Gary Logan
July 11, 2018

Pediatrician Alain Joffe, former director of the Student Health and Wellness Center at The Johns Hopkins University, addresses the issues for parents and students.

Are college-bound freshmen concerned about health issues?
Joffe: Students tend to be mostly concerned about where their dorm is located and who their roommate is. Big questions include, “Do I bring my PS4 or Xbox?” Which roommate will bring the mini fridge? Then they are worried about getting into the class they really want.

What should they be aware of?
Joffe: One thing is that going off to college is a big deal. For the student there is this exciting newfound freedom, but there is also this major transition. Things they depended on in high school are going to be different or not there. There may be times when they feel overwhelmed —they went from being monitored and handed medicine to the whole world is their oyster without that structure.

What kind of health issues arise?
Joffe: Stress is by far the biggest issue. That includes academic stress, an enormous need to succeed, and financial stress — “Do I have to work while I attend school?” Student debt on the horizon is a very real issue, too. Parents’ concerns bring stress, too. Consequently, anxiety becomes a predominant health issue. Not surprisingly, sleep difficulties are a primary problem.

Academic stress?
Joffe: The deck has been reshuffled, and while the student may have been at the top of the class in high school, he or she now finds everybody was also at the top of the class. It is a big transition, one many students struggle with, but that is part of growing up and building resilience.

How can they deal with that?
Joffe: They can think about how they were challenged in the past, how they stepped up to face challenges. They should know it is OK to ask for help — it is not a sign of weakness — it is even OK to fail. Often failure is the genesis of doing better. Students need to cut themselves a break — their parents are not going to give up on them and pull them out of school.

Other health issues?
Joffe: Living in a college dorm during your freshman year is like being back in nursery school. Students are in close quarters, sharing cups, food and hookah. It is virtually impossible to isolate students. So having them up-to-date on immunizations is good for them and other students.

Any concerns at college regarding medications?
Joffe: For medications for attention deficit disorder (ADD), among other conditions, their dosing schedule may need to change. Also, students taking medications not prescribed to them is a significant issue on campus. Because medication misuse tends to be widespread, many university health centers will not prescribe ADD medications.

What can students do?
Joffe: Students with ADD should contact and register with the school’s disability services early on and/or meet with a counselor. Some schools require that the student meet with a time-management or academic support specialist first before the health or counseling center will prescribe ADD medication. Again, for the student, their management team (parents and prescribing pediatrician) is no longer on-site — there is no one looking over their shoulder making sure they get their homework done early and that they do not study until 2 or 3 a.m. and not make it to class the next morning. For some students, freshman year in college is a time to experiment with their medication schedule. The problem is, if things do not work out well, the entire semester may be in jeopardy.

Any thoughts for parents and incoming students regarding alcohol, drugs and sex?
Joffe: Students need to understand the implications of alcohol or drug use. Colleges generally have strict guidelines—for example, if you get drunk and punch your fist through a wall, there will likely be consequences. Marijuana use is not benign — studies show that students who use marijuana quite a bit often wind up skipping class a lot, and if you skip class a lot your GPA goes down. Studies have also found that — contrary to what students believe — the use of stimulants does not increase GPAs. Regarding sexual behaviors, heavy alcohol and drug use interferes with the ability to say yes or no, to hear what your partner is saying. Today, no school will accept “I was drunk and did not know what I was doing.” Students need to understand that silence does not mean, “Yes, I want to have sex” and that “No means no” and not “Try harder.” Being intoxicated does not excuse your behavior. Regarding these issues, both pediatricians and parents should talk with students before the student goes off to college.

Can parents and students pre-empt such issues before heading off to college?
Joffe: First off, it is important to select the right college and find the best fit for the student. If the student has significant mental health issues, does the college have a good support network? There is a huge diversity in college health centers and what they offer. Some universities, typically smaller ones, have totally outsourced their health services because fiscally it does not make sense for them to finance a health center on campus. The smaller colleges contract with family practice groups and pay them for a certain number of slots each day, or with a private physician to hold clinic at the school a few times during the week.

How is that different for health care access for the student?
Joffe: The big schools have folded all the health services into more accessible, on-campus university support services. Also, specific health services can be varied. At the bigger schools, you can have blood drawn, lab testing, infusions and imaging right there. In the contracted-out primary care model without imaging or X-ray services, testing is triaged out. In considering schools, it is important for families to check out their available health services, especially mental health services. It is also important for students with chronic health conditions to determine what kinds of services are available at the health center and how they would access specialty care if needed.

Why is that?
Joffe: In some places, mental health counseling services are integrated, in others outsourced. Most counseling centers on campuses come from the model of developmental change, and the vast majority of students they see are students who are going through normal developmental bumps in the road. More and more, though, they are being asked to counsel serious mental health issues. Often times, intractable cases are referred off campus.

Other important issues for the student and family?
Joffe: In the precollege visit, parents should find out what their insurance can or cannot do. Oftentimes their insurance plan may provide good coverage at home or in state but it does not work out of state. In addition, parents may not be aware that if they buy into a student health insurance program, the cost of that can be folded into the student’s aid package. Thinking through the health insurance issues is important.

Any closing thoughts?
Joffe: Yes. If a student wears contact lens, make sure he or she also takes a pair of glasses to college.