Who, What, When
A brief health history of Skidmore, 1911-2009 Care and feeding of Skiddies, 1911-2009
Food and drug administration? Skidmore has strategies to support student well-being
At college, even choice is a challenge Q&A with college-stress expert Karen Levin Coburn '63
Food and drug administration?
Skidmore tests, teaches, and treats to promote student wellness
by Kathryn Gallien
If it takes a sound body to support a sound mind, then college health professionals have their work cut out for them. At colleges around the country, students bring to campus more emotional problems, eating and sleep disorders, and chronic illnesses than ever before. Couple that with the sudden freedom of lifestyle choices, and just being at college can play havoc with the student body. Students work hard and party hard. They are stressed out and sometimes depressed. They don’t always get the exercise, sleep, or nutrition they need.
As any professor with an early-morning class can tell you, a rich nightlife and poor lifestyle habits can take their toll on classroom performance. Substance abuse and physical inactivity, in particular, are statistically linked to poor attendance, lack of attention, and academic failure.
What’s a college to do?
“When I started at Skidmore three years ago, we formed a new office—health promotion,” says Jen Burden, a certified health-education specialist with a Harvard doctorate in nutritional
epidemiology. She explains, “I was charged with assessing health on campus, figuring out how to address it more broadly and comprehensively.” Thanks to key donations—the Shipley Intervention and Research Fund, established by Judy Lyman Shipley ’57 and husband Walter, and a gift from Craig Bollman and his family, which includes daughter Marisa Bollman ’08 —Burden was able to bring on two full-time staffers: substance-abuse prevention coordinator Kate Rose Bobseine and health educator Kate Child. The three collaborate closely with Skidmore’s health service and counseling center and with a squad of students newly trained as peer health educators.
Burden grounds her approach to each issue in extensive research. She surveys the students about alcohol and drugs annually; other surveys are done every other year—mental health, sleep, stress, physical activity, sex or “hooking up,” relationship violence, and eating problems. By posting the surveys online, making them anonymous, and keeping them short, she gets remarkably high rates of participation.
Her data show that fewer than 10% of students meet national recommendations for physical activity, 43% use tobacco (most of them as “social smokers”), and they average less than six hours of sleep a night. But the areas that concern her most are depression, alcohol abuse, hooking up, and eating disorders. For troubles like these, health education is not enough. Burden endeavors “to make sure the opportunities, services, support, and structures are all in place so that students can make healthy choices more easily.”
On October 10, National Depression Screening Day, Skidmore’s professional and student health promoters worked out in the open to bring attention and visibility to this often hidden problem. Paul Matteis ’11 and others strung up 1,100 mortarboards along a campus walkway to represent the average number of American college students who commit suicide each year—“those who could have graduated, but were hindered by severe mental illness,” as Matteis puts it. A psychology major who is aiming for med school, Matteis signed up for Burden’s honors course “Health Peer Education” to learn and then reach out to other students. He and his peers can help steer those struggling mentally or emotionally to services on campus—particularly the counseling center, which sees more than half of Skidmore students at some point in their four years.
“The number-one thing I worry about is depression,” Burden says. “I think a lot of our students are having mental health issues, and about 15% of them answer a questionnaire in a way that indicates they are most likely clinically depressed.” In her recent survey, completed anonymously online by 643 Skidmore students, more than half the respondents admitted to at least one symptom of depression—lack of energy, insomnia, restlessness—while the 15% who may be clinically depressed reported five or more symptoms. And there was a strong correlation between depressive symptoms and grade-point averages below 3.0.
Most troubling, says Burden, is that “only about half the students who screened positive are getting counseling. If you do the math, a lot of students are walking around distressed, and we don’t know about them.” But there’s a new tool to help find them. As one of twenty colleges and universities selected to participate in the National College Depression Partnership, funded by the Charles Engelhard Foundation, Skidmore has begun using the screening questionnaire known as the PHQ-9. The survey is voluntary and confidential, but not anonymous, so students scoring as clinically depressed can be contacted and encouraged to get help. Burden says, “We hope that soon every student who comes into health services, for any reason, will fill out this brief nine-question form.”
Meanwhile, she is haunted by the anonymous results: “Oh, my gosh! As I read these answers I think, ‘I want to know who you are. Let’s talk about this.’”
Drinking at colleges is perpetually in the news, no more so than last summer, when nearly 130 college and university presidents signed the Amethyst Initiative calling into question the effectiveness of keeping the legal drinking age at twenty-one. Skidmore’s president, Philip Glotzbach, did not sign the agreement—nor, says Burden, should he have. “It’s a good, valid question to be asking, but the way the letter was written, they already had their conclusion: They want that drinking age lowered.” If age is the focus, she argues, “there is biological evidence that brain development isn’t complete—in the frontal cortex, where decision-making is controlled—until the mid-twenties. So if they’re judging based on biology, they should be arguing to increase the drinking age.” For Burden and her colleagues, the focus isn’t age but risk reduction. “If you’re going to decide to drink,” she says, “what we care about is that you do it in a responsible way that is not detrimental to your physical, mental, or academic health.”
With some health issues, there are simple solutions. For students whose schedules are too tight to get to the gym, an elliptical trainer placed in a residence-hall laundry room fills the bill. But when it comes to drinking, says Burden, “we’re talking about changing a culture.” It’s a pervasive culture that tolerates and even celebrates drinking to excess, and it’s one that new students fit into with ease: more than 31% of Skidmore freshmen report getting drunk within their first forty-eight hours on campus. Close to half of the first-years say they don’t drink, but by senior year their ranks dwindle to less than 10%; meanwhile, the 14% of heavy drinkers in the first year swells to 41% by senior year.
Last year Skidmore began requiring all first-years to complete and pass the online, NIH-funded alcohol- and drug-abuse
prevention course called MyStudentBody.com, which helps them assess their own risks for drinking-related problems.
Should a serious problem arise, Skidmore professionals and a network of certified alcohol counselors are prepared for action. They can’t just call up a student and say, “I hear you have a drinking problem.” But sometimes a friend, faculty member, or coach will express concern and convince a student to seek help. “And it’s funny,” Burden reports, “how students will often start the conversation with ‘I’m sure this is not the phone call you want to get.’ And I always reply, ‘No, no, no; this is exactly the kind of call I want to get.’ ”
If only they got more calls. Too often, students don’t want to rat out a friend or get into trouble. Burden notes, “The idea of getting in trouble trumps the idea of someone being really sick or dying. That’s just where they’re at developmentally.”
Some students have no choice but to come in and talk to the professionals. And then they encounter one of the most successful tools in combating the drinking culture: a program called BASICS—Brief Alcohol Screening and Intervention for College Students. Students referred to BASICS are required to meet with a trained counselor for two one-hour sessions of “motivational interviewing” and then follow up a month later with an online survey that assesses the counseling experience and reports changes they have made. “If students are caught violating alcohol and drug policy and it has reached a level of concern,” Burden reports, “they’re funneled into BASICS through campus safety or res life.” These aren’t cases of simply finding an open container in someone’s room, she adds. “But if you are drunk and disorderly, if you’re playing drinking games, if you are a hospital transport, then you are on your way to see one of us.”
Last year 103 students completed BASICS, 62% for alcohol violations and 35% for marijuana violations (with the remaining 3% brought in for both). Three-quarters of them were male, and 55% were first-year students. The one-month follow-ups showed that nearly 54% had changed their alcohol or drug use: They drank less often (79%), drank less in a single sitting (41%), were more likely to have a designated driver (31%), avoided drinking games (28%), and alternated nonalcoholic beverages with their drinks (24%). While many participants reacted initially with skepticism or even anger, in the end they were overwhelmingly positive. One wrote, “BASICS encouraged me to think about my drinking behaviors and monitor my consumption levels…. I realized that alcohol furthers many other emotional issues I am dealing with. I can focus on self-improvement if I drink less often.”
College students are going to drink, and Burden acknowledges that most of them will turn out fine. But she would like to know what young alumni find after heading out into the real world. “We have a lot of students who say, ‘Well, I won’t drink like this after I graduate.’ And I say, ‘OK, but this is your lifestyle now, so how do you get there?’”
On campuses drinking and “hooking up” in a sexual encounter are, well, intimately linked. Two people meet at a party or a bar, have a few drinks, and then hook up—which can mean anything from making out to intercourse, with the understanding that there’s no commitment.
“Dating is gone,” Burden declares. In its place is a system for socializing that begins with sex and may lead to friendship or a romantic relationship. Survey respondents have written, “All of my relationships have started as a hookup.” For Burden “that’s backward,” but for many students that’s just how it is. Burden surveyed 800 students and found that nearly 90% have hooked up (according to their own definition); their average age on their first encounter was fifteen; and they’ve hooked up with anywhere from one to fifty people, with seventeen as the average.
More than 75% of Skidmore students have had sexual intercourse, but only one-third of sexually active students say they use condoms every time, whether because they were drunk or on the Pill or simply enjoy sex more without them. They seem equally cavalier about the threat of sexually transmitted infections: Half have never been tested, primarily because they don’t feel at risk. Yet among the other half, 9% tested positive for an STI. Charlie Jacobson ’09, a peer health educator who is researching the hookup culture, says, “I’d like health-promotion events to focus more on safe sex: condom use and STI screenings. Ditto for the staff and student advocates of Skidmore’s Center for Sex and Gender Relations, which offers information, distributes condoms, and sponsors campus events.
While some argue that hooking up has roots dating back to the campus free-love movements of the 1960s, Burden sees it as a culture shift that has gained traction over the past decade. A few years ago Clio Dobyns ’06 and Alissa Mun ’06 studied it for their psychology thesis, “Hooking up at Skidmore College: Motivations and emotions surrounding the hook-up culture,” which they presented at the Eastern Psychological Association. They found that 79% of students had hooked up, with an average of three different partners for women and five different partners for men. Just a few years later Burden would find the total to be 90%. Dobyns and Mun defined hooking up as a consensual sexual encounter with no explicit intent to continue the relationship. Yet when they asked about expectations, they found that 42% of females and 13% of males hoped a relationship would form. And often it did. “We learned that almost 40% of the participants who were in an exclusive relationship had it start off as a hookup,” recalls Mun, who is now doing breast-cancer research at Georgetown University. And Burden’s research found that 55% of students had a hookup evolve into a committed relationship.
But there remain a host of concerns about a very sexually active population for whom alcohol is an easy social lubricant and safe sex is too often an inconvenience.
According to the National Eating Disorders Association, nearly 10 million women and 1 million men in America are struggling with an eating disorder such as anorexia or bulimia, which can be a life-or-death battle. Burden says a vast majority of Skidmore’s female students report unhealthy weight-loss or weight-maintenance strategies combined with a negative body image. Potentially dangerous behaviors include fasting, excessive exercise, self-induced vomiting, and use of diet pills and laxatives. More than three-quarters of Skidmore women admit they are “terrified of being overweight.” On a recent screening questionnaire, 16% of Skidmore females scored in
a way that indicates a probable diagnosable eating disorder. While that’s comparable to rates at other educational institutions, Skidmore bucks national trends when it comes to its female athletes, who appear to be at lower risk (6–7%), and its dancers, who evidence no increased risk over the population as a whole.
For one eating-disorder survivor currently at Skidmore, the transition from home to college exacerbated the anorexia that had begun during senior year in high school. She had first applied to a college where she could continue the gymnastics that had so defined her early life, and when she did not get in, she was devastated. “It started slow,” she recalls.
“I just started to restrict and limit portions. I was depressed and confused about my identity because I was ending my life as a gymnast. I remember feeling that this could be my new person, because when I was losing weight I felt good.
I knew something I was good at: I was good at not eating,
I was good at losing weight.”
Every emotion she felt about going off to college related to eating. She says she was “worried about gaining the ‘freshman fifteen’” and also excited about escaping her mother’s watchful eye. “At college, ED is harder for people to catch”—and she was good at hiding it. She obsessed about restricting food and getting exercise; she became severely underweight, physically weak, and emotionally empty. “I could see in the mirror that I was skin and bones, but I couldn’t stop. ED is very controlling. You go with it so you can cope, and then at a certain point you’re not in control and can’t stop it.”
She talks about this now in hopes of helping other students, knowing full well that the stresses of college life combined with newfound freedoms and evolving identities make this a particularly dangerous time. She admits, “I still have body image problems and can, especially during periods of high stress, have feelings of inadequacy—thinking my stomach is fat and having a very large urge to restrict my food intake or make sure I expend enough calories.” But she doesn’t act on those impulses, she says, “as I definitely do not want to return to my ED.”
When fellow students become concerned about roommates or friends, “I tell them to not talk about food with the person—that’s what people with ED are experts at: talking about food.” Instead, she suggests simply asking how the person is feeling and offering: “If you need to talk to me, I’m here.”
As for Burden and her colleagues, they reach out by sponsoring campus events such as Eating Disorder Awareness Week and Love Your Body Week. While they hope to keep students from ending up in an ED crisis, they know what to do when it happens. The student survivor recalls: “The day I broke down, I was scared about whether I could survive the night. I went to health services and they put me on the scale. I weighed 80 pounds.” She was taken to the hospital and transferred to an inpatient treatment program. “They told me at health services that I couldn’t stay here anymore,” she says. “They saved my life.”
Their space is small, but the purview of Skidmore’s health services, counseling, and health promotions is large: illness and injury care, physicals and lab tests, alcohol and drug information and counseling, smoking cessation information, and treatment of social and emotional problems ranging from adjustment issues to sexual assault. For the future, Burden dreams of a Skidmore wellness center with room for programming that the cramped space in Jonsson Tower doesn’t allow. She’d also like to expand and consolidate online resources into one Web site with high visibility. She figures you can never have too many avenues for promoting health and fitness.
Hence the growing cadre of student health educators. “This a great opportunity to reach out to students, without any hidden agenda,” says sophomore Matteis. With its nonjudgmental approach, he says, “our group is not looking to get anyone in trouble or stop people from partying. We just want to provide accurate, unbiased information, enabling students to make educated decisions.” For Sarah Bashaw ’11, another pre-med student, it’s a chance to combat misconceptions about alcohol, drugs, and sex—for instance, “students assume that all college students drink, and they think of binge drinking as normal,” but she wants them to know it is not normal for everybody.
“I find college an interesting time,” Bashaw muses. “It is a huge transition between being a dependent and becoming independent and self-sufficient. It is a time of self-discovery, and it causes some interesting choices and decisions to be made due to pressure from peers, stress, misconceptions, and self-doubt.”
College life certainly brings a welter of health and wellness challenges, but Jen Burden is optimistic. She submits, “We are doing great things here. We are doing the research to make sure that we’re aware of the issues, and we are taking steps to make Skidmore a healthier place for students.” And what really makes her upbeat is the character of Skidmore’s students. “Even though they are struggling with tough stuff and don’t always make the best choices in terms of their health, they are amazing people.”
Editor's note: To join the discussion about student health issues and strategies, click here. A summary of survey results will be reported in the next issue.