By Susan J. Blumenthal, M.D., and Beth Louise Hoffman
After spending the final days of the semester frantically finishing term papers and cramming for exams, college students all over the country will return home to celebrate the holiday season with their families, and the majority of these students will be women. Between 1969 and 1999, the number of undergraduate college women rose from 2.9 million to 7.4 million, and today women represent 58 percent of the undergraduate student population and are the majority in most graduate and professional schools. (1,2) For many students, going to college is the first time they must grapple with the challenges of independent living and take full responsibility for decisions that will affect their future health. In particular, college women face unique challenges when it comes to making choices related to nutrition, smoking, and alcohol and drug use. As the number of college women continues to rise, it is important to address these challenges and provide opportunities to educate women about the importance of creating a foundation for life-long health.
While college is a time of tremendous growth and self-discovery, its unique demands also pose challenges to women trying to maintain a healthy lifestyle, strengthen self-esteem, address personal safety issues, and prevent illness in the years ahead. College students must assume new responsibilities, negotiate relationships and cope with academic demands. Risky behavior such as smoking, drug and alcohol abuse, poor nutrition, lack of physical activity, safety issues, and communicable and sexually transmitted diseases are all significant threats to the health of college women. In addition, more and more college students, particularly women, are finding themselves overwhelmed by the pressure to succeed. According to a recent UCLA survey of college freshmen, 38 percent of college women reported feeling frequently overwhelmed. (3) Thirty percent of college women also reported suffering from insomnia within the past three months, a condition that can be a symptom of anxiety, depression, and stress. (4) Even more troubling, 50 percent of college women surveyed by the American College Health Association said they had experienced depression so severe at some point in time that they could "barely function." (5) Depression is a major risk factor for suicide, the second leading cause of death among college students. Although the rate of suicide among undergraduate college women is roughly half that of their male counterparts, research shows that by the time they reach graduate school, women commit suicide at roughly the same rate as men (6,7) This is an alarming trend, especially considering that in the general population men commit suicide nearly four times as often as women. (8)
High stress levels can also increase the risk of college women adopting health damaging behaviors as coping mechanisms. Some college women use cigarette smoking or alcohol as ways to relieve stress and promote social interaction. Almost 30 percent of college women report smoking a cigarette in the past 30 days. (9) In 2005, 12.8 percent of college women reported daily cigarette smoking, and 7.1 percent (compared to 6 percent of college men) reported heavy daily smoking. (7) A 2006 study on smoking differences between college men and women found that while there was little quantitative difference in the prevalence of smoking between the two sexes, women were more likely to smoke at parties or with friends as a way to fit in with a group and prove "that [they] were the type of person who was not afraid to take a risk." (10) Oftentimes, cigarette smoking and alcohol consumption occurred together, an association that is especially problematic since alcohol use among college women continues to rise. A March 2007 study revealed that from 1993-2005 binge drinking rose by 22 percent in college women, nearly double the increase in men, and 37 percent of college women surveyed said they drank on 10 or more occasions in the last month. (11)
Women and men metabolize alcohol differently. Alcohol is a risk factor for injuries and also for disease later in life including breast cancer. Heavy drinking puts young women at an increased risk of sexual assault. A 2002 report on college drinking by the National Institute on Alcohol Abuse and Alcoholism found that more than 70,000 college women experience alcohol-related assault or date rape in the United States each year. (12) Even more sobering, according to the National Institute of Justice 20 percent to 25 percent of women in the United States are the victims of sexual assault while in college, but fewer than five percent of these victims tell police or other campus authorities about the incident. (13,14) Furthermore, 20-25 percent of college students report that they have a sexually transmitted infection (STI) or have transmitted an STI to their sexual partner. It is estimated that nearly one-half of all new sexually transmitted infections occur in 15-24 year olds, even though they represent only 25 percent of the ever sexually active population. (15,16) Sixty percent of college women who have a sexually transmitted infection (STI), including HIV/AIDS, report that they were under the influence of alcohol at the time they had the sexual encounter with the infected person. (17)
In addition to alcohol use, many women become preoccupied with body image and food intake during their college years. College women are especially vulnerable to the sociocultural pressure to be thin and many fashion magazines and media images are targeted to college women, leading to unrealistic expectations of body image. It is estimated that 5-10 percent of post-pubescent women have a clinically diagnosable eating disorder, but as many as one-third of college women report disordered eating habits such as purposely restricting their food intake, binge-eating, and using diet pills or laxatives to control their weight, and 83 percent of college women diet no matter how much they weigh. (18,19) Rather then looking at how to achieve a healthy weight in a healthy way, many college women become overly focused on the number on the scale, leading them to engage in dangerous weight control tactics that can have negative health consequences. This can be a time to learn about healthy eating and exercise -- two important ingredients in the recipe for a healthier future.
College can be a wonderful experience full of intellectual and personal growth, a time to build on existing interests, discover new passions, and make lifelong friends. Today's college woman has a lot of choices with unlimited opportunities, and that's why it is important to set reasonable goals, find stimulating and relaxing activities, and make healthy choices. Most college campuses provide health services for college women, and websites such as this provide a user-friendly, single point of access to health information for college women across the country. This website was designed and built by students at Brandeis University as part of a course in computer sciences and women's studies.
College women are faced with choices about behaviors that will influence their health today and for the rest of their lives, such as smoking, nutrition, alcohol and drug use, exercise, and relationships. With the holiday season upon us and millions of college women returning home to celebrate with their families, the best gift they can give themselves is to make healthy choices today to ensure a healthier future in the years to come.
For more information on college women's health issues, visit www.4collegewomen.org.
Rear Admiral Susan Blumenthal, M.D. (ret.) is the Distinguished Advisor for Health and Medicine at the Center for the Study of the Presidency in Washington, D.C. and a Clinical Professor at Georgetown and Tufts University Schools of Medicine. She is the Founding Director of the website http://www.4collegewomen.org. Dr. Blumenthal served for over 20 years in health leadership positions in the Federal government, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health in the US Department of Health and Human Services, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health.
Beth Louise Hoffman, a recent magna cum laude graduate of Brown University, is a health policy fellow at the Center for the Study of the Presidency. She will begin her medical education at the University of Pennsylvania School of Medicine in the fall of 2008.
1 Lewin, Tamar. "At Colleges, Women Are Leaving Men in the Dust." 9 July 2006. The New York Times. 5 December 2007
2 "Archived: Getting There: A Report for National College Week, November 1999." U.S. Department of Education. 4 December 2007.
3 Zavala, Rodrigo. "Study Shows Depression Common Among College Students." 1 November 2005. Xpress online: San Francisco State University. 10 December 2007.
4 "Health Education: Sleep." 9 March 2007. Brown University. 2 December 2007.
5 Wallace, Robin. "Colleges Struggle, Innovate to Meet Mental Health Needs of Students." 29 August 2006. FoxNews.com. 4 December 2007.
6 "Promoting Mental Health and Preventing Suicide in College and University Settings." [PDF] 21 October 2007. Suicide Prevention Resource Center. 11 December 2007.
7 "Wasting the Best and the Brightest: Substance Abuse at America's Colleges and Universities." [PDF] March 2007. The National Center on Addiction and Substance Abuse at Columbia University. 11 December 2007.
8 "Suicide: Facts at a Glance." [PDF] Summer 2007. Centers for Disease Control and Prevention. 12 December 2007.
9 Rigotti Nancy A., Lee, Jae Eun, and Henry Wechsler. "US College Students' Use of Tobacco Products." JAMA. 284 (2000): 699-705.
10 Nichter, Mimi, Nichter, Mark, Lloyd-Richardson, Elizabeth E., Flaherty, Brian, Carkoglu, Asli and Nicole Taylor. "Gendered Dimensions of Smoking Among College Students." Journal of Adolescent Research. 21(2006): 215-243.
11 Zwillich, Todd. "Rise in Alcohol Abuse by College Women." 15 March 2007. MedicineNet.com. 4 December 2007.
12 Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism. "A Call to Action: Changing the Culture of Drinking at U.S. Colleges." [PDF] April 2002. National Institute on Alcohol Abuse and Alcoholism. 4 December 2007.
13 "Understanding Sexual Violence Fact Sheet." [PDF] 2007. Centers for Disease Control and Prevention. 5 December 2007.
14 Masterson, Kathryn. "Suffering Through Silence." 2 December 2007. Chicago Tribune. 3 December 2007.
15 Dama, Sravanthi. "STDs Most Common, Prevalent College Student Threat." 11 November 2005. TheTriangle.org. 11 December 2007.
16 "College Health and Safety." 20 August 2007. Centers for Disease Control and Prevention. 11 December 2007.
17 "University Health Services: Sex and Alcohol." The University of Texas at Austin. 5 December 2007.
18 "Most College Women Diet on a Regular Basis." 30 May 2006. Yale Medical Group. 3 December 2007.
19 "Disordered Eating Past and Present" WebMD. 12 December 2007.