James C. Turner

Declining Negative Consequences Related to Alcohol Misuse Among Students Exposed to a Social Norms Marketing Intervention on a College Campus

Objective: The authors examined whether alcohol-related negative consequences decreased among students exposed to an intervention. Participants: Beginning in 1999, approximately 2,500 randomly selected undergraduates from a 4-year US university annually participated in a Web-based survey over 6 years. Methods: The educational intervention used social norms initiatives. Main outcome measures included recall of intervention, estimated blood alcohol content (eBAC) when drinking, and 10 negative consequences from alcohol within the past year. Results: First-year students recalling exposure had lower odds of negative consequences (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.64-0.95) and of having an eBAC higher than .08 (OR = 0.76, 95% CI = 0.62-0.92). Over the 6 study years, the odds among all participants of experiencing (a) none of 10 alcohol consequences nearly doubled (OR = 2.13, 95% CI = 1.82-2.49) and (b) multiple consequences decreased by more than half (OR = 0.43, 95% CI = 0.36-0.50). Conclusions: These findings have important implications for US colleges and universities engaged in the reduction of harm associated with alcohol misuse.

College Health Surveillance Network: Epidemiology and Health Care Utilization of College Students at US 4-Year Universities

Abstract Objective: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Participants: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Methods: Participating schools uploaded de-identified electronic health records from student health services monthly. Results: During this study, just over 800,000 individuals used the health centers, comprising 4.17 million patient encounters. Sixty percent of visits included primary care, 13% mental health, 9% vaccination, and 31% other miscellaneous services. The 5 most common specific diagnostic categories (with annual rates per 100 enrolled students) were preventive (16); respiratory (12); skin, hair, and nails; infectious non–sexually transmitted infection (5 each); and mental health (4). Utilization and epidemiologic trends are identified among subpopulations of students. Conclusions: CHSN data establish trends in utilization and epidemiologic patterns by college students and the importance of primary and behavioral health care services on campuses.

Causes of Mortality Among American College Students: A Pilot Study

This pilot study from self-selected institutions of higher education provides an estimate of the causes and rates of mortality among college students between the ages of 18 and 24 years old. One hundred fifty-seven 4-year colleges participated in an online survey of student deaths during one academic year. A total of 254 deaths were reported. The mortality rates (per 100,000) were as follows: total accidental injuries, 10.80; suicide, 6.17; cancer, 1.94; and homicide, 0.53. Within the accident and injury category, alcohol-related vehicular deaths (per 100,000) were 3.37 and alcohol-related nontraffic injuries were 1.49. Men had significantly higher rates of suicide (10.46) than women (2.34). Suggestions for future research and implications of these findings are discussed.

The Longitudinal Pattern of Alcohol-Related Injury in a College Population: Emergency Department Data Compared to Self-Reported Data

Background: Self-report survey is the most common method of obtaining information from college students on substance use and its consequences. However, the validity and reliability of self-report data, especially in relationship to harmful substance use, is frequently called into question. Objectives: To establish the convergent validity of self-reported alcohol-related injury data and data from a university-affiliated hospital Emergency Department (ED) across a seven year period. (2) To examine the trend lines for relative risk of alcohol-related injury. Methods: Two existing data sets at a major public university are compared: records of 1,253 ED admissions for alcohol-related reasons and 13,518 survey responses. Convergent validity is evaluated with the Pearson correlation coefficients of the two data sets for 2001/2002 through 2007/2008. Longitudinal trends for each data set are evaluated by change in relative risk. Results: Over the seven years, 51% of ED visits for alcohol-related reasons were due to injury, and 14% of survey respondents who drank alcohol reported alcohol-related injury. Both decreased significantly over the years: from 62% to 45% for ED reports and from 24% to 9% for self reports. ED visits for alcohol-related injury and self-reported alcohol-related injury are highly correlated: r = .67, 45% shared variance. Conclusions: The comparison establishes convergent validity for the self-report data and decreased rates of alcohol-related injury. Scientific Significance: These findings support the validity in college populations of self-report data about negative consequences associated with drinking alcohol.

Legal Ages for Purchase and Consumption of Alcohol and Heavy Drinking Among College Students in Canada, Europe, and the United States

ABSTRACT Heavy drinking and associated negative consequences remain a serious problem among college students. In a secondary analysis of data from two published study, the authors examine the correlation between minimum legal age to purchase and/or consume alcohol and rates of heavy drinking among college students in 22 countries. The published studies use identical definitions of heavy drinking and similar methodologies. In the study of 20 European countries and the United States, there is a positive correlation between prevalence of heavy drinking and both minimum legal purchase age (r =.34) and minimum legal drinking age (r =.19); in the study of Canada and the United States, there is a perfect positive correlation (r = 1.0). Examination of this evidence does not support the conclusion that a lower minimum legal age for purchase and/or consumption of alcoholic beverages is a protective factor for decreasing heavy drinking among college students.

Low Plasma Levels of Adrenocorticotropic Hormone in Patients with Acute Influenza

Plasma levels of adrenocorticotropic hormone (ACTH) and cortisol were measured in young adults with influenza virus type A (H3N2) infection for whom cultures were positive and in comparable controls without symptoms or other evidence of illness. The mean plasma ACTH level +/- SE in 19 patients with acute influenza was 13.5 +/- 2.1 pg/mL compared with 23 +/- 3.2 pg/mL in 11 controls (P = .02). Mean plasma ACTH levels +/- SE had risen to 21 +/- 4.1 pg/mL in specimens obtained from patients during convalescence. The mean plasma cortisol level +/- SE in patients with acute influenza was 13.7 +/- 1.4 micrograms/dL compared with 10.8 +/- 1.0 micrograms/dL in controls (P = not significant). ACTH levels in individual controls were relatively higher than their cortisol levels, but ACTH levels in patients tended to be lower than cortisol levels in paired specimens. These findings suggest that influenza virus type A infection may have an inhibitory effect on the production or release of ACTH.

Local influenza-like illness surveillance at a university health system during the 2009 H1N1 influenza pandemic.

BACKGROUND The 2009 novel H1N1 influenza epidemic generated interest in regional and national influenza surveillance methods. Some systems revamped traditional syndromic and laboratory surveillance techniques, whereas others tracked influenza by Internet-based searches or other unique methods. We hypothesized that an influenza-like illness (ILI) surveillance system at a single university hospital would be accurate and useful for monitoring local influenza activity and impact. METHODS We developed a system of ILI surveillance at 8 sentinel sites associated with a university health care system before the pandemic 2009-10 influenza season. Most sentinel sites used a symptom-based definition of ILI, whereas others used electronic medical records-based definitions. RESULTS Results of the local ILI surveillance network correlated well with the onset and peak of the influenza season compared with state and regional ILI data, closely approximated cases of microbiologically confirmed influenza, demonstrated early onset of illness in one site in the sentinel site network, and were available several days sooner than data from existing surveillance systems. CONCLUSIONS Local influenza surveillance at a single-institution level provided timely, useful, and accurate information, which helped guide resource utilization during the pandemic influenza season. The system was an important supplement to state and regional influenza surveillance.

Alcohol-related vehicular death rates for college students in the commonwealth of Virginia

Abstract Objective: Determine rate of college student alcohol-related vehicular traffic fatalities in Virginia during 2007. Participants: Undergraduates at colleges and universities in Virginia. Methods: Institutions with membership in the American College Health Association were invited to participate in a survey. Data collected from institutional reports of student deaths due to vehicular accidents. Results: Twenty-four institutions were invited to participate. Sixteen responded (response rate = 67%), comprising total enrollment of 117,100 for 17- to 24-year-olds (56% of total college population in state). Five traffic deaths were reported, representing 4.3 deaths per 100,000 students. Based on statewide statistics that estimate alcohol contributes to 38.9% of traffic deaths, rate of alcohol-related motor vehicle deaths is 1.7 deaths per 100,000 college students in Virginia, which is 89% lower than leading national estimates. Conclusions: These findings suggest that past estimates of alcohol-related vehicular deaths among college students are overstated.

Response to Letter to the Editors: “Alcohol-Related Vehicular Death Rates for College Students in the Commonwealth of Virginia”

W e appreciate Dr Hingson et al’s thoughtful response to our recent study.1 We too were surprised at the unexpectedly low mortality rates among the queried schools. This was an exploratory study from the outset and an attempt to confirm rates in Virginia that would be predicted by Dr Hingson’s extensive body of work.2–4 In order to observe 1,400 to 1,500 alcohol-related vehicular deaths each year in the United States, according to Hingson et al’s estimates, approximately 2,800 to 3,000 college students would be dying annually in traffic accidents (based on their assumption that approximately 49% of fatal accidents are due to alcohol). Over 10 years, this represents close to 30,000 deaths of students aged 18 to 24 years—more Americans than have died in the World Trade Center and Pentagon attacks as well as all military actions since 2001: a stunningly high number and equivalent to the loss of the entire campus population of a land grant institution in 1 decade. What has been puzzling to us is that if college students are dying at this rate from traffic accidents alone (excluding all other causes of mortality), we must assume institutions would both know about these deaths and would be appropriately alarmed. Perhaps not widely appreciated is that institutions have access to a number of sources of information about students who die. It would be exceedingly rare for a student to succumb from an illness or accident without university officials knowing details about the death (even if occurring off cam-

Non-group a streptococci as common isolates from throat culture among college students with pharyngitis.

A s part of the evaluation and management of pharyngitis in a college health service, we use rapid group A Streptococcus antigen testing (Clearview Strep A exact II Dipstick) with “back up” culture of the negative swabs. Because of the association of non–group A Streptococcus organisms in pharyngitis in the college population, isolates from throat cultures are also examined for the Streptococcus dysgalactiae, subspecies equisimilis, specifically β-hemolytic groups C and G.1–3 A Quality Improvement review of all throat swab tests was conducted at our health service over a 2-year period (June 1, 2008 to June 1, 2010). Throat swabs are obtained primarily in the context of throat pain suggestive of pharyngitis/tonsillitis. Clinical management is guided by clinical presentation and laboratory test results. Our university has a student enrollment of approximately 21,000 students. During the 2 years of this study, 68% of our patients were aged 17 to 22 years old, 18% 23 to 26 years old, and 14% 27 years and older. Fifty-eight percent of patients were female, 12% Asian, 8% African American, 4% Hispanic, 66% white, and 10% unclassified or not identified by ethnicity. Over 2 years, 1991 throat swabs were collected. One hundred twenty-three (6.2%) were positive for group A Streptococcus on the rapid antigen testing (and were not further cultured). Twenty-five (1.3%) isolates were identified as group A Streptococcus on culture for a total of 148 (7.5% of the total) considered positive for group A. One hundred fifty-eight (7.9%) isolates were identified as group C Streptococcus subspecies equisimilis and 68 (3.4%) group G. Total results