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Glenn D. Braunstein, M.D. Headshot

As Kids Head to College, Keep a Healthy Focus

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The nest is emptying, mom and dad: your kids are heading off to college, and you're feeling a mix of pride, relief, sadness and more than a little worry. You've been your households' chief health officers, helping your youngsters deal with their diet, physical activity and an array of medical matters, from parental diagnoses to at-home emergency care. You've steered your teens, so far, through the tricky shoals of alcohol or drug use, sexual experimentation, peer pressure, academic achievement and lots of life's triumphs, as well as its sadness, disappointment and rejection.

Now after your years of tending and relative control over this glowing person who's suddenly insisting on adulthood, what can parents do for their teens' continuing good health -- besides fretting and wringing their hands -- as they head off to colleges and universities across the Southland and the country? A few thoughts:

Keep them covered. Be careful to ensure that your student remains insured. More than half of children had health insurance coverage through their parents' employers in 2009, according to the U.S. Census Bureau. While those statistics are for children 18 and younger, an important provision of the new Affordable Care Act of 2010 affecting older dependent children kicked in as of January 2011. Now, kids heading off to college, or who otherwise remain dependent, can stay on their parents' health plans until age 26. Such employer-based insurance, if possible, often is the best choice, since it's generally comprehensive coverage. A drawback: If your student heads out of state, and your insurance plan has a network of in-state physicians, you'll face higher co-pays when your offspring sees an out-of-network doctor.

If staying on your plan is not an option, look closely at what their college offers your students. If your youngster has a chronic condition, or you think they may need the services more than usual, spend some time on campus checking out whether the school has a health center. See what it offers, whether it hits the basics -- such as checking out an infection or treating an outbreak of flu -- and whether it really can handle a more serious health problem. More than half of all colleges offer health insurance plans for students, with an eye on keeping them affordable. But investigate the plans carefully, because a 2008 Government Accounting Office report found that both costs and benefits are all over the map. Premiums, for example, can range from $30 a year to $2,400; benefits can range from a cap of $2,500 per illness to unlimited lifetime coverage. If the unthinkable happens, or if a student has a chronic condition, a $2,500 cap will hardly make a dent in the cost of medical treatment. And it is a sad truth that young men, because of their distinctive brain development, are especially prone to reckless, impulsive behavior that can lead to tragedy for themselves or others. A consequence of such behavior can be costly emergency and sustained care. So please, continue to protect your student and your family finances. Now is not the time for a student to go without health insurance.

Vaccinations. If you've been smart enough to ignore the nonsense about vaccinations and you've kept your kids up to date with their shots when younger, good for you. But don't relax yet. You're not quite finished. (I've written before on shots and the hoax behind widespread misconceptions about them.) It's time to ensure your collegians get their needed boosters and immunizations. The Centers for Disease Control and Prevention has plenty of information online about what's needed. Some parents continue to be unaware of the error in fear-mongering messages about shots, or they ignore the facts, putting their own children and others at risk for diseases than can be halted with proper immunizations. As a result, we're seeing increases in diseases that had been halted in their tracks. In California, pertussis, or whooping cough, has been reported at the highest levels since 1958, so a new state law requires students in grades 7 through 12 to receive a whooping cough booster before the school year. (A grace period of 30 days, allowing for conditional attendance, has recently been enacted.) The new law will no doubt help California parents and college-bound teens avoid the public health challenge of an inadequately vaccinated population, but this year's graduating seniors may have missed the new requirement. Be sure they haven't missed the booster shot for pertussis.

College freshman are at slightly increased risk for bacterial meningitis, especially those who live in dorms. Rates of meningitis are lower among military recruits than among college students, though they are about the same age, because since 1982, all recruits have been routinely vaccinated against the disease. As of 2000, all military academies also vaccinated against meningitis. While not an across-the-board requirement for college freshman, some 34 states, including California, require colleges to give incoming freshmen information on meningitis and the protection offered by vaccines, and 15 states (though not California) require vaccination against the disease unless a waiver is provided.

The HPV vaccine (human papillomavirus), in three doses, can be given to girls ages 13 and older. This first cancer-preventing immunization was a breakthrough made controversial not by its disease-fighting properties but by its link to sexual activity. The vaccine prevents certain strains of cervical cancer. But because it's ideally given at young ages, before most girls become sexually active, some parents worried that they were giving their daughters a green light to have sex. If your daughter has not yet received the vaccine, now is the time, before she heads to college. Boys, too, can benefit from one form of the vaccine, Gardasil®. It's been shown to prevent genital warts and anal cancer.

With all the tuition bills you're paying, you don't want your child to miss class because of the flu. Current CDC recommendations for flu shots don't include college-aged adults. But a recent study of 13,000 college students found that those who had received flu shots were less likely to get sick, go to a health care center, miss class or fall down in academic performance during flu season.

A different kind of care package. No doubt, you'll be sending the kids off with their favorite batch of chocolate chip cookies, their favorite pillow and maybe a newly crocheted afghan. How about adding a satchel full of health supplies? Dental floss, toothpaste, toothbrushes, sunscreen, anti-bacterial cream and bandages can fill the first dorm room medicine cabinet with the basics and help encourage your student to keep up good habits. You can't make them floss or use sunscreen, but you can ensure they've got the supplies. Also, if you know that your child is sexually active, adding a few condoms wouldn't hurt either.

Students also can go off to campus armed with an important understanding of their own health history. Besides ensuring their personal medical records are accessible if needed, have you talked about the family's medical history? When students receive care at a college health clinic or from a new physician in the university community, they'll need to provide information about parents and relatives. Does your child know if heart disease runs in the family, that Uncle Walter had diabetes or that Aunt Betty is a breast cancer survivor? Do they know if there is alcoholism or mental illness in the family tree? College-bound kids are old enough to know these things -- and to begin to understand their implications for their own health.

Coping and Mental Health. We've got cell phones, emails, texts, Facebook posts and tweets to stay in touch, and now is the perfect time to use them. Keep listening. Be there to talk uneasy freshmen through possible anxiety and loneliness in their new worlds, in which it may seem as if everyone was a National Merit scholar, star athlete, accomplished performer and student body leader. Even though college provides a protective environment, the stresses of taking control of their lives, maybe for the first time, can rattle young people: They're unaccustomed to managing money and paying bills, keeping their own schedules, taking care of their stuff, whether clothes, costly texts or pricey tech gadgets that break down or disappear -- and dealing with the consequences. Fending for themselves, even with dorm feedings, and tackling some serious sedentary study, many young people balloon in weight, gaining a documented 6 to 15 pounds and starting lifelong bad habits. Feeling blue can go beyond a sometime challenge to a major concern in young people, and they and their schools report that mental health issues, especially depression, are big; let's not forget that many serious mental disorders show up first at this point before affecting adults for the rest of their lives. Let students know their school has teachers and counselors willing to listen and possibly point them to professional help. Especially if depression runs in the family or your child has had episodes earlier in life, listen for clues of sleeplessness or excessive sleeping, changes in appetite, or a loss of interest in exercise, studies or friends. There are fine materials available on teen depression and, yes, suicide, which triples in incidence in older teens and is six times more prevalent among college-aged males than females.

Sex, Drugs and Alcohol. Most worrisome, these three concerns are a tangle that, when combined, only increase the dangers presented by the others. Your child is an adult by some standards, and you've probably already talked yourself blue in the face with warnings throughout the high school years. But as they head out the door, for what it's worth, you might shout out some familiar reminders: Sexually transmitted diseases are preventable! Drugs and alcohol can be a fatal combination! Add some sobering statistics. College-aged kids are at greater risk than older adults of acquiring a sexually transmitted disease, according to a 2009 report by the Centers for Disease Control and Prevention. College students drink more than their peers who are not in school, and binge drinking peaks between the ages of 21 and 23. The rate of illegal drug use among college students is holding steady at about 20 percent.

You've talked about all of this. They've listened, and you can only hope they've heard. They're walking around in their new adult bodies, eager to be independent. And, hard as it is, you know in your heart that it's time to loosen your hold on those strings you've held so tightly for so long. Keep talking, keep listening, and good luck!