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Community college health services
JOURNALOF ADOLESCENTHEALTHCARE1:225-228,1981
Community College Health Services Are They Necessary? JEFFREY E. L I N D E N B A U M , M . D . , ROBERT J. H U N N E R , M.A., A N D ROBERT W. DEISHER, M . D .
A preliminary study was undertaken to assess the potential predictors of the medical care needs of the students attending a community college. No definite medicalsocial-economic parameters were useful predictors. The self-assessed primary health needs were documented. These were generally in areas not traditionally managed by college health services, particularly the visual, dental, and preventive health care concerns. Based on our data, colleges with limited resources may need to reassess their medical care priorities for students.
KEYWORDS: Community college health services In recent years, several articles (1-4) have focused on the health problems of students at residential colleges. Little is known about the health needs of students at commuter community colleges, particularly those in large urban centers. The medical care needs of these students may be different from those living in dormitories or in small towns. Commuter community college students often live at or near home, and parental medical support, and are generally familiar with community facilities. Studies at large mixed residential-commuter colleges have
From the Division of AdolescentMedicine, Departmentof Pediatrics, University of Washington School of Medicine and the Department of Pediatrics and AdolescentMedicine, Group Health Cooperativeof Puget Sound, Seattle, Washington. Supported by Maternal and Child Health Services, Health Services and Mental Health Administration, Department of Health, Education and WelfareProject913, and the Washington State Departmentof Social and Health Services Project 10-H-800001-05-1. Direct reprint requests to: Group Health Medical Center, Northgate Medical Staff, 10200 First Avenue Northeast, Seattle, WA 98125. Manuscript accepted June 2, 1980.
shown that living at home or in home cities (5,6) significantly reduces the frequency with which one uses college health services. Unlike dormitory students, community college students live a distance from the campus, a variable which tends to reduce health service utilization (7-10). The urban setting generally provides a number of community medical resources, often charging according to the patient's ability to pay, whereas smaller communities have more limited services. Finally, the demographic and social characteristics of the urban commuter college students are different from those in residential colleges (10). The present study was designed to survey some of the medical, social, and economic parameters and medical care resources, utilization, and needs of a group of urban commuter community college students. Methods
and Materials
The survey was conducted at a commuter community college in an urban residential area of Seattle, Washington, where there were no existing student health services. This school had an enrollment of 5400 students, with approximately 15% from nonwhite minority groups. Many students held full or part-time jobs, and approximately 50% received some form of financial assistance. One-half of the students were under age 25 years. There were roughly equal numbers of full and part-time students, as well as of married and single students. The study group of 75 unselected students was similar in composition to the school population with respect to sex and race, but with a higher percentage of
© Societyfor AdolescentMedicine,1981 Publishedby ElsevierNorth Holland,Inc., 52 VanderbiltAve., New York,NY10017
225
ISSN0197-0070/81/010225-04/$02.25
226
LINDENBAUM ET AL.
single (67%), fulbtime (88%), and younger (16% < 25 y.o.) students. The students were asked by a " y o u t h counselor" enrolled in the college's " y o u t h assistance training program" to complete a 31-item questionnaire. In addition to demographic information, the survey questionnaire asked about present sources of medical care, perceived health care needs, and opinions concerning staffing, funding, and services of a potential community college health service. A total of 73 questionnaires were completed, five only partially.
Results Seventy-nine percent (N = 58) of the respondents reported that they had at least one source of medical care. Of these, 78% (N = 45) were satisfied with their source. Of the 21% (N = 15) of the sample who denied a regular source of medical care, 80% (N -12) had visited a physician one or more times during the previous year and 60% (N = 9) had made two or more visits. Thus, it appears that an outside source of care was available to most students. Only 4% (N = 3) of the sample denied a source of care and had not seen a physician during the previous 12 months. There was no significant relationship between sex or income status and whether or not an individual had a stated source of care, though a slightly higher percentage of low income students listed a source of care. Students less than 20 or more than 25 years of age and those w ho were married, were more likely to have a source of care. Eight percent of those living at home reported no source of care, yet all had visited a physician one or more times in the past year. Of the 49 students not living at home, 25% reported no source of care, but 85% had also seen a physician within the past year. This suggests that students living at home are more likely to have a source of care. Thirty-four percent (25 students) of the sample reported a current medical condition. Eleven of these students were doing nothing about their condition. Six had a source of care, and five did not. Fourteen students were seeking care for their current condition. Eleven of these students had a regular source of care; three of these 14 students denied a source of care but reported doing something about their condition. In sum, then, eight students reported a current condition but no regular source of care and 17 students reported a condition and a reg-
JOURNAL OF ADOLESCENT HEALTH CARE Vol. 1, No. 3
ular source of care. All of the respondents with a current condition (except for one student with a dental problem) either had a regular source of care or had been to a physician in the past year. Twenty-five percent of the untreated medical conditions reported by the respondents were dental and 30% vision, preventive care, and mental health concerns. The remaining conditions stated included exhaustion, diabetes, sore throat, multiple lipomas, headaches, and personal problems. The primary areas of dental, vision, and preventive and mental health are not usually dealt with in small traditional college health services. Among the students with untreated conditions and no source of care, 60% had dental conditions, 20% required routine care, and 20% did not specify what the untreated condition was.
About 35% of the students less than 26 years of age stated they would not use a student health service if one were available. A slightly higher percentage of the low income students took this stand. On the other hand, all the students over 26 years of age said they would use a student health service. When asked about financial support for a student health service, 24% of the sample reported a willingness to contribute over $10/year, 52% less than $10/year and 24% were unwilling to pay. For reference, in 1975, the University of Washington Health Service estimated its costs at about $25.00/student/ year (11).
Discussion This small uncontrolled survey is subject to a number of criticisms. First, the age of our population as compared with the school population is skewed. About 50% of our students were in the 20-25 year age group, a group reporting a greater percentage of no source of care. This bias would appear to overstate the need for medical care services on campus. The same is true for marital status. Our survey population contained a higher proportion of unmarried students than in the overall college population, a group less likely to have a source of care. This bias again would be in the direction of overstating the need for medical care services. Yet, in spite of these two biases, it still appears that the need for traditional medical care service is limited. Although the number of students surveyed is small and no hard conclusions can be drawn, the trends are evident. Therefore, it appears that we should not assume that all community colleges require additional health ser-
March 1981
vices, but rather that each college should carefully assess the needs of their students before developing or modifying their health care services. In reviewing the literature we found few objective data from urban commuter community colleges regarding health service utilization, use of alternative resources, unmet needs, predictors of needs, effects of a health service on performance or attendance and cost-benefit data. Queens College (12), an urban commuter college, reported that 80-90% of their students had some form of medical msurance, a percentage similar to that at the University of Washington (11). A number of authors have proposed shifts in community college health service roles with no substantial data to support their beliefs (13-15). Very recently, after our study was completed, the University of Houston, a large, urban, commuter, full-service university, published data (10) supporting our findings. Their study found that there were differences in population and needs between the commuter schools and residential universities. Commuting students used the student health service considerably less, preferring and having outside resources. Their conclusion for urban commuter universities was either to expand services significantly, including service to dependents, or to eliminate medical services, except for perhaps coordinating the utilization of community resources. Given the limited funds of many community colleges, the minimal willingness of students to contribute money to support health services, and some evidence that students are already obtaining care, what should be the health service priorities of an urban commuter community college? One priority should be to assess accurately and then meet the needs of their students, which, for example, in our study would necessitate providing services in the areas of dentistry, vision, preventive care, and mental health. An alternative approach would be to recognize that for commuter community colleges in large urban settings, the students seem to obtain care without a health service and the community generally has available health services that far excel that which could be reasonably provided by a community college (13). In this setting, rather than focusing on remedial services, the thrust of the health service would be in public health and future-oriented interventions. Health education aimed at prevention, in such areas as drugs, smoking, alcoholism, venereal disease, contraception, sexuality, stress, hypertension, obesity, and self-care, is one possible, nontraditional role with the potential for
COMMUNITY COLLEGE HEALTH SERVICES
2,.27
having a significant impact. Research and consultation with students and faculty are other such roles. Other alternative roles have also been proposed and merit consideration (13-15). Again, one wonders if students would avail themselves of preventive health, health education, dental, vision, or mental health services. Therefore, community colleges, in addition to assessing the unmet needs of its students, should attempt to analyze the degree to which such services, if provided, would be utilized. In this preliminary survey we have found that the students at a commuter community college obtained health care even when n O student health service was available. Unmet needs existed in the areas of vision, dentistry, preventive care, and mental health. We suggest that small, traditional health services may not be appropriate for urban commuter community colleges with limited health care funds. Therefore, rather than needlessly duplicating existing resources, these community colleges should assess the unmet needs of its students and consider exploring the extent to which health care services could be met by the surrounding community. This might allow them to provide services, often in nontraditional areas, which perhaps would achieve more benefit per health care dollar than is achieved by a limited traditional health service.
References 1. Herbolsheimer H, Ballard BL: Multiple screening in evaluation of entering college and university students. JAMA 166:444, 1958 2. Kolbe LJ, Iverson DC: An assessment of student health needs: Implications for the planning and utilization of college health services. J Am Coil Health Assoc 26:263, 1978 3. Comstock LK, Slome C: A health survey of students: I. Prevalence of perceived problems; II. Satisfaction, attitudes and knowledge. J Am Coll Health Assoc 22:150, 1973 4. Hoffman WK, Madsen MK: College student health care needs at the University of Wisconsin-Milwaukee. J Am Coll Health Assoc 25:296, 1977 5. Gold JH: Utilization of the student health clinic. J Am Coll Health Assoc 21:477, 1973 6. Gold JH: Student health clinics in Great Britain: Six studies. J Am Coil Health Assoc 23:280, 1975 7. Simon JL, Smith DB: Change in location of a student health service: A quasi-experimental evaluation of the effects of distance on utilization. Medical Care 11:59, 1973 8. Allegrante JP, Collins J~, O'Rourke TW: A discriminant anal~ ysis of student utilization behavior at a university health service. J Am Coll Health Assoc 26:145, 1977 9. VanDort BE, Moos RH: Distance and the utilization of a student health center. J Am Coll Health Assoc 24:159; 1976 10. Tristan MP, Cheney CC, Novelli WJ Jr: A descriptive and
228
LINDENBAUM ET AL.
analytic study of the student health services of an urban university. J Am Coll Health Assoc 26:268, 1978 11. Getzen TE, Bergy GG: Utilization of medical care by college students. J Am Coll Health Assoc 25:277, 1977 12. Woody RH: College health services: Demise or rebirth? J Sch Health 43:442, 1973
JOURNAL OF ADOLESCENT HEALTH CARE Vol. 1, No. 3
13. Gage RW: Developing a health program for the community college. J Am Coll Health Assoc 19:152, 1971 14. Marshall CP, Gold M: Health insurance and urban college students. J Am Coll Health Assoc 24:134, 1976 15. Robitaille ME, Shaaru RB, Richie ND: Health care utilization of student families at the University of Florida. J Am Coll Health Assoc 26:158, 1977
Community College Health Services Are They Necessary? JEFFREY E. L I N D E N B A U M , M . D . , ROBERT J. H U N N E R , M.A., A N D ROBERT W. DEISHER, M . D .
A preliminary study was undertaken to assess the potential predictors of the medical care needs of the students attending a community college. No definite medicalsocial-economic parameters were useful predictors. The self-assessed primary health needs were documented. These were generally in areas not traditionally managed by college health services, particularly the visual, dental, and preventive health care concerns. Based on our data, colleges with limited resources may need to reassess their medical care priorities for students.
KEYWORDS: Community college health services In recent years, several articles (1-4) have focused on the health problems of students at residential colleges. Little is known about the health needs of students at commuter community colleges, particularly those in large urban centers. The medical care needs of these students may be different from those living in dormitories or in small towns. Commuter community college students often live at or near home, and parental medical support, and are generally familiar with community facilities. Studies at large mixed residential-commuter colleges have
From the Division of AdolescentMedicine, Departmentof Pediatrics, University of Washington School of Medicine and the Department of Pediatrics and AdolescentMedicine, Group Health Cooperativeof Puget Sound, Seattle, Washington. Supported by Maternal and Child Health Services, Health Services and Mental Health Administration, Department of Health, Education and WelfareProject913, and the Washington State Departmentof Social and Health Services Project 10-H-800001-05-1. Direct reprint requests to: Group Health Medical Center, Northgate Medical Staff, 10200 First Avenue Northeast, Seattle, WA 98125. Manuscript accepted June 2, 1980.
shown that living at home or in home cities (5,6) significantly reduces the frequency with which one uses college health services. Unlike dormitory students, community college students live a distance from the campus, a variable which tends to reduce health service utilization (7-10). The urban setting generally provides a number of community medical resources, often charging according to the patient's ability to pay, whereas smaller communities have more limited services. Finally, the demographic and social characteristics of the urban commuter college students are different from those in residential colleges (10). The present study was designed to survey some of the medical, social, and economic parameters and medical care resources, utilization, and needs of a group of urban commuter community college students. Methods
and Materials
The survey was conducted at a commuter community college in an urban residential area of Seattle, Washington, where there were no existing student health services. This school had an enrollment of 5400 students, with approximately 15% from nonwhite minority groups. Many students held full or part-time jobs, and approximately 50% received some form of financial assistance. One-half of the students were under age 25 years. There were roughly equal numbers of full and part-time students, as well as of married and single students. The study group of 75 unselected students was similar in composition to the school population with respect to sex and race, but with a higher percentage of
© Societyfor AdolescentMedicine,1981 Publishedby ElsevierNorth Holland,Inc., 52 VanderbiltAve., New York,NY10017
225
ISSN0197-0070/81/010225-04/$02.25
226
LINDENBAUM ET AL.
single (67%), fulbtime (88%), and younger (16% < 25 y.o.) students. The students were asked by a " y o u t h counselor" enrolled in the college's " y o u t h assistance training program" to complete a 31-item questionnaire. In addition to demographic information, the survey questionnaire asked about present sources of medical care, perceived health care needs, and opinions concerning staffing, funding, and services of a potential community college health service. A total of 73 questionnaires were completed, five only partially.
Results Seventy-nine percent (N = 58) of the respondents reported that they had at least one source of medical care. Of these, 78% (N = 45) were satisfied with their source. Of the 21% (N = 15) of the sample who denied a regular source of medical care, 80% (N -12) had visited a physician one or more times during the previous year and 60% (N = 9) had made two or more visits. Thus, it appears that an outside source of care was available to most students. Only 4% (N = 3) of the sample denied a source of care and had not seen a physician during the previous 12 months. There was no significant relationship between sex or income status and whether or not an individual had a stated source of care, though a slightly higher percentage of low income students listed a source of care. Students less than 20 or more than 25 years of age and those w ho were married, were more likely to have a source of care. Eight percent of those living at home reported no source of care, yet all had visited a physician one or more times in the past year. Of the 49 students not living at home, 25% reported no source of care, but 85% had also seen a physician within the past year. This suggests that students living at home are more likely to have a source of care. Thirty-four percent (25 students) of the sample reported a current medical condition. Eleven of these students were doing nothing about their condition. Six had a source of care, and five did not. Fourteen students were seeking care for their current condition. Eleven of these students had a regular source of care; three of these 14 students denied a source of care but reported doing something about their condition. In sum, then, eight students reported a current condition but no regular source of care and 17 students reported a condition and a reg-
JOURNAL OF ADOLESCENT HEALTH CARE Vol. 1, No. 3
ular source of care. All of the respondents with a current condition (except for one student with a dental problem) either had a regular source of care or had been to a physician in the past year. Twenty-five percent of the untreated medical conditions reported by the respondents were dental and 30% vision, preventive care, and mental health concerns. The remaining conditions stated included exhaustion, diabetes, sore throat, multiple lipomas, headaches, and personal problems. The primary areas of dental, vision, and preventive and mental health are not usually dealt with in small traditional college health services. Among the students with untreated conditions and no source of care, 60% had dental conditions, 20% required routine care, and 20% did not specify what the untreated condition was.
About 35% of the students less than 26 years of age stated they would not use a student health service if one were available. A slightly higher percentage of the low income students took this stand. On the other hand, all the students over 26 years of age said they would use a student health service. When asked about financial support for a student health service, 24% of the sample reported a willingness to contribute over $10/year, 52% less than $10/year and 24% were unwilling to pay. For reference, in 1975, the University of Washington Health Service estimated its costs at about $25.00/student/ year (11).
Discussion This small uncontrolled survey is subject to a number of criticisms. First, the age of our population as compared with the school population is skewed. About 50% of our students were in the 20-25 year age group, a group reporting a greater percentage of no source of care. This bias would appear to overstate the need for medical care services on campus. The same is true for marital status. Our survey population contained a higher proportion of unmarried students than in the overall college population, a group less likely to have a source of care. This bias again would be in the direction of overstating the need for medical care services. Yet, in spite of these two biases, it still appears that the need for traditional medical care service is limited. Although the number of students surveyed is small and no hard conclusions can be drawn, the trends are evident. Therefore, it appears that we should not assume that all community colleges require additional health ser-
March 1981
vices, but rather that each college should carefully assess the needs of their students before developing or modifying their health care services. In reviewing the literature we found few objective data from urban commuter community colleges regarding health service utilization, use of alternative resources, unmet needs, predictors of needs, effects of a health service on performance or attendance and cost-benefit data. Queens College (12), an urban commuter college, reported that 80-90% of their students had some form of medical msurance, a percentage similar to that at the University of Washington (11). A number of authors have proposed shifts in community college health service roles with no substantial data to support their beliefs (13-15). Very recently, after our study was completed, the University of Houston, a large, urban, commuter, full-service university, published data (10) supporting our findings. Their study found that there were differences in population and needs between the commuter schools and residential universities. Commuting students used the student health service considerably less, preferring and having outside resources. Their conclusion for urban commuter universities was either to expand services significantly, including service to dependents, or to eliminate medical services, except for perhaps coordinating the utilization of community resources. Given the limited funds of many community colleges, the minimal willingness of students to contribute money to support health services, and some evidence that students are already obtaining care, what should be the health service priorities of an urban commuter community college? One priority should be to assess accurately and then meet the needs of their students, which, for example, in our study would necessitate providing services in the areas of dentistry, vision, preventive care, and mental health. An alternative approach would be to recognize that for commuter community colleges in large urban settings, the students seem to obtain care without a health service and the community generally has available health services that far excel that which could be reasonably provided by a community college (13). In this setting, rather than focusing on remedial services, the thrust of the health service would be in public health and future-oriented interventions. Health education aimed at prevention, in such areas as drugs, smoking, alcoholism, venereal disease, contraception, sexuality, stress, hypertension, obesity, and self-care, is one possible, nontraditional role with the potential for
COMMUNITY COLLEGE HEALTH SERVICES
2,.27
having a significant impact. Research and consultation with students and faculty are other such roles. Other alternative roles have also been proposed and merit consideration (13-15). Again, one wonders if students would avail themselves of preventive health, health education, dental, vision, or mental health services. Therefore, community colleges, in addition to assessing the unmet needs of its students, should attempt to analyze the degree to which such services, if provided, would be utilized. In this preliminary survey we have found that the students at a commuter community college obtained health care even when n O student health service was available. Unmet needs existed in the areas of vision, dentistry, preventive care, and mental health. We suggest that small, traditional health services may not be appropriate for urban commuter community colleges with limited health care funds. Therefore, rather than needlessly duplicating existing resources, these community colleges should assess the unmet needs of its students and consider exploring the extent to which health care services could be met by the surrounding community. This might allow them to provide services, often in nontraditional areas, which perhaps would achieve more benefit per health care dollar than is achieved by a limited traditional health service.
References 1. Herbolsheimer H, Ballard BL: Multiple screening in evaluation of entering college and university students. JAMA 166:444, 1958 2. Kolbe LJ, Iverson DC: An assessment of student health needs: Implications for the planning and utilization of college health services. J Am Coil Health Assoc 26:263, 1978 3. Comstock LK, Slome C: A health survey of students: I. Prevalence of perceived problems; II. Satisfaction, attitudes and knowledge. J Am Coll Health Assoc 22:150, 1973 4. Hoffman WK, Madsen MK: College student health care needs at the University of Wisconsin-Milwaukee. J Am Coll Health Assoc 25:296, 1977 5. Gold JH: Utilization of the student health clinic. J Am Coll Health Assoc 21:477, 1973 6. Gold JH: Student health clinics in Great Britain: Six studies. J Am Coil Health Assoc 23:280, 1975 7. Simon JL, Smith DB: Change in location of a student health service: A quasi-experimental evaluation of the effects of distance on utilization. Medical Care 11:59, 1973 8. Allegrante JP, Collins J~, O'Rourke TW: A discriminant anal~ ysis of student utilization behavior at a university health service. J Am Coll Health Assoc 26:145, 1977 9. VanDort BE, Moos RH: Distance and the utilization of a student health center. J Am Coll Health Assoc 24:159; 1976 10. Tristan MP, Cheney CC, Novelli WJ Jr: A descriptive and
228
LINDENBAUM ET AL.
analytic study of the student health services of an urban university. J Am Coll Health Assoc 26:268, 1978 11. Getzen TE, Bergy GG: Utilization of medical care by college students. J Am Coll Health Assoc 25:277, 1977 12. Woody RH: College health services: Demise or rebirth? J Sch Health 43:442, 1973
JOURNAL OF ADOLESCENT HEALTH CARE Vol. 1, No. 3
13. Gage RW: Developing a health program for the community college. J Am Coll Health Assoc 19:152, 1971 14. Marshall CP, Gold M: Health insurance and urban college students. J Am Coll Health Assoc 24:134, 1976 15. Robitaille ME, Shaaru RB, Richie ND: Health care utilization of student families at the University of Florida. J Am Coll Health Assoc 26:158, 1977