The current outbreak of Ebola hemorrhagic fever (or Ebola Virus Disease, EVD) in West Africa moved to the forefront of American media attention following the medical evacuation of two ill Americans in early August. The sudden presence of patients with EVD in the United States raised a lot of concern among the general public about the risk of transmission. It also initiated new discussions in health care facilities regarding their preparedness for patients who could present with EVD. The oft-repeated reference to infectious diseases being “just one plane ride away” suddenly became very real.

But it’s not new. Providers in college health probably understand, and experience, the health risks associated with travel more than in most health care settings. Our population travels a lot – across the state, across the country, and around the world. Then they all return to their campuses en masse several times each year, sometimes sharing recently acquired microbes with their fellow students, faculty, and the community.

We should all be prepared to deal with the next big thing, including diseases exotic (chikungunya) or common (norovirus). If a student comes into your health center with a fever and reports recent travel to Africa, he or she is far more likely to have malaria than Ebola (and both have similar clinical presentations). But you’ll want to be able to respond effectively to either situation. There are some specific actions we can take now to prepare for what might show up this fall. 

Here are a few ideas:

• Every health center should have emergency preparedness plans in place that include infectious diseases as a contingency. A single case of MERS-CoV – or even measles – would likely trigger a public health emergency response. Dust off old plans and update them accordingly.

• Providers should incorporate a simple travel history question to be asked of all patients with acute febrile illness (“have you traveled outside the United States in the last two weeks?”) and know what to do when the answer is “yes.” Generally, patients who develop specific signs and symptoms within 10 days of travel should be evaluated for the illnesses associated with the countries from which they traveled. Persons potentially exposed to someone with Ebola need to monitor their health for up to 21 days. Detailed guidelines for screening and management based on country and disease are posted on the U.S. Centers for Disease Control and Prevention (CDC) web site. If you use an electronic health record, you can add screening questions to note templates or as provider prompts.

• Establish appropriate infection control policies and enforce them. If available in your health center, utilize negative pressure isolation exam rooms for any patient with a cough illness. Make sure staff are trained in using personal protective equipment, properly fitted with respirators, and current on recommended immunizations.

• Identify someone in your health center to monitor CDC guidance and provide situation updates to staff. Stay abreast of travel recommendations. Sign up for electronic communications from the CDC’s Health Alert Network or the Center for Infectious Disease Research and Policy (CIDRAP).
  

• Build relationships and coalitions with your campus and community partners – student housing, study abroad programs, the international student office, student affairs, campus administration, public relations, plus local and state public health departments. Identify local experts and know who the point of contact is in your health department. Work with these partners to provide a consistent message to your students.
  

• Ensure your student population is highly immunized, with a special focus on international students. Recognize that many vaccine-preventable diseases – measles and pertussis in particular – are much more prevalent in other parts of the world. Develop the capacity to easily identify students at risk and consider sending targeted messages to them when needed. How quickly could you identify, notify, and potentially quarantine students susceptible to measles, should a case occur on your campus?
  

• If students are traveling abroad, both the U.S. State Department and the CDC provide country-specific advice regarding travel precautions. Keep your international study programs and students up to date with this information. It’s important to keep disease risk in perspective, though: motor vehicle accidents are the leading cause of death and injury for students in study abroad programs, not infectious diseases.

Ebola Virus Disease is currently a global public health emergency and presents a potential risk for travelers returning to the U.S. from affected countries. The situation in West Africa is likely to get worse before it gets better. Similar risks exist for MERS-CoV, novel influenza H7N9 and H5N1, measles, and other infections around the world. An important strategy in response to such emerging disease threats is to apply a universal approach to surveillance, screening, and infection control. College health professionals should also focus on providing relevant and scientifically accurate information to students, parents, staff, and faculty. Be ready for whatever will come in the door next.

ACHA’s Emergency Planning Guidelines for Campus Health Services: An All-Hazards Approach
Travel Health Resources

The American College Health Association’s Sexual Health and Clinical Care Coalition (SHECCC) wants to provide you with an update on what has been going on and what you can expect in the future for the GYT: Get Yourself Tested campaign.

This April, we shifted our efforts to promote GYT through the fall 2014 back-to-school campaign. However, you may still download GYT supplies, including posters, flyers, and handouts, here. Physical toolkits with pre-printed materials will not be available this year since the GYT campaign is focusing on back-to-school branding, and will we be collecting any GYT data from you as we have in the past. We hope this does not inconvenience you and your plans for the spring, but we are diligently working on a large boost in the fall with new branding.

If your college or university has been considering implementing GYT on campus, there is now peer-reviewed evidence published in the Journal of Sexually Transmitted Diseases to support the campaign’s efficacy. The article, entitled An Assessment of the GYT: Get Yourself Tested Campaign: An Integrated Approach to Sexually Transmitted Disease Prevention Communication, is an evaluation of campaign efforts from 2009-2010 and shows promising evidence that the campaign has the ability to reach youth, prompt dialogue about sexual health and testing, and increase STI testing at select testing locations across the country. This evidence can assist colleges and universities in need of administrative buy-in to support implementation of the GYT campaign. Findings specific to GYT college implementation should be published in Cases in Public Health Communication and Marketing later this year. 

Results from the 2012 ACHA Pap Test and STI Survey show a continued increase in GYT campaign participation among colleges since 2009. Participation in the GYT campaign resulted in a significant increase in STI testing during the month of April among those schools who promoted this campaign. 

Also, be sure to check out the archived Bringing GYT to Your Campus webinars (Webinar 1 and Webinar 2) where college health professionals discuss easy steps for successfully implementing the GYT campaign on their campuses and share their lessons learned. ACHA is offering 1.0 CHES continuing education credit for these webinars. Credit will be given for either Part 1 or Part 2 but not for both webinars. If you receive credit for Part 1 you are not eligible for additional credit for Part 2. Click here for more information. 

Improve the health of all students, staff, and faculty on college campus nationwide – an expansive goal that is the mission of Healthy Campus 2020. The 10-year national initiative to accomplish that goal reflects the major public health concerns that impact college students in the U.S.

In order to achieve any objective, your target audience needs to have an understanding of the health concern (knowledge) and want to change their behavior to get the desired effect (attitude).

When our target audience is college students, we can use many tools in our health communication toolbox to aid us in reaching an objective. No single tool can accomplish an objective, and we need a multifaceted approach to achieve behavior change. Some of the tools you already use to spread health messages might include social norming messages, collaboration with other departments, fliers, posters, workshops, events, campaigns, awareness weeks, movies, and/or outside speakers. 

Consider adding this tool to your toolbox: video. You can create your own videos at your health center, use videos created by other health organizations, or do both!

Why use video? 
College students want quick and easy access to information. The faster the information can be found and the easier it is to understand, the better. Pictures, charts, graphs, infographics, and videos can portray information in a quick, easy-to-comprehend format.

As we all know, and the data supports, college students are massive users of the internet. They make up a very large portion of social media users and, in particular, use video-sharing sites such as YouTube. According to the Pew Research Center Report on Video-Sharing, 92 percent of 18-29 year olds have used video sharing sites, and 47 percent have used those sites “yesterday.” With many of our students spending their time online using video sites, we have an opportunity to reach them with our health messages through video.   

How can college health centers nationwide use video to their advantage? Repackage traditional ways of presenting health information to students, add some out-of-the-box thinking, follow best practices, and create a video. Although creating a video takes knowledge, time, effort, and resources, a video’s ability to reach a large number of students is just one “share” away.  

Videos can be an additional tool to help achieve Healthy Campus 2020 student objectives. For example, one student objective is to reduce the proportion of students who report that their academic performance was adversely affected by cold/flu/sore throat in the past 12 months. Many college health centers and other health agencies used video to promote flu shots during flu season. Here are a few examples: 

• Flu – Coming To A Campus Near You by The University of New Hampshire Health Services
• UCF Singing Flu Shot Campaign and Debunking Myths About The Flu Shot by The University of Central Florida Health Services
• Wilbur and Wilma Get Their Flu Shots at Campus Health by The University of Arizona Campus Health Service
  
• CDC Flu Prevention Videos 
  
• WebMD Flu & Cold Prevention Video 
  

Video gives us the ability to repackage and reframe health messages into a format which better resonates with college students. Add this powerful tool to your health communication toolbox – and stay tuned for a future blog post with details of how various campuses have implemented videos.

By: M. Dolores Cimini, PhD, University at Albany, SUNY

We know from the research literature on college student alcohol use that target populations such as first-year students, student-athletes, fraternity and sorority members, students mandated for alcohol policy violations, and students seeking health and counseling care for concerns unrelated to their alcohol use are often at highest risk for alcohol abuse and related negative consequences…and they are less likely to seek intervention for these issues.

We also know that the research literature and best practice guidelines state unequivocally that engaging students in screening and brief intervention addressing their alcohol use is associated with reductions in consumption and related consequences as well as the increased use of protective behaviors.

Since 2006, UAlbany’s STEPS Comprehensive Alcohol Screening and Brief Intervention Program, based on the BASICS model and designed to meet the distinct and complex needs of different kinds of students, has been delivering personalized feedback on alcohol use to each student who participates.

Some examples:

• Student-athletes are screened after team meetings, receiving information on alcohol use and athletic performance in their feedback profiles.
• First-year students participate in online screening within the first month of college, followed by a brief intervention that focuses on alcohol use as it relates to college adjustment. 
  

We are currently collecting data on the newest arm of our STEPS program designed for our fraternity and sorority members; here, we are focusing on factors such as alcohol use and fraternity and sorority reputation as well as the role of alcohol use in fraternity and sorority rituals. 

In the same way that we have worked to engage our students in alcohol screening and brief intervention, we have learned that it’s important to engage stakeholders, including service providers, coaches, advisors, first-year experience staff members, and faculty members, in the planning process and keep them informed of successes and challenges. Our stakeholders often underestimate their role in making a screening and brief intervention program successful, and they are always quite surprised and impressed to learn of the impact they have on our students. 

By 2009, when the program received the ACHA Best Practices in College Health Award, the program had reached more than 13,000 students. Four years later, our efforts are continuing to work: with more than 21,000 students screened for alcohol use to date, we have seen statistically significant reductions in alcohol use and associated negative consequences across each target population. 

Perhaps even more importantly, our students are providing positive feedback on the interventions. They appreciate how easily they can access and resonate with the issues that are on their minds.

By: George Brown, University of Alabama, chair of the Engagement Subcommittee of the ACHA Healthy Campus Coalition and co-chair of the NIRSA Health and Wellbeing Commission 

Institutions of higher education across the country encourage students, faculty, staff, alumni, and even community members to attain and maintain health through facilities, programs, and services. Many institutions provide technologically-advanced state-of-the-art recreation and fitness facilities for cardio and strength and conditioning purposes as well as impressive aquatic centers and climbing/challenge course offerings. Convenient hours, safe and well-supervised equipment, and low costs all aid in attracting a wide variety of exercise and fitness enthusiasts.  

Encompassing More than Physical Wellbeing 

While exercise and fitness play a big role in campus recreation, these programs also impact their campus in further wellness dimensions. In fact, NIRSA: Leaders in Collegiate Recreation (formerly the National Intramural-Recreational Sports Association) recently created and recognized the Health and Wellbeing Commission as a core strategic value of their organization. NIRSA provides a vast array of resources for collegiate recreation departments seeking to maximize awareness and promote health and wellbeing in their campus communities. While recreation offerings on college and university campuses have long been associated with improving physical wellness (stronger bodies, improved muscular tone, increased cardiorespiratory endurance), the NIRSA Health and Wellbeing Commission is seeking to contribute to the dialog on the role and importance campus recreation plays in many other aspects of health.  
Outside of physical health, campus recreation resources also impacts:

• Social Wellbeing: Playing intramural and club sports on teams formed by affinity groups such as residence halls, fraternities, sororities, and faith-based organizations develops an appreciation for teamwork, cooperation, and sportsmanship. Being a part of a group promotes interactions that transcend the sport or activity, creating friendships and support groups.

• Emotional Wellbeing: Working out can provide healthy releases of stress and anxiety often associated with the pressures of college life. Physical activity can improve coping mechanisms that are often challenged in collegiate settings.

• Intellectual Wellbeing: Studies repeatedly show that study breaks – especially those that include physical activities and exercise – improve comprehension and retention of academic course material.

Involving Campus Recreation in Wellbeing Initiatives 

When institutions embark on health and wellbeing initiatives such as Healthy Campus or other campus-wide health programs, recreation departments are often asked to provide resources and expertise on physical wellness. Campus recreation staff and services can impact participants more broadly as well.  Recreation centers are high-traffic locations and are a good place to share/post health-related information such as smoking cessation programs, alcohol and other drug awareness campaigns, safe spring break alternatives, and stress reduction resources around final exams.

Recreation Promotion

Getting folks involved in recreation is easy. Many programs offer introductory fitness classes, individual and group personal training, and sports leagues that seek “free agents” who may not have established team connections. Do not let your campus community members be misled by the myth that they have to be a superstar athlete to participate. Today’s campus recreation departments offer something for everyone and provide a way to connect with others who share a desire to stay healthy and well. 

Visit your campus recreation facility today to learn more, participate, and connect on campus-wide health and wellness initiatives!

By: Stacy Andes, Villanova University, and Tavis Glassman, University of Toledo

The American College Health Association’s Alcohol, Tobacco and Other Drugs Coalition (ACHA ATOD) focuses on substance abuse prevention and treatment specific to the college student population. An issue of increasing concern for the coalition involves non-medical prescription drug use (NMPDU). Although its prevalence ranks a distant fourth to alcohol, tobacco and marijuana use on college and university campuses, non-medical use of prescription drugs far exceeds other illicit drug use. Of particular concern is the link between NMPDU and the use of other drugs, often in combination, which poses additional risks for students today.

For the purposes of this blog, non-medical prescription drug use is generally defined as the use of a prescription medication:

• For anything other than its intended purpose;
• By someone other than the person to whom it is prescribed; or
• In a dosage other than prescribed.

This definition applies to the illicit user as well as to the prescribed user who is not using the medication as prescribed.

Scope of the Problem
Non-medical prescription drug use is a problem throughout the United States and has been classified as an epidemic by the Centers for Disease Control and Prevention. Still, it is important for colleges and universities to assess the extent of use on their respective campuses. In the earliest studies, rates of non-medical prescription stimulant use on our Nation’s campuses were reported to range from 0 to 25 percent,1 and trend data between 1993 and 2005 alerted the public health community to rate increases between 93 percent and 450 percent across various prescription drugs (e.g., stimulants, painkillers, sedatives, and tranquilizers).2

In most cases, reported use rates on campuses around the country from 2008-2012 are less than 10 percent for any prescription drug category (e.g., painkillers and stimulants) and, in some instances, less than 5 percent (antidepressants, sedatives, and erectile dysfunction drugs) for past year use.3 These trends are consistent with results from both the Monitoring the Future survey4 and in ongoing longitudinal studies in the Northeast5 and Midwest.6 Nonetheless, these rates are unacceptably high, and campus officials may be unaware of the potential consequences of NMPDU, which can include drug-related emergency room visits, sexual assault, violent behavior, and academic misconduct (e.g., use of prescription drugs to improve test scores).

Guiding Comments and Recommendations

• Link NMPDU with alcohol use. College health professionals and other campus officials are only beginning to understand who is at risk for NMPDU. Institutions of higher education with advanced admissions standards located in the Northeast demonstrate disproportionately high rates of non-medical prescription stimulant use.1 Additionally, studies have consistently found that white, male, Greek-affiliated students are at the greatest risk.1,7,8,9 This profile is similar to that of individuals with a higher risk for alcohol use, as drinking and drug-use behaviors are highly correlated.10 College health professionals, therefore, should consider utilizing evidence-based practices that target high-risk alcohol use (e.g., brief motivational interviewing) to also address NMPDU.
  

• Increase perceived harmfulness. As with alcohol use, college students generally perceive NMPDU as relatively harmless. In one study,11 40 percent of students assigned only moderate risk to non-medical use of prescription stimulants (e.g., Adderall®) and analgesics (e.g., Vicodin®). Compounding the problem is that many students suffer from “optimistic bias,” mistakenly believing that the negative consequences associated with drug use happen to others and not themselves. Because prescription medications are produced legally and distributed through doctors, students often perceive them as safer than illicit drugs, further reducing the stigma associated with their use. College health professionals should consider increasing students’ awareness and assessment of the harm associated with non-medical prescription drug use through their social marketing and educational outreach efforts.12
  

• Leverage the prescribed user. Research shows that the prescribed user, under medical supervision, demonstrates the same risk as the average college student for illicit drug use. However, prescribed users who overuse and non-medical users both exhibit a much greater risk for illicit drug use.13 College health professionals should educate students in the appropriate use of prescription drugs and work to build their confidence in managing requests (from friends or other students, for example) to share or sell their medication.
  

• Utilize social norms marketing. Research indicates college students and others grossly overestimate the extent of non-medical prescription drug use.12 For instance, students may think that 75 percent of their peers use Adderall® non-medically, when in fact fewer than 10 percent do. Correcting these misperceptions may result in decreased NMPDU.
  

• Work with local partners. Because alcohol and other drug use impacts both the campus and the surrounding community, colleges and universities should seek to engage and work closely with local partners – healthcare providers, pharmacies, merchants, and law enforcement, to name a few. While many students obtain prescription medications from their peers for free, we also know that students are “doctor shopping” and selling medications to other students.4 Reducing access in the community can also help to reduce access on campus.12
  

Coalition and Related Reports
The ACHA ATOD Coalition provides resources related to alcohol, tobacco, and other drug prevention as well as evidence-based intervention strategies. A number of resources are currently available on the ACHA ATOD Coalition webpage, including the Non-Medical Prescription Drug Use Toolkit for Health Promotion Professionals and links to national data sources on ATOD issues on college and university campuses.

Latest data reveals internet interest in beer pong may be on the decline and is certainly down from a peak in August 2009. According to Google Trends, a free online tool that displays the relative interest in online search terms, the trend for the term "beer pong" (combined with similar terms such as "beer pong table" and "beer pong rules") has not received as much interest after peaking several years ago. While online search interest appears to fluctuate over time, the current interest is hovering around 60 percent of the 2009 peak- a range not seen since around 2005-2006.

It's interesting to note that interest seems to spike each summer. Perhaps these searches are coming from first-year college students looking up rules to the game, learning more about it before heading off to school, or concerned parents. 

Does this mean the most popular college drinking game is on the decline? Not necessarily. Just because people aren't searching for beer pong as frequently, doesn't mean college students have stopped playing. In fact, the Google Trends data probably has more to do with mainstream reporting on beer pong than it does with actual drinking rates.

The search term peaks in 2008 and 2009 could be explained by the increase in the number of popular news articles on the subject. Here are some headlines that could have contributed to the beer pong buzz:

• The War on Beer Pong - This TIME Magazine article from July 31, 2008, mentions a Nintendo Wii game called "Beer Pong" that was causing a lot of controversy at the time. 
• Introducing the next great American pastime: beer pong - This ESPN The Magazine article from January 14, 2008, describes the increasing popularity of beer pong tournaments and national championships. 

In my opinion, beer pong isn't seen as something new or underground anymore; it's become a mainstream part of the college drinking environment. With beer pong online and video games and countless references in movies and YouTube videos, beer pong is probably less exciting and mysterious to high school students. To illustrate my point, check out the Google Trends for the search term "smoking alcohol." The sudden spike in June 2013 is likely the result of the media catching wind of a dangerous new craze, but that doesn't mean everyone is doing it. It's new and different and interesting – hence, the surge in online searches.

The Advisory Committee on Immunization Practices is a group of medical and public health experts that develops vaccine recommendations. The Centers for Disease Control and Prevention uses these recommendations to develop vaccine schedules that include the target age, number of doses, and dose interval. The recommendations are the cornerstone of prevention in U.S. health care. 

ACHA is one of 30 professional organizations with an official liaison to the ACIP. As the ACHA representative, I am charged with providing input regarding the impact of ACIP recommendations in the college health setting, and I attended the most recent ACIP meeting at CDC in Atlanta this past October. At this meeting – one of three held each year – the committee discussed vaccine research, safety, and supply, among other things.

Here are some of the topics that were addressed by the ACIP at its October meeting:

Meningococcal vaccine back in the news: The ACIP voted to recommend use of quadrivalent vaccine MenACWY CRM in infants (aged 2-23 months) at increased risk meningococcal disease. The vaccine protects against meningitis serogroups A, C, W, and Y. This is the first quadrivalent vaccine for meningitis that the FDA has approved for use in infants under six months. It may also be used for healthy infants prior to travel to countries in which meningococcal disease is epidemic. This is the same conjugated meningitis vaccine used in the adolescent and college age population.

Pertussis vaccine supply: All pertussis-containing vaccines have been in short supply, and although shipping has resumed, availability will remain somewhat low over the next several months. Follow vaccine shortages here.

Influenza: Influenza activity in the U.S. is currently minimal, so there’s still time to get our students immunized. The most successful approach? One study showed that 71% got the flu vaccine if a provider both recommended and offered the vaccine in the same visit. Last year showed important increases in flu vaccines coverage in adults over 18 and all health professionals. Follow flu activity this season here.

The next meeting will be in February 2014. Some of the topics on the agenda:

MMWR “General Recommendations on Immunization”: This document will contain important updates in vaccine administration, use of multi-dose vials, and safety engineered syringes.  

ACIP Statement on HPV Vaccine: ACIP is working on providing further guidance on the HPV vaccine to address the low uptake in adolescents compared to other vaccines that are given at this age. Part of the problem has been that parents may regard the HPV vaccine as a gateway to sex and not the cancer-prevention strategy that it really is. In the meantime, have you seen CDC’s Tips and Time-savers for Talking with Parents About HPV Vaccine? 

CDC’s Updated Immunization Schedules: Updates to the vaccine schedule are released each February schedule. ACHA’s Recommendations for Institutional Prematriculation Immunizations will also be updated to reflect the new schedule and recommendations on vaccines for college students. 

Minutes and presentation slides from ACIP meetings can be found here. 

The Virginia Commonwealth University’s Clicker Enhanced Social Norms Marketing program began in 2005 with the goal of reducing high-risk drinking and related harm. At the heart of this program is the recognition that presenting students with accurate information about their peers’ alcohol use reinforces healthy behaviors.

The social norms marketing campaign is improved through alcohol education sessions utilizing clicker technology. In the sessions, students use hand-held wireless devices that transmit personal responses to questions asked, and their responses are instantly displayed as graphs. This immediate feedback shows students the gap between their perception and the reality of actual alcohol use on campus. 

These sessions challenge participants to observe healthy behaviors rather than the unhealthy behaviors that often seem more visible. Data have demonstrated that students who participate in the clicker sessions have more accurate perceptions of normative alcohol use than those who do not attend a session and are more likely to limit their alcohol use. 

Because the program proved to have such positive impact on the decision‐making development of students, ACHA awarded it the Best Practices in College Health Award in the category of Health Education and Promotion Services in 2010. The success of the program spurred VCU’s Wellness Resource Center to explore a variety of other misperceptions and how these can be addressed in a similar fashion.

This fall,  through real-time clicker feedback, 1,867 incoming students were able to see that while most of them perceived that only 30% of Americans support LGBT people in being who they are, their own responses revealed that 89% of those freshman support LGBT people in being who they are.

Knowing the difference in perception versus reality is very useful, to both college health professionals and students, and that’s why we at VCU love our clickers. Anyone have other questions they have found helpful in making their campus healthier?