The Health of (Student) Nations

CHICAGO -- The debut of a new national database tracking who visits college health centers and why -- the first of its kind -- generated considerable interest here Thursday at the annual convention of the American College Health Association. But it remains to be seen whether that interest will be enough for the College Health Surveillance Network, which just after completion of its pilot stage includes only 19 colleges, to reach its full potential to improve medical services -- potential the project's creators believe is significant.

"College students represent a pretty critical subpopulation of Americans," said James C. Turner, a professor of internal medicine and executive director of the department of student health at the University of Virginia, which sponsors the project jointly with the Centers for Disease Control. "This concept of sharing private health information with a central health network is very controversial right now, but if we really want to understand what's going on in medicine... we really need to tap into the ability to share data."

So far, the database accounts for nearly 608,000 students, about 30 percent of whom visited the health centers at their respective four-year research institutions in 2011.

"Because two-thirds of our students do not even cross our threshold in a given year," Turner said, "this reaffirms the importance of reaching out to our campus communities."

With only one college participating, the West is the least-represented region, though the pending approval of another institution there will bring the database's total members, whose student bodies are reflective of the national college-going population, to 20. And Turner said that after the ACHA presentation, three more institutions said they would join and several others said they'd pitch the idea back home.

The database includes information on such areas as reason for visit, student demographics, visits per student for different diagnoses, and frequency of diagnoses by region. Rather than rely on survey questions like the National College Health Assessment, the only real comparable data mechanism, the College Health Surveillance Network analyzes the records at participating health centers. (While arguably more reliable than a survey, the system comes with additional burdens, and not just the hesitancy to share records even when they're anonymous. The necessary Institutional Review Board approval to participate can take months to obtain, and the database software takes up to 20 hours to set up. And institutional differences in record coding can cause inconsistencies.)

Examining data from the past full calendar year, there's no shortage of interesting findings -- even if they're "perhaps raising more questions than answers," Turner said.

For instance, it's not surprising that respiratory infections, "the bread and butter of college health," were the most common reason for a visit to the health center, Turner said. But why are males 47 percent more likely than females to seek treatment for those infections? Why are students in the West 88 percent more likely to do so than those in the East?

And, as evidenced by a slew of other findings, "you're only limited by your imagination in terms of the type of data you can extract," Turner said.

There are of course the basics: the second most-common reason for visits was screenings for conditions such as sexually transmitted infections and hypertension, or for women, pap smears. Despite the fact that only eight of the participating colleges submitted counseling records, depression was the third most common issue. After that came an oddball: back disorders.

Highlighting a few diagnoses of interest, the presenters showed that about 5,000 students were diagnosed with human papillomavirus (HPV), 2,000 with mononucleosis, 1,590 with strep throat and 1,360 with hypertension. Just more than 1,000 were obese or overweight.

But Turner and his colleagues -- Evelyn Wiener, executive director of the student health service at the University of Pennsylvania, and Sarah Van Orman, executive director of university health services at the University of Wisconsin at Madison -- broke the data down even further.

On average, students made 1.7 medical visits, 0.1 preventative visits, and 0.39 mental health visits in the 2011 calendar year (those findings are on par with the NCHA). But some conditions prompt more visits than others. Averaging 2.68 visits per patient, about 6,200 students diagnosed with depression made 16,000 visits total (the Midwest had the most students visiting for depression). That was second only to students diagnosed with eating disorders, who visited the health center 5.7 times each on average.

While the West saw the most respiratory treatment, it had the lowest flu vaccination rates, with 450 in every 10,000 students getting vaccinated. With 1,390 per 10,000 students doing so in the Northeast, that region conducted the most vaccinations.

The researchers also looked at what vaccines students got before entering college, and found some encouraging results: rates of vaccinations among undergraduate and graduate students for hepatitis B, HPV, measles, mumps and rubella (MMR), and tetanus, diphtheria and pertussis (Tdap) all increased from 2010 to 2011. Particularly for the complete three-dose HPV vaccines, which for undergraduate women rose from 40 percent vaccinated to 46 percent in 2001, "I think that this will represent a public health success," Wiener said.

Turner hopes to expand the network to include more than 150 colleges and 2.5 million students, which will enable closer examination of the sub-populations that visit health centers. Another aspiration is weekly or even real-time reporting of diagnoses and symptoms, which in theory could help halt the spread of conditions like mumps or the flu.

And when one person in the audience suggested the creation of guidelines for institutions regarding what kind of data to gather, particularly where student health concerns deviate from those in general medical practice, Turner also levied a charge to ACHA.

"Perhaps this is something that the benchmarking committee could consider," he said. "We have the tool available for you to get the data, but really, it's up to ACHA to establish what is the standard set of data that we want."