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R E S E A R C H B R I E F National Study on AACC-RB-02-10 Community College Health By Nan Ottenritter T he national Bridges to Healthy Communities project of the American Association of Community College’s (AACC) helps provide education and information programs to prevent HIV infection and other serious health problems in youth and students. In 1996 and 2000, AACC conducted national surveys concerning administration and leadership, curricular and co-curricular programs, health services, and community collaboration. Results of the first survey are described in a 1998 publication, Community Colleges Tackle Student Health and HIV/AIDS. This research brief summarizes the findings of the 2000 survey which included most of the 1996 survey questions as well as more detail about community college health centers and services. Findings include: • Alcohol and other drugs, disability awareness, ble diseases,exercise and fitness, and nutrition sexual assault, and multiculturalism/diversity are are secondary concerns. the campus health concerns most frequently • The percentage of responding colleges offering mentioned in written college policies. service learning opportunities in HIV/AIDS, alco- • Twenty percent of responding campuses had an hol/drugs, and human sexuality increased from HIV/AIDS task force or similar advisory committee. 1996 to 2000. Ninety percent of responding colleges did not offer a specific HIV/AIDS course. • The number of responding community colleges offering faculty and staff development in HIV/ • Among responding campuses, 41 percent target- AIDS-related issues declined from an average of 75 ed persons engaging in high-risk behaviors for percent in 1996 to an average of 56 percent in 2000. health-related activities through events, promo- tional materials, and services. Between 20 and 30 • Alcohol and other drugs, multiculturalism and percent targeted populations that are dispropor- diversity, and stress management continue to be tionately affected by HIV infection, including the most frequently addressed health concerns in African Americans, Hispanics/Latinos, men who classes and presentations. Offerings on communica- have sex with men, youth, and women. • Forty-two percent of responding colleges had FIGURE 1: Success Factors for Healthy health centers on campus. Campuses • HIV testing was available to students on 15 • Campus environment • Prevention programs percent of the responding campuses; 58 percent and policy • Attending to priority with this service tested fewer than 50 students in • Health messages populations one year. The percentage of responding colleges • Professional development • Health services offering sexually transmitted disease (STD) • Student leadership • Collaboration testing increased from 17 percent in 1996 to 27 percent in 2000. Methodology geographic region and enrollment. However, as shown in figure 2, urban and suburban colleges were I n September 2000, AACC surveyed all U.S. com- more likely to respond, and rural or small town col- munity colleges to gather data on administration and leges were less likely to respond to the survey. leadership, curricular and co-curricular programs, Colleges that responded in 1996 are not neces- college health centers and health services, and com- sarily represented in the group of respondents in munity collaborations related to HIV/AIDS. 2000; i.e., the same colleges were not tracked over Distributed to college presidents and student health the four-year period. Therefore it cannot be said coordinators, the surveys were completed by student with certainty that responses of a particular com- health directors (18.6 percent of responding col- munity college have changed in this period. These leges), deans of student services (16.4 percent), col- data do, however, provide a snapshot of administra- lege nurses (10.9 percent), deans of allied health and tion and leadership, curricular and co-curricular nursing (9.2 percent) and other institutional admin- programs, health services, and community collabo- istrators. Of the 1,100 colleges receiving the survey, ration in community colleges in 1996 and in 2000. we received usable surveys from 406 colleges, for an The 2000 survey included several questions institutional response rate of 37 percent. Several col- that were not asked in the 1996 instrument. The leges supplied more than one response, and when new questions focused on four general areas: this occurred, the college was contacted to deter- frequency and respondent satisfaction with the mine which response to use. The percentage of delivery of health messages on campus, curricular responding colleges in the brief refers to the number and co-curricular programs, college health centers, of responding colleges for each question. and details regarding the availability of HIV testing The responding colleges were representative of on campus. The new questions addressed three community colleges nationwide with respect to primary concerns: FIGURE 2 Locations of Responding Colleges Other 4% Suburban Urban 30% 36% Small Town/Rural 30% 2 • AACC/Bridges FIGURE 3 Health Issues Addressed Through Written Policy Alcohol/Other Drugs Disability Awareness Sexual Assault Multiculturalism/Diversity Communicable Diseases Smoking Cessation Emotional Health/Suicide Prevention Domestic Violence Exercise/Fitness Sexual Identity/Orientation Sexual Health Stress Management Nutrition Spirituality Cancer 0 10 20 30 40 50 60 70 80 90 100 Percentage • Community college operations and teaching are • Questions about campus health centers were becoming more technology-dependent. Health added because of numerous inquiries to AACC educators are using technology to reach students from community colleges. with health information through chat rooms, Web sites, e-mail messages, online syllabi, and Administration and Leadership distance learning courses. The use of anony- mous self-assessment of risk behaviors via com- C ollege leaders set the tone for how colleges handle puters appears to hold important possibilities for health issues on a campus. AACC was particularly disseminating information and getting people interested in written policies, college directives con- into treatment. cerning HIV/AIDS, distribution of health informa- • The 2000 survey reflects the priorities set in the tion and messages, and reasons for not becoming U.S. Public Health Service’s Healthy People 2010 involved in HIV activities. Figure 3 illustrates the per- goals by asking questions about disparities in centages of responding colleges with written policies health because of racial and gender differences. in specific areas. A majority of responding colleges The survey queried colleges about campus pro- had policies concerning alcohol and other drugs, dis- grams directed towards Hispanics/Latinos, ability awareness, sexual assault, and multicultural- African Americans, men who have sex with men, ism/diversity. Based on feedback from Bridges to youth, and women. Healthy Communities project personnel, data were AACC/Bridges • 3 FIGURE 4 Faculty and Staff Development in HIV/AIDS 100 90 80 70 e 60 g a ent 50 c r e P 40 30 20 10 0 Programs Devoted Programs that Included Programs on General Solely to HIV/AIDS Issues HIV/AIDS Issues Health Issues 1996 2000 collected for the first time in the 2000 survey on can- become more seamlessly integrated into institutions. cer, communicable diseases, and domestic violence. In a separate question regarding formats used to Responses changed significantly from 1996 to deliver health messages to students, posters and 2000 regarding faculty and staff development oppor- brochures, credit, and non-credit courses were found tunities provided for HIV/AIDS-related issues. to be the most popular and most frequently used Figure 4 illustrates the decline of HIV-related and mechanisms. Less frequently used—but still popu- general health programs. Yet the percentages of lar—methods for delivery of health messages to stu- responding colleges with an official, institutionalized dents were annual distribution of campus policies budget allocated for HIV/AIDS education (8 per- and co-curricular programs and services. cent) remained the same in both surveys, as did the In the 2000 survey, 20 percent of responding col- percentage of colleges with an HIV/AIDS task force leges reported having an HIV/AIDS task force or or advisory committee (20 percent). advisory committee. Eight percent had an institution- Colleges distributed HIV/AIDS and general alized budget allocated for HIV/AIDS education. health information through a variety of venues on Figure 6 illustrates reasons for institutional non- campus. Figure 5 illustrates distribution in the involvement in HIV/AIDS. The reasons remained responding colleges. The number of colleges using fairly consistent from 1996 to 2000. Insufficient special programs, new student orientation, and resources were the most highly ranked current reason posters to distribute HIV/AIDS information for not becoming involved (64 percent of respon- declined from 1996 to 2000. This could indicate that dents). The lowest ranked reason was significant HIV/AIDS is less visible on campuses or that it has opposition (8 percent). 4 • AACC/Bridges FIGURE 5 Sources of HIV/AIDS and General Health Information on Campus in 2000 Posters Flyers Personal Counseling Special Programs Student Health Centers Campus Newspaper New Student Orientation Email Messages Academic Advising Radio/TV Programs Campus Webpage Housing Registration 0 10 20 30 40 50 60 70 80 Percentage HIV/AIDS General Health FIGURE 6 Reasons for Institutional Non-Involvement in HIV/AIDS in 2000 Insufficient Resources Other Not an Issue on this Campus Insufficient Faculty/Staff Support Inusfficient Administration Support Insufficient Student Support Inusfficient Expertise Significant Opposition 0 5 10 15 20 25 30 35 40 45 Percentage Very Important Moderately Important AACC/Bridges • 5 Curricular and Co-curricular strategy for dealing with health issues. There has Programs been a significant rise in health-related service learning opportunities from 1996 to 2000. Figure 8 O ne of the most effective ways to reach students shows the increase in service learning opportunities on a community college campus is through the directed toward specific health issues. classroom itself. Many students are employed full- In keeping with specifications set forth in time, juggling myriad responsibilities, and conse- Healthy People 2010, the 2000 survey included quently come to campus only for classes. Many do questions about specific populations, including not participate in student activities such as health those who engage in high-risk behaviors that put fairs, special presentations, or student life activities, them at risk for HIV infection and populations even though 84 percent of responding colleges that are disproportionately affected by HIV indicated that they conduct such activities. Figure 7 infection. The results are shown in Figure 9. illustrates which health issues were identified as Except for persons engaging in high risk priorities for classes and presentations. behaviors, all other high-incidence populations Many community colleges introduced service receive attention from approximately one out of learning in curricular programs in the 1990s as a four colleges. FIGURE 7 Health Issues Addressed Through Classes and Presentations Alcohol/Other Drugs Stress Management Multiculturalism/Diversity Exercise Nutrition Communicable Diseases Disability Awareness Sexual Assault Domestic Violence Sexual Health Emotional Health Smoking Cessation Cancer Sexual Identity/Orientation Spirituality 0 10 20 30 40 50 60 70 80 90 100 Percentage 6 • AACC/Bridges FIGURE 8 Service Learning Opportunities in 1996 and 2000 60 50 40 e g a nt 30 e c r e P 20 10% 10 17% 0 HIV/AIDS Alcohol/Drugs Human Sexuality 1996 2000 FIGURE 9 Populations Targeted for Health-Related Activities Persons Engaging in High-Risk Behaviors Women Youth African Americans Hispanics/Latinos Men Who Have Sex with Men 0 5 10 15 20 25 30 35 40 45 Percentage AACC/Bridges • 7 FIGURE 10 Community Colleges with Health Centers Without With Health Centers Health Centers 58% 42% College Health Centers and Figure 12 shows the percentage of survey Health Services respondents offering various types of reproductive health care on their campuses. Percentages from F orty-two percent of the respondents indicated 1996 and 2000 survey respondents are similar that they had a health center on campus. Ninety- except for one notable difference: a greater per- nine percent of those with health centers also made centage of respondents now offer STD testing (27 referrals to outside agencies and 90 percent invited percent in 2000 as opposed to 17 percent in 1996). agencies to provide services on campus. Of those The 2000 survey included questions pertaining indicating that they did not have a center, 91 per- to frequency of HIV testing, the number of stu- cent said they provided referrals to outside agencies dents tested, and funding sources. In 1996, 14 per- and 66 percent reported inviting outside agencies cent of responding campuses offered HIV testing to provide services on the campus. to their students. In 2000, that number rose slightly The majority of respondents with college to 15 percent. The majority of responding campus- health centers (74 percent) had nurse-directed cen- es offering HIV testing to students did so at least ters. Eighty-four percent were open 30 hours a once a semester or quarter (51 percent). Fifty-eight week or more when classes were in session; very few percent of responding campuses tested less than 50 (only six percent) were open 20 hours or less. In students per year. Overwhelmingly, campuses that addition to serving students, many campuses offered had testing services were funded by off-campus primary care to spouses, children, faculty, staff, and means, with the largest percentage of responding visitors. Figure 11 illustrates who was eligible for campuses (21 percent) funded by city, county, and care at those campuses that had health centers. state health departments. 8 • AACC/Bridges FIGURE 11 Persons Besides Students Eligible for Care at Community College Health Centers Students' Spouses Students' Children Faculty Faculty Spouses Faculty Children Staff Staff Spouse Staff Children Visitors 0 10 20 30 40 50 60 70 80 90 Percentage FIGURE 12 Types of Reproductive Health Services Information on STDs Information on Abstinence Safe Sex Programs/ Counseling Other Condoms/Dental Dams/ Other Latex Barriers Sexuality Counseling STD testing Other forms of birth control 0 10 20 30 40 50 60 70 80 Percentage AACC/Bridges • 9 Collaboration with Community form of collaboration in both 1996 and 2000. The desire of community colleges to partner with com- A dditional questions about collaboration were munity organizations remained consistently high added to the 2000 survey. They refer to (1) cross- (65 percent to 70 percent) in both surveys. Figure campus collaboration between student services and 14 illustrates these findings. academic programs, and (2) community college collaboration with four-year colleges and universities on Conclusion a specific health initiative. Both of these approaches hold promise for unifying a campus and assuring the A delivery of consistent health messages. A third s institutions that serve students, parents, recent approach, which was addressed in the 2000 survey, is immigrants, and a broad spectrum of the members of community college collaboration with state and local our society, community colleges are uniquely positioned education agencies and neighboring schools. This to influence the way the nation responds to health approach meets the dual objectives of enhancing issues. If community colleges can create environments coordinated school health programs and providing that support health and deliver relevant information service learning sites for community college students. and skills-building activities to students and staff, Collaborations with community organizations— they have the potential to improve public health. The particularly with city, county, and state health following resources are offered as a guide to develop departments and hospitals—were the most popular campus-based health policies and procedures. FIGURE 13 Community Collaboration on Health Issues Groups within Campus* Institutions of Higher Education* Health Department Hospital For-Profit Medical Offices Not-For-Profit Medical Offices Hospice Community Organizations State Education Agencies* Local Education Agencies* Local High Schools* Local Elem/Middle Schools* 0 10 20 30 40 50 60 70 80 90 100 Percentage * not included in 1996 survey 1996 2000 10 • AACC/Bridges