Richard P. Keeling

Presentation of Unrecognized Attention Deficit Hyperactivity Disorder in College Students

Mental health providers at university counseling and health centers should be alert to the possibility that college students with previously unrecognized attention deficit hyperactivity disorder (ADHD) may present for initial evaluation at their centers. This study was a systematic chart review of 42 students at an Upper Midwest university who were diagnosed with ADHD during calendar year 1993. Diagnoses were made by the treating psychiatrist, who reviewed records for presenting problems; recent associated problems; previous evaluations as a child, adolescent, or adult; and associated problems in childhood. Presenting problems included ADHD symptoms, mood symptoms, nonspecific learning disability, and academic underachievement. Associated problems were depressive disorders, anxiety disorders, drug and alcohol abuse or both, dependency, legal problems, learning disabilities, and eating disorders. Thirty-three percent had been evaluated for academic or behavior problems as children, and 36% had sought previous psychological care for non-ADHD symptoms as adults. Thirty-one percent were presenting at the university health center for their first evaluation. Childhood histories showed educational underachievement, learning disabilities, and behavior problems.

Men, Gender, and Health: Toward an Interdisciplinary Approach

interest in men’s health,little came of it. It was, perhaps, difficult to sell the idea that men, as a group, were endan gered; mortality statistics about their compar ative disadvantages notwithstandi ng, most men are more powerful than women at e very level of social and economic class. Few men in most cultures have sought to claim the identity and territory of the at-risk, not-so-powerful man revealed by most men’s health scholarship. Or , perhaps, the very prob lems that endanger men’s health conspired to undermine discussion of it—especially among men. It is not the easiest thing, the study of men’s health. Open the door, and you are quickly in a different world , full of mind-bending term i n o l ogy (some of wh i ch wo rks and serves better than simpler terms to eng age the meaning of masculinity and its challenges, but some of which simply generates fog and seems intended only to fortify an emer ging discipline by armoring it with arcane neolo gisms). Read about men’s health and you encounter both the “spin”of panicky overstatement and the dense thicket of sociological jargon. The trouble is, the overstatements are not all wrong , and the jargon has evolved because standard terms and descriptions somehow fail to name or characterize ade quately the issues that pertain to gender , health, and, especially, masculinity. Our concern about men’s health is not sufficiently addressed by traditional concepts of disease , nor by the usual health statistics. It is, itself, telling that neither our language nor our concepts of health have, until recently, accommodated the theories and questions most central to understanding the relationships among health, masculinity, and men’s well-being . Chances are, though, that you have come to hear increasingly clear signals amidst the rhetorical static . The media have begun discussing issues related to the well-being of boys and men. Although simplistic notions and stereotypes abound when men’s health is popularized , the presence of men’s health (and of a ma gazine bearing that name) on n ewsstands and television shows suggests the gr a d u a l

Social Norms Research in College Health

ocial norms,” whether understood as an epistemology, or theory, of health behavior-a way of knowing and explaining the factors that influence or determine the health-related choices students make-or as a strategy in social marketing programs designed to promote better or healthier decisions, has become a common feature of thought and action in college health. A “social norms approach” has emerged, in fact, as a kind of social norm of its own; including certain concepts or techniques based somehow on social norms is now de rigueur in campus health promotion. The rhetoric of prevention conferences and workshops regularly includes phrases like “a social norms intervention” or “the social norms model,” and, less formally, “social norming.” Like peer education programs a decade ago, social norms strategies have rapidly become popular, imitable, and well accepted; using them assures professional alignment with a shared sense of movement and progress in college health, and not using them seems somehow out of step. As was the case with the first generations of peer education programs, there is, at the same time, substantial variation in the understanding, application, and nature of social norms approaches. What seems like a good idea can birth a myriad of progeny. The ideas and principles underlying interventions based on social norms have produced thoughtful, reasonable, and evaluable programs on some campuses (two of them described in the research reports in this issue). That same rigor has not, however, assisted the design and implementation of social norms projects everywhere, and, too often, social norms programs have become a convenient, defensible hammer with which to hit every available (and troubling) behavioral or attitudinal nail. Just as the heyday of peer education featured several subspecies of peer specialists trained to address topics from HIV/AIDS or sexual violence prevention to study skills, stress management, and multicultural awareness, so the idea of advancing campus health by the broad ap-

Binge drinking and the college environment.

aken together, the 3 major articles on college drinking in this issue of the Journal disallow complaT cency, forbid shallow analysis, and demand renewed commitments. These are extensive national studies of drinking patterns and programs at hundreds of institutions, involving many thousands of students, arid conducted over as many as 8 years. They provide an essential, if bracing, view of trends and a cautious assessment of what we, in our binary way of thinking, call our successes and failures. There is nothing in them that should make us feel even briefly comfortable; neither should they paralyze us. We discover most what surprises few of us: that the work has just begun. The key findings include these:

The political, social, and public health problems of binge drinking in college.

n the abstract of their report of results from the Harvard School of Public Health 1999 College Alcohol Survey I about the effectiveness of campus alcohol programs, Henry Wechsler and his colleagues observe that “ ... the actions college health providers have undertaken thus far may not be a sufficient response.” Their article leads an issue in which drinking problems are, yet again, our primary focus-a fact that in and of itself suggests both their pressing priority and the absence of clear solutions-or, at least, of demonstrated results that can be brought to scale and applied broadly in higher education. The 1999 results simply confirm what most college health professionals already know from their own experience: Binge drinking is, as Wechsler says in his title, “a continuing problem.” The Harvard researchers learned that the prevalence of binge drinking has not changed, overall; two of five students were binge drinkers in 1993, 1997, and 1999. It is likely that nearly all of the students surveyed in 1993 are no longer in college; many of the 1997 respondents have graduated or departed as well-all of which suggests that the durability of binge drinking as a phenomenon of campus culture across student generations is impressive, and all the more so, given the flotilla of interventions launched against it since the early 1990s. Taken in the greater context of history, this is no surprise; drinking problems in higher education are hardly recent discoveries. But we do not document even a dent in the rate of binge drinking, despite almost a decade of good intentions and a parade of promising practices. The subtleties and nuances of the 1999 study are. however, arguably of more importance than the overall finding that binge drinking survives more or less intact. Between 1993 and 1999, the frequency of abstention from alcohol among students significantly increased, to 19%; during the same interval, the percentage of students who met the Harvard criteria for frequent binge drinking increased as

Knowledge and Attitudes of University Health Service Clients about Genital Herpes: Implications for Patient Education and Counseling.

Abstract Genital herpes virus infection is an important target for health education efforts because of its apparently rising incidence in the college student population and because it can have potentially serious psychological as well as medical consequences. In order to better understand the health education and counseling needs of students, the present study surveyed knowledge and attitudes about genital herpes of 190 university students using a gynecology clinic and of 161 students using a general medical clinic. The students were found to have a high degree of familiarity with the disease, its cause, and mode of transmission, but tended to view the consequences of the disease as more severe than is actually warranted by the common medical complications. There was some degree of misinformation about prevention and treatment of the disease and some negative attitudes about patients suffering from it, but the survey respondents endorsed a high level of responsible behavior with regard to the disease and ...

The college health opportunity.

, erhaps what most distinguishes college health from healthcare in any other form or setting is the opportunity it offers. All of the articles in this issue of the Journal recognize and embrace some aspect of that opportunity as they describe the ways in which college health can make important contributions that may materially improve the health and well-being of students, people who are in some relation to students, and whole populations, both during and after college. But how do we understand the opportunity? What does it offer, and what does it require of us? Katherine A. Forrest, who has prepared an extraordinarily complete and compelling review of men’s reproductive and sexual health, envisions college health as the meeting ground between young men’s psychosexual development and the resources and influence of expert healthcare professionals. Male college students of traditional undergraduate age are not yet finished as men; at the same time, they are just beginning to make independent decisions about health and healthcare. This is the time, Forrest suggests, to introduce health-related programs and services that are customized for men’s needs and are specifically oriented toward making men comfortable with seeking health information, getting the help they need from healthcare providers, and understanding the challenges they face in a culture that expects and enforces styles of masculinity that are fundamentally unhealthy for them. Establishing a theme that will be echoed in the work of our other authors, Forrest locates the special opportunities of college health beyond the routine clinical processes of stimulus and response. If it would explore and make the most of those opportunities, college health cannot stop at

Why college health matters.

his issue of the Journal offers a selection of very different articles, all of which respond in one T way or another to a fundamental and pressing question: College health for what? Or, put another way: Why, and how, does college health matter? Getting most directly at that point, the writers of the 2 Viewpoints inspire us, reminding us from their different perspectives of why we do what we do. (By the way, because nobody is conceivably in college health for the money. that possible answer is rather securely off the table.) Paula L. Swinford, a distinguished past president of the American College Health Association, locates college health programs (note, not incidentally, her choice of words: college health progrums, rather than college health centers) centrally, at the heart of the mission of institutions of higher education. Responsible for advancing the health of students, good college health programs strengthen and fortify the campus learning environment while supporting the cognitive, emotional, behavioral, and social development of each student. Ergo, the success of health-related programs and services in college is measured not in their relative ability to construct an cdifice of knowledge but in their capacity to infuse elements of flexibility, resilience, and coherence into students’ academic and personal lives. The best college health programs protect and advance the health of students in ways, and along pathways, that liberate students’ minds. So it is, as Swinford so carefully argues, that effective college health programs are not-have not been-annot bepurely clinical operations, no matter how sound and valu-

Food: Sustenance and Symbol

t once sustenance and symbol, food makes life possible but also demonstrates (and sometimes influences) its complexity. No food, no life. Where famine, poverty, indifference, or war still shrink human existence, the relationship between food and life is that direct, that simple: people die without it. Few readers of this journal-and few of the students we serve-have known hunger as anything other than an abstraction, at most a temporary inconvenience with no particular emotional punch. “I’m hungry” only means “When do we eat?’ It is not just a deficiency in our perspective or a limitation in our world view that leads us to miss the cultural irony in the contrast between our worry about college women’s adherence to the Dietary Guidelines for Americans (DGA) and our passive acceptance of the emaciated faces of children in television advertisements soliciting contributions to charities that seek to provide them with food. There is no way to associate our hunger, such as it ever is, with what starving children must endure; nothing in our history or experience prepares us for any richness of empathy with them. In many ways, we cannot even imagine their starvation. We can, however, imagine eating disorders. We have no trouble envisioning obesity, and we are utterly and completely comfortable with the whole concept of weight loss. There are a great many more commercials for weightreducing diets, foods, exercise equipment, and devices than there are for the solemn philanthropies that confront hunger. In the grand thermodynamics of weight control, we pump our way through the “fat burn” cycles programmed into aerobic exercise machines, from treadmills to stair climbers. Exercise is no longer just directed toward something we used to call “physical fitness”; it has become a cosmetic

Risks to students' lives: setting priorities.

Comment on: Guns and gun threats at college. Miller M, Hemenway D, Wechsler H. J Am Coll Health. 2002; 51(2):57-65. Language: en