportunities exist in the college setting.
  4. Opportunities for collaboration often exist between professionals in adolescent health and college health.
  5. Collaboration among insurance providers, local health care providers, health care providers in the college health program, and the university health care systems or medical schools can benefit all parties and especially students.
  6. College health professionals may be a source of ongoing referrals to other health care professionals of patients needing hospitalization or secondary and tertiary care consultations.
  7. Significant opportunities exist for both teaching and research.

The Philosophy of a Model College Health Program

Services that support and enhance the health of college students developed in colleges and universities over the last 150 years for numerous reasons such as the following (Swinford, 2002):

  • A call from faculty to create a support system to maintain the student's health for academic studies

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  • The public health and communicable disease concerns of a compact campus community, particularly before the advent of vaccines and antibiotics
  • The specialized medical needs of a predominately adolescent and young adult population that may differ from health care provided in the surrounding community
  • The confidentiality needs of young adults as they establish a new relationship with parents and their health care providers
  • The need for access to care and treatment for the many uninsured individuals in the college student population

A college health program is more than just the provision of quality medical services on campus. At its best, college health embraces a model that encompasses a variety of services focused on students' physical, emotional, and social health in the context of their cultural and academic influences. The “college health program” model is defined as a coordinated and planned set of policies, procedures, activities, programs, and services to enhance, protect, promote and improve the health and well-being of students, faculty, and staff of colleges, universities, and other IHEs (AAHE, 2006). This model includes significant interactions with the campus community and uses the best methods of health promotion and prevention including primary, secondary, and tertiary prevention. In addition, college health programs are usually staffed by a multidisciplinary team that includes members from various professional disciplines including medical, nursing, counseling, health promotion, and ancillary services staff. The Carnegie Foundation outlined college health as:

“The caring intersection between health and education. It is a community with a shared vision and common cause… college health is developmentally appropriate, educationally effective, medically expert, accessible, and convenient.”

--(Boyer, 1987)

Similar to the best of adolescent health care, health care for college students involves treating medical conditions while assessing, intervening, and preventing the student's behavioral and health risks. College health services also seek to reduce risk and reinforce behaviors that create health for the individual and for the community. The best practices in college health continually assess the student population on the particular campus to track their health status and identify service needs. Then the health center can provide a portfolio of services that include high-quality medical care, attention to psychosocial and developmental needs, primary prevention within the campus community, reduction of risk, and promotion of health at the individual and campus level. This may involve assessing health status and promoting health in students, who may never visit the health center, through, for example, population-based primary prevention programs such as mandatory prematriculation alcohol education. This may also involve campus outreach vaccination programs. Campus involvement often overlaps academic life, and student affairs programs such as residential life and orientation. The best practice of college health seeks such educational opportunities and promotes learning not just during the clinical visit or counseling appointment but throughout the campus culture.

Depending on the population's needs and the campus resources, a college health program may include the following (ACHA, 1999):

  1. Providing primary care, including medical and counseling services that are more accessible than community services and are specifically designed for students
  2. Providing services based on informative data regarding the health status and risk behaviors of the population and the change in response to that information
  3. Providing of health services that are caring and student centered
  4. Engaging health care professionals and campus partners in a multidisciplinary team approach
  5. Participating in campus life and advancing the academic mission and student learning mission of the institution
  6. Working with student affairs partners within a student development framework
  7. Preventing of illness, injury, and disease and reducing risk behaviors and promoting health-enhancing behaviors as a primary mission parallel to screening, treatment, and cure of illness, injury, and disease
  8. Welcoming the diversity of the student population by building cultural competency skills for the staff
  9. Encouraging of student participation as advisors to development and review of services
  10. Teaching students to become wise health care consumers, knowledgeable about accessing services in the health care delivery system
  11. Using prepayment to help maximize access to preventive services and treatment care without financial barriers

The American College Health Association (ACHA)'s Guidelines for a College Health Program states that: “Current sociological trends, high-risk identification, public health issues, health care finance reform, and changes in preventive medicine have broad institutional implications. College health programs have a unique opportunity to help meet those new challenges.”

Enrollment

There are almost 4,400 IHEs in the United States, with approximately 17.6 million students in Fall 2006, likely rising to approximately 18.8 million by the year 2010 and 19.5 million by 2014 (Hussar, 2005; National Center for Education Statistics, 2003). Data and extensive tables are available from the National Center for Education Statistics at http://nces.edu.gov/programs/digest as well as the almanac issues of the Chronicle of High Education.

Gender

Approximately 42% are male and 58% female.

Full Time Versus Part Time

Approximately 62% are full time and 38% part-time.

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Age Distribution (Fall, 2005)

(Digest of Education Statistics, NCES 2007)

Age

Millions Actual 2005 Projected 2006

Percent Actual 2005 Projected 2006

14–17 years

0.176

 1.0

 

0.181

 1.0

18–19 years

3.660

20.9

 

3.700

21.0

20–21 years

3.728

21.3

 

3.780

21.4

22–24 years

3.047

17.4

 

3.049

17.3

25–29 years

2.456

14.0

 

2.538

14.4

30–34 years

1.312

 7.5

 

1.294

 7.3

>35 years

3.108

17.8

 

3.105

17.6

Overall, 60.6% of enrolled students are 24 years or younger.

Digest of Education Statistics, 2006, National Center for Education Statistics, U.S. Department of Education, http://nces.ed.gov/programs/digest.

College Enrollment by Racial Group (1995–2005)

(The Chronicle of Higher Education, Almanac Issue 2007–2008)

 

1995 (%)

2005 (%)

White

72.2

65.7

Black

10.3

12.6

Hispanic

 7.6

10.8

Asian or Pacific Islander

 5.5

 6.5

American Indian/Alaska native

 0.9

 1.0

Non-resident alien

 3.2

 3.3

Total high school graduates enrolled in college by race: (61.6%)

Race

2001

1978

White

64.2%

50.5%

Black

54.6%

46.4%

Hispanic

51.5%

41.5%

Types of Universities (2005–2006)

(National Center for Education Statistics, 2006, N = 4,276 universities and colleges)

Four year (60% with majority being private)

 

  Public 4-year institutions

 640

  Private 4-year institutions

1,942

Two year (40% with majority being public)

 

  Public 2-year institutions

1,053

  Private 2-year institutions

 641

Number of Colleges by Enrollment, Fall 2005

 

All

Public

Private

Under 200

483

 14

469

200–499

616

 52

564

500–999

605

 91

514

1,000 to 2,499

916

328

588

2,500 to 4,999

657

382

275

5,000 to 9,999

484

384

100

10,000 to 19,999

311

263

 48

20,000 to 29,999

126

113

 13

30,000 or more

 55

 48

 7

Level of Student

Approximately 86% of enrolled students in 2004 were undergraduate students

Undergraduate:  14,780,630/17,272,044 = 85.6%

Postbaccalaureate:  2,491,414/17,272,044 = 14.4%

  First-professional: 334,529 (1.9%)

  Graduate: 2,156,885 (12.5%)

  (Chronicle of Higher Education, 2006)

Changing Student Profile

  1. The enrollment of students aged 25 years and above increased from 4.9 million in 1987 to 6.89 million in 2005; and increase of 41%. Although the proportion of students aged 25 years and above increased from 38% in 1987 to 43.8% in 1995, this percentage dropped in 2005 back down to 39.3% (The Chronicle of Higher Education, Almanac of Higher Education 2007–8).
  2. Women played a major role in the increase of enrollment between 1982 and 2005. The enrollment of women in college increased from 6.4 million in 1982 to over 10 million in 2005, representing an average annual growth rate of more than 2.5%, for a 57.5% increase over the period (The Chronicle of Higher Education, Almanac of Higher Education 2007–8).
  3. After several years of stagnation, the number of international college students coming to the United States was up again from 1998 onward, with an increase of almost 14% between 2000 and 2003. The number of international students has increased from approximately 179,000 in 1976 to 407,000 in 1990 and to 584,000 in 2005. Almost two thirds of the international students are from Asia.
  4. Approximately 25% of students do not have health insurance coverage and it is estimated that another 18% to 24% have inadequate insurance. Nationally, noninsurance rates rise rapidly with level of students from approximately 12% as freshman to almost 30% as seniors.
  5. Increasing numbers of undergraduate college students are on financial aid with the percentage of any aid rising from 58.7% in 1992–1993 to 72.5% in 1999–2000 to 76.1% in 2003–2004 (Digest of Education Statistics, 2006, National Center for Education Statistics, U.S. Department of Education, http://nces.ed.gov/programs/digest).
  6. Enrollment as a percentage of all 18- to 24-year-olds has increased between 1990 and 2001 from 35.2% to 39.3% for white, non-Hispanic; from 25.3% to 31.3% for African-Americans; and from 15.8% to 21.7% for Hispanic students (National Center for Education Statistics, 2005).
  7. Projections of future enrollment
  8. Between 2004 and 2014 enrollment is expected to go up from 17.6 million to 19.5 million in colleges and universities.

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  1. By age: The above increase is expected to be 16% for students 18 to 24 years old and 5% for students who are 35 years and older.
  2. By sex: The above increase is expected to be 12% for men and 21% for women.
  3. By attendance status: The above increase is expected to be 20% for full-time students and 14% for part-time students.
  4. By level: The increase is expected to be 16% for undergraduates, 21% for graduates, and 32% for first-professional students.
  5. By public versus private institutions: The increase is expected to be 17% in public institutions and 19% in private institutions.

By far the majority (80%) of college students attend campuses that have some organized arrangement for advancing their health (Patrick, 1988). Nationally, there are approximately 1,500 to 1,650 college health centers. There are approximately 10 million students making as many as 30 million visits per year at an approximate cost of $1.4 billion. In addition, approximately 5% to 25% of these students use the counseling center.

Morbidity and Mortality

Availability of data regarding morbidity and mortality in college students is less than that in other populations. Although an age-group is easily identified in most data sets, current college enrollment is rarely collected as part of standard demographic data. Given this, in recent decades the college student population has attracted specific focus. There was overall data collected from the youth risk behavior surveillance: National College Health Risk Behavior Survey (NCHRBS)—United States, 1995. While this was over 10 years ago, currently yearly health status data is available from the ACHA as the American College Health Association-National College Health Assessment Survey, the ACHA-NCHA (since 1999). National data are also available specifically on drug use from several studies, including Monitoring the Future Study (since 1975), Core Alcohol and Drug Survey (since 1989), the College Alcohol Study (Wechsler, 1997; 1999; 2002), and the Cooperative Institutional Research Program (CIRP) Freshman Survey.

Some overall trends found in the CIRP Freshman Survey have included the following:

  • Tobacco use: Down since 1966 (15%), to 1987 (7.2%), and 2006 (5.3%)
  • Alcohol use: Beer use down since 1987( 65.4%) to 2006 (42.3%) and “wine and other liquor” down since 1987 (67.8%) to 2006 (48.6%)
  • Mental health: Feeling “Overwhelmed” has been up since 1987 (18.6%) to 2006 (28.7%). However, this is lower than the 30.7% listing this in 1999. “Feeling depressed” has been down since 1987 (9%) to 2006 (7.3%).

2006 Spring ACHA-NCHA

Acknowledging the need for college student population health status data, the ACHA began conducting national surveys in the spring of 2000. The 2006 ACHA-NCHA data set (results available at www.acha.org) includes 117 IHEs (113, 4-year and 4, 2-year institutions) that chose randomly selected students (N = 94,806). While the students are selected on a randomized manner, the IHEs were not chosen on a random basis. In terms of student enrollment, 24 had more than 20,000 students; 37 had between 10,000 and 19,999; 26 had between 5,000 and 9,999; 14 had between 2,500 and 4,999; and 16 had less than 2,500. The sample of students was 61% female and 82% undergraduate. The ethnicity of the students was 73% white, 5% African-American, 6% Hispanic, 12% Asian, and 4% other. Almost 88% of the students reported having some kind of health care insurance. Thirteen percent of the students sample had a monthly unpaid credit card balance of $1,000 or more. This data is available at <http://www.acha.org/projects_programs/assessment.cfm>. The ACHA-NCHA data throughout the rest of this chapter is from the aforementioned Web site or from the ACHA-NCHA's Reference Group Data Report (Spring, 2006).

The ACHA-NCHA suggests the following:

  • Many college students were involved in activities that placed them at increased risks.
  • Heavy drinking episodes: More than one third (37%) of college students reported at least one event of consuming five or more alcoholic drinks at a setting, during the 2-week period preceding the survey.
  • Many college students fail to protect themselves against sexually transmitted diseases (STDs) and pregnancy. Of the students who are sexually active, a little more than half (52%) used a condom the last time they had vaginal intercourse.
  • Approximately 60% of students failed to engage in vigorous or moderate physical activity at recommended levels 3 or more times/week.

Injuries

Unintentional Injuries

2006 ACHA-NCHA data (within the last school year)

  • 5.9% rarely or never used a seat belt (of drivers).
  • 67.5% rarely or never wore bicycle helmets (of riders).
  • 84.6% rarely or never wore helmets when inline skating (of skaters).
  • 22.4% rarely or never wore motorcycle helmet (of riders).
  • 5% drove a car after having five or more drinks in last 30 days (of drivers).

Intentional Injuries

2006 ACHA-NCHA data (within the last school year)

  • 6.2% were involved in fights (11.3% in males and 3% in females).
  • 1.4% experienced sexual penetration against their will (1.8% females and 0.7% males) while 2.7% experienced attempted sexual penetration against their will.
  • 8.4% experienced sexual touching against their will (10.7% females and 4.2% males).

Suicide

2006 ACHA-NCHA data

Suicidal ideation and attempt (within the last school year)

 

Suicidal Ideation

Suicide Attempt

Total

9.3%

1.3%

Female

9.8%

1.3%

Male

8.4%

1.2%

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Although lower than the high school adolescent population, in which almost 12% of female adolescents and 5.6% of boys have attempted suicide, the rates are still significant. Of the group, 43.8% reported feeling so depressed it was difficult to function in the last year.

Alcohol, Tobacco, and Other Drug Use

Monitoring the Future data for college students is available in the figures and tables in this chapter and further information is available in Volume II of the National Survey Results onDrug Use, 1975–2006, Monitoring the Future (Johnston et al., 2005, www.monitoringthefuture.org). This data examines both young adult high school graduates aged 19 to 32 as well as college students. See Tables for lifetime, annual, 30 day, and 30-day daily prevalence use of drugs among college students compared to their age-matched peers not in college. Tables give the trends in these prevalence rates from 1980 to 2006. Figure 84.1 shows trends in annual prevalence of any illicit drug, Figure 84.2 shows trends in 2-week prevalence of five or more drinks in a row, and Figure 84.3 shows trends in daily cigarette usage. Starting in 1980, the 2006 survey marks the 26th year of following up drug use in the college population. Trends noticed in this report include the following:

  • Overall, use of illicit drugs fell among American college students and young adults between late 1970s and early 1990s. These declines seemed most correlated with perceived risk and not availability of the drug. However, there have been increases in the usage rates since 1994 for many drugs among high school seniors and college students.
  • In 2006, the rank order for annual prevalence of using any illicit drug was 12th graders (36.5%), college students (33.9%), 19- to 28-year-olds (32.1%), 10th graders (28.7%), and 8th graders (14.8%). In general, the trends for most illicit drugs use in college students paralleled noncollege peers in the 1980s. However, in the 1990s the trends diverge; college students showed less increase than their age-mates not in college. In 2006, for most categories of drugs, college students showed rates of use that are similar to those of their age peers. Annual prevalence for any illicit drug is 33.9% among college students versus 32.1% among noncollege age-mates. For any illicit drug other than marijuana this difference is 18.1% versus 18.4%. For a few drugs, college students show higher rates of use than their age-mates including Ritalin, marijuana and hallucinogens. While college-bound seniors have below-average rates of use in high school for all of the illicit drugs, these students' eventual use of some illicit drugs becomes equal or exceeds those not attending college. This has become known as the “catching up” or “college effect.” This influence has been correlated to leaving the parental home after graduation (more likely in college students) or getting married (less likely in college students).
  • Smoking:In the first half of the 1990s, smoking rose among college students and their same-age peers, although the increases were not as steep for either group as they were among high school seniors. However, in 1998 and 1999, while smoking was declining among secondary school students in all grades, smoking increased significantly for college students. Between 1990 and 1999, the 30-day prevalence of cigarette smoking in college students rose from 22% to 31% and daily smoking rose from 12% to 19%. The year 2000 shows, for the first time in several years, a decline in college student smoking. This is likely reflective of the decline in younger students as they work their way into college. In 2006, out of all the substances studied, cigarette smoking showed the greatest absolute difference between age-matched college students and non–college students (9.2% daily smoking prevalence versus 18.6% for same aged high school graduates not in college). Among college students, females had a slightly higher probability of being a daily smoker from 1980 through 1994, with a reversal of this from 1994 to 2001. Since 2001, there is little consistent gender difference in smoking among college students.
  • Alcohol use:Alcohol has been tried by 86.6% of college students. In 2006, the lifetime and annual use of alcohol among college students was not significantly different from age-matched peers not in college. In 2006, 30-day use was higher (65%) in college students than non–college age-matched peers (61%) but daily drinking in college students was lower (4.8%) than their non–college peer group (5.7%). However, college students have the highest rate of occasions of heavy drinking (five or more drinks in a row in the last 2 weeks). In 2006, this was 11% for 8th graders, 22% for 10th graders, 25.1% for 12th graders, 40.2% (45.2% in males) for college students, and 34.7% for age-matched peers not in college. Episodes of heavy drinking have declined far less among college students than high school seniors and noncollege age-mates. Between 1981 and 1992, heavy drinking dropped by 11 percentage points among noncollege 19- to 22-year-olds, but only by 2 percentage points among college students. Therefore, college students stand out as having high rates of binge (or party) drinking. Because college-bound seniors in high school are consistently less likely to report occasions of heavy drinking compared to non–college-bound students, it appears that the higher rates of heavy drinking episodes in college indicate a college-related increase in binge drinking or what is being called the “college effect.” Among college students and young adults in general, there are substantial gender differences in alcohol use. College males drink the most with 50% of college males reporting five or more drinks in a row over prior 2 weeks compared to 34.4% of college females. Over the years of this survey, alcohol use did not increase as other illicit drug use decreased and in fact the opposite appeared true. This supports the notion that alcohol use moves much more in parallel with other illicit drugs, rather than in the opposite direction.
  • Marijuana use:The annual prevalence of marijuana use among college students decreased markedly from 1981 through 1991, from 51% to 27%. In the 1990s, there was an increase in marijuana use in college students that followed the increase in high school students as these students replaced their peers in college. This was a reversal of the way the epidemic started in the 1960s when drug usage started on college campuses and spread downward to high school students and then to junior high school students. Daily marijuana use rose substantially among college students between 1992 and 2003 but appears to have decreased since.
  • Lysergic acid diethylamide(LSD): During the early 1980s, one of the largest proportional declines in college

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students was for use of LSD with annual prevalence rates falling from 6.3% in 1982 to 2.2% in 1985. However, usage increased after 1985, reaching 6.9% in 1995. After peaking in 1995, use among college students and young adults declined through 2005 (0.7%) but increased in 2006 to 1.4%. However, there is some evidence that at the same time there may have been some displacement of LSD usage to ecstasy (methylenedioxymethamphetamine [MDMA]) as well as tranquilizer usage.

  • MDMA (ecstasy):MDMA (ecstasy) had a substantial increase in annual use in college students starting in 1995 (3.6%) to 2001 (9.2%). However, 2002 (6.8%) marked the beginning of a decline with the annual prevalence rate at 2.6% in 2006.

TABLE 84.1
Lifetime Prevalence of Use for Various Types of Drugs, 2006: Full-Time College Students versus Others Among Respondents 1 to 4 Years Beyond High School (Entries are percentages)

 

Total

Males

Females

 

Full-Time College

Others

Full-Time College

Others

Full-Time College

Others

LSD, lysergic acid diethylamide; MDMA, methylenedioxymethamphetamine
“*” indicates a percentage of <0.05%.
a Use of “any illicit drug” includes any use of marijuana, hallucinogens, cocaine, heroin or other narcotics, amphetamines, sedatives (barbiturates), or tranquilizers not under a doctor's orders.
b This drug was asked about in three of the six questionnaire forms. Total n in 2006 for college students is approximately 640.
c This drug was asked about in five of the six questionnaire forms. Total n in 2006 for college students is approximately 1,060.
d This drug was asked about in four of the six questionnaire forms. Total n in 2006 for college students is approximately 850.
e This drug was asked about in two of the six questionnaire forms. Total n in 2006 for college students is approximately 430.
f Only drug use that was not under a doctor's orders is included here.
g On the basis of the data from the revised question, which attempts to exclude inappropriate reporting of nonprescription amphetamines.
h This drug was asked about in one of the six questionnaire forms. Total n in 2006 for college students is approximately 210.
From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:234. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.

Any illicit druga

50.6

61.0

55.0

58.0

47.8

63.3

Any illicit druga

           

Other than marijuana

26.3

35.5

29.2

33.9

24.4

36.7

Marijuana

46.9

57.8

52.8

55.0

43.1

59.8

Inhalantsb

7.4

11.9

8.5

12.6

6.6

11.4

Hallucinogens

10.6

14.9

15.5

17.0

7.5

13.4

LSD

3.5

6.8

4.7

7.9

2.8

6.1

Hallucinogens

           

Other than LSD

10.1

13.6

15.3

15.7

6.8

12.0

Cocaine

7.7

17.1

10.5

18.3

6.0

16.2

Crackc

2.3

6.2

2.7

6.5

2.0

6.0

Other cocained

6.2

17.1

8.8

18.1

4.7

16.4

MDMA (Ecstasy)b

6.9

12.3

7.0

11.3

6.8

13.0

Heroin

0.7

2.0

1.1

2.5

0.4

1.7

With a needlee

0.3

0.6

0.8

1.0

*

0.3

Without a needlee

0.8

1.9

0.8

3.3

0.8

0.8

Other narcoticsf

14.6

19.7

18.5

19.2

12.1

20.0

Amphetamines, adjustedf,g

10.7

17.5

11.9

15.2

9.9

19.2

Methamphetaminee

2.9

10.5

4.0

11.3

2.2

10.0

Icee

1.7

8.1

3.3

6.8

0.7

8.9

Sedatives (Barbiturates)f

6.3

11.1

8.5

11.3

4.9

10.9

Tranquilizersf

10.0

16.1

12.4

15.1

8.4

16.8

Alcohol

84.7

83.8

83.0

83.8

85.7

83.8

Been drunkb

73.1

76.4

72.1

79.4

73.7

74.2

Flavored alcoholic beverageh

80.9

79.5

78.7

75.5

82.4

82.2

Cigarettes

NA

NA

NA

NA

NA

NA

Steroidse

1.9

1.3

3.9

3.0

0.7

*

Approximate weighted n = 1,280

870

500

370

780

500

TABLE 84.2
Annual Prevalence of Use for Various Types of Drugs, 2006: Full-Time College Students versus Others Among Respondents 1 to 4 Years Beyond High School (Entries are percentages)

 

Total

Males

Females

 

Full-Time College

Others

Full-Time College

Others

Full-Time College

Others

LSD, lysergic acid diethylamide; MDMA, methylenedioxymethamphetamine; GHB, gamma hydroxybutyrate.
“*” indicates a percentage of <0.05%.
a Use of “any illicit drug” includes any use of marijuana, hallucinogens, cocaine, heroin or other narcotics, amphetamines, sedatives (barbiturates), or tranquilizers not under a doctor's orders.
b This drug was asked about in three of the six questionnaire forms. Total n in 2006 for college students is approximately 640.
c This drug was asked about in five of the six questionnaire forms. Total n in 2006 for college students is approximately 1,060.
d This drug was asked about in four of the six questionnaire forms. Total n in 2006 for college students is approximately 850.
e This drug was asked about in two of the six questionnaire forms. Total n in 2006 for college students is approximately 430.
f Only drug use that was not under a doctor's orders is included here.
g On the basis of the data from the revised question, which attempts to exclude inappropriate reporting of nonprescription amphetamines.
h This drug was asked about in one of the six questionnaire forms. Total n in 2006 for college students is approximately 210.
From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:235. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.

Any illicit druga

33.9

39.7

39.2

39.3

30.6

39.9

Any illicit druga

           

 Other than marijuana

18.1

23.0

22.6

23.6

15.2

22.5

Marijuana

30.2

35.2

35.8

34.9

26.6

35.3

Inhalantsb

1.5

3.5

1.6

3.8

1.4

3.3

Hallucinogens

5.6

5.7

10.1

7.1

2.7

4.6

 LSD

1.4

2.5

1.9

3.6

1.0

1.6

 Hallucinogens

           

  Other than LSD

5.4

4.8

9.7

6.1

2.7

3.7

Cocaine

5.1

9.9

7.3

12.9

3.7

7.6

 Crackc

1.0

2.1

1.0

2.3

1.0

2.0

 Other cocained

3.8

9.8

5.9

14.1

2.6

6.7

MDMA (Ecstasy)b

2.6

5.2

3.8

4.7

1.9

5.6

Heroin

0.3

1.0

0.5

1.3

0.2

0.7

 With a needlee

0.3

0.5

0.8

0.7

*

0.3

 Without a needlee

0.3

1.2

0.6

2.1

0.2

0.6

Other narcoticsf

8.8

11.9

12.8

13.3

6.3

10.9

 OxyContine

3.0

3.6

5.4

4.8

1.5

2.8

 Vicodine

7.6

11.1

12.3

12.4

4.6

10.2

Amphetamines, adjustedf,g

6.0

8.6

7.2

7.9

5.3

9.0

 Ritaline,f

3.9

3.0

5.0

4.5

3.1

1.9

 Methamphetaminee

1.2

4.7

1.2

5.8

1.2

3.8

 Icee

0.6

3.3

0.9

2.4

0.4

4.0

Sedatives (Barbiturates)f

3.4

6.3

4.7

6.1

2.6

6.4

Tranquilizersf

5.8

8.5

8.0

8.9

4.4

8.1

Rohypnole

0.2

0.7

0.3

1.5

0.2

0.2

GHBe

*

0.4

*

0.8

*

0.2

Ketaminee

0.9

1.3

1.5

0.8

0.5

1.6

Alcohol

82.1

78.9

80.5

80.0

83.0

78.0

 Been drunkb

66.2

63.6

66.5

68.0

66.0

60.4

 Flavored alcoholic beverageh

63.5

59.0

59.7

54.2

66.0

62.2

Cigarettes

30.9

44.6

34.1

45.9

28.8

43.6

Steroidse

0.8

0.7

2.0

1.6

*

*

Approximate weighted n = 1,280

870

500

370

780

500

TABLE 84.3
Thirty-Day Prevalence of Use for Various Types of Drugs, 2006: Full-Time College Students versus Others Among Respondents 1 to 4 Years Beyond High School (Entries are percentages)

 

Total

Males

Females

 

Full-Time College

Others

Full-Time College

Others

Full-Time College

Others

LSD, lysergic acid diethylamide; MDMA, methylenedioxymethamphetamine.
“*” indicates a percentage of <0.05%.
a Use of “any illicit drug” includes any use of marijuana, hallucinogens, cocaine, heroin or other narcotics, amphetamines, sedatives (barbiturates), or tranquilizers not under a doctor's orders.
b This drug was asked about in three of the six questionnaire forms. Total n in 2006 for college students is approximately 640.
c This drug was asked about in five of the six questionnaire forms. Total n in 2006 for college students is approximately 1,060.
d This drug was asked about in four of the six questionnaire forms. Total n in 2006 for college students is approximately 850.
e Only drug use that was not under a doctor's orders is included here.
f On the basis of the data from the revised question, which attempts to exclude inappropriate reporting of nonprescription amphetamines.
g This drug was asked about in two of the six questionnaire forms. Total n in 2006 for college students is approximately 430.
h This drug was asked about in one of the six questionnaire forms. Total n in 2006 for college students is approximately 210.
From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:236. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf

Any illicit druga

19.2

21.8

23.4

21.5

16.6

22.0

Any illicit druga

           

  Other than marijuana

8.2

10.6

10.3

11.3

6.9

10.1

Marijuana

16.7

18.6

21.3

18.9

13.8

18.3

Inhalantsb

0.4

0.6

0.7

0.9

0.3

0.5

Hallucinogens

0.9

1.2

1.5

1.2

0.5

1.3

 LSD

0.3

0.4

0.4

0.5

0.2

0.4

 Hallucinogens

           

 Other than LSD

0.7

1.0

1.2

1.0

0.4

0.9

Cocaine

1.8

3.2

3.2

3.5

1.0

3.0

 Crackc

*

0.5

0.1

0.4

*

0.6

 Other cocained

1.3

3.2

2.3

3.7

0.7

2.8

MDMA (Ecstasy)b

0.6

1.1

0.7

1.3

0.6

0.9

Heroin

0.2

0.4

0.4

0.6

0.0

0.2

Other Narcoticse

3.1

4.8

4.3

5.6

2.3

4.3

Amphetamines, adjustede,f

2.5

3.0

2.1

3.2

2.7

2.9

 Iceg

*

1.5

*

2.0

*

1.1

Sedatives (Barbiturates)e

1.3

2.6

1.3

2.2

1.2

2.8

Tranquilizerse

2.1

3.7

2.9

4.9

1.6

2.9

Alcohol

65.4

61.0

65.7

64.9

65.2

58.1

 Been drunkb

47.6

40.2

52.2

46.9

44.7

35.2

 Flavored alcoholic beverageh

26.2

30.5

19.7

34.2

30.6

28.1

Cigarettes

19.2

35.7

20.9

38.3

18.1

33.8

   Approximate weighted n = 1,280

870

500

370

780

500

  • Amphetamines:Between 1982 and 1992 amphetamine annual use declined among college students from 21% to 3.6%. However, annual use increased among college students to 7.2% in 2001 and has decreased since then to 6.0% in 2006. The annual use prevalence is 8.6% for age-matched peers not in college. The perceived risk dropped in 1993 and this may account for the increase in usage in the 1990s.

P.1088

 

TABLE 84.4
Thirty-Day Prevalence of Daily Use for Various Types of Drugs, 2006: Full-Time College Students versus Others Among Respondents 1 to 4 Years Beyond High School (Entries are percentages)

 

Total

Males

Females

 

Full-Time College

Others

Full-Time College

Others

Full-Time College

Others

“*” indicates a percentage of <0.05%.
a Daily use is defined as use on 20 or more occasions in the past 30 days except for cigarettes, for which actual daily use is measured, and for five or more drinks, for which the prevalence of having five or more drinks in a row in the last two weeks is measured.
b Only drug use that was not under a doctor's orders is included here.
c On the basis of data from the revised question, which attempts to exclude inappropriate reporting of nonprescription amphetamines.
From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:237. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.

Marijuanaa

4.3

6.7

5.5

8.0

3.6

5.7

Cocainea

0.1

0.2

0.2

0.2

*

0.3

Amphetamines, adjusteda,b,c

0.4

0.1

0.3

*

0.4

0.2

Alcohol

           

Dailya

4.8

5.7

7.3

7.5

3.2

4.3

Five or more drinks in a row in past 2 wk

40.2

34.7

45.2

41.1

37.1

29.8

Cigarettes

           

Daily

9.2

25.8

9.9

27.2

8.7

24.8

Half-pack or more per day

4.9

17.0

6.9

17.6

3.6

16.5

     Approximate weighted n = 1,280

870

500

370

780

500

TABLE 84.5
Lifetime, Annual, and 30-Day Prevalence of an Illicit Drug Use Index, 2005: Full-Time College Students versus Others among Respondents 1 to 4 Years beyond High School

 

Total

Males

Females

 

Full-Time College

Others

Full-Time College

Others

Full-Time College

Others

Entries are percentages
a Use of “any illicit drug” includes any use of marijuana, hallucinogens, cocaine, heroin or other narcotics, amphetamines, sedatives (barbiturates), or tranquilizers not under a doctor's orders.
From Johnston LD, O'Malley PM, Bachman JG, et al. Monitoring the future volume II of the national survey results on drug use, 1975–2005, Bethesda, MD: National Institute on Drug Abuse, www.monitoringthefuture.org. 2006.

 

Lifetime

Any illicit druga

52.3

61.6

54.2

62.1

51.3

61.3

Any illicit drug

           

 other than marijuana

26.5

35.2

29.0

36.5

25.1

34.1

 

Past 12 Months

Any illicit drug

36.6

39.6

40.7

40.8

34.2

38.7

Any illicit drug

           

 other than marijuana

18.5

23.4

21.1

24.0

16.9

23.0

 

Past 30 Days

Any illicit drug

19.5

23.9

22.9

27.0

17.5

21.7

Any illicit drug

           

 other than marijuana

8.2

11.0

10.3

11.0

7.0

11.0

Approximate weighted N =

1,360

850

500

360

860

490

P.1089

 

P.1090

 

TABLE 84.6
Trends in Lifetime Prevalence of Various Types of Drugs Among College Students 1 to 4 Years Beyond High School

 

Percentage who used in lifetime

 

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

‘05–’06change

 

LSD, lysergic acid diethylamide; MDMA, methylenedioxymethamphetamine.
Level of significance of difference between the two most recent years: s = 0.05, ss = 0.01, sss = 0.001. Any apparent inconsistency between the change estimate and the prevalence estimates for the two most recent years is due to rounding.
“NA” indicates data not available.
a “Any illicit drug” includes use of marijuana, hallucinogens, cocaine, heroin or other narcotics, amphetamines, sedatives (barbiturates), methaqualone (until 1990), or tranquilizers not under a doctor's orders.
b This drug was asked about in four of the five questionnaire forms in 1980–1989, in five of the six forms in 1990–1998, and in three of the six forms in 1999–2006. Total n in 2006 is approximately 650.
c In 2001 the question text was changed on half the questionnaire forms. “Other psychedelics” was changed to “other hallucinogens,” and “shrooms” was added to the list of examples. For tranquilizers, “Miltown” was replaced with “Xanax” in the list of examples. Beginning in 2002 the remaining forms were changed to the new wording.
d This drug was asked about in two of the five questionnaire forms in 1989, in two of the six questionnaire forms in 1990–2001, and in three of the six questionnaire forms in 2002–2006. Total n in 2006 is approximately 650.
e This drug was asked about in two of the five questionnaire forms in 1987–1989, in all six questionnaire forms in 1990–2001, and in five of the six questionnaire forms in 2002–2006. Total n in 2006 is approximately 1,070.
f This drug was asked about in one of the five questionnaire forms in 1987–1989 and in four of six questionnaire forms in 1990–2006. Total n in 2006 is approximately 850.
g Only drug use that was not under a doctor's orders is included here.
h In 2002 the question text was changed on hall of the questionnaire forms. The list of examples of narcotics other than heroin was updated: Talwin, laudanum, and paregoric—all of which had negligible rates of use by 2001—were replaced by Vicodin, OxyContin, and Percocef. The 2002 data presented here are based on the changed forms only; n is one half on n indicated. In 2003 the remaining forms were changed to the new wording. The data are based on all forms in 2003 and beyond.
i On the basis of the data from the revised question, which attempts to exclude inappropriate reporting of nonprescription amphetamines.
j This drug was asked about in the two of the six questionnaire forms. Total n in 2006 is approximately 430.
k “Sedatives, adjusted” data are a combination of barbiturate and methaqualone data.
l Use of “Any Rx Drug” includes any use of amphetamines, sedatives (barbiturates), franquilizers, and/or narcotics other than heroin not under a doctor's orders.
m In 1993 and 1994, the question text was changed slightly in three of the six questionnaire forms to indicate that a “drink” meant “more than just a few sips.” Because this revision resulted in rather little change in reported prevalence in the surveys of high school graduates, the data for all forms combined are used in order to provide the most reliable estimate of change. After 1994 the new question text was used in all six of the questionnaire forms.
n This drug was asked about in three of the six questionnaire forms. Total n in 2006 is approximately 640.
o This drug was asked about in one of the six questionnaire forms. Total n in 2006 is approximately 220.
p This drug was asked about in one of the five questinnaire forms in 1989 and in two of the six questionnaire forms in 1990–2006. Total n in 2006 is approximately 430.
q Daily use is defined as use on 20 or more occasions in the past 30 days except for cigarettes, for which actual daily use is measured, and for five or more drinks, for which the prevalence of having five or more drinks in a row in the last 2 weeks is measured.
r Revised questions about amphetamine use were introduced in 1982 to more completely exclude inappropriate reporting of nonprescription amphetamines. The data in italics are therefore not strictly comparable to the other data.
From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:249–251. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.

 

Approximate weighted n

1,040

1,130

1,150

1,170

1,110

1,080

1,190

1,220

1,310

1,300

1,400

1,410

1,490

1,490

1,410

1,450

1,450

1,480

1,440

1,440

1,350

1,340

1,260

1,270

1,400

1,360

1,280

   

Any illicit druga

69.4

66.8

64.6

66.9

62.7

65.2

61.8

60.0

58.4

55.6

54.0

50.4

48.8

45.9

45.5

45.5

47.4

49.0

52.9

53.2

53.7

53.6

51.8

53.9

52.2

52.3

50.6

-1.8

 

Any illicit druga

                                                         

Other than marijuana

42.2

41.3

39.6

41.7

38.6

40.0

37.5

35.7

33.4

30.5

28.4

25.8

26.1

24.3

22.0

24.5

22.7

24.4

24.8

25.5

25.8

26.3

26.9

27.6

28.0

26.5

26.3

-0.3

 

Marijuana

65.0

63.3

60.5

63.1

59.0

60.6

57.9

55.8

54.3

51.3

49.1

46.3

44.1

42.0

42.2

41.7

45.1

46.1

49.9

50.8

51.2

51.0

49.5

50.7

49.1

49.1

46.9

-2.2

 

Inhalantsb

10.2

8.8

10.6

11.0

10.4

10.6

11.0

13.2

12.6

15.0

13.9

14.4

14.2

14.8

12.0

13.8

11.4

12.4

12.8

12.4

12.9

9.6

7.7

9.7

8.5

7.1

7.4

+ 0.3

 

Hallucinogensc

15.0

12.0

15.0

12.2

12.9

11.4

11.2

10.9

10.2

10.7

11.2

11.3

12.0

11.8

10.0

13.0

12.6

13.8

15.2

14.8

14.4

14.8

13.6

14.5

12.0

11.0

10.6

-0.5

 

LSD

10.3

8.5

11.5

8.8

9.4

7.4

7.7

8.0

7.5

7.8

9.1

9.6

10.6

10.6

9.2

11.5

10.8

11.7

13.1

12.7

11.8

12.2

8.6

8.7

5.6

3.7

3.5

-0.2

 

Hallucinogens

                                                         

Other than LSDc

11.6

9.0

10.6

8.3

9.2

8.1

7.8

6.8

6.2

6.2

6.0

6.0

5.7

5.4

4.4

6.5

6.5

7.5

8.7

8.8

8.2

10.7

11.0

12.8

10.1

10.6

10.1

-0.5

 

MDMA (Ecstasy)d

NA

NA

NA

NA

NA

NA

NA

NA

NA

3.8

3.9

2.0

2.9

2.3

2.1

3.1

4.3

4.6

6.8

8.4

13.1

14.7

12.7

12.9

10.2

8.3

6.9

-1.3

 

Cocaine

22.0

21.5

22.4

23.1

21.7

22.9

23.3

20.6

15.8

14.6

11.4

9.4

7.9

6.3

5.0

5.5

5.0

5.6

8.1

8.4

9.1

8.6

8.2

9.2

9.5

8.8

7.7

-1.1

 

Cracke

NA

NA

NA

NA

NA

NA

NA

3.3

3.4

2.4

1.4

1.5

1.7

1.3

1.0

1.8

1.2

1.4

2.2

2.4

2.5

2.0

1.9

3.1

2.0

1.7

2.3

+ 0.6

 

Other cocainef

NA

NA

NA

NA

NA

NA

NA

18.1

14.2

16.0

10.2

9.0

7.6

6.3

4.6

5.2

4.6

5.0

7.4

7.8

8.1

8.3

8.6

8.5

9.3

8.1

6.2

-1.9

 

Heroin

0.9

0.6

0.5

0.3

0.5

0.4

0.4

0.6

0.3

0.7

0.3

0.5

0.5

0.6

0.1

0.6

0.7

0.9

1.7

0.9

1.7

1.2

1.0

1.0

0.9

0.5

0.7

+ 0.2

 

Other narcoticsg,h

8.9

8.3

8.1

8.4

8.9

6.3

8.8

7.6

6.3

7.6

6.8

7.3

7.3

6.2

5.1

7.2

5.7

8.2

8.7

8.7

8.9

11.0

12.2

14.2

13.8

14.4

14.6

+ 0.2

 

Amphetaminesg

29.5

29.4

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

 

Amphetamines, adjustedg,i

NA

NA

30.1

27.8

27.8

25.4

22.3

19.8

17.7

14.6

13.2

13.0

10.5

10.1

9.2

10.7

9.5

10.6

10.6

11.9

12.3

12.4

11.9

12.3

12.7

12.3

10.7

-1.6

 

Methamphetaminej

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

7.1

5.1

5.3

5.0

5.8

5.2

4.1

2.9

-1.2

 

Crystal meth. (Ice)j

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

1.0

1.3

0.6

1.6

1.3

1.0

0.8

1.6

2.2

2.8

1.3

2.3

2.0

2.9

2.2

2.4

1.7

-0.7

 

Sedatives

                                                         

 (Barbiturates)g

8.1

7.8

8.2

6.6

6.4

4.9

5.4

3.5

3.6

3.2

3.8

3.5

3.8

3.5

3.2

4.0

4.6

5.2

5.7

6.7

6.9

6.0

5.9

5.7

7.2

8.5

6.3

-2.2 s

 

Sedatives, adjustedg,k

13.7

14.2

14.1

12.2

10.8

9.3

8.0

6.1

4.7

4.1

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

 

Methaqualoneg

10.3

10.4

11.1

9.2

9.0

7.2

5.8

4.1

2.2

2.4

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

 

Tranquilizersc,g

15.2

11.4

11.7

10.8

10.8

9.8

10.7

8.7

8.0

8.0

7.1

6.8

6.9

6.3

4.4

5.4

5.4

6.9

7.7

8.2

8.8

9.7

10.7

11.0

10.6

11.9

10.0

-1.9

 

Any Rx drugl

35.9

34.2

34.9

33.7

32.3

29.8

28.5

26.3

24.2

22.0

20.5

20.3

18.4

17.0

15.1

17.6

15.5

18.4

17.7

19.3

19.8

21.1

20.7

22.8

22.9

22.9

22.2

-0.7

 

Alcoholm

94.3

95.2

95.2

95.0

94.2

95.3

94.9

94.1

94.9

93.7

93.1

93.6

91.8

89.3

88.2

88.5

88.4

87.3

88.5

88.0

86.6

86.1

86.0

86.2

84.6

86.6

84.7

-2.0

 

Been drunkn

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

79.6

76.8

76.4

74.4

76.6

76.2

77.0

76.8

75.1

74.7

76.1

75.1

74.9

73.4

72.9

73.1

+ 0.2

 

Flavored alcoholic beverageo

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

79.0

84.5

80.9

-3.6

 

Cigarettes

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

 

Steroidsp

NA

NA

NA

NA

NA

NA

NA

NA

NA

0.4

1.5

1.4

1.7

1.9

0.5

0.8

0.6

1.6

0.9

1.3

0.6

1.5

1.2

1.2

1.6

1.0

1.9

+ 0.9

 

P.1091

 

P.1092

 

TABLE 84.7
Trends in Annual Prevalence of Various Types of Drugs Among College Students 1 to 4 Years Beyond High School

Percentage who used in past year

 

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

‘05–’06change

LSD, lysergic acid diethylamide; MDMA, methylenedioxymethamphetamine; GHB, gamma hydroxybutyrate
Level of significance of difference between the two most recent years: s = 0.05, ss = 0.01, sss = 0.001. Any apparent inconsistency between the change estimate and the prevalence estimates for the two most recent years is due to rounding.
“NA” indicates data not available.
a “Any illicit drug” includes use of marijuana, hallucinogens, cocaine, heroin or other narcotics, amphetamines, sedatives (barbiturates), methaqualone (until 1990), or tranquilizers not under a doctor's orders.
b This drug was asked about in four of the five questionnaire forms in 1980–1989, in five of the six forms in 1990–1998, and in three of the six forms in 1999–2006. Total n in 2006 is approximately 650.
c In 2001 the question text was changed on half the questionnaire forms. “Other psychedelics” was changed to “other hallucinogens,” and “shrooms” was added to the list of examples. For tranquilizers, “Miltown” was replaced with “Xanax” in the list of examples. Beginning in 2002 the remaining forms were changed to the new wording.
d This drug was asked about in two of the five questionnaire forms in 1989, in two of the six questionnaire forms in 1990–2001, and in three of the six questionnaire forms in 2002–2006. Total n in 2006 is approximately 650.
e This drug was asked about in two of the five questionnaire forms in 1987–1989, in all six questionnaire forms in 1990–2001, and in five of the six questionnaire forms in 2002–2006. Total n in 2006 is approximately 1,070.
f This drug was asked about in one of the five questionnaire forms in 1987–1989 and in four of six questionnaire forms in 1990–2006. Total n in 2006 is approximately 850.
g Only drug use that was not under a doctor's orders is included here.
h In 2002 the question text was changed on hall of the questionnaire forms. The list of examples of narcotics other than heroin was updated: Talwin, laudanum, and paregoric—all of which had negligible rates of use by 2001—were replaced by Vicodin, OxyContin, and Percocef. The 2002 data presented here are based on the changed forms only; n is one half on n indicated. In 2003 the remaining forms were changed to the new wording. The data are based on all forms in 2003 and beyond.
i On the basis of the data from the revised question, which attempts to exclude inappropriate reporting of nonprescription amphetamines.
j This drug was asked about in the two of the six questionnaire forms. Total n in 2006 is approximately 430.
k “Sedatives, adjusted” data are a combination of barbiturate and methaqualone data.
l Use of “Any Rx Drug” includes any use of amphetamines, sedatives (barbiturates), franquilizers, and/or narcotics other than heroin not under a doctor's orders.
m In 1993 and 1994, the question text was changed slightly in three of the six questionnaire forms to indicate that a “drink” meant “more than just a few sips.” Because this revision resulted in rather little change in reported prevalence in the surveys of high school graduates, the data for all forms combined are used in order to provide the most reliable estimate of change. After 1994 the new question text was used in all six of the questionnaire forms.
n This drug was asked about in three of the six questionnaire forms. Total n in 2006 is approximately 640.
o This drug was asked about in one of the six questionnaire forms. Total n in 2006 is approximately 220.
p This drug was asked about in one of the five questinnaire forms in 1989 and in two of the six questionnaire forms in 1990–2006. Total n in 2006 is approximately 430.
q Daily use is defined as use on 20 or more occasions in the past 30 days except for cigarettes, for which actual daily use is measured, and for five or more drinks, for which the prevalence of having five or more drinks in a row in the last 2 weeks is measured.
r Revised questions about amphetamine use were introduced in 1982 to more completely exclude inappropriate reporting of nonprescription amphetamines. The data in italics are therefore not strictly comparable to the other data.
From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:252–253. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.

Approximate weighted n

1040

1130

1150

1170

1110

1080

1190

1220

1310

1300

1400

1410

1490

1490

1410

1450

1450

1480

1440

1440

1350

1340

1260

1270

1400

1360

1280

 

Any illicit druga

56.2

55.0

49.5

49.8

45.1

46.3

45.0

40.1

37.4

36.7

33.3

29.2

30.6

30.6

31.4

33.5

34.2

34.1

37.8

36.9

36.1

37.9

37.0

36.5

36.2

36.6

33.9

-2.6

Any illicit druga

                                                       

 Other than marijuana

32.3

31.7

29.9

29.9

27.2

26.7

25.0

21.3

19.2

16.4

15.2

13.2

13.1

12.5

12.2

15.9

12.8

15.8

14.0

15.4

15.6

16.4

16.6

17.9

18.6

18.5

18.1

-0.4

Marijuana

51.2

51.3

44.7

45.2

40.7

41.7

40.9

37.0

34.6

33.6

29.4

26.5

27.7

27.9

29.3

31.2

33.1

31.6

35.9

35.2

34.0

35.6

34.7

33.7

33.3

33.3

30.2

-3.2

Inhalantsb

3.0

2.5

2.5

2.8

2.4

3.1

3.9

3.7

4.1

3.7

3.9

3.5

3.1

3.8

3.0

3.9

3.6

4.1

3.0

3.2

2.9

2.8

2.0

1.8

2.7

1.8

1.5

-0.4

Halluchinogensc

8.5

7.0

8.7

6.5

6.2

5.0

6.0

5.9

5.3

5.1

5.4

6.3

6.8

6.0

6.2

8.2

6.9

7.7

7.2

7.8

6.7

7.5

6.3

7.4

5.9

5.0

5.6

+ 0.5

 LSD

6.0

4.6

6.3

4.3

3.7

2.2

3.9

4.0

3.6

3.4

4.3

5.1

5.7

5.1

5.2

6.9

5.2

5.0

4.4

5.4

4.3

4.0

2.1

1.4

1.2

0.7

1.4

+ 0.7

 Hallucinogens

                                                       

  Other than LSDc

5.2

4.7

5.4

3.9

4.1

3.9

3.8

3.1

3.4

3.1

3.0

3.1

2.6

2.7

2.8

4.0

4.1

4.9

4.4

4.5

4.4

5.5

5.8

7.1

5.6

5.0

5.4

+ 0.5

 MDMA (Esctasy)d

NA

NA

NA

NA

NA

NA

NA

NA

NA

2.3

2.3

0.9

2.0

0.8

0.5

2.4

2.8

2.4

3.9

5.5

9.1

9.2

6.8

4.4

2.2

2.9

2.6

+ 0.3

Cocaine

16.8

16.0

17.2

17.3

16.3

17.3

17.1

13.7

10.0

8.2

5.6

3.6

3.0

2.7

2.0

3.6

2.9

3.4

4.6

4.6

4.8

4.7

4.8

5.4

6.6

5.7

5.1

+ 0.6

 Cracke

NA

NA

NA

NA

NA

NA

1.3

2.0

1.4

1.5

0.6

0.5

0.4

0.6

0.5

1.1

0.6

0.4

1.0

0.9

0.9

0.9

0.4

1.3

1.3

0.8

1.0

+ 0.2

 Other cocainef

NA

NA

NA

NA

NA

NA

NA

10.7

10.6

9.3

5.1

3.2

2.4

2.5

1.8

3.3

2.3

3.0

4.2

4.2

4.1

4.1

5.0

5.1

6.3

5.0

3.8

-1.2

Heroin

0.4

0.2

0.1

*

0.1

0.2

0.1

0.2

0.2

0.1

0.1

0.1

0.1

0.1

0.1

0.3

0.4

0.3

0.6

0.2

0.5

0.4

0.1

0.2

0.4

0.3

0.3

-0.1

Other narcoticsg,h

5.1

4.3

3.8

3.8

3.8

2.4

4.0

3.1

3.1

3.2

2.9

2.7

2.7

2.5

2.4

3.8

3.1

4.2

4.2

4.3

4.5

5.7

7.4

8.7

8.2

8.4

8.8

+ 0.4

 OxyContinj

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

1.5

2.2

2.5

2.1

3.0

+ 0.9

 Vicodinj

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

6.9

7.5

7.4

9.6

7.6

-2.1

Amphetaminesg

22.4

22.2

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Amphetamines, adjustedg,i

NA

NA

21.1

17.3

15.7

11.9

10.3

7.2

6.2

4.6

4.5

3.9

3.6

4.2

4.2

5.4

4.2

5.7

5.1

5.8

6.6

7.2

7.0

7.1

7.0

6.7

6.0

-0.7

 Ritaling,j

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

5.7

4.7

4.7

4.2

3.9

-0.4

 Methamphetaminej

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

3.3

1.6

2.4

1.2

2.6

2.9

1.7

1.2

-0.5

 Crystal meth.(Ice)j

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

0.1

0.1

0.2

0.7

0.8

1.1

0.4

0.8

1.0

0.5

0.5

0.6

0.8

0.9

1.1

1.4

0.6

-0.7

Sedatives

                                                       

(Barbiturates)g

2.9

2.8

3.2

2.2

1.9

1.3

2.0

1.2

1.1

1.0

1.4

1.2

1.4

1.5

1.2

2.0

2.3

3.0

2.5

3.2

3.7

3.8

3.7

4.1

4.2

3.9

3.4

-0.5

 Sedatives, adjustedg,k

8.3

8.0

8.0

4.5

3.5

2.5

2.6

1.7

1.5

1.0

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

 Methaqualoneg

7.2

6.5

6.6

3.1

2.5

1.4

1.2

0.8

0.5

0.2

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Tranquilizersc,g

6.9

4.8

4.7

4.6

3.5

3.6

4.4

3.8

3.1

2.6

3.0

2.4

2.9

2.4

1.8

2.9

2.8

3.8

3.9

3.8

4.2

5.1

6.7

6.9

6.7

6.4

5.8

-0.6

Any Rx drugl

26.0

24.8

23.9

21.2

18.6

15.0

14.4

11.1

10.2

9.0

9.0

8.0

7.3

7.7

7.0

9.6

8.3

11.0

9.6

10.5

11.5

12.7

13.7

14.8

14.7

15.0

14.6

-0.4

Rohypnolj

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

0.7

0.4

0.3

0.1

0.2

+ 0.1

GHBj

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

0.6

0.3

0.7

0.4

*

-0.4

Ketaminej

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

1.3

1.0

1.5

0.5

0.9

+ 0.3

Alcoholm

90.5

92.5

92.2

91.6

90.0

92.0

91.5

90.9

89.6

89.6

89.0

88.3

86.9

85.1

82.7

83.2

83.0

82.4

84.6

83.6

83.2

83.0

82.9

81.7

81.2

83.0

82.1

-1.0

 Been drunkn

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

69.1

67.3

65.6

63.1

62.1

64.2

66.8

67.0

65.4

64.7

68.8

66.0

64.7

67.1

64.2

66.2

+ 2.0

 Flavored alcoholic beverageg

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

63.2

67.0

63.5

-3.6

Cigarettes

36.2

37.6

34.3

36.1

33.2

35.0

35.3

38.0

36.6

34.2

35.5

35.6

37.3

38.8

37.6

39.3

41.4

43.6

44.3

44.5

41.3

39.0

38.3

35.2

36.7

36.0

30.9

-5.1 ss

Steroidsp

NA

NA

NA

NA

NA

NA

NA

NA

NA

0.4

0.5

0.6

0.2

0.9

0.2

0.4

0.2

0.7

0.2

0.9

0.1

0.6

0.5

0.3

0.6

0.5

0.8

+ 0.2

P.1093

 

P.1094

 

TABLE 84.8
Trends in 30-Day Prevalence of Various Types of Drugs Among College Students 1 to 4 Years Beyond High school

Percentage who used in last 30 days

 

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

‘05–’06change

LSD, lysergic acid diethylamide; MDMA, methylenedioxymethamphetamine.
Level of significance of difference between the two most recent years: s = 0.05, ss = 0.01,sss = 0.001. Any apparent inconsistency between the change estimate and the prevalence estimates for the two most recent years is due to rounding.
“*” indicates a percentage of <0.05%
“NA” indicates data not available.
a “Any illicit drug” includes use of marijuana, hallucinogens, cocaine, heroin or other narcotics, amphetamines, sedatives (barbiturates), methaqualone (until 1990), or tranquilizers not under a doctor's orders.
b This drug was asked about in four of the five questionnaire forms in 1980–1989, in five of the six forms in 1990–1998, and in three of the six forms in 1999–2006. Total n in 2006 is approximately 650.
c In 2001 the question text was changed on half the questionnaire forms. “Other psychedelics” was changed to “other hallucinogens,” and “shrooms” was added to the list of examples. For tranquilizers, “Miltown” was replaced with “Xanax” in the list of examples. Beginning in 2002 the remaining forms were changed to the new wording.
d This drug was asked about in two of the five questionnaire forms in 1989, in two of the six questionnaire forms in 1990–2001, and in three of the six questionnaire forms in 2002–2006. Total n in 2006 is approximately 650.
e This drug was asked about in two of the five questionnaire forms in 1987–1989, in all six questionnaire forms in 1990–2001, and in five of the six questionnaire forms in 2002–2006. Total n in 2006 is approximately 1,070.
f This drug was asked about in one of the five questionnaire forms in 1987–1989 and in four of six questionnaire forms in 1990–2006. Total n in 2006 is approximately 850.
g Only drug use that was not under a doctor's orders is included here.
h In 2002 the question text was changed on hall of the questionnaire forms. The list of examples of narcotics other than heroin was updated: Talwin, laudanum, and paregoric—all of which had negligible rates of use by 2001—were replaced by Vicodin, OxyContin, and Percocef. The 2002 data presented here are based on the changed forms only; n is one half on n indicated. In 2003 the remaining forms were changed to the new wording. The data are based on all forms in 2003 and beyond.
i On the basis of the data from the revised question, which attempts to exclude inappropriate reporting of nonprescription amphetamines.
j This drug was asked about in the two of the six questionnaire forms. Total n in 2006 is approximately 430.
k “Sedatives, adjusted” data are a combination of barbiturate and methaqualone data.
l Use of “Any Rx Drug” includes any use of amphetamines, sedatives (barbiturates), franquilizers, and/or narcotics other than heroin not under a doctor's orders.
m In 1993 and 1994, the question text was changed slightly in three of the six questionnaire forms to indicate that a “drink” meant “more than just a few sips.” Because this revision resulted in rather little change in reported prevalence in the surveys of high school graduates, the data for all forms combined are used in order to provide the most reliable estimate of change. After 1994 the new question text was used in all six of the questionnaire forms.
n This drug was asked about in three of the six questionnaire forms. Total n in 2006 is approximately 640.
o This drug was asked about in one of the six questionnaire forms. Total n in 2006 is approximately 220.
p This drug was asked about in one of the five questinnaire forms in 1989 and in two of the six questionnaire forms in 1990–2006. Total n in 2006 is approximately 430.
q Daily use is defined as use on 20 or more occasions in the past 30 days except for cigarettes, for which actual daily use is measured, and for five or more drinks, for which the prevalence of having five or more drinks in a row in the last 2 weeks is measured.
r Revised questions about amphetamine use were introduced in 1982 to more completely exclude inappropriate reporting of nonprescription amphetamines. The data in italics are therefore not strictly comparable to the other data.
From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:254–255. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.

Approximate weighted n

1040

1130

1150

1170

1110

1080

1190

1220

1310

1300

1400

1410

1490

1490

1410

1450

1450

1480

1440

1440

1350

1340

1260

1270

1400

1360

1280

 

Any illicit druga

38.4

37.6

31.3

29.3

27.0

26.1

25.9

22.4

18.5

18.2

15.2

15.2

16.1

15.1

16.0

19.1

17.6

19.2

19.7

21.6

21.5

21.9

21.5

21.4

21.2

19.5

19.2

-0.3

Any illicit druga

                                                       

 Other than marijuana

20.7

18.6

17.1

13.9

13.8

11.8

11.6

8.8

8.5

6.9

4.4

4.3

4.6

5.4

4.6

6.3

4.5

6.8

6.1

6.4

6.9

7.5

7.8

8.2

9.1

8.2

8.2

0.0

Marijuana

34.0

33.2

26.8

26.2

23.0

23.6

22.3

20.3

16.8

16.3

14.0

14.1

14.6

14.2

15.1

18.6

17.5

17.7

18.6

20.7

20.0

20.2

19.7

19.3

18.9

17.1

16.7

-0.4

Inhalantsb

1.5

0.9

0.8

0.7

0.7

1.0

1.1

0.9

1.3

0.8

1.0

0.9

1.1

1.3

0.6

1.6

0.8

0.7

0.6

1.5

0.9

0.4

0.7

0.4

0.4

0.3

0.4

+ 0.1

Hallucinogensc

2.7

2.3

2.6

1.8

1.8

1.3

2.2

2.0

1.7

2.3

1.4

1.2

2.3

2.5

2.1

3.3

1.9

2.1

2.1

2.0

1.4

1.8

1.2

1.8

1.3

1.2

0.9

-0.3

 LSD

1.4

1.4

1.7

0.9

0.8

0.7

1.4

1.4

1.1

1.4

1.1

0.8

1.8

1.6

1.8

2.5

0.9

1.1

1.5

1.2

0.9

1.0

0.2

0.2

0.2

0.1

0.3

+ 0.2

 Hallucinogens

                                                       

  Other than LSDc

1.9

1.2

1.4

1.0

1.2

0.7

1.2

0.8

0.8

1.1

0.8

0.6

0.7

1.1

0.8

1.6

1.2

1.2

0.7

1.2

0.8

0.8

1.1

1.7

1.2

1.1

0.7

-0.3

MDMA (Ecstasy)d

NA

NA

NA

NA

NA

NA

NA

NA

NA

0.3

0.6

0.2

0.4

0.3

0.2

0.7

0.7

0.8

0.8

2.1

2.5

1.5

0.7

1.0

0.7

0.8

0.6

-0.2

Cocaine

6.9

7.3

7.9

6.5

7.6

6.9

7.0

4.6

4.2

2.8

1.2

1.0

1.0

0.7

0.6

0.7

0.8

1.6

1.6

1.2

1.4

1.9

1.6

1.9

2.4

1.8

1.8

0.0

 Cracke

NA

NA

NA

NA

NA

NA

NA

0.4

0.5

0.2

0.1

0.3

0.1

0.1

0.1

0.1

0.1

0.2

0.2

0.3

0.3

0.1

0.3

0.4

0.4

0.1

*

-0.1

 Other cocainef

NA

NA

NA

NA

NA

NA

NA

3.5

3.2

3.2

1.0

1.0

0.9

0.6

0.3

0.8

0.6

1.3

1.5

1.0

0.9

1.5

1.4

1.9

2.2

1.8

1.3

-0.5

Heroin

0.3

*

*

*

*

*

*

0.1

0.1

0.1

*

0.1

*

*

*

0.1

*

0.2

0.1

0.1

0.2

0.1

*

*

0.1

0.1

0.2

+ 0.1

Other narcoticsg,h

1.8

1.1

0.9

1.1

1.4

0.7

0.6

0.8

0.8

0.7

0.5

0.6

1.0

0.7

0.4

1.2

0.7

1.3

1.1

1.0

1.7

1.7

3.2

2.3

3.0

3.1

3.1

0.0

Amphetaminesg

13.4

12.3

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Amphetamines, adjustedg,i

NA

NA

9.9

7.0

5.5

4.2

3.7

2.3

1.8

1.3

1.4

1.0

1.1

1.5

1.5

2.2

0.9

2.1

1.7

2.3

2.9

3.3

3.0

3.1

3.2

2.9

2.5

-0.4

 Methamphetaminej

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

1.2

0.2

0.5

0.2

0.6

0.2

0.1

0.2

+ 0.1

 Crystal Meth. (Ice)j

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

*

*

*

0.3

0.5

0.3

0.1

0.2

0.3

*

*

0.1

*

0.3

0.1

0.2

*

-0.2

Sedatives

                                                       

(Barbiturates)g

0.9

0.8

1.0

0.5

0.7

0.4

0.6

0.5

0.5

0.2

0.2

0.3

0.7

0.4

0.4

0.5

0.8

1.2

1.1

1.1

1.1

1.5

1.7

1.7

1.5

1.3

1.3

0.0

 Sedatives, adjustedg,k

3.8

3.4

2.5

1.1

1.0

0.7

0.6

0.6

0.6

0.2

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

 

 Methaqualoneg

3.1

3.0

1.9

0.7

0.5

0.3

0.1

0.2

0.1

0.0

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

 

Tranquilizersc,g

2.0

1.4

1.4

1.2

1.1

1.4

1.9

1.0

1.1

0.8

0.5

0.6

0.6

0.4

0.4

0.5

0.7

1.2

1.3

1.1

2.0

1.5

3.0

2.8

2.7

2.2

2.1

-0.1

Any Rx drugl

15.6

13.3

11.4

8.4

7.1

5.7

5.5

3.9

3.5

2.6

2.5

2.2

2.3

2.6

2.2

3.3

2.3

4.1

3.9

4.3

5.6

5.4

6.4

6.6

6.9

6.5

6.5

0.0

Alcoholm

81.8

81.9

82.8

80.3

79.1

80.3

79.7

78.4

77.0

76.2

74.5

74.7

71.4

70.1

67.8

67.5

67.0

65.8

68.1

69.6

67.4

67.0

68.9

66.2

67.7

67.9

65.4

-2.5

Been drunkn

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

45.0

45.0

43.8

42.8

37.9

40.3

46.4

44.3

44.6

43.9

44.7

44.4

40.4

47.4

43.1

47.6

+ 4.5

 Flavored alcoholic beverageo

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

34.0

30.9

26.2

-4.7

Cogarettes

25.8

25.9

24.4

24.7

21.5

22.4

22.4

24.0

22.6

21.1

21.5

23.2

23.5

24.5

23.5

26.8

27.9

28.3

30.0

30.6

28.2

25.7

26.7

22.5

24.3

23.8

19.2

-4.6ss

Steroidsp

NA

NA

NA

NA

NA

NA

NA

NA

NA

*

0.2

0.3

0.2

0.2

0.2

0.1

*

0.2

0.2

0.4

*

0.3

*

0.1

*

*

*

0.0

P.1095

 

TABLE 84.9
Trends in Thirty-Day Prevalence of Daily Use of Various Types of Drugs Among College Students 1 to 4 Years Beyond High School, 2006

Percentage who used daily in last 30 days

 

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

‘05–’06change

Level off significance of difference between the two most recent years: s = 0.05, ss = 0.01, sss = 0.001. Any apparent inconsistency between the change estimate and the prevalence estimates for the two most recent years is due to rounding.
“*” indicates a percentage of <0.05%.
“NA” indicates data not available.
g Only drug use that was not under a doctor's orders is included here.
i On the basis of the data from the revised question, which attempts to exclude inappropriate reporting of nonprescription amphetamines.
m In 1993 and 1994, the question text was changed slightly in three of the six questionnaire forms to indicate that a “drink” meant “more than just a few sips.” Because this revision resulted in rather little change in reported prevalence in the surveys of high school graduates, the data for all forms combined are used in order to provide the most reliable estimate of change. After 1994 the new question text was used in all six of the questionnaire forms.
n This drug was asked about in three of the six questionnaire forms. Total n in 2006 is approximately 640.
q Daily use is defined as use on 20 or more occasions in the past 30 days except for cigarettes, for which actual daily use is measured, and for five or more drinks, for which the prevalence of having five or more drinks in a row in the last 2 weeks is measured.
From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:256–257. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.

Approximate weighted n

1,040

1,130

1,150

1,170

1,110

1,080

1,190

1,220

1,310

1,300

1,400

1,410

1,490

1,490

1,410

1,450

1,450

1,480

1,440

1,440

1,350

1,340

1,260

1,270

1,400

1,360

1,280

 

Marijuanaq

7.2

5.6

4.2

3.8

3.6

3.1

2.1

2.3

1.8

2.6

1.7

1.8

1.6

1.9

1.8

3.7

2.8

3.7

4.0

4.0

4.6

4.5

4.1

4.7

4.5

4.0

4.3

+ 0.3

Cocaineq

0.2

*

0.3

0.1

0.4

0.1

0.1

0.1

0.1

*

*

*

*

*

0.1

*

*

*

*

*

*

*

*

*

*

0.1

0.1

0.0

Amphetaminesg,q

0.5

0.4

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Amphetamines, adjustedg,i,q

NA

NA

0.3

0.2

0.2

*

0.1

0.1

*

*

*

0.1

*

0.1

0.1

0.1

*

0.2

0.1

0.1

0.1

0.2

0.1

0.3

0.2

0.2

0.4

+ 0.1

Alcoholm

                                                       

 Dailyq

6.5

5.5

6.1

6.1

6.6

5.0

4.6

6.0

4.9

4.0

3.8

4.1

3.7

3.9

3.7

3.0

3.2

4.5

3.9

4.5

3.6

4.7

5.0

4.3

3.7

4.6

4.8

+ 0.2

 Been drunkn,q

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

0.5

0.2

0.3

0.8

0.5

0.1

1.3

0.8

1.0

0.7

0.5

0.8

1.1

0.8

0.5

0.6

0.0

 Five or more drinks in a row in last 2 wk

43.9

43.6

44.0

43.1

45.4

44.6

45.0

42.8

43.2

41.7

41.0

42.8

41.4

40.2

40.2

38.6

38.3

40.7

38.9

40.0

39.3

40.9

40.1

38.5

41.7

40.1

40.2

+ 0.1

Cigarettes

                                                       

 Daily

18.3

17.1

16.2

15.3

14.7

14.2

12.7

13.9

12.4

12.2

12.1

13.8

14.1

15.2

13.2

15.8

15.9

15.2

18.0

19.3

17.8

15.0

15.9

13.8

13.8

12.4

9.2

-3.2 ss

 Half-pack or More per day

12.7

11.9

10.5

9.6

10.2

9.4

8.3

8.2

7.3

6.7

8.2

8.0

8.9

8.9

8.0

10.2

8.5

9.1

11.3

11.0

10.1

7.8

7.9

7.6

6.8

6.7

4.9

-1.8 s

  • P.1096

 

Cocaine: Use of cocaine in college students dropped dramatically from 1983 to 1994 (17.3% annual use to 2%), however this has increased to 5.1% in 2006.

  • Other drugs:Among college students, the annual prevalence of Vicodin use increased from 6.9% in 2002 to 7.6% in 2006, Rohypnol use decreased from 0.7% to 0.2%, GHB use decreased and ketamine use also decreased from 1.3% to 0.9%. Ritalin usage decreased slightly in annual use from 5.7% in 2002 to 3.9% in 2006. Tranquilizers also followed a similar pattern as cocaine usage with annual prevalence falling from 6.9% in 1980 to 1.8% in 1994 and then reversing to 6.9% in 2003. The rates from 2003–2006 have decreased to 5.8%. Overall, LSD use has fallen precipitously since 2001 while narcotics other than heroin and tranquilizers have become much more important drugs of illicit use.
 

FIGURE 84.1 Any illicit drug: Trends in annual prevalence among college students vs. others. (From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07–6206). Bethesda, MD: National Institute on Drug Abuse;2007:258. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.)

Tobacco

2006 ACHA-NCHA Number of days of any cigarette use in last 30 days”

 

≥10 Days

1–9 Days

Total

8.4%

 9.3%

Female

7.8%

 8.7%

Male

9.2%

10.2%

Interestingly, the students' perception of tobacco use rates of students was much higher. Reported actual daily use of cigarettes for all students within the last 30 days was 4.3%, which compares with how often students perceived the typical student on campus used cigarettes within the same time. The perceived daily use of cigarettes by all students was 32.1%.

Alcohol

2006 ACHA-NCHA “How many days did you consume any alcohol in last 30 days?”

 

≥10 Days

1–9 Days

Total

15.6%

54%

Female

13%

55.9%

Male

20%

51.1%

Interestingly, the students' perception of alcohol use rates of students was much higher. For all students, 17.2% reported actually never drank alcohol within the last 30 days, which compares with how often students perceived the typical student on campus used alcohol within the same time. The perception was only 3.6% of all students never drank alcohol within the last 30 days.

High-risk drinking (five or more drinks at a sitting in last 2 weeks)

Frequency

Total

Female

Male

None

62.9%

68%

54%

1–2 times

21.4%

21%

25%

3–5 times

11.3%

 9%

15%

≥6times

 3.4%

 1%

 6%

Consequences of Drinking in Last School Year for Those Who Drink Alcohol

  • 18.2% had an injury to self.
  • 4.1% injured another person.
  • 35.7% did something they later regretted.
  • 1.3% were involved in forced sexual activity by someone else.
  • 13.9% were involved in unprotected sexual activity.

College Students: Who Drinks?

Evidence suggests that the highest number of high-risk drinkers (defined as having five or more drinks at a sitting for men and four or more drinks at a sitting for women) are in fraternities and sororities (Fig. 84.4).

Marijuana Use

2006 ACHA-NCHA “How many days did you use marijuana in last 30 days?”

 

≥10 Days

1–9 Days

Total

4.5%

10%

Female

3%

 9%

Male

6%

11%

Interestingly, the students' perception of marijuana use rates of students was much higher. Reported actual daily

P.1097


use of marijuana for all students within the last 30 days was 1.2%, which compares with how often students perceived the typical student on campus used marijuana within the same time. The perceived daily use of marijuana by all students was 18.5%.

 

FIGURE 84.2 A: Alcohol: Trends in 2-week prevalence of five or more drinks in a row among college students versus others. B: Alcohol: Trends in 2-week prevalence of five or more drinks in a row among male versus female college students. (From Johnston LD, O'Malley PM, Bachman JG, et al. (2006). Monitoring the Future national survey results on drug use, 1975–2006. Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:274. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.)

Sexuality

Sexually Transmitted Diseases

College populations are generally unidentifiable in overall reports on STDs. There are no random frequency studies that have been performed in this population. In general, national STD studies focus on adolescents and homeless and incarcerated youth. College students often do not recognize the risks and availability of treatment for most STDs.

Chlamydia

Although there are no randomized frequency studies on college campuses, the overall prevalence appears to be falling. One college reported a rate of >9% in 1990, falling to just >3% by 1994.

P.1098

 

Sexual Behaviors

2006 ACHA-NCHA Prevalence of intercourse

 

Ever Had Vaginal Intercourse

Ever Had Anal Intercourse

Ever Had Oral Intercourse

Total

 68.6%

 25.1%

 72.1%

Female

69%

23%

72%

Male

68%

29%

73%

 

FIGURE 84.3 Cigarettes: Trends in 30-day prevalence of daily use among college students versus others. (From Johnston LD, O'Malley PM, Bachman JG, et al. (2007). Monitoring the Future national survey results on drug use, 1975–2006: Volume II, College students and adults ages 19–45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse;2007:278. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2_2006.pdf.)

 

FIGURE 84.4 College students—who drinks? (From Wechsler H, Davenport AE, Dowdall GW, et al. Binge drinking, tobacco, and illicit drug use and involvement in college athletics: a survey of students at 140 American colleges. J Am Coll Health 1997;45:195, with permission.)

Prevalence condom use at last sexual intercourse (excluded if “never did this activity”)

 

During Vaginal Intercourse

During Anal Intercourse

During Oral Intercourse

Total

52.1%

27.7%

3.8%

Number of partners (vaginal, oral, anal intercourse) within the last school year

 

None

One

Two or Three

Four or More

Total

 29.2%

 46.5%

 16.7%

 7.6%

Female

29%

49%

16%

 5%

Male

30%

43%

17%

11%

Emergency Contraception Use and Unintended Pregnancies—Last Year

  • 11.2% of sexually active college students reported using (or reported their partner used) emergency contraception (“morning after pill”) within the last school year (male, 9.7%; female, 12.7%)
  • 2.1% of college students who had vaginal intercourse within the last school year reported experiencing an unintentional pregnancy or their partner pregnant within the last school year (male, 2.2%; female, 2%)

P.1099

 

TABLE 84.10
Weight Classification (BMI in kg/m
2) for Males and Females

 

<18.5 Underweight

18.5–24.9 Healthy Weight

25–29.9 Overweight

30–34.9 Class I Obesity

35–39.9 Class II Obesity

40 Class III Obesity

Total

4.5%

64.1%

21.9%

6.2%

2.1%

1.2%

Females

5.6%

67.6%

17.8%

5.5%

2%

1.4%

Males

2.6%

58.2%

28.8%

7.4%

2.1%

0.8%

Dietary, Physical Activity and Sleep Behaviors

Dietary Behaviors

2006 ACHA-NCHA “In the last 30 days, to lose weight you …”

 

Dieted

Exercised

Purged

Used Diet Pills

Total

34.5%

55.2%

2.5%

3.6%

Females

42.4%

62.7%

3.6%

4.6%

Males

22.1%

43.7%

0.7%

1.9%

Physical Activity Behaviors

2006 ACHA-NCHA “In the last week, participated in exercise for at least 20 minutes …”

 

None

1 or 2 Days

3 to 5 Days

6 or 7 Days

Total

24.4%

31.4%

35.6%

8.6%

Females

25.7%

31.2%

35% 

8% 

Males

22.1%

31.7%

36.6%

9.6%

Sleep Behaviors

2006 ACHA-NCHA “In the last week, getting enough sleep to feel rested in the morning …”

 

None

1 or 2 Days

3 to 5 Days

6 or 7 Days

Total

10.4%

28% 

47.7%

13.9%

Females

10.8%

28.3%

47.1%

13.8%

Males

 9.4%

27.4%

49.1%

14.1%

Body Mass Index

2006 ACHA-NCHA Data Estimated body mass index (BMI) incorporates reported gender, height, and weight (Table 84.10).

Preventative Health Care, Problems, and Health Information

Preventative Health Care Practices

2006 ACHA-NCHA Preventive health care practices among college students:

Hepatitis B vaccination

73.4%

Meningococcal vaccination

57.1%

Chicken pox vaccination

50%

Flu immunization last year

26%

Dental examination last year

77.2%

Testicular self-examination last month

38.8%

Breast self-examination last month

39.4%

Gynecological examination last year

59.2%

Cholesterol check in last 5 years

45.1%

Health Problems

2006 ACHA-NCHA Within the last school year, college students reported experiencing:

Back pain

46.6%

Allergy problems

45.5%

Sinus infection

28.8%

Depression

17.8%

Strep throat

13.2%

Anxiety disorder

12.4%

Asthma

11.2%

Ear infection

 9.3%

Seasonal affective disorder

 8.1%

Bronchitis

 7.8%

Carpal tunnel

 6.8%

Fracture

 4.7%

High blood pressure

 4.5%

Substance abuse

 3.4%

High cholesterol

 4%

Chronic fatigue

 3.4%

Bulimia

 2.3%

Genital warts

 2.2%

Monoucelosis

 2.2%

Anorexia

 1.9%

Endometriosis

 1%

Genital herpes

 1%

Diabetes

 0.9%

Chlamydia

 0.8%

Hepatitis B or C

 0.4%

Pelvic inflammatory disease

 0.3%

Human immunodeficiency virus

 0.3%

Tuberculosis

 0.2%

Gonorrhea

 0.2%

Health Information

2006 ACHA-NCHA Health information believability and sources

 

Believe

Use as Source of Information

Medical staff

90.1%

59.7%

Health educators

89.2%

51.6%

Parents

64.3%

73.2%

Faculty/coursework

66.3%

37.8%

Leaflets/pamphlets

60.8%

51.1%

Campus newspaper

47%

26.7%

Peer educators

46.1%

18.4%

Resident assistant/advisors

36%

16.9%

Friends

24.4%

60.6%

Magazines

22%

52.5%

Religious center

24.2%

 9.9%

Internet

23%

72.4%

Television

12.6%

43.2%

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It appears that medical staff members and health educators have high believability among students but are used only by approximately 50% of students for their health information. At the same time, 61% of students use friends for their health information but only 24% believe them. Television and the Internet are also ranked low on believability but are sources of health information for approximately half of students.

Impediments to Academic Success

2006 ACHA-NCHA Data: Within the last school year students reported the following factors affecting their individual academic performance, that is, received an incomplete, dropped a course; received a lower grade in a class, on an examination, or on an important project:

Stress

32%

Cold/flu/sore throat

26%

Sleep difficulties

23.9%

Concern for a troubled friend or family

18%

Depression/anxiety disorder/seasonal affective disorder

15.7%

Relationship difficulty

15.6%

Internet use/computer games

15.4%

Death of a friend/family member

 8.5%

Sinus or ear infection/bronchitis/step throat

 8.3%

Alcohol use

 7.3%

Allergies

 4.2%

Injury

 3.3%

Learning disability

 3.2%

Chronic pain

 2.9%

Chronic illness

 2.7%

Drug use

 2.3%

Mononucleosis

 1.5%

Eating disorder/problem

 1.3%

Pregnancy (yours or partner's)

 0.9%

Assault (sexual)

 0.8%

Assault (physical)

 0.6%

Sexually transmitted disease

 0.4%

With more than 87.3% of students having some type of medical access insurance and the quality and convenience of health care on campus, it appears that of the top ten impediments to academic success only two are biomedical, while psychosocial issues, such as depression, relationships, and stress carry the greatest impact on student learning. Alcohol use, ranked at number ten, creates high-risk situations for both the individual student and the institution. Other issues, such as sexual assault, are not as prevalent but have devastating consequences. This is the first data of its type and illuminates the relationship between health and learning.

Types of Health Problems

Students presented to health centers with the following:

  1. Acute medical problems: Primary care including minor infections (Epstein-Barr virus infections, genitourinary tract infections, upper respiratory tract infections, and acute gastroenteritis), musculoskeletal injuries, minor trauma, and skin problems. Occasionally, some of the infections become life threatening, such as meningitis and tuberculosis. Reproductive issues are common, including the diagnosis and treatment of STDs, contraception, emergency contraception, routine gynecology, men's health care, and unintended pregnancies.
  2. Chronic medical problems: Many college undergraduate and older graduate students receive care at the health center for chronic medical conditions, including asthma, diabetes, seizure disorders, thyroid disorders, hypertension, hyperlipidemia, eating disorders, and malignancies. In addition, the incidence rates of certain malignancies such as Hodgkin disease, melanoma, testicular neoplasms, leukemia, and primary bone cancer in this age-group are increased compared with those of other age-groups.
  3. Mental health issues: Many college students are under increased stress and the following are frequent on college campuses—stress-related symptoms, eating disorders, anxiety, depression, suicidality, chronic fatigue, and other disorders affecting academic performance such as attention-deficit disorder.
  4. Substance abuse: Diagnosis and treatment
  5. Screening for STDs
  6. Immunization requirements
  7. Screening for tuberculosis
  8. Routine screening for other health risks including smoking and hyperlipidemia
  9. Behavioral health issues such as unsafe sexual behaviors, high-risk alcohol use, and tobacco use.

Trends

Some trends that appear to be occurring among college students include (data may not be available) the following:

  • More students are entering college with chronic disease such as asthma, diabetes, physical disabilities, and treated mental health disorders.
  • More students are traveling abroad.
  • More students are interested in herbal and complementary medicine interventions.
  • Few universities have overnight infirmaries. Most IHEs can no longer justify the cost, risk, and resources associated with overnight infirmaries and so students attend to each other in their place of residence, are

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hospitalized in local facilities, or go to the residence of a parent or guardian for care.

Challenges

With the many changes in the health care field, there are numerous challenges facing both student affairs and health care professionals in the college health setting of the 21st century. Some of these include the following:

  1. Stability of finances: In a 1991 survey of 400 colleges the source of funds was as follows:
  2. 85% funding prepaid (46% general fees and 39% a designated health fee)
  3. 5% service fees
  4. 10% grants and donations

However, as funding becomes tighter in higher education, college health programs will need to continue to explore alternative, cost-effective funding mechanisms. Many college health clinics have formed fund-raising and development programs of their own and participate in funded research.

  1. Continued national accreditation of ambulatory care services.
  2. Continued integration into campus and academic life.
  3. Improved information technology: Students comprise one of the largest groups with high-speed access to Internet information. They are also a group that expects communication through this modality. College health programs will need to adapt to these changes and use this technology for communication regarding appointments, laboratory results, medical care, and prevention services. In a review of electronic communication by college health centers with students, Neinstein (2000) found that 64% of health centers used electronic communication with patients and 27% used e-mail to give out medical advice. Other uses included giving out laboratory test results, making appointments, and communicating insurance issues. Many health centers now use an electronic health record.
  4. Improved facilities: Many student health center buildings are old, outdated, and need replacement. This, along with other student services, often has a lower priority to academic buildings in IHEs.
  5. Strong supplemental insurance policies: Another critical issue among college students is coverage for health care, particularly beyond what a college health program can cover. Approximately 20% to 33% of the 19- to 24-year-old age-group are uninsured or underinsured. In addition, coverage may not extend outside the local area. It is critical that college health programs explore adequate coverage opportunities for students and that students and their parents strongly consider insurance options during college years. Important questions to explore include the following:
  6. What are the deductibles and co-payments and what is the maximum lifetime coverage?
  7. What coverage is provided when the student is out of school during winter and summer breaks?
  8. Does the coverage include common items such as contraception, acne treatment, immunizations, mental health, smoking cessation, and substance abuse?

The Precollege Visit

Information for Providers to Consider When Sending Their Patients Off to College

The precollege visit marks the beginning of the transition for the adolescent from health care that has largely been supervised by the parent to health care that is a personal responsibility. There are various concepts of what might be included in this visit. Stashwick (1997) describes a comprehensive visit as that intended to update the medical history, perform a complete physical examination, screen for health-risk behaviors, update immunizations, and provide counseling and education. Time constraints and prematriculation health requirements of the university may alter the nature and focus of this visit.

Prematriculation Requirements

Most universities require certain immunizations and tuberculosis screening, and others will have a health form that must be completed before the student arrives on the campus. The parental expectations for this visit then will be to have these prematriculation requirements met so the college-bound student may register for classes.

Health History

Health-risk behaviors are important to consider before the adolescent leaves for college. Screening questions should cover the following:

  • Eating disorders
  • Tobacco use
  • Alcohol and other potential substances of abuse including anabolic steroids
  • Sexual behaviors
  • Emotions that indicate depression or risk of suicide
  • History of emotional, physical, or sexual abuse
  • Learning or school problems especially prior evaluation and treatment of attention-deficit disorder
  • Risk factors for tuberculosis

Given the time constraints of the visit, the provider may elect to do the screening history by a questionnaire. The major drawback to this approach is that the adolescent will most likely be accompanied by a parent, and given the sensitivity of the questions that need to be asked, the adolescent may not feel comfortable responding openly. Alternative approaches include having the adolescent complete the questionnaire in an examination room or having the provider ask the questions directly once the parent has left the room.

An example of comprehensive screening questions on these topics can be found in the NCHA survey, which is posted on the ACHA Web site (at www.acha.org). Table 84.11 gives examples of a simplified version of these questions. Another potential source for screening questions is the National Health and Nutrition Examination Survey created by the National Center for Health Statistics and available at the Centers for Disease Control and Prevention (CDC) Web site (at www.cdc.gov). Figure 84.5 is a screening form given to students at the University of Southern California on the first visit.

Examination

If a complete physical examination had been performed in the last 3 years, the assessment during the precollege visit may be limited to determination of the

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height, weight, and blood pressure, as well as performance of a focused physical examination based on problems uncovered in the screening history. For the sexually active female, a pelvic examination with Papanicolaou (Pap) smear and testing for STDs is indicated. If the college-bound student presents for a preparticipation sports physical, a more comprehensive physical assessment is necessary and the reader is referred to excellent summaries on this topic (Smith, 1997).

TABLE 84.11
Examples of Screening Questions

GHB, gamma-hydroxybutyrate; HIV, human immunodeficiency virus.

Eating disorders:

·   Do you worry about gaining weight? Do you feel that food controls your life?

·   Do you do any of the following (select all that apply)?

1.  Exercise to lose weight

2.  Diet to lose weight

3.  Vomit or take laxatives to lose weight

4.  Take diet pills to lose weight

5.  None of the above

·   Have you ever been told that you had anorexia nervosa or bulimia? Tobacco use:

·   Have you ever used any tobacco products (cigarettes, cigars, smokeless tobacco)?

Alcohol and other abusable substances:

·   Do you drink alcohol (beer, wine, liquor)?

·   Do you use marijuana (pot, hash, hash oil)?

·   Do you use cocaine (crack, rock, freebase)?

·   Do you use amphetamines (diet pills, speed, meth, crank)?

·   Do you use steroids for body building or to improve athletic performance?

·   Do you use other drugs such as Rohypnol (roofies), GHB or liquid X?

Sexual behaviors:

·   Have you ever been sexually active?

·   Are you currently sexually active?

·   Have you ever been diagnosed with a sexually transmitted infection (STD) such as chlamydia, gonorrhea, syphilis, pelvic inflammatory disease, genital warts (human papillomavirus), herpes, hepatitis B, or HIV?

·   Do you practice safe sex (use a condom or dental dam)?

·   Do you use a method of contraception?

·   Have you unintentionally become pregnant or gotten someone else pregnant?

·   Have you been tested for HIV?

Mental health

·   Do you have any mental health disorders?

·   Do you feel depressed, sad, or lonely?

·   Have you ever seriously considered or attempted suicide?

·   Do you have difficulty controlling your temper?

Emotional, physical, or sexual abuse:

·   Have you been or are you in a relationship that is emotionally, physically, or sexually abusive?

Learning problems

·   Have you been told you had a learning disorder or attention deficit disorder?

Risk for tuberculosis infection:

·   Have you ever had a positive skin test for tuberculosis?

·   Were you born in a country other than the United States? If yes, where?

·   Have you ever injected street drugs?

·   Have you tested positive for HIV?

·   Have you ever resided in, volunteered in, or worked in a prison, nursing home, hospital, residential facility for patients with acquired immunodeficiency syndrome, homeless shelter, or a refugee camp?

·   Have you ever been on steroids (prednisone, cortisone) for at least a month?

The Body Mass Index

The BMI is helpful in assessing whether the adolescent is underweight or overweight. A simplified calculation of BMI, along with its classification has been published by the National Heart, Lung, and Blood Institute Obesity Education Initiative. To estimate BMI, multiply the adolescent's weight (in pounds) by 703 and divide by the height (in inches) squared. This approximate BMI can then be classified as in Table 84.12. Underweight individuals may have anorexia nervosa and further

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screening should be performed. Weight-loss counseling should be provided for those individuals whose BMI is ≥25 kg/m2 as well as screening for hyperlipidemia and type 2 diabetes.

 

FIGURE 84.5 Patient history screening form. (From USC University Park Health Center. www.usc.edu/uphc, with permission.)

 

FIGURE 84.5 (Continued)

 

FIGURE 84.5 (Continued)

Blood Pressure Screening

Blood pressure standards based on gender and percentile of height have been developed for the older adolescent. Blood pressure readings above the 95th percentile should be considered indicative of hypertension and should be investigated for an organic cause. Blood pressure readings between the 90th and 95th percentile indicate the need for careful monitoring over the next few months (Table 84.13).

TABLE 84.12
Classification for Body Mass Index

Classification

Body Mass Index

From National Heart, Lung, and Blood Institute. Obesity Education Initiative. The practical guide to identification, evaluation and treatment of overweight and obesity in adults. National Heart, Lung, and Blood Institute. Available at www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm, with permission.

Underweight

≥18.5 kg/m2

Normal weight

18.5–24.9 kg/m2

Overweight

25–29.9 kg/m2

Obesity (class 1)

30–34.9 kg/m2

Obesity (class 2)

35–39.9 kg/m2

Extreme obesity (class 3)

≥40 kg/m2

Diagnostic Testing

Diagnostic testing during the precollege visit is limited.

  1. Cholesterol: The Expert Panel on Blood Cholesterol Levels of Children and Adolescents recommends that adolescents whose parents have a serum cholesterol of >240 mg/dL and adolescents older than 19 years should be screened for total blood cholesterol level (nonfasting) at least once. If the parental cholesterol level is unknown or if the adolescent has other risk factors for future cardiovascular disease (e.g., smoking, hypertension, obesity, diabetes mellitus, excessive consumption of dietary saturated fats, and cholesterol), then ordering a screening serum cholesterol level (nonfasting) is also reasonable.
  2. STD screening: Screening tests for chlamydia, gonorrhea, syphilis, and/or human immunodeficiency virus (HIV) should be based on risk factors. A Pap smear (preferably liquid-based) should be obtained annually for all sexually active females.
  3. Tuberculosis screening: A skin test for tuberculosis should be placed only if there are risk factors for tuberculosis exposure (CDC, 2000). The major risk factor for exposure to tuberculosis in the college-bound population is birth in a tuberculosis-endemic country. The ACHA guidelines indicate that students should undergo tuberculin skin testing if they have arrived within the last 5 years from countries exceptthose on the following list:
  4. American region:
  • Canada
  • Jamaica
  • Saint Kitts and Nevis
  • Saint Lucia
  • United States of America
  • Virgin Islands (United States)
  1. European region:
  • Belgium
  • Denmark
  • Finland
  • France
  • Germany
  • Greece
  • Iceland
  • Ireland
  • Italy
  • Liechtenstein
  • Luxembourg
  • Malta
  • Monaco
  • Netherlands
  • Norway
  • San Marino
  • Sweden
  • Switzerland
  • United Kingdom
  1. Western Pacific region:
  • American Samoa
  • Australia
  • New Zealand

Other risk factors for tuberculosis that would prompt a skin test include HIV infection, injection drug use, and clinical conditions such as diabetes, chronic renal failure, cancer, low body weight, gastrectomy, chronic malabsorption syndromes, prolonged corticosteroid therapy, or other immunosuppressive disorders. Also at risk are those who have lived in, worked in, or volunteered in high-risk congregate settings such as prisons, nursing homes, hospitals, residential facilities for patients with acquired immunodeficiency syndrome, or homeless shelters. Guidelines for interpretation of the skin test result can be found in the CDC's core curriculum on tuberculosis, which is available at state health departments or at the CDC Web site (at www.cdc.gov). Individuals with positive skin test results should have a chest radiograph. If the chest radiograph is negative and there are no contraindications to preventive therapy, isoniazid should be prescribed daily for 9 months.

  1. Immunizations: Most colleges and universities mandate proof of certain immunizations before arrival on campus. Although the ACHA, 2000 report gives guidelines for institutional prematriculation immunizations, the institution may vary these requirements as mandated by state law or otherwise. Therefore, to minimize disruption in the enrollment process, the health history form provided to the college-bound student by the college or university should be consulted. If proof of immunization cannot be obtained, then titers demonstrating immunity may often be substituted. An alternative is to reimmunize. Many colleges now require or strongly recommend immunization against varicella and hepatitis B. These inoculations may be begun at the precollege visit and either completed before leaving for college or after arriving on campus.

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Meningococcal vaccination: The 2005 recommendation by the CDC's Advisory Committee on Immunization Practices (ACIP) is to:

  1. Immunize adolescents aged 11 to 12 years (during the pre-adolescent visit) or
  2. Immunize adolescents aged 15 years (high school entry) or
  3. Immunize incoming college freshmen living in dormitories.

The older groups would be phased out when younger groups are immunized.

College freshmen living in dormitories or residence halls are at modestly increased risk of meningococcal disease (4.6 per 100,000) relative to other persons their age who are not attending college (1.4 per 100,000). Vaccination with the meningococcal polysaccharide vaccine will decrease the risk for meningococcal disease in these individuals but efficacy is less than 100% against serogroups C, Y, W-135, and A. It will confer no protection against serogroup B disease, and should an outbreak of meningococcal disease occur on campus even those who have been vaccinated should seek medical attention. There are two vaccines available, a quadrivalent polysaccharide vaccine and a quadrivalent conjugate vaccine. The conjugate vaccine has the potential for higher antibody levels, longer protection, and potential elimination of the carrier state.

TABLE 84.13
A: Blood Pressure Levels for the 90th and 95th Percentiles of Blood Pressure for Girls Aged 16 and 17 Years by Percentiles of Height

   

Systolic BP (mm Hg)

Diastolic BP (mm Hg)

Age (yr)

Height Percentiles

5%

10%

25%

50%

75%

90%

95%

5%

10%

25%

50%

75%

90%

95%

BP, blood pressure.
From National High Blood Pressure Education Program, update on the Task Force. On blood pressure in children and adolescents. National Institutes of Health; September 1996. NIH publication no. 96–3790.

16

90th

122

122

123

125

126

127

128

79

79

79

80

81

82

82

 

95th

125

126

127

128

130

131

132

83

83

83

84

85

86

86

17

90th

122

123

124

125

126

128

128

79

79

79

80

81

82

82

 

95th

126

126

127

129

130

131

132

83

83

83

84

85

86

86

B: Blood Pressure Levels for the 90th and 95th Percentiles of Blood Pressure for Boys Aged 16 and 17 Years by Percentiles of Height

   

Systolic BP (mm Hg)

Diastolic BP (mm Hg)

Age (yr)

Height Percentiles

5%

10%

25%

50%

75%

90%

95%

5%

10%

25%

50%

75%

90%

95%

16

90th

125

126

128

130

132

133

134

79

79

80

81

82

82

83

 

95th

129

130

132

134

136

137

138

83

83

84

85

86

87

87

17

90th

128

129

131

133

134

136

136

81

81

82

83

84

85

85

 

95th

132

133

135

136

138

140

140

85

85

86

85

88

89

89

Pertussis vaccination: In recent years, pertussis (whooping cough) has increased approximately 400% in adolescents and adults. It appears to account for 20% to 30% of cough lasting more than 2 weeks in adolescents and adults. It also appears that adolescents and young adults are a significant source vector (76% of cases) leading to the rising infection rates in infants. Recent ACIP recommendations include

  1. Tdap should replace Td for all 11- and 12-year-olds and those aged 13 to 18 years who have not yet received a Td booster should receive Tdap in place of Td.
  2. Adults who have not received a Td immunization during the last 10 years should receive a single dose of Tdap vaccine. In addition, those not previously given Tdap vaccine may be given Tdap vaccine at shorter intervals (<10 years) following last Td immunization in settings of wound management and increased risk (including pertussis outbreaks) and contact with infants.
  3. In addition, women are encouraged to receive Tdap vaccine before conception.

Tdap and conjugate meningococcal vaccine should be given simultaneously.

It would therefore appear that college students may be a prime group to get revaccinated with Tdap. This could prevent significant morbidity during college semesters and also prevent significant infections in at-risk infants. This would also be important in the urgent care setting in college health centers.

Health Guidance

The remainder of the precollege visit should be devoted to the provision of health guidance information. Selected information, based on responses to the screening questionnaire, may be discussed during the office visit and additional information may be given out as handouts or brochures. The American Academy of Pediatrics publishes a brochure entitled “Health Care for College Students,” which covers recommendations for sleep, nutrition, exercise, responsible sexual activity including abstinence, responsible drinking including abstinence, common health problems, mental health, and safety on campus. The ACHA publishes a multitude of brochures on many of these topics as well. The Healthy Student, A Parent's Guide to Preparing Teens for the College Years is available

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from the Society for Adolescent Medicine (http://www.adolescenthealth.org/The_Healthy_Student.pdf).

For the adolescent with chronic medical conditions, an attempt should be made to arrange for transition of care, either to the health care providers in the college health service or to community providers near the college or university. The parent should sign a release of information (for the minor child) and a copy of the medical record, or an introductory letter summarizing the medical history should be sent to the new provider.

Information for Parents to Consider When Sending Their Children Off to College

Available College Health Center Services and Costs

The college-bound student and parents should ask for information about the college health service. Services provided by the college health service are often found on the college's Web site. Campus health services vary from large multispecialty centers providing all outpatient primary care, specialty, and diagnostic services to those that provide only rudimentary first aid. In general, however, college health services provide high-quality, low-cost accessible primary care and health education services. Parents and students should determine what services are available and what the student health fee (if any) covers.

After-hours Care

Information about provision of after-hours care and emergency services, pharmacy services, and the location of the referral hospital should be obtained and the information kept in an accessible location.

Health Insurance

Most colleges have no facilities such as infirmaries for overnight stays. Parents should ensure that the college-bound student has adequate health insurance to cover hospitalization and emergency, specialty, and diagnostic health services. It is estimated that currently 25% to 30% of college students are uninsured. An unexpected medical bill can interrupt or terminate a college career, and it is strongly recommended that students not go without adequate health insurance. Many campuses sponsor a group health insurance plan for students at reasonable rates. Parents should check the following:

  1. Benefits: It is wise to explore the benefits of any and all plans to determine prescription drug policies, whether there are in-network providers in the college area, and the basics about out-of-network coverage, particularly as it concerns access to emergency care and hospitalization.
  2. Insurance card: The student should be advised to carry a copy of his or her health insurance card at all timesand have the name and phone number of the primary care provider.

Consent and Confidentiality

  1. Minor consent: If the college-bound student will be an unemancipated minor child on arrival on campus, the parent should sign a generic “consent for treatment” and forward this to the college health service. Many institutions provide this statement on their prematriculation health history form. The parent should be aware that certain disorders or conditions may be treated without parental consent, even if the student is an unemancipated minor. These may include diagnosis and treatment of STDs, contraception, pregnancy, and family planning; mental health or emotional disturbance; and/or substance abuse.
  2. Alcohol use: As of 1998, federal law permits, but does not require, colleges and universities to notify parents any time a student younger than 21 years violates drug or alcohol laws. Many institutions have since adopted a policy of mandatory parental notification if a student is found to be involved in risky or illegal behavior such as underage drinking, public drunkenness, drugs, or criminal activity. Because colleges and universities vary in their approach to this issue, the parent should become familiar with the policies on their child's campus.
  3. Confidentiality: Once the student is of age 18 years, he or she is considered an adult. At this point, the college health service will adopt a policy of strict confidentiality regarding medical records and medical information. Medical information will not be released to anyone (even the parent who is paying the tuition and fees) without the student's written consent or a court order. This new approach to confidentiality often causes anguish and frustration on the part of the parent but is essential if the student is to engage openly in a professional relationship with the health care provider. Furthermore, confidentiality is essential if the college health service is to assist the student in assuming increasing responsibility for personal health care. Counseling services on campus will adopt the same policy of strict confidentiality.

Personal Health Information

The parent should ensure that the student is knowledgeable about his or her personal health information.

  1. Medications: The student should have a list of all medications, dosages, and frequency of dosing and should be aware of why the medication was prescribed.
  2. Allergies: The student should be aware of all allergies to medications, foods, and others, and should have some knowledge of the type of reaction (e.g., hives, rash, trouble breathing, and shock).
  3. Family medical history: The student should be aware of important family medical history and should keep this current.
  4. Prior health problems and records: If the student has a prior history of a chronic or significant medical or psychiatric condition, make sure a copy of these records is sent to the student health service or counseling service.
  5. Precollege examination and immunizations: This can be an important opportunity/time to review health history including reproductive health and mental health issues with a student's primary care physician. It is also a time to bring immunizations up to date. This information is discussed previously in this chapter.

First Aid Supplies

Every student should have basic health care supplies and equipment to deal with minor illnesses and injuries.

  1. First aid kit
  2. Bandages
  3. Antibiotic ointment
  4. Elastic wrap such as an Ace wrap

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  1. Liquid soap
  2. 2 × 2 Gauze pads
  3. Acetaminophen
  4. Ibuprofen
  5. Pepto-Bismol
  6. Cough and cold medicine
  7. Sore throat lozenges or throat spray
  8. Allergy medicine
  9. Electronic thermometer
  10. Ice pack or chemical cold pack

Guidance Regarding Transition

Parents should be aware that entering college marks a transition for the student that reaches far beyond merely leaving home. Parents will no longer be personally responsible for attending to the health care needs of their son or daughter. Rather, the student begins the process of learning self-care and good health practices. Parents can assist with this process by “letting go” and allowing students to engage in their own decision making. The campus health service will assist with this transition, by one-on-one counseling and education within the clinic and through programmed health promotion activities on campus. Through these combined efforts, the student will transition toward a state of optimal health, physically, emotionally, socially, intellectually, and spiritually.

Web Sites

Health Resources

http://www.columbia.edu/cu/healthwise/alice.html. Go Ask Alice includes health question and answers from Columbia University.

http://www.health.gov/healthypeople/. Healthy people 2010 home page.

Organizations

http://www.nces.ep.gov. National Center Education Statistics.

http://www.acha.org/. American College Health Association home page, includes position papers.

http://www.chronicle.com/ Chronicle of Higher Education.

http://www.acpa.org/. American College Personnel Association - College Student Educators International.

http://www.nacubo.org/. National Association of College and University Business Officers.

http://www.naspa.org/. National Association of Student Personnel Administrators.

http://www.aaahc.org/. Accreditation Association for Ambulatory Health Care.

http://www.aaahc.org/. Accreditation Association for Ambulatory Health Care.

http://www.jcaho.org/. Joint Commission on Accreditation of Healthcare Organizations, home page.

http://www.edc.org/hec/. The U.S. Department of Education established the center to provide nationwide support for campus alcohol and other drug-prevention efforts.

References and Additional Readings

Advisory Committee on Immunization Practices. Meningococcal disease and college students: recommendations of the Advisory Committee on Immunization Practices (ACIP),MMWR 2000;49(RR-11-20).

American Association for Health Education, National Commission for Health Education Credentialing, Inc., & Society for Public Health Education. A competency-based framework for health educators. Allentown, PA, 2006.

American College Health Association. Guidelines for a college health program. Baltimore, 2001.

American College Health Association. Recommendations for institutional prematriculation immunizations. American College Health Association. 2005. Available at www.acha.org.

American College of Health Association. The American College Health Association National College Health Assessment (ACHA-NCHA), Spring 2003 Reference Group report. J Am Coll Health 2005:53;199.

Boyer EL. College: the undergraduate experience in America. New York: Harper & Row, 1987.

Centers for Disease Control and Prevention. Core curriculum on tuberculosis: what the clinician should know? 4th ed. Atlanta, GA: Centers for Disease Control and Prevention, 2000. Available at state health departments or at www.cdc.gov/nchstp/tb/pubs/corecurr/.

Christmas WA. The evolution of Medical Services for Students at College and Universities in the United States. J Am Coll health. 1995;43:241.

Chronicle of Higher Education. Almanac issue 2007–2008, http://chronicle.com/free/almanac/2007.

DeArmond M. College health 2000, American College Health Association, 1987.

DeArmond MM. The future of college health. J Am Coll Health 1995;43:258.

DeArmond MM, Bridwell MW, Cox JW, et al. College health toward the year 2000. J Am Coll Health 1991;39:249.

Digest of Education Statistics, 2006, National Center for Education Statistics. U.S. Department of Education, http://nces.ed.gov/programs/digest.

Elster AB, Kuznets NJ, eds. AMA Guidelines for Adolescent Preventive Services (GAPS): recommendations and rationale. Baltimore: Williams & Wilkins, 1994.

Goldstein MA. Preparing adolescent patients for college. Curr Opin Pediatr 2002;14:384.

Greydanus DE, Rimsza ME, Matytsina L. Contraception for college students. Pediatr Clin North Am 2005;52:135.

Hussar WJ. Projections of Education Statistics to 2014 (NCES 2005–074). U.S. Department of Education, National Center for Education Statistics. Washington, DC: U.S. Government Printing Of?ce, 2005.

Jackson M, Weinstein H. The importance of healthy communities of higher education. J Am Coll Health 1997;45:237.

Johnston LD, O'Malley PM, Bachman JG, et al. Monitoring Future national survey results on drug use, 1975–2006, Volume I, Secondary school students. NIH Publication No. 07-6205. Bethesda, MD: National Institute on Drug Abuse; Available at: http://www.monitoringthefuture.org/pubs/monographs/vol1_ 2006.pdf.

Johnston LD, O'Malley PM, Bachman JG, et al. Monitoring the Future national survey results on drug use, 1975–2006, Volume II: College students and adults ages 19–45 NIH Publication No. 07-6206. Bethesda, MD: National Institute on Drug Abuse. Available at: http://www.monitoringthefuture.org/pubs/monographs/vol2 2006.pdf.

Keeling RP. Why college health matters [Editorial]? J Am Coll Health 2002;50:261.

Lyznicki JM, Nielsen NH, Schneider JF. Cardiovascular screening of student athletes. Am Fam Physician 2000;62:765.

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National Association of Student Personnel Administrators and American College Health Association. Principles of good practice for student affairs: statement and inventories. National Association of Student Personnel Administrators and American College Health Association, May 1998.

National Center for Education Statistics. http://www.nces.ed.gov. 2005.

National Heart, Lung, and Blood Institute. Obesity Education Initiative. The practical guide to identification, evaluation and treatment of overweight and obesity in adults. Available at www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm. Accessed 2007

Packwood W. College student personnel services. Charles C. Thomas Publisher, 1977:298–365.

Patrick K. Student health: medical care within institutions of higher education. JAMA 1988;260:3301.

Prouty AM, Protinsky HO, Canady D. College women: eating behaviors and help-seeking preferences. Adolescence 2002;37:353.

Pryor JH, Hurtado S, Saenz VB, et al. The American Freshman: Forty Year Trends. Los Angeles: Higher Education Research Institute, UCLA 2007.

Rimsza ME. Sexually transmitted infections: new guidelines for an old problem on the college campus. Pediatr Clin North Am 2005;52:217.

Rimsza EM, Kirk GM. Common medical problems of the college student. Pediatr Clin North Am 2005;52:9.

Smith DM. American Academy of Family Physicians, Preparticipation Physical Evaluation Task Force. Preparticipation physical evaluation, 2nd ed. Minneapolis: Physician and Sports medicine, 1997.

Stashwick CA. The pre-college visit: make the most of it. Intern Med 1997;14:89.

Swinford PL. Advancing the health of students: a rationale for college health programs. J Am Coll Health 2002;50:309.

Wechsler H, Davenport AE, Dowdall GW, et al. Binge drinking, tobacco, and illicit drug use and involvement in college athletics: a survey of students at 140 American colleges. J Am Coll Health 1997;45:195.

Wechsler H. Molnar BE. Davenport AE. Baer JS. College alcohol use: a full or empty glass?. J Am College Health. 1999;47(6):247.

Wechsler H. Lee JE. Kuo M. Seibring M. Nelson TF. Lee H. Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993–2001. J Am College Health. 2002;50(5):203.

Working Group Report from the National High Blood Pressure Education Program, Update on the Task Force (1987). On blood pressure in children and adolescents. National Institutes of Health; September 1996. NIH publication no. 96–3790.

Editors: Neinstein, Lawrence S.

Title: Adolescent Health Care: A Practical Guide, 5th Edition

Copyright ©2008 Lippincott Williams & Wilkins

> Back of Book > Appendices > Appendix I - Reference Materials on Adolescence

Appendix I

Reference Materials on Adolescence

Lawrence S. Neinstein

General Adolescent Medicine

American Academy of Pediatrics. Guidelines for health supervision III. Elk Grove Village: American Academy of Pediatrics, 2002.

Aten CB, Gotlieb EM, eds. Caring for adolescent patients, 2nd ed. Elk Grove Village: American Academy of Pediatrics, 2006.

Braithwaite RL, Taylor SE, eds. Health issues in the black community. San Francisco: Jossey-Bass, 2001.

Coupey SM. Primary care of adolescent girls. Philadelphia: Hanley & Belfus, 2000.

Elster AB, Kuznets NJ. AMA guidelines for adolescent preventive services [GAPS]: recommendations and rationale. Chicago: American Medical Association, 1995.

Friedman SB, Fisher M, Schonberg K. Comprehensive adolescent health care, 2nd ed. St. Louis: Mosby, 1998.

Gallagher R, Heald F, Carrell D. Medical care of the adolescent. New York: Appleton-Century-Crofts, 1976.

Goldstein MA. Boys into men: staying healthy through the teen years. Westport: Greenwood Press, 2000.

Greydanus DE, Patel DR, Pratt HD. Essential adolescent medicine. New York: McGraw-Hill, 2006.

Hofmann AD, Greydanus DE, eds. Adolescent medicine, 3rd ed. Stamford: Appleton & Lange, 1997.

Holmes KI, Mardh PA, Sparling PF, et al. eds. Sexually transmitted diseases, 3rd ed. New York: McGraw-Hill, 1999.

Irwin C. Principles of adolescent medicine. New York: Elsevier Science, 2000.

Jacobson MS, ed. Adolescent nutritional disorders: prevention and treatment. New York: New York Academy of Sciences, 1997.

Kaufman M. Easy for you to say: questions and answers for teens living with chronic illness or disability. Buffalo: Firefly Books, 2005.

Koss-Chioino JD, Vargas LA. Working with Latino youth: culture, development, and context. San Francisco: Jossey-Bass, 1999.

McAnarney ER, Kriepe RE, Orr PP, et al. eds. Textbook of adolescent medicine. Philadelphia: WB Saunders, 1992.

McDonald RE, Avery DR, eds. Dentistry for the child and adolescent, 7th ed. Harcourt Health Sciences, 1999.

Moore S. Youth, AIDS, and sexually transmitted diseases (adolescence and society). London, New York: Routledge, 1996.

Neinstein LS. Adolescent health care: a practical guide. Philadelphia: Lippincott Williams & Wilkins, 2008.

Prescott HM. A doctor of their own: the history of adolescent medicine. Cambridge: Harvard University Press, 1998.

Rickert VI, ed. Adolescent nutrition: assessment and management. New York: Chapman & Hall, 1996.

Ryan C, Futterman D. Lesbian & gay youth: care and counseling. New York: Columbia University Press, 1998.

Shannon JB. Adolescent health sourcebook, 2nd ed. Detroit: Omnigraphics, 2006.

Sorenson RC. Adolescent sexuality in contemporary America. New York: World Publishing, 1973.

Stanitski CL. Pediatric and adolescent sports medicine. Boston: Little, Brown and Company, 1994.

Tanner IM. Growth at adolescence. London: Blackwell Science, 1962.

U.S. Congress, Office of Technology Assessment, Adolescent Health—Volume I: Summary and Policy Options, OTA-H-468 (Washington, DC: U.S. Government Printing Office, 1991).

U.S. Congress, Office of Technology Assessment, Adolescent Health—Volume II: Background and the Effectiveness of Selected Prevention and Treatment Services, OTA-H-466(Washington, DC: U.S. Government Printing Office, 1991).

World Health Organization. The health of young people: a challenge and a promise. Geneva: World Health Organization, 1993.

Psychosocial Concerns

Adams G, ed. Adolescent development: the essential readings. Malden: Blackwell Science, 2000.

Aguilera DC. Crisis intervention: theory and methodology. St. Louis: Mosby–Year Book, 1998.

Allmond BW, Tanner LJ, Gofman HF. The family is the patient: Using family interviews in children's medical care, 2nd ed. Baltimore: Lippincott Williams & Wilkins, 1999.

Bauman L. The ten most troublesome teen-age problems and how to solve them. Secaucus: Carol, 1997.

Barrett PM, Ollendick TH. Handbook of interventions that work with children and adolescents: prevention and treatment. Hoboken: John Wiley and Sons, 2004.

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Berman AL, Jobes DA. Adolescent suicide: assessment and intervention. Washington, DC: American Psychological Association, 2006.

Blos P. The adolescent passage: developmental issues. New York: International Universities Press, 1979.

Bonino S, Cattelino E, Ciairano S. Adolescents and risk: behaviors, functions, and protective factors. New York: Springer-Verlag New York, 2005.

Brach H. The golden cage: the enigma of anorexia nervosa. New York: Vintage Books, 1979.

Bruch H. Eating disorders: anorexia nervosa, obesity, and the person within. New York: Basic Books, 1973.

Brumbert JJ. Fasting girls: the history of anorexia nervosa. New York: Vintage Books, 2000.

Caissy GA. Early adolescence: understanding the 10- to 15-year-old. New York: Insight Books, 1994.

Carnegie Council on Adolescent Development. Great transitions: preparing adolescents for a new century/concluding report, Carnegie council on adolescent development. New York: Carnegie Corporation of New York, 1995.

Cheng K, Myers K. Child and adolescent psychiatry: the essentials. Philadelphia: Lippincott Williams & Wilkins, 2005.

Costin C. The eating disorder sourcebook: a comprehensive guide to the causes, treatments, and prevention of eating disorders, 3rd ed. New York: McGraw-Hill, 2007.

D'Onofrio A. Adolescent self-injury: a comprehensive guide for counselors and health care professionals. New York: Springer-Verlag New York, 2007.

Elkind D. A sympathetic understanding of the child: birth to sixteen, 3rd ed. Boston: Allyn & Bacon, 1994.

Elkind D. All grown up and no place to go: teenagers in crisis. Reading: Addison Wesley, 1998.

Erikson E. Identity, youth, and crises. New York: WW Norton, 1968.

Fishman HC. Treating troubled adolescents: a family therapy approach. New York: Basic Books, 1988.

Forgatch M, Patterson G. Parents and adolescents: living together. II, 2nd ed. Champaign: Research Press, 2005.

Freeman A, Reinecke M, eds. Personality disorders in children and adolescents. Hoboken John Wiley and Sons, 2007.

Fritz GK. Child and adolescent mental health consultation in hospitals, schools, and courts. Washington, DC: American Psychiatric Press, 1993.

Gallagher J, Harris HI. Emotional problems of adolescents. New York: Oxford University Press, 1976.

Goreczny AJ, Hersen M. Handbook of pediatric and adolescent health psychology. Boston: Allyn & Bacon, 1999.

Green WH. Child and adolescent clinical psychopharmacology. Philadelphia: Lippincott Williams & Wilkins, 2007.

Holinger PC. Suicide and homicide among adolescents. New York: Guilford Press, 1994.

Hughes JN, La Greca AM, Conoley JC. Handbook of psychological services for children and adolescents. New York: Oxford University Press, 2000.

Jaffe M. Adolescence. New York: John Wiley and Sons, 1998.

Jessor R, ed. New perspectives on adolescent risk behavior. Cambridge, New York: Cambridge University Press, 1998.

Jessor R, Jessor SC. Problem behavior and psychosocial development: a longitudinal study of youth. New York: Academic Press, 1977.

Kasper S, den Boer JA, Ad Sitsen JM. Handbook of depression and anxiety, 2nd ed. New York: Marcel Dekker Inc, 2003.

King RA, Apter A. Suicide in children and adolescents. New York: Cambridge University Press, 2003.

Lask B, Bryant-Waugh R. Eating disorders in childhood and adolescence. New York: Taylor and Francis, 2007.

Le Grange D. Treating bulimia in adolescents: a family-based approach. New York: Guilford Press, 2007.

Lerner RM, Lerner JV, eds. Theoretical foundations and biological bases of development in adolescence. New York: Garland, 1999.

Mattis SG, Ollendick TH. Panic disorder and anxiety in adolescence. Malden: Blackwell Science, 2002.

Minuchin S, Rosman BL, Baker L. Psychosomatic families: anorexia nervosa in context. Cambridge: Harvard University Press, 1978.

Offer D, Ostroy E, Howard KI, eds. Patterns of adolescent self-imaging. San Francisco: Jossey-Bass, 1984.

Offer D, Sabshin M, Offer J. The psychological world of the teenager: a study of normal adolescent boys. New York: Basic Books, 1969.

Patterson G, Forgatch M. Parents and adolescents: living together. I. The basics. Champaign, Illinois, Research Press, 2005.

Reynolds WM, Johnston HE. Handbook of depression in children and adolescents. New York: Plenum Publishing, 1994.

Rice FP. Child and adolescent development. Upper Saddle River: Prentice Hall, 1997.

Robin AL. ADHD in adolescents: diagnosis and treatment. New York: Guilford Press, 1998.

Santrock JW. Adolescence, 11th ed. Boston: McGraw-Hill, 2007.

Scales P. Developmental assets: a synthesis of the scientific research on adolescent development. Minneapolis: Search Institute, 1999.

Shaffer DR. Developmental psychology: childhood and adolescence, 7th ed. Belmont: Wadsworth/Thomson, 2007.

Sorenson RC. Adolescent sexuality in contemporary America. New York: World Publishing, 1973.

Spruijt-Metz D. Adolescence, affect, and health. Hove, East Sussex, UK: Psychology Press, 1999.

Steinberg L. Adolescence, 7th ed. Boston: McGraw-Hill, 2005.

Stubbe D. Child and adolescent psychiatry: a practical guide. Philadelphia: Lippincott Williams & Wilkins, 2007.

Weiss SI. Coping with the beauty myth: a guide for real girls. New York: Rosen, 2000.

Wiener JM, Dulcan MK, eds. Textbook of child and adolescent psychiatry, 3rd ed. Washington, DC: American Academy of Child and Adolescent Psychiatry and American Psychiatric Press, 2004.

Wodarski JS, Wodarski LA, Dulmus CN. Adolescent depression and suicide: a comprehensive empirical intervention for prevention and treatment. Springfield: Charles C Thomas Publisher, 2003.

Wolfe DA. Adolescent risk behaviors: why teens experiment and strategies to keep them safe New Haven. Yale University Press, 2006.

Wolfe DA, Mash EJ. Behavioral and emotional disorders in adolescents: nature, assessment, and treatment. New York: Guilford Press, 2006.

Wolman BB. Adolescence: biological and psychosocial perspectives. Westport: Greenwood Press, 1998.

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Adolescent Gynecology

Carpenter SEK, Rock JA, eds. Pediatric and adolescent gynecology. Philadelphia: Lippincott Williams & Wilkins, 2000.

Curtis MG, Overhold S, Hopkins MP, eds. Glass' office gynecology. Philadelphia: Lippincott Williams & Wilkins, 2006.

Emans SJH, Laufer MR, Goldstein DP. Pediatric and adolescent gynecology, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2005.

Garden AS, ed. Paediatric and adolescent gynaecology. London, New York: Arnold, Oxford University Press, 1998.

Goldfarb AF. Clinical problems in pediatric and adolescent gynecology. Philadelphia: Current Medicine, 1998.

Hatcher RA, Trussel J, Nelson AL, et al. Contraceptive technology, 19th ed. Atlanta, Contraceptive Technology Communications, 2008.

Mishell DR, ed. Reproductive endocrinology. Philadelphia: Current Medicine, 1999.

Sanfilippo JS, Muram D, Lee PA, et al. eds. Pediatric and adolescent gynecology, 2nd ed. Philadelphia: WB Saunders, 2001.

Womens Health Care Physicians. Health care for adolescents. Washington, DC American College of Obstetricians and Gynecologists, 2003.

Books for Teens and Parents

Anderson A. Making weight: men's conflicts with food, weight, shape and appearance. Carlsbad: Gurze Books, 2000.

Beecher M. Parents on the run: a common sense book for today's parents. New York: Calahad Books, 1974.

Bennett D, Rowe L. What to do when your children turn into teenagers. New York: Doubleday Division of Random House, 2003.

Blume J. Letters to Judy: what your kids wish they could tell you. New York: Putnam's Sons, 1986.

Canfield J, Hansen MV, Kirberger K. Chicken soup for the teenage soul: 101 stories of life, love and learning. Deerfield Beach: Health Communications Inc, 1997.

Cole B. Hair in funny places: a book about puberty. New York: Hyperion Books for Children, 2000.

Collins L. Eating with your anorexic: how my child recovered through family-based treatment and yours can too. New York: McGraw-Hill, 2005.

Columbia University Health Education Program. The “Go Ask Alice” book of answers: a guide to good physical, sexual and emotional health. New York: Henry Holt & Co, 1998.

Coombs HS. Teenage survival manual: how to reach 20 in one piece (and enjoy every step of the journey), 5th ed. new millennium ed. San Francisco: Halo Books, 1998.

Cordes H. Girl power in the mirror: a book about girls, their bodies, and themselves. Minneapolis: Lerner, 2000.

Crompton V, Kessner EZ. Saving beauty from the beast: how to protect your daughter from an unhealthy relationship. Boston: Little, Brown and Company, 2003.

De Prisco J, Riera M. Field guide to the American teenager: a parent's companion. Cambridge: Perseus Publishing, 2000.

Dinkmeyer D, McKay GD. The STEP approach to parenting your teenager. Circle Pines: American Guidance Service, 1998.

Elkind D. Understanding your child from birth to sixteen. Boston: Allyn and Bacon, 1999.

Fairchild B, Hayward N. Now that you know: a parent's guide to understanding their gay and lesbian children. New York: Harcourt Brace, 1998.

Forgatch M, Patterson G. Parents and adolescents: living together. II., 2nd ed. Champaign: Research Press, 2005.

Freeman CG. Living with a work in progress: a parent's guide to surviving adolescence. Columbus: National Middle School Association, 1996.

Gaffney CR. Dr. Gaffney's coaching guide for better parents and stronger kids. Wilsonville: BookPartners, 1997.

Ginsburg KR. A parent's guide to building resilience in children and teens: giving your child roots and wings. Elk Grove Village: American Academy of Pediatrics, 2006.

Ginsburg K, Jones M, Jablow MM. Less stress, more success: a new approach to guiding your teen through college admissions and beyond. Elk Grove Graphics: American Academy of Pediatrics, 2006.

Ginott HG. Between parent and teenager. New York: Macmillan, 1969.

Gordon S. When living hurts. New York: Union of American Hebrew Congregations, 1994.

Gordon S, Gordon J. Raising a child responsibly in a sexually permissive world. Holbrook: Adams Media, 2000.

Gravelle K. What's going on down there?: answers to questions boys find hard to ask. New York: Walker and Co, 1998.

Haffner D. Beyond the big talk: every parent's guide to raising sexually healthy teens–from middle school to high school, and beyond. New York: Newmarket Press, 2001.

Haffner D. From diapers to dating: a parent's guide to raising sexually healthy children, 2nd ed. New York: Newmarket Press, 2004.

Harris SO. When growing up hurts too much: a parent's guide to knowing when and how to choose a therapist with your teenager. Lexington: Lexington Books, 1990.

Harris RH, Emberley M. It's perfectly normal: changing bodies, growing up, sex, and sexual health. Cambridge: Candlewick Publishers, 2004.

Kaufman M, ed. Mothering teens: understanding the adolescent years. Charlottetown: Genergy Books, 1997.

Kimball G. The teen trip: the complete resource guide. Chicago: Equality Press, 1997.

Madaras L. My body, my self for boys. New York: New Market Press, 1995.

Madaras L. The what's happening to my body? book for boys: the new growing-up guide for parents and sons, 3rd ed. New York: Newmarket Press, 2001.

Madaras L. The “what's happening to my body” book for girls: the new growing-up guide for parents and daughters, 3rd ed. New York: Newmarket Press, 2001.

McCoy K. Understanding your teenager's depression: issues, insights, and practical guidance for parents. New York: Berkley Publishing Group, 1994.

McCoy K. Growing and changing. New York: Berkley Publishing Group, 2003.

McCoy K, Wibbelsman C. Crisis-proof your teenager. New York: Bantam Books, 1991.

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McCoy K, Wibbelsman C. Life happens: a teenager's guide to friends, failure, sexuality, love, rejection, addiction, peer pressure, families, loss, depression, change, and other challenges of living. New York: Berkley Publishing Group, 1996.

McCoy K, Wibbelsman C. The teenage body book. New York: Perigee, 1999.

McGraw J. Life strategies for teens. New York: Fireside, 2000.

Middleman AB, Pfeifer KG. American Medical Association boys' guide to becoming a teen. San Francisco: Jossey-Bass, 2006.

Ng G. Everything you need to know about self-mutilation: a helping book for teens who hurt themselves. New York: Rosen, 1998.

Panzarine S. A parent's guide to the teen years: Raising your 11 to 14 year old in the age of chat rooms and navel rings. New York: Facts On File, 2000.

Patterson G, Forgatch M. Parents and adolescents: living together. The basics. Champaign, Illinois, Research Press, 2005.

Patterson GR, Forgatch MS. Parents and adolescents living together: Part 2: family problem solving. 2nd Edition. Champaign Illinois: Research Press, 2005.

Pollack W. Real boys: rescuing our sons from the myths of boyhood. New York: Henry Holt & Company, 1999.

Ponton L. The sex lives of teenagers. New York: Dutton, 2000.

Pruitt D. Your adolescent: emotional, behavioral, and cognitive development from early adolescence through the teen years. New York: NY Collins Publishing, 2000.

Richardson J, Schuster MA. Everything you never wanted your kids to know about sex, (but were afraid they'd ask): the secrets to surviving your child's sexual development from birth to the teens. New York: Crown Publishers, 2003.

Siegel M. Surviving an eating disorder: strategies for family and friends. New York: HarperPerennial, 1997.

Slap GB, Jablow MM. Teenage health care. New York: Pocket Books, 1994.

Steinberg L. The ten basic principles of good parenting. New York: Simon & Schuster, 2004.

Steinberg LD, Levine A. You and your adolescent: a parent's guide for ages 10 to 20. New York: Harper & Row, 1997.

Weisman B, Weisman M. What we told our kids about sex. San Diego: Harcourt Brace Jovanovich, 1987.

Weston C. Girl talk: all the stuff your sister never told you. New York: Harper Perennial, HarperCollins, 1997.

Wolf AE. “Get out of my life, but first could you drive me and Cheryl to the mall?”: a parent's guide to the new teenager. New York: Farrar, Straus and Giroux, 2002.

Journals

Adolescence

Libra Publishers, 391 Willets Road, Roslyn Heights, NY 11577 (Quarterly journal of current research in areas of social work and psychology.)

Adolescent Medicine Clinics

Elsevier Science Publishing Co, 6277 Sea Harbor Drive

Orlando, FL 32887–4800655. Adolescent Medicine Clinics is the journal of the AAP Section on Adolescent Health. The hardcover journal is published 3 times annually.

Archives of Pediatrics and Adolescent Medicine

American Medical Association P.O. Box 10946 Chicago, IL 60610-0946

Current Problems in Pediatric and Adolescent Health Care

Mosby, A Division of Elsevier Science Publishing Co, 6277 Sea Harbor Drive Orlando, FL 32887–4800655

Jounral of Adolescent and Pediatric Gynecology

Elsevier Science Publishing Co, 6277 Sea Harbor Drive Orlando, FL 32887–4800655 (Official quarterly publication of the North American Society for Pediatric and Adolescent Gynecology.)

Journal of Adolescent Health

Elsevier Science Publishing Co, 6277 Sea Harbor Drive Orlando, FL 32887–4800655 (Official quarterly publication of the North American Society for Pediatric and Adolescent Gynecology.)

Journal of Adolescent Research

Sage Publications, Inc., 2455 Teller Road, Newbury Park, CA 91320, 805-499-0721 (Official publication of the Society for Research on Adolescence.)

Journal of American College Health

Heldref Publications, 4000 Albemarle Street, NW, Washington, DC 20016 (Journal dedicated to the exchange of information related to health care issues in community colleges, colleges, and universities.)

Journal of Youth and Adolescence

Plenum Publishing Corp., 233 Spring Street, New York, NY 10013 (Multidisciplinary quarterly research journal.

Editors: Neinstein, Lawrence S.

Title: Adolescent Health Care: A Practical Guide, 5th Edition

Copyright ©2008 Lippincott Williams & Wilkins

> Back of Book > Appendices > Appendix II - Other Resources and Services

Appendix II

Other Resources and Services

Lawrence S. Neinstein

General Resources and Services

The Center for Early Adolescence, School of Medicine, University of North Carolina at Chapel Hill, D-2 Carr Mill Town Center, Carrboro, NC 27510; 919-966-1148. (Offers bibliographies and booklets on many areas concerning young adolescents, such as community services, parenting, and sexuality.) Available from the center:
 Understanding Early Adolescence: A Framework, by J. P. Hill
 Understanding Families With Young Adolescents, by L. D. Steinberg
 Schools for Young Adolescents: Adapting the Early Childhood Model, by S. Feeney Resource Lists

 “Adolescent Literature”
 “Community Resources”
 “Early Adolescence”
 “Educating Young Adolescents”
 “Parenting”
 “Religion”
 “Sex Education”

Abortion Services

Check telephone listings under
 Clergy counseling service
 National Abortion Federation Hotline: 800-772-9100
 National Organization for Women
 Planned Parenthood

Counseling Services

Check telephone listings under 
 Family Services Association
 County department of health
 Counseling clinics
 Mental health clinics
 United Fund

Hotline Services

Adolescent Crisis Intervention and Counseling (the “nine” line): 800-999-9999 (24 hours, 7 days)
AIDS
 Centers for Disease Control and Prevention (CDC)
  Acquired Immunodeficiency Syndrome (AIDS) Hotline: 800-342-2347 (24 hours, 7 days)
  Spanish: 800-344-7432 (8 a.m. to 2 a.m., Eastern time, 7 days)
  TTY: 888-232-6348 (Monday through Friday, 10 a.m. to 10 p.m., Eastern time)
 Teens AIDS: 800-440-8336 (staffed by teens for teens; Fridays and Saturdays, 6 p.m. to midnight, Eastern time)
 Teens TAP (Teaching AIDS Prevention), an AIDS information line for teens (not a crisis line): 800-234-8336 (Monday through Friday, 4 p.m. to 8 p.m., Central Standard time)

Gay and Lesbian Youth Hotline (not a crisis line): 800-773-5540 (Thursday through Saturday, 12 p.m. to 8 p.m., Eastern time)

Hit Home, a national youth crisis line for suicide, abuse, pregnancy, depression, counseling, and intervention: 800 442–4673 (24 hours, 7 days)

National Child Abuse Hotline, for suspected child abuse reports and for referrals: 800-422-4453 (800 4-A-CHILD) (24 hours, 7 days)

National Domestic Violence/Child Abuse/Sexual Abuse: 800-799-SAFE/800-799-7233/800-787-3224 TDD, 800-942-6908 Spanish Speaking 24-hour-a-day 7 days a week hotline, Provides crisis intervention and referrals to local services and shelters for victims of partner or spousal abuse.

National Herpes Hotline: 919-361-8488 (Monday through Friday 9 a.m. to 7 p.m., Eastern time)

National Runaway Switchboard Hotline (for youth or parents:1 800 RUNAWAY (800) 786–2929) (24 hours)

National Youth Crisis Hotline: 1-800-442-HOPE (4673) Provides counseling and referrals to local drug treatment centers, shelters, and counseling services. Responds to youth dealing with pregnancy, molestation, suicide, and child abuse. Operates 24 hours, 7 days a week.

Rape Hotline 1800 656-HOPE

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STD Hotline: 800-227-8922 (Monday through Friday, 8 a.m. to 11 p.m., Eastern time)

Check local operator or directory for hotlines listed under
 Crisis counseling
 Counseling
 Drug abuse
 Rape
 Runaways
 Suicide

Information also available from

National Clearinghouse for Mental Health Information, P. O. Box 2345, Rockville, MD 20847-2345, (800) 729–6686

See also “Adolescent Clinics” section later in this appendix.

Alcohol and Drug Problems

Books

Bukstein OG. Adolescent substance abuse: assessment, treatment, and prevention. New York: John Wiley and Sons, 1995.

Carroll CR, Durrant LH. Drugs in modern society. Boston: McGraw-Hill, 2000.

Dayton T. Trauma and addiction: ending the cycle of pain through emotional literacy. Deerfield Beach: Health Communication, 2000.

Dodgen CE, Shea MW. Substance use disorders: assessment and treatment. San Diego: Academic Press, 2000.

Erlich LB. A textbook of forensic addiction, medicine, and psychiatry. Springfield: Charles C Thomas Publisher, 2001.

Falkowski C. Dangerous drugs: an easy-to-use reference for parents and professionals. Center City: Hazelden, 2000.

Frances RJ, Miller SI. Clinical textbook of addictive disorders. New York: Guilford Press, 1998.

Gold MS. Smoking and illicit drug use. New York: Haworth Medical Press, 1998.

Hardiman M. Overcoming addiction: a common sense approach. Freedom: Crossing Press, 2000.

Henderson EC. Understanding addiction. Jackson: University Press of Mississippi, 2000.

Kandel DB. Stages and pathways of drug involvement: examining the gateway hypothesis. New York: Cambridge University Press, 2001.

Ladewig D. Basic and clinical science of substance related disorders. New York: Basel, 1999.

Lawton SA. Drug information for teens : health tips about the physical and mental effects of substance abuse. Detroit: Omnigraphics, 2006.

Liddle HA, Rowe CL. Adolescent substance abuse : research and clinical advances. New York: Cambridge University Press, 2006.

Lowinson JH. Substance abuse: a comprehensive textbook. Philadelphia: Lippincott Williams & Wilkins, 2005.

McCrady BS, Epstein EE. Addictions: a comprehensive guidebook. New York: Oxford University Press, 1999.

McNeece AC, DiNitto DM. Chemical dependency: a systems approach. Boston: Allyn and Bacon, 1998.

Maisto SA, Galizio M, Connors GJ. Drug use and abuse. Fort Worth: Harcourt Brace College Publishers, 1999.

Margolis RD. Treating patients with alcohol and other drug problems: an integrated approach. Washington, DC: American Psychological Association, 1998.

Milkman HB, Sunderwirth SG. Craving for ecstasy: how our passions become addictions and what we can do about them. San Francisco: Jossey-Bass, 1998.

Miller NS. The principles and practice of addictions in psychiatry. Philadelphia: WB Saunders, 1997.

Niesink RJM. Drugs of abuse and addiction: neurobehavioral toxicology. Boca Raton: CRC Press, 1999.

Orcutt JD, Rudy DR. Drugs, alcohol, and social problems. Lanham: Rowman and Littlefield, 2003.

Ott PJ, Tarter RE, Ammerman RT. Sourcebook on substance abuse: etiology, epidemiology, assessment, and treatment. Boston: Allyn and Bacon, 1999.

Rogers PD, Werner MJ. Substance abuse. Philadelphia: WB Saunders, 1995.

Rotgers F. Main title: treating alcohol problems. Hoboken: Wiley-Liss, 2006.

Schuckit MA. Drug and alcohol abuse: a clinical guide to diagnosis and treatment. New York: Springer-Verlag New York, 2006.

Schaler JA. Addiction is a choice. Chicago: Open Court, 2000.

Senay EC. Substance abuse disorders in clinical practice. New York: WW Norton, 1998.

Sheen B. Teen alcoholism. San Diego: Lucent Books, 2004.

Smith DE, Seymour RB. Clinician's guide to substance abuse. New York: McGraw-Hill, Health Professions Division, 2001.

Sullivan E, Fleming M. A guide to substance abuse services for primary care clinicians. Rockville: U.S. Department of Health and Human Services; Public Health Service; Substance Abuse and Mental Health Services Administration, 1997.

Winters KC, ed. Adolescent substance abuse: new frontiers in assessment. New York: The Haworth Press, 2006.

Yoshida R, ed. Trends in alcohol abuse and alcoholism research. Hauppauge: Nova Science Publishers, 2006.

Organizations

Al-Anon Family Group Headquarters
 1600 Corporate Landing Parkway, Virginia Beach, VA 23454-5617; (888) 4AL-ANON

Alcohol and Drug Helpline
 800-821-4357 (Provides referrals to local facilities where adolescents and adults can seek help for alcohol and drug problems.)

Alcohol Hotline
 800-252-6465 (800-ALCOHOL)

Alcoholics Anonymous
 PO Box 459, Grand Central Station, New York, NY 10163; 212-870-3400; or check local office

American Council on Alcoholism
 800-527-5344 (Provides treatment referrals, counseling, and advice for alcoholics and their families and friends.)

Boys Clubs of America
 1275 Peachtree Street, N.E., Atlanta, GA 30309-3506, (404) 487–5700

Cocaine Anonymous World Services
 National Referral Information line (not a hotline): 800-347-8998
 World Service Office: 310-559-5833
 National Cocaine Hotline: 800-262-2463 (800-COCAINE)

Narcotics Anonymous
 PO Box 9999, Van Nuys, CA 91409; 818-773-9999; Fax: 818-700-0700

P.1119

 

National Clearinghouse for Alcohol Information
 PO Box 2345, Rockville, MD 20847-2345; 800-729-6686

National Clearinghouse for Alcohol and Drug Information
 PO Box 2345, Rockville, MD 20847-2345; 800-729-6686

National Council on Alcoholism
 22 Cortlandt Street, Suite 801, New York, NY 10007-3128; (800) 475-HOPE

National Council on Alcoholism and Drug Dependence, Inc
 800-622-2255 (Provides information and referrals to local counseling.)

National Federation of Parents for Drug-Free Youth
 11159-B South Town Square St. Louis, MO 63123(314) 845-1933

National Institute on Drug Abuse
 6001 Executive Boulevard, Bethesda, MD 20892-9561; 301-443-1124

Parent Resources Institute for Drug Education
 40 Hurt Plaza, Suite 210 Atlanta, GA 30303(404) 577-4500

Sexuality

Books

The Alan Guttmacher Institute (AGI). Sex and America's teenagers. New York: Alan Guttmacher Institute, 1994.

Bell R. Changing bodies, changing lives: a book for teens on sex and relationships. New York: Times Books, 1998.

Carrera MA. Adolescent sexuality and pregnancy prevention. New York: Bernice and Milton Stern National Training Center for Adolescent Sexuality and Family Life Education, The Children's Aid Society, 1996.

Cocca C. Adolescent sexuality: a historical handbook and guide. Westport: Praeger, 2006.

Columbia University Health Education Program. The “Go Ask Alice” book of answers: a guide to good physical, sexual and emotional health. New York: Henry Holt & Co, 1998.

Gordon S. Seduction lines heard around the world and answers you can give. Buffalo: Prometheus Books, 1987.

Gordon S, Gordon J. Raising a child responsibly in a sexually permissive world. Holbrook: Adams Media, 2000.

Haffner D. Beyond the big talk : every parent's guide to raising sexually healthy teens–from middle school to high school, and beyond. New York: Newmarket Press, 2001.

Haffner D. From diapers to dating : a parent's guide to raising sexually healthy children, 2nd ed. New York: Newmarket Press, 2004.

Harris RH, Emberley M. It's perfectly normal: changing bodies, growing up, sex, and sexual health. Cambridge: Candlewick Publishers, 2004.

Hyde M, Forsyth EH. Safe sex 101: an overview for teens. Minneapolis: Twenty-First Century Books, 2006.

McCoy K. Growing and changing. New York: Berkley Publishing Group, 2003.

McCoy K, Wibbelsman C. The teenage body book. New York: Perigee, 1999.

Nardo D. Teen sexuality. San Diego: Lucent Books, 1997.

Park JM, Card JJ, Muller KL. Just the facts: what science has found out about teenage sexuality and pregnancy in the U.S. San Jose: Sociometrics Corporation, 1998.

Rekers GA. Handbook of child and adolescent sexual problems. New York: Lexington Books, 1995.

Reisser PC. Parents' guide to teen health: raising physically and emotionally healthy teens. Wheaton: Tyndale House Publishers, 2001.

Sawyer K. Sex and the teenager: choices and decisions. Notre Dame: Ave Maria Press, 1999.

Organizations

AIDS Information Line, CDC, National Human Immunodeficiency Virus (HIV) and AIDS Hotline
 800-232-4636

American Social Health Association
 PO Box 13827, Research Triangle Park, NC 27709; 919-361-8400

Center for Population Options
 140016th Street, N.W. Suite 100, Washington, DC 200036; 202-667-1142

International Planned Parenthood Federation, Western Hemisphere Regional Office
 120 Wall Street, 9th floor, New York, NY 10005-3092; 212-248-6400

National Family Planning and Reproductive Health Association
 1627 K Street, NW, 12th floor, Washington, DC 20006; 202-293-3114

National Sex and Drug Forums
 330 Ellis Street, San Francisco, CA 94102

Planned Parenthood-World Population
 434 West 33rd Street, New York, New York 10001; 212-541-7800

Sex Information and Education Council of the United States (SIECUS) (main office)
 130 West 42nd Street, suite 350, New York, NY 10036-7802; 212-819-9770

Society for Adolescent Medicine (SAM)
 1916 Copper Oaks Circle, Blue Springs, MO 64015; 816-224-8010

Sex Education Resources

Manuals

Contact the following organizations for up-to-date educational manuals: 
 Planned Parenthood, national and local
 Family Planning Federation
 Local school district
 National Clearinghouse for Family Planning Information, Rockville, MD
 U.S. Department of Health and Human Services (U.S. Government Printing Office)

Other Resources

Odin Books
 1110 West West Broadway, Vancouver, BC; 800-223-6346 (Education resource lists available on education curricula and reference lists on topics such as self-esteem, attention-deficit disorder, depression, child abuse, eating disorders, and teen pregnancy.)

ETR Associates
 4 Carbonero Way, Scotts Valley, CA 95066 ; 1-800-321-4407 (Many pamphlets and books on AIDS, family life, sexual abuse, sexuality, drug abuse prevention, and reproductive health.)

P.1120

 

POPLINE (POPulation information onLINE)
 Johns Hopkins University, Population Information Program, 111 Market Place, suite 310, Baltimore, MD 21202-4024; 410-659-6300
 Online service: National Library of Medicine, Bethesda, MD; 800-638-8480 (for user ID and password) (Citations and abstracts to the worldwide literature on population and family planning.)

Planned Parenthood Federation of America
 434 W 33rd Street,, New York, NY 10001; 800 829–7732 (Many pamphlets, books, and videotapes on reproductive health care; also available is Current Literature in Family Planning, a monthly review of literature in family planning.)

Teenage Pregnancy

Books

Alan Guttmacher Institute.
 Disparities in rates of unintended pregnancy in the United States, 1994 and 2001 perspectives on sexual and reproductive health article. June 2006.
 In the know: questions about pregnancy, contraception and abortion frequently asked questions. May 2006.
 Assessing costs and benefits of sexual and reproductive health interventions: detailed data and analysis on the benefits of investing in sexual and reproductive health care. December 2004.
 U.S. teenage pregnancy statistics: overall trends, trends by race and ethnicity and state-by-state information state-level data on teenage pregnancy. February 2004.
 Unintended pregnancy in the United States most current data (update in progress). January 1998.
 Contraception counts: ranking state efforts state and congressional district fact sheets on meeting women's needs for contraception. February 1996.
 Sex and America's teenagers. New York: Alan Guttmacher Institute, 1994.

Battle SE. The black adolescent parent. New York: Haworth Press, 1987.

Becker E, Rankin E, Rickel AU. High-risk sexual behavior: interventions with vulnerable populations. New York: Plenum Publishing, 1998.

Breedlove GK, Schorfheide A. Adolescent pregnancy. White Plains: March of Dimes, 2001.

Cherry AL, Dillon ME, Rugh D. Teenage pregnancy: a global view. Westport: Greenwood Press, 2001.

Cothran H. Teen pregnancy and parenting. San Diego: Greenhaven Press, 2001.

Dudley W. Pregnancy. San Diego: Greenhaven Press, 2001.

Furstenberg FL, Brooks-Gunn J, Morgan SP. Adolescent mothers in later life. New York: Cambridge University Press, 1987.

Hardy JB, ed. Adolescent pregnancy in an urban environment: issues, programs, and evaluation. Washington, DC: Urban Institute Press, 1991.

Humenick SS, Wilkerson NN, Paul NW. Adolescent pregnancy: nursing perspectives on prevention. White Plains: March of Dimes Birth Defects Foundation, 1991.

Lawson A, Rhode DL. The politics of pregnancy: adolescent sexuality and public policy. New Haven: Yale University Press, 1993.

Lerman E, Moffett J. Teen moms: the pain and the promise. Buena Park: Morning Glory Press, 1997.

Luker K. Dubious conceptions: the politics of teenage pregnancy. Cambridge: Harvard University Press,1996.

Mayden B, Castro W, Annitto M. First talk: a teen pregnancy prevention dialogue among Latinos. Washington, DC: CWLA Press, 1999.

Merrick E. Reconceiving black adolescent pregnancy. Boulder: Westview Press, 2000.

Robinson BE. Teenage fathers. Lexington: Lexington Books, 1988.

U.S. Department of Education. Compendium of school-based and school-linked programs for pregnant and parenting adolescents. Washington, DC: National Institute on Early Childhood Development and Education, Office of Educational Research and Improvement, U.S. Department of Education, 1999.

Zabin LS. Adolescent sexual behavior and childbearing. Newbury Park: Sage Publications Inc, 1993.

Zollar AC. Adolescent pregnancy and parenthood: an annotated guide. New York: Garland, 1990.