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Objective: College students use electronic nicotine delivery systems (ENDS) more often than any other US demographic group. In a novel application of the acquired preparedness model, we examined how proximal (e.g., cognitions) and distal (e.g., dispositional) influences accounted for ENDS use and dependence. Participants: Undergraduates (N = 1075; 72% female, 74% White) from seven US campuses completed an online survey between October 2019-March 2020. Methods: We modeled ENDS use and dependence, respectively, as zero-inflated Poisson distributions with impulsivity as an independent variable and perceived risks and benefits of e-cigarettes as mediators. Results: Students higher in impulsivity perceived more benefits and, in turn, reported greater ENDS use and dependence. Curiosity and friends' use motivated ENDS initiation; stress management and nicotine motivated continued use. Conclusions: ENDS interventions should be tailored to students higher in impulsivity, as they hold more favorable perceptions of ENDS, and should enhance skills to manage stress and nicotine cravings.

This study explored substance use trajectories and associations with mental health among an ethnically/racially diverse college student sample before and during the COVID-19 pandemic. We combined repeated cross-sections and panel data from a total of 3,247 college students assessed with an online survey in 2018, 2019, and in three waves in 2020. We estimated trends in substance use and their relation to mental health over the survey waves using generalized estimating equations (GEE). Our results revealed notable associations between 30-day substance use patterns, time of assessment, and psychological well-being. These findings suggest a complex interplay between access to substances, context of substance use, and mental health. We discuss several initiatives that have been launched in response to the results of this ongoing study. Such initiatives may serve as examples for expanding similar efforts to other commuter colleges to prevent further increases in mental health problems and risky substance use.

Objective: Disparities in physical activity (PA) and PA antecedents, such as exercise self-efficacy, based on the intersection of gender and race/ethnicity among college students are poorly understood. This study aimed to examine differences in PA and exercise self-efficacy based on the intersection of gender and race/ethnicity. Methods: An online survey collected data on demographics (age, gender, race/ethnicity), PA, and exercise self-efficacy from students (n = 5341) enrolled in general health and wellness at a large Northeastern U.S. University. Differences in PA and exercise self-efficacy based on gender and race/ethnicity were examined using two-way ANOVAs. Results: Analyses revealed significant differences in overall PA and exercise self-efficacy based on gender and race/ethnicity. A significant interaction between gender and race/ethnicity was found in relation to PA, but not exercise self-efficacy. Conclusion: Findings demonstrate the need for universities to tailor PA promotion efforts, and to consider how gender and race/ethnicity may intersect to influence PA participation.

Objective: We provide a step-by-step guide for developing, administering, evaluating, and acting on a survey-based study of graduate student mental health. Methods: Blueprint focuses on forging student-faculty collaboration and is based on Harvard University's Graduate Student Mental Health Initiative (GSMHI). The survey tool we use includes validated screening instruments for depression, anxiety, imposter phenomenon, self-esteem, alcohol consumption, exercise and sleep habits, and loneliness. It also includes environmental questions that collect epidemiologic data, as well as ratings of advising relationships and student dynamics. Results: After 6 years, GSMHI has analyzed data from 30 different PhD programs and 4,866 students, overseen the implementation of more than 60 departmental action plans, and performed 9 follow-up surveys to assess progress. It has achieved high response rates (60-90%), discovered wide variation in mental health and environmental factors across departments, and supported experiments with interventions. Conclusion: We hope this blueprint helps other universities run similar initiatives.

Objective: The present study explored differences in four domains of university adjustment (i.e. personal-emotional, social, academic, and institutional attachment) among students with and without a history of engaging in non-suicidal self-injury (NSSI) and examined the independent influence of NSSI on university adjustment. Participants and Methods: Participants were 231 students from a large Canadian university who completed an online survey during their first and second year of university examining their perceived stress, perceived social support, coping self-efficacy, and university adjustment. Results: Relative to students who never engaged in NSSI, those who did reported lower levels of university adjustment across domains. However, NSSI was not a significant predictor of university adjustment after accounting for perceived stress, perceived social support, and coping self-efficacy. Conclusions: This study provides preliminary evidence that engaging in NSSI may not confer additional risk for university adjustment, as students' psychological resources appear to be stronger determinants of adjustment.

Objective: Problem-drinking among university students is common and poses serious health-related risks. Therefore, identifying and addressing associated factors is important. Participants and methods: A large cross-sectional online-survey with 12,914 university students from Berlin was conducted from November 2016 to August 2017. Relative-risk- and correlation-analysis was used to identify factors associated with problem-drinking and regular heavy-drinking. Independent t-tests compared impulsivity and personality traits, chi-square-tests compared drinking motives between risk- and non-risk-drinkers. Results: Male gender, tobacco-smoking, illegal substance use, impulsivity and various sociodemographic and psychosocial variables were significantly related to problem/heavy-drinking. Extraversion was a risk, conscientiousness and agreeableness were protective factors. Drinking-motives did not differ significantly between risk- and non-risk-drinkers. Generally, the main drinking-motives were to feel elated, relax and social purposes. Conclusion: The identified markers and related problem behaviors may serve as a tool to enhance the identification of student subgroups at risk for problem/heavy-drinking, and hence improve targeted health-intervention-programs.

Objective: To examine the associations among stress, positive affect, binge drinking, and coping drinking motives. Participants: Students (n = 351, M[subscript age] = 19.7, 74.6% female) at a northeastern public university. Methods: Participants completed an online survey assessing perceived stress, frequency of experiencing positive emotions, frequency of binge drinking, and coping drinking motives. Results: Stress and positive emotions were not significantly related to frequency of binge drinking but were significantly correlated with coping motives for drinking. Regression analyses with all predictors, age, and gender in the model revealed the same: stress and positive emotion were not significantly related to binge drinking but were significantly related to coping motives. The interaction between stress and positive emotions predicting frequency of binge drinking or coping motives was nonsignificant. Conclusions: Findings suggest the utility of exploring positive emotions in risk and resilience research focused on college student drinking and of targeting positive emotions to decrease students' copingrelated alcohol use.

Objective: This cross-sectional study examined correlations between physical activity and anthropometrics as well as sleep quality and anthropometrics. Participants College students (n = 85) with average age 25.6 ± 5.4 years. Methods Participants received full-body dual-energy x-ray absorptiometry scans and completed validated surveys: Habitual Physical Activity questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale. Results: Males reported more sports-related physical activity than females (p = 0.041). Physical activity indices and percent body fat were inversely correlated (total [rho] = -0.320, p < 0.001; sport [beta] = -0.378, p = 0.003). Participants had poor overall sleep quality (PSQI = 6.19 ± 2.99). The PSQI sleep quality index: disturbance was directly correlated with body mass index (BMI) ([beta] = 0.328, p = 0.007). Conclusion: Health interventions on college campuses should promote more physical activity and better quality sleep as these factors were related to improved body anthropometrics and potentially reduced chronic disease risk.

Objective: This study aimed to investigate interactions among physical fitness, sleep quality, sedentary behavior, and depression among female college freshmen. Participants: A cohort of 1,514 Chinese female college freshmen (M[subscript age] = 18.8 ± .63) were recruited from four universities. Methods: Participants completed a survey assessing depression, sleep quality (sleep duration and sleep onset latency), and sedentary behavior, and performed physical fitness measurements. Results: Physical fitness indexes were associated with sleep quality and sedentary behavior (ps < 0.05) but not with depression. Depression was positively associated with sedentary behavior and sleep onset latency, but negatively associated with sleep duration (ps < 0.01). The model tests revealed that sleep quality ([beta] = -0.57, p < 0.01) and sedentary behavior ([beta] = 0.14, p < 0.01) served as mediators between physical fitness and depression, respectively. Conclusions: Increasing sleep quality and minimizing sedentary behavior may build resilience to depression among Chinese female college freshmen.

Objective: The aim of this study was to formatively evaluate a health communication campaign on body image targeting undergraduate female students. Participants: A total of 331 students at a large public Midwestern university participated in the study. Methods: Researchers used central intercept procedures to recruit students from residence halls. After viewing the campaign materials, students completed an online survey assessing their message endorsement and level of eating disorder symptomology and provided open-ended comments. Results: Students appreciated the message and thought it was effective, though students with greater body image concerns were less receptive to the message. Thematic analysis indicated students perceive body image to be a relevant issue, yet they want the university to provide more attention to, and information on, the topic. Conclusions: Overall, students understood the message and found it helpful. Nevertheless, students with body image issues responded less favorably, warranting the need for secondary and tertiary prevention.

Objective: We sought to identify the general health of college students. Participants: A total of 4402 university freshmen and sophomores were recruited to report their general health through an online questionnaire. Methods: Responses from the DePaul Symptom Questionnaire were analyzed. We then conducted latent class analyses to evaluate 54 different symptoms among participants. Results: A four class solution was identified, consisting of a group of asymptomatic students (35.65%), a second group of students reporting mild fatigue and sleep symptoms (38.87%), a third group reporting moderate sleep and fatigue symptoms (20.36%), and a group reporting moderate and severe complaints on the majority of symptoms (5.11%). Female students had 2.07 times the relative risk of the severe symptom class of men. Indigenous students have 2.88 times the relative risk of occupying the severe symptom class than non-indigenous students. Conclusions: The results suggest that about 5% of college students have varied symptoms of a moderate to severe degree. Future research is needed to better assess whether there are biological associations with these self-report findings, as well as to determine longer-term implications of these symptoms.

Objective: Previous research has found women who experience eight or more Adverse Childhood Experiences (ACEs) are 3.5 times as likely to be victims of adult IPV. This study examined the relationship between ACEs and IPV (physical violence, sexual violence, psychological violence, and stalking) among college students. Participants: This study was conducted among undergraduate students (N = 2,900) at two large, non-profit, public universities in the United States. Methods: Students completed a web-based survey addressing self-reported ACEs and violence that occurred within the current academic year. Chi-square tests and logistic regression models were used to evaluate the relationship between ACEs and violence. Results: College students with higher ACE scores were more likely to experience violence. Students with ACE scores of four or higher were between 1.9-4.9 times more likely to experience violence. A dose response relationship was found between ACE score and experiences of violence. Conclusions: Campus violence prevention programs may benefit from incorporating discussion of ACEs into programing.

Objective: College students are a high-risk population for sexual assault exposure. This study examines (1) sociodemographic differences in student perceptions of institutions of higher education (IHEs) responses to sexual assault reporting and (2) the relationship between student perceptions, knowledge of campus sexual assault (CSA) services, and general help-seeking intentions. Participants: A sample of 1,648 college students completing an online survey during the 2016-2017 academic year. Methods: A secondary analysis of data from the Healthy Minds Study. Results: Transgender/nonconforming, sexual minority, and domestic students held more negative perceptions of IHEs. Positive perceptions were significantly associated with increased odds for both formal (odds ratio [OR] = 1.09, p < 0.05) and informal help-seeking intentions (OR = 1.05, p < 0.05). Knowledge of CSA services did not significantly moderate the relationship between perceptions of IHEs' responses and help-seeking intentions. Conclusions: Student perceptions of their IHEs vary based on aspects of identity and may contribute to general help-seeking.

Objective: Investigate the relationship between intensities of physical activity and severity of drunkorexia behaviors. Participants: First-year college students living in residence halls (n = 127) completed an online survey comprising drinking, drunkorexia, and physical activity. Methods: Multiple hierarchical linear regressions were implemented to examine if physical activity intensity correlates to drunkorexia severity. Results: Vigorous physical activity was the only physical activity intensity significantly associated with severity of drunkorexia behaviors. Conclusions: First-year college students' duration of vigorous physical activity in relation to severity of drunkorexia behaviors may vary contingently on the motivation for vigorous physical activity. Practitioners need to consider physical activity can be a co-occurring risk behavior in combination with alcohol misuse.

Objective: This study developed and tested new measures of youth perceptions of parental active efforts to track their activities during adolescence and college. Participants and Methods: Between March and October 2016, a sample of 314 college students aged 18-25 completed a survey including their perceptions of their parent's active tracking efforts during high school and college. Items were then analyzed, and internally consistent measures were derived. Results: The new measures demonstrated significant convergent validity with the three sources of parental knowledge constructs (parental solicitation, parental control, and youth disclosure). Greater perceived parental active tracking efforts during adolescence and in college were associated with better health behaviors in both time periods. Conclusions: The newly derived measures represent appropriate and predictive indices of parental tracking behaviors during adolescence and college, designed specifically with these populations in mind, to be used in pre-intervention and intervention work with parents.

Objective: Assess the impact of survey non-response and non-completion for a campus climate survey. Participants: Intended for all degree-seeking students at a large, public, midwestern university, November 2014. Methods: The survey covered sexual assault experiences and related attitudes. We identify the magnitude and potential impact of survey non-response by comparing demographic data between respondents and non-respondents, sexual assault prevalence between early and late respondents, and demographic and attitudinal data between survey completers and partial completers. Results: Demographic groups were differentially represented in the survey. Sexual assault prevalence based on survey results may be underestimated for men, overestimated for women. Sensitive questions did not increase drop-off. Students completing more of the survey differed from those completing less. Conclusions: Colleges must plan survey administration and data sensitivity analysis to reduce potential for bias. Resources for sexual assault-related needs based on estimates from campus climate surveys with high non-response will likely be misallocated.

Understanding the unique health needs of college students and establishing best practices to address them depend, heavily, on the inherent quality and contribution of the research identifying these needs. College health-focused publications currently exemplify less than ideal statistical reporting practices. Specifically, college health practitioners and researchers continue to rely heavily upon null hypothesis significance testing (NHST) as the sole standard for effectiveness, validity, and/or replicability of scientific studies, even though NHST itself was not designed for such purposes. Herein we address the following questions: (a) What is NHST? (b) What are the inherent limitations of NHST? (c) What are recommended alternatives to NHST? and (d) How can editorial policies promote adopting NHST alternatives? Using college health data from the CORE 2011 Alcohol and Drug survey, we provide a heuristic example demonstrating how effect sizes do not suffer from the same limitations as NHST.

Objective: To examine differences in complete response rates for depression screening questions based on demographic characteristics. Methods: Cross-sectional study examining associations between demographic characteristics and completely responding depression-screening questions. Participants: "Healthy Minds Study" data, collected in a public University in February 2016, where 7,326 students participated. Results: women (AOR: 0.69; 95% CI =0.57-0.83) and gay/lesbian students (AOR: 0.24; 95% CI =0.10--0.60) had better complete response rates. Non-US (AOR: 1.46; 95% CI =1.03-2.07), black (AOR: 3.32; 95% CI =1.92-5.77), and Middle-Eastern students (AOR: 3.73; 95% CI =1.73-8.02) had lower complete response rates. Conclusions: Our study shows sex, gender, citizenship, and race categories have significant differences in complete response rates for the outcome. Our findings have several implications; including recognizing interventions for depression based on responders may not target those that tend to be "partial-responders". Efforts in survey design, recruiting and completion of surveys should be maximized.

Objective: To understand how missing data may influence conclusions drawn from campus sexual assault surveys. Methods: We systematically reviewed 40 surveys from 2010-2016. We constructed a pseudo-population of the total population targeted across schools, creating records proportional to the respective response rate and reported sexual assault prevalence. We simulated the effects of 9 scenarios where the sexual assault prevalence among nonresponders differed from that of responders. Results: The surveys represented a total female undergraduate population of 317,387 with only 77,966 (24.6%) survey responses. Among responders, 20.4% reported experiences of sexual assault. However, prevalence of sexual assault could theoretically range from 5.0 to 80.4% under extreme assumptions about prevalence in nonresponders. Smaller, but still significant differences were observed with less extreme assumptions. Conclusions: Missing data are widespread in campus sexual assault surveys. Conclusions drawn from these incomplete data are highly sensitive to assumptions about the sexual assault prevalence among nonresponders.

Objective: This investigation longitudinally examined the participation of Black college students in the American College Health Association's National College Health Assessment (ACHA-NCHA). Participants: All respondents to ACHA-NCHA from the years 2008, 2011, & 2014 were included in the analysis. Methods: This study compared the descriptive demographic student characteristics from the 2008, 2011, & 2014 ACHA-NCHA data to the National Center for Education Statistics (NCES) college enrollment for the corresponding years. Results: Despite constituting 14.5% of the total enrollment in 4-year universities and colleges from 2005 to 2013, Black students represented about 7% of the ACHA-NCHA respondents. Conclusion: Having a sample lacking valid representation of minorities can further lead to biased and flawed assumptions. Therefore, organizations such as ACHA should make concerted efforts to gather data that is reflective of national enrollment rates.

Objective: The purpose of the study was to examine student perspectives about college mental health including the primary mental health issues affecting students, common college student stressors, student awareness of campus mental health resources, and mental health topics students want more information about. Participants: Participants were 822 undergraduate and graduate students enrolled in a private university. The study was conducted during September 2016. Methods: As part of a public health course in program planning, undergraduate students surveyed their peers about their experience with mental health and mental health resources. Results: Stress was perceived as the largest mental health issue. Students most wanted more information about school/work/life balance followed by stress management. Electronic newsletters, social media, and on-campus seminars were the top strategies that students suggested as ways to reach them. Conclusions: The results provide student perspectives on mental health that may be useful in developing effective outreach efforts.

Objective: To examine the psychometric properties of a measure of cannabis-specific Protective Behavioral Strategies (PBS), which assesses ways in which students may reduce cannabis-related risk. Participants: Respondents to the American College Health Association-National College Health Assessment II (N = 580) during Spring 2015. Methods: Exploratory Factor Analysis (EFA) and Exploratory Structural Equation Modeling (ESEM) were used to identify and replicate the factor structure of the measure. Results: Results support a four-factor model (Respiratory Health, Frequency/Quantity, Socializing, and General Health) with close approximate fit (?[superscript 2] (310) = 565.96, p < 0.001, RMSEA = 0.038 (0.033, 0.043; 90% CI), CFI = 0.961, TLI = 0.929, SRMR = 0.033). Support for the convergent validity and construct validity of the measure was also found. Conclusions: This is the initial step in the development of a standard, psychometrically validated measure of cannabis PBS that has the potential to inform future research and interventions.

Objective: We explored the potential mediating role of willingness to experience drinking consequences and other traditional alcohol outcome predictors (descriptive norms, injunctive norms, positive alcohol expectancies) in explaining the association between college alcohol beliefs1 (CABs) and the actual experience of drinking consequences among college students. Participants: The sample consisted of 415 college students tested in October 2014. Methods: Participants responded to an online survey. Results: When compared to both types of norms and positive alcohol expectancies, CABs demonstrated the strongest associations to both willingness to experience drinking consequences and actual drinking consequences among college students. A multiple mediation analysis revealed that the impact of CABs on students' actual drinking consequences was mediated only through their willingness to experience drinking consequences. Conclusions: Students' college alcohol beliefs and their corresponding willingness to experience drinking consequences should be targeted in prevention and intervention programs designed to address the problem of college student drinking.

Objective: To evaluate the effect of a campus-wide social norms marketing intervention on alcohol-use perceptions, consumption, and blackouts at a large, urban, public university. Participants: 4,172 college students (1,208 freshmen, 1,159 sophomores, 953 juniors, and 852 seniors) who completed surveys in Spring 2015 for the Spit for Science Study, a longitudinal study of students' substance use and emotional health. Methods: Participants were e-mailed an online survey that queried campaign readership, perception of peer alcohol use, alcohol consumption, frequency of consumption, and frequency of blackouts. Associations between variables were evaluated using path analysis. Results: We found that campaign readership was associated with more accurate perceptions of peer alcohol use, which, in turn, was associated with self-reported lower number of drinks per sitting and experiencing fewer blackouts. Conclusions: This evaluation supports the use of social norms marketing as a population-level intervention to correct alcohol-use misperceptions and reduce blackouts.

Objective: College students may be at heightened risk for suicide and suicidal behavior due to maladaptive cognitive-emotional factors and failure to practice basic health behaviors. However, self-compassion and wellness behaviors may protect against risk. The relation between self-compassion and suicidal behavior and the contributing roles of depressive symptoms and wellness behaviors was examined. Participants: Participants were 365 undergraduate students. Data were collected in April 2015. Methods: A cross-sectional, survey design was employed. Participants completed measures assessing self-compassion, depressive symptoms, wellness behaviors, and suicidal behavior. Serial mediation analyses were conducted covarying age, sex, and ethnicity. Results: Self-compassion was inversely related to suicidal behavior, and this relationship was serially mediated by depressive symptoms and wellness behaviors. Conclusions: Self-compassion may protect against suicidal behavior, in part, due to reduced depressive symptoms and heightened engagement in wellness behaviors. Individual and campus-wide strategies promoting self-compassion and wellness behaviors may reduce suicide risk on college campuses.

Objectives: Anxiety sensitivity (AS) is associated with cannabis use. People high in AS may use cannabis to cope with elevated anxiety. This association is consistently supported in the literature. However, we have much to learn about the mechanisms of the AS pathway to cannabis use. We aimed to examine negative urgency--the tendency to act impulsively when distressed--as a mediator of the association of AS with cannabis problems and cannabis dependence symptoms. We hypothesized that negative urgency would uniquely mediate the association of AS with cannabis outcomes after controlling for other facets of impulsivity. Participants and Methods: Postsecondary students (N = 91; Fall 2012) completed online self-reports. To participate, students needed to be =18 years old, enrolled in postsecondary studies, and needed to report current cannabis use. Results: Negative urgency uniquely mediated associations between AS and cannabis problems and dependence symptoms. Conclusions: Our findings suggest a mechanistic role of negative urgency in the AS pathway to cannabis misuse.

Objective: Mental health literacy (MHL) is low in college-aged men potentially resulting in impaired mental wellbeing. This study assessed MHL, psychosocial determinants, and help-seeking behaviors among male university students. Participants: Male undergraduate and graduate students were surveyed in Spring 2017 (n = 1,242) at a large southeastern university in the United States. Methods: Preexisting validated scales for MHL, psychosocial determinants, and help-seeking intention were used in measurement and demographic variables were collected. T-tests and one-way ANOVA were performed to measure differences between groups. Results: Participants showed low scores for all constructs with statistically significant differences between undergraduate and graduate students, as well as between races and major classifications. Undergraduate men had moderate MHL and low intentions to seek professional care. Conclusions: Interventions focusing on increasing mental health knowledge and improving beliefs can improve MHL among male college students. Further, interventions should be tailored for racial groups and major classifications.

Objective: This study investigated associations between adverse childhood experiences (ACE) prior to age 18 years and multiple health behaviors (eg, cigarette and other substance use) and outcomes (eg, obesity, depression) for a large college sample. Participants: 2,969 college students from seven universities in the state of Georgia were included in the analysis. Methods: Web-based surveys were completed by students (45-60 minutes) during the spring semester, 2015. Results: Findings indicate that more ACEs are associated with higher levels of depressive symptoms, ADHD symptoms, cigarette use, alcohol use, marijuana use, and BMI, in addition to lower levels of fruit and vegetable intake, and sleep. Conclusion: ACEs may carry forward in the lifespan to influence a range of unhealthy outcomes among college students. College intervention programs may benefit by recognizing the pervasiveness of ACEs and their associations with health behaviors and outcomes, and include interventions across more than one health behavior.

Objective: This study examined whether self-help (books, websites, mobile apps) increases help seeking for mental health problems among college students by minimizing stigma as a barrier. Participants and Methods: A survey was conducted with 200 college students reporting elevated distress from February to April 2017. Results: Intentions to use self-help were low, but a significant portion of students unwilling to see mental health professionals intended to use self-help. Greater self-stigma related to lower intentions to seek professional help, but was unrelated to seeking self-help. Similarly, students who only used self-help in the past reported higher self-stigma than those who sought professional treatment in the past. Although stigma was not a barrier for self-help, alternate barriers were identified. Conclusions: Offering self-help may increase rates of students receiving help for mental health problems, possibly by offering an alternative for students unwilling to seek in-person therapy due to stigma concerns.

Objective: This study explores the impact racism has on the drinking behaviors of Black college women. Little is known about Black college women's experience of racism and the impact racism has on their psychological wellbeing and drinking behaviors. The current study fills a gap in our understanding of the role racism plays in the risky drinking behavior of Black college women. Participants: 469 Black college women ages 18-29 were sampled from 8 colleges and universities across the US, in 3 waves from December 2014-August 2017. Results: Findings suggest that general life stress and perceived racism are significantly associated with alcohol use among Black college women. However, only increased experiences of racism increase Black college women's engagement in risky drinking. Conclusions: The findings of this study serve as an entry point for a more nuanced assessment of stressors among Black college women that may inform drinking behaviors in this population.

Objective: There is growing interest in the effectiveness of disaster preparedness at universities. Although several studies have examined student preparedness perceptions, a better understanding of factors that may influence actual preparedness is needed. Participants: Seven hundred sixty-five undergraduate and graduate students at a southeastern U.S. university completed an online survey in September 2013. Methods: Participants were administered an online survey that included questions regarding disaster preparedness and their experiences with disasters. Results: Students' disaster concern was more related to perceived preparedness over actual preparedness; disaster experience significantly predicted both actual and perceived preparedness. Perceived university preparedness was a significant predictor of disaster concern. Conclusion: The results suggest that perceived and actual preparedness are related but not entirely equivalent, which emphasizes the importance of differentiating the two constructs. Limitations of the current study and recommendations for future research are provided.

Objective: We examine how sexual activity relates to sexual well-being within the context of sexual attitudes, sexual agency, and sexual desire. Participants/Methods: We surveyed 471 college women in 2012-2014 who had ever had sex. Results: Sexual agency and sexual desire consistently predicted well-being, regardless of recent sexual activity. There was a significant interaction between recent sexual activity (none, casual, or exclusive relationship) and sexual attitudes. Exclusive sex was associated with higher than average sexual well-being, especially for women with permissive attitudes. Women who had casual sex and held permissive to average attitudes had the next highest levels of well-being, but those with non-permissive attitudes fell substantially below the overall mean. Women who had no recent sex were consistently below the mean, especially for women with more permissive attitudes. Conclusions: A disconnect between sexual attitudes and recent sexual activity may lower women's sexual well-being.

Objective: To examine the association between nonmedical use of over-the-counter medications (NMUOTC) and nonmedical use of prescription drugs (NMUPD). Participants: University students surveyed on NMUOTC and NMUPD between August and December 2011 (N = 939). Methods: Cross-sectional data analysis of online survey. Results: The majority of respondents were women, undergraduate, Caucasian, and not affiliated with Greek life. NMUPD and NMUOTC were reported by 21.4% and 11.2% of students, respectively. NMUOTC was significantly associated with NMUPD in unadjusted analyses and after adjustment for gender, age, race/ethnicity, and Greek membership (odds ratio: 3.37, 95% confidence interval: 2.17, 5.23). Secondary analyses showed a relationship between over-the-counter (OTC) cough medication misuse and NMUPD, OTC stimulant misuse and prescription stimulant misuse, and OTC sleep aid misuse with prescription depressant misuse. Conclusions: Results suggest the importance of both measuring the prevalence of OTC misuse and incorporating its misuse into assessments of polydrug use in the university population.

Objective: To investigate how alcohol marketing and peers may promote college students' alcohol use through social media. Participants: College students (N = 682) aged 18 to 22 years from a large Southern university completed paper surveys in April 2014. Methods: Structural equation modeling was used to investigate relationships among variables as well as moderation by gender and race. Results: Drinking behavior was directly related to perceived norms and attitudes toward alcohol that develop, in part, from direct and indirect interactions with their online and offline peers, as well as engagement with alcohol-related content on social media. Gender and ethnicity moderated some effects. Conclusions: College student drinking is influenced by friends' alcohol-related content posted on social networking sites and by greater engagement with traditional and online alcohol marketing. College campus alcohol misuse interventions should include components to counter peer influences and alcohol marketing on social media.

Objective: To identify preferences for and use of short-acting hormonal (e.g., oral contraceptives, injectable contraception) or long-acting reversible contraception (LARC) among community college students in Texas. Participants: Female community college students, ages 18 to 24, at risk of pregnancy, sampled in Fall 2014 or Spring 2015 (N = 966). Methods: We assessed characteristics associated with preference for and use of short-acting hormonal or LARC methods (i.e., more-effective contraception). Results: 47% preferred short-acting hormonal methods and 21% preferred LARC, compared to 21% and 9%, respectively, who used these methods. A total of 63% of condom and withdrawal users and 78% of nonusers preferred a more effective method. Many noted cost and insurance barriers as reasons for not using their preferred more-effective method. Conclusions: Many young women in this sample who relied on less-effective methods preferred to use more-effective contraception. Reducing barriers could lead to higher uptake in this population at high risk of unintended pregnancy.

Objective: To conduct a pilot test of a brief, self-guided, home-based program designed to improve male condom use attitudes and behaviors among young women. Participants: Women aged 18-24 years from a large Midwestern University reporting having had penile-vaginal sex with two or more partners in the past 3 months. Sixty-seven enrolled; 91.0% completed the study. Methods: A repeated measures design was used, with assessments occurring at baseline, immediately post intervention (T2), and 30 days subsequent (T3). Results: Condom use errors and problems decreased, condom-related attitudes and self-efficacy improved, and experiences of condom-protected sex were rated more positively when comparing baseline with T2 and T3 scores. Further, the proportion of condom-protected episodes more than doubled between T1 and T3 for those in the lowest quartile for condom use at baseline. Conclusion: This low-resource, home-based program improved condom-related attitudes and promoted the correct and consistent use of condoms.

Objective: This study's purpose was to describe urban college students' communication about hookah with health care providers. Participants: Participants included a random sample of undergraduate urban college students and health care providers. Methods: Students surveyed determined the epidemiology of hookah use in this population, how many health care providers asked about hookah, and how many students admitted hookah use to a physician. Results: Of 375 students surveyed, 78 (20.8%) had never tried it, 284 (75.7%) had smoked hookah at least once, and 64 students (22.6%) were classified as frequent hookah smokers. Only 15 (4.7%) reported a health care provider asking about hookah during visits, whereas 36 (12.7%) admitted their hookah use to a health care provider. Conclusion: Hookah use was found to be highly prevalent among students in one urban university. This study supports the hypothesis that few health care providers broach the topic with patients. Additional research on health consequences of hookah use, education, and improved screening is warranted.

Objective: To examine college students' technology-assisted sexual communication perceptions and practices alongside their beliefs about the effectiveness of face-to-face (F-t-F) sexual communication. Participants: 144 college students at a private university in the Northeast, U.S., completed a survey in October 2016. Method: A cross-sectional online survey examined how college students use text messaging and private social media messaging to communicate with romantic partners about sexual health issues. Results: Students who have communicated with romantic partners via technology reported being likely to do so again in the future, to perceive the effectiveness of technology-assisted sexual communication to be comparable to F-t-F sexual communication, and to be confident in their ability to initiate sexual communication with romantic partners via F-t-F communication. Conclusions: College students may see text messaging and social media messaging as useful for sexual communication, which has important implications for college health professionals who wish to promote frequent, effective sexual communication.

Objective: The current study examined predictors of well-being, including quality of life and academic engagement, in a sample of student service members and veteran college students. Methods: Eighty-seven student service members/veterans (SSM/V) completed an online survey containing questions about post-deployment social support, emotion regulation skills, psychological distress, academic engagement, quality of life, and demographics. Participants were recruited from September 2012 through May 2014. Results: Results provided partial support for the proposed bi-directional mediational relations between post-deployment social support and emotion regulation predicting to quality of life and academic engagement. Path models indicated that both post-deployment social support and emotion regulation skills partially mediated the relation with quality of life while accounting for the effect of psychological distress, and that emotion regulation skills fully mediated the relation between social support and academic engagement. Conclusions: These findings suggest that both social support and emotion regulation skills may be useful targets for health promotion and intervention efforts for this population. Limitations and clinical implications for the development of on-campus SSM/V focused health promotion services are discussed.

Objective: This study examined how freshman year substance use prospectively predicted time to college graduation, and whether delayed graduation predicted postponed adoption of adult roles and future substance use. Participants: Participants were part of a longitudinal study that began in 2004. The first analyses focused on freshman year (N = 2,050). The second analyses corresponded to a subset of participants at age 27 (N = 575). Methods: Measures included self-reported substance use, adult role adoption, and university reported graduation dates. Results: Results indicated that frequent binge drinking and marijuana use during freshman year predicted delayed college graduation. Those who took longer to graduate were more likely to have lower incomes and were less likely to obtain a graduate degree. Taking 5-6 years to graduate was associated with greater likelihood of alcohol-related problems. Conclusions: Findings support the importance of interventions during freshman year of college to decrease substance use and promote timely graduation.

Objective: The current research aimed to understand differences in smoking-related identity among college students and to illustrate the distinct characteristics of nonidentified smokers (NIS). Participants: Students from 2 colleges in Massachusetts (N = 538; April 2016). Methods: Respondents reported by online survey whether or not they had smoked a cigarette in the past 30 days and if they self-identified as smokers. Nonsmokers (NIS) and identified smokers (IS) were then compared on their smoking attitudes and behavior. Results: NIS made up 12.5% of the sample and 64% of all tobacco users. NIS perceived themselves as less addicted and were more confident in their ability to quit smoking. They also were less likely to smoke alone, buy their own cigarettes, or have friends who smoked. Conclusions: College health officials can best motivate NIS to quit smoking by focusing on peer norms and the potential of long-term addiction.

Objective: To analyze the overlap of nonsuicidal self-injury (NSSI) and suicide-related behaviors (SRB) among college students with regard to demographics, mental health, and coping styles. Participants: Respondents were 572 undergraduate students at a southwestern public university. Methods: Data were collected in 2015. Respondents completed a demographic survey and assessments of NSSI, SRB, internalizing symptoms (ie, anxiety, stress, and depression), aggression, and negative coping strategies. The survey was administered via a Web-based procedure. Results: Women reported more frequent cutting behaviors than men. Endorsement of NSSI was also associated with an increased likelihood of lifetime SRB. A subgroup of students endorsing both NSSI and SRB demonstrated poorer mental health, more negative coping, and self-reported female sex. Conclusions: College healthcare providers may benefit from competency-based training in techniques for the combination treatment of NSSI and SRB, as well as culturally based models of suicide.

Objective: To investigate sexual orientation differences in college men's motivations for HIV testing. Participants: 665 male college students in the Southeastern United States from 2006 to 2014. Methods: Students completed a survey on HIV risk factors and testing motivations. Logistic regressions were conducted to determine the differences between heterosexual men (HM) and sexual minority men (SMM). Results: SMM were more motivated to get tested by concern over past condomless sex, while HM were more often cited supporting the testing program "on principle" and wanting a free t-shirt. SMM and HM differed in behaviors that impact HIV risk and other demographics. However, differences in testing motivation by concern over past condomless sex or wanting a free t-shirt persisted when controlling for these demographic and behavioral differences. Conclusions: Appropriately designed HIV prevention interventions on college campuses should target SMM's distinct concern over past condomless sex as a testing motivation.

Objective: The present study investigated the well-being of bystanders who witness and intervene in sexual assault and dating violence situations on campus. Participants: Participants were 321 young men and women from a large university in the southeastern United States. Methods: Participants completed a survey at the end of the Spring semester of 2015 about risky situations they had witnessed, with follow-up questions about their responses to the situations (eg, whether they intervened or not) and feelings about their responses. Participants also completed standardized measures of posttraumatic stress disorder and depression. Results: Over 90% of the participants reported witnessing at least 1 of the risky events presented to them, and approximately 50% reported intervening in events. Intervening was associated with positive feelings, but traumatic stress symptoms were related to witnessing events and intervening. Conclusions: Results have direct implications for developing appropriate training programs for bystander intervention programs on college campuses.

Objective: This study explored the association of stress and depression with a multidimensional sleep problems construct in a sample of 2-year college students. Participants: The sample consisted of 440 students enrolled in 2-year study from Fall 2011 to Fall 2013. Methods: Participants in an obesity prevention study completed surveys assessing sleep, stress, and depression at baseline, 4, 12, and 24 months. Multilevel models predicting sleep problems were conducted to distinguish episodic from chronic reports of stress and depression. Results: Participants were primarily women (68%), white (73%), young adults (M age = 22.8), with an average of 8.4 hours of sleep per night. Neither stress nor depression was predictive of sleep quantity; however, they were predictive of sleep quality. Conclusions: Results show that sleep quality rather than sleep quantity may be the greater health concern for young adults, suggesting that intervention programs targeting depression, stress management, and healthy sleep patterns are warranted.

Objective: This pilot study assessed an electronic health diary method designed to collect data about critical health incidents experienced by college students who have chronic health conditions. Participants: Nine university students with chronic medical conditions were recruited to complete a series of e-mail-based surveys, sent once every 3 days across the fall 2014 semester. Methods: In each survey, participants described a health-related incident that occurred within the past day and cited resources that helped or could have helped in that situation. They completed follow-up interviews and ranked the importance of cited resources. Results: The diary completion rate was 78.3% (141/180). Most frequently affected management areas were activities (61.3%), monitoring (34.9%), and problem-solving (34.3%). Resources considered helpful included situational knowledge, campus health professionals, peer support, and relaxation opportunities. Conclusions: Prompted health incidents diary method achieved a high completion rate and provided data that could be useful for college health researchers and practitioners.

Objective: Drinking alcohol during the exams can affect academic performance and future career options, but is rarely investigated. Drinking motives, sociodemographics and personality characteristics are investigated in nonabstainers and weekly drinkers during the exams. Participants: 7,181 Belgian university students who anonymously responded to an email invitation to an online survey. Methods: Logistic regressions and mixed design analysis of variance on cross-sectional data. Results: One-third of the students continued drinking during the exams, with 40% drinking weekly. Nonabstainers were mainly men, elder, internally motivated when drinking, and housed with parents or independently. Weekly drinkers were similar, except mainly housed in student apartments or independently. Personality characteristics were nonsignificant. All drinking motives were less pronounced during the exams, with smaller differences for internal motives. Conclusions: Mainly linked to internal drinking motives, drinking during the exams in higher education is underestimated. The characteristics and motives of students doing so can be used in future interventions.

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

Objective: Examine the impact of maladaptive coping style on the association between source of stress (academic, interpersonal, intrapersonal, environmental) and alcohol use (consumption, heavy episodic drinking, driving under the influence) among college students. Participants: 1,027 college students completed an online survey in April 2014. Methods: To test the mediating effects of maladaptive coping on the association between academic stress and alcohol use variables, indirect effects were examined using the PROCESS analytical framework for SPSS. Results: Maladaptive coping and academic stress were associated with alcohol use outcomes. Moreover, maladaptive coping mediated the relationship between academic stress and two of three alcohol use outcomes (consumption, heavy episodic drinking). Conclusions: Among college students, the association between academic stress and alcohol use may be driven by maladaptive coping. College students may benefit from interventions that seek to improve coping skills, potentially alleviating the burden of academic stress and decreasing problematic alcohol use.

Objective: Behaviors of weight conscious drinkers (BWCD) include disordered eating, excessive physical activity (PA), and heavy episodic drinking. Considering that approximately 25% of the college students report BWCD, it is important to investigate what characteristics increase the likelihood of college students engaged in BWCD for both moderate and vigorous PAs. Participants: A total of 510 college students were recruited from a large, public southeastern university. Methods: Participants completed a cross-sectional survey during the spring 2015 semester. Results: Of 510 respondents, 11.2% reported moderate PA-based BWCD and 14.7% reported vigorous PA-based BWCD. Weight loss intention, BMI and Greek affiliation predicted both moderate and vigorous BWCD. Conclusions: Study findings suggest that Greek-affiliated students and students with weight loss intentions might be at an increased risk for BWCD. Along with promoting lower levels of alcohol consumption, college practitioners should consider discussing issues of weight and body image with college students as they relate to maladaptive drinking behavior.