A Summer Assignment
College kids need a physical, too, and now's a good time
Note to parents of college students home for the summer: Sometime during these jampacked weeks of job demands and friends, you may want to schedule a nice long visit with the doctor.
When the kids aren't sleeping, they may seem too brimming with health to bother. But many young adults—having outgrown the pediatrician without graduating to a new doctor—are getting no preventive care, and experts say they badly need it. Consider: Nearly half of full-time college students binge drink, use prescription drugs recreationally, or abuse illegal drugs each month, according to the National Center on Addiction and Substance Abuse at Columbia University. One in 7 young adults reports having experienced a serious mental illness such as depression in the past year, finds a data review by Jane Park, a researcher in the division of adolescent medicine at the University of California-San Francisco school of medicine. Fourteen percent of students surveyed by the American College Health Association admitted using withdrawal as their method of birth control the last time they had sex; 12 percent of women said they sought emergency contraception in the previous school year.
Yes, students will find the campus health center or their local ER when they sprain an ankle or suffer from alcohol poisoning. But there's a risk in going years without comprehensive healthcare at this age, says Claire Brindis, director for health policy at UCSF. Brindis would prescribe a comprehensive annual exam (and suggests getting an appointment early in the summer, in case any follow-up care is needed). Unnoticed- and untreated-problems like anxiety, an eating disorder, or substance abuse can kill, or at the very least wreak havoc with school performance. Of the top 10 reasons students in the ACHA survey gave for their grades dropping, more than half were related to their physical or mental health.
Why suffer? "I don't want to feel that bad for that long ever again," says Seth Kester-Irwin, a rising sophomore at Davidson College in North Carolina who went almost all the first semester with a sinus infection that pushed him to the brink of misery. Finally, at home in Berkeley, Calif., over winter break, he saw a doctor and got a prescription. Kester-Irwin realizes now that he should have known better than to wait: His dad is a physician.
The physical your grown child needs will be quite different from what either a younger child or an older adult would expect to have—and considerably more detailed than the cursory exam, plus vaccinations, required before heading to campus. So it's a good idea to ask a few questions before deciding on a doctor. Experts recommend looking for a style of practice that openly addresses sexually transmitted diseases, mental health, substance abuse, tobacco use, and daredevil behavior. "They're not at risk for heart attack or cancer in large numbers like older adults, but they're at risk for consequences of psycho-social behavior," says David Bell, medical director of the Young Men's Clinic at New York Presbyterian Hospital-Mailman School of Public Health, Columbia University.
Teasing out how a student balances his work-study job with that crush of English papers, for example, may reveal that he's been pulling all-nighters with the help of his roommate's Ritalin. A probing discussion of how a young woman manages her feelings of loneliness can uncover signs of an eating disorder, suicide risk, or substance abuse. Finally, the conversation should cover how often your child chooses a side of vegetables over fries, and whether the IM'ing ever stops long enough to allow time for exercise.
In addition, a range of lab tests may be called for—though families may well have to request that the doctor offer them. "A lot of parents don't want to believe their child may be having sex," says Cynthia Burwell, chair of Healthy Campus 2010, the American College Health Association's initiative to get college administrations to promote healthful choices by students. But STDs are a real risk, and a full work-up is not standard practice. The rate of infection with gonorrhea or chlamydia, each of which can result in lasting pain and infertility if untreated, is higher between the ages of 15 and 24 than in any other age group.
Screening for both can now be performed using a urinalysis, good news for young men whose only option used to be an uncomfortable swab inside the urethra. (Some doctors still use the old technique, so a call ahead may be in order.) Syphilis and HIV testing is typically done with a blood test, but saliva tests for HIV are available. By the time a patient is 18, privacy laws prevent doctors from sharing his or her health records without permission, so there's no need to fear that a disapproving parent will be clued in.
Cancer check. A genital exam is also key. Young men should be checked by a doctor for testicular masses; the cancer is rare, but early treatment yields a very high cure rate. According to the National Cancer Institute, young women should have their first Pap smear about three years after first having sex but no later than age 21. The test should detect abnormal cells or HPV, the virus that can lead to cervical cancer. Because the cancer is very rare in women under age 25, waiting up to three years between tests may be acceptable. Earlier is better with Gardasil, the HPV vaccine, but it can be administered for girls and young women up to age 26.
Anyone battling the "freshman 15" might want to add a blood-glucose screen. Research published last week in the Lancet suggests that type 2 diabetes is a serious and growing problem in teens and that they are not getting screened appropriately. Stanley Mirsky, associate clinical professor of metabolic diseases at Mount Sinai School of Medicine in New York and a member of the board of overseers of the Joslin Diabetes Center in Boston, would advise a test for someone with any of the following: a family history of diabetes, an extra 5 to 10 pounds, or a couch-potato lifestyle.
Parents have an educational role to play, before and after the appointment. Daughters need to know that when a doctor asks if she could be pregnant, it's not out of nosiness and it's not a value judgment, explains Lesley Sacher, director of the student health center at Florida State University. For the future, they might benefit from a discussion of how to get out of a situation in which they're being pressured to have sex. Sons need to know about STDs and about how to read a woman's signals that no means no. Everybody needs to hear about the dangers of binge drinking.
The talk may be uncomfortable, but "these are life-course issues," says Brindis. "It's either pay now or pay later."
BACK ON CAMPUS...
When students are asked about their health, "I don't know" is not a good answer. Experts say they should be able to:
Offer a medical history. In the ER, it may be critical to be able to recount their own history, plus key details of the family history.
Make an appointment. And keep it. They should also be able to decipher their insurance card and understand the copay.
Fill a prescription. They also need to understand the importance of following instructions that come with it.
Release information. Privacy laws prevent the sharing of information about college-age kids. Students who want the doctor to fill in Mom and Dad need to ask to sign a release-of-information form, or they're on their own.
This story appears in the June 11, 2007 print edition of U.S. News & World Report.