Important Points Made by the Speakers
- Young adults take different pathways through high school and college and into the workplace, and several of these pathways have received little attention from researchers. (Schneider)
- Longitudinal cohort studies are needed that allow for the analyses of pathways from school to work and of subgroups, including subgroups defined by social class. (Schneider)
- More randomized trials of health-related interventions are needed to evaluate their effects. (Schneider)
- Many college students with substance abuse or mental health problems do not receive the services they need to remain healthy. (Bailie)
- Screening programs can identify students who need services and are not accessing them on their own. (Bailie)
The transition from school to work can have relevance throughout a person’s life. Whether this transition occurs after high school or after college, it establishes a direction for all subsequent work experiences. It also places a focus on schools and colleges as the last major institutions that group a large number of people together in one place, which provides an opportunity for prevention and intervention efforts. Two speakers examined schools and universities in this context—one focusing on several
alternate pathways from school to work, and the other on the health and safety of the college population.
Educational attainment can have a strong effect on the health and well-being of young adults, observed Barbara Schneider, John A. Hannah University Distinguished Professor in the College of Education and Department of Sociology at Michigan State University. This effect is partly due to occupational choice and income. But increasing levels of education lead to different thinking and decision-making patterns, improve critical thinking skills, and provide individuals with better access to information. For example, education increases understanding of the nature of scientific inquiry and trust in scientific evidence, which is important for the prevention of health problems, said Schneider.
Schneider looked in turn at high school graduates and dropouts, certificate holders, 2-year college students, and 4-year college students.
The high school graduation rate in the United States is highly uneven among schools. In some suburban districts, the graduation rate exceeds 90 percent, and in some urban districts it can be as low as 50 percent (Schneider, 2013). Schneider said the overall dropout rate has declined from 12 percent in 1990 to 7 percent in 2010. However, the situation for some groups, such as Hispanics, blacks, and American Indians, is dire. Nearly 70 percent of black male dropouts, for example, will spend time in prison by their mid-30s.
Several other populations that tend to be overlooked in high schools need greater attention, said Schneider. Refugees and undocumented immigrants have needs that are often unmet in high schools. Lesbian, gay, bisexual, transgender, and queer/questioning youth, said Schneider, can be the victims of bullying in high school and in college. In general, school violence continues to be a problem, particularly in urban areas.
Another group that is often overlooked consists of certificate holders. These are young adults who might or might not have graduated from high school and go on to earn certificates to work in fields such as wholesale and retail trade, manufacturing, construction, and hotels and restaurants. These jobs tend to be temporary, part-time, or informal—a trend that has been exacerbated by the Great Recession, said Schneider. They typically do not provide health insurance, and they may lead to frustration, discontent, and an inability to formulate successful pathways into more stable employment, training, and intimate relationships. “This is a population that I feel we need to spend a lot more time on, especially given the kinds of jobs that they are likely to have.”
When they are in high school, most students think they are going to
college. Among high school seniors, more than 70 percent said they expected to finish college, and more than half of those students expected to go to graduate school (Schneider and Stevenson, 1999). But many of these students will never achieve those ambitions. Schneider noted that they may have an inconsistent knowledge base and understanding about educational expectations and career plans. They and their parents may be uninformed about the types of academic preparation, credentials, and degrees needed for certain types of jobs, which is especially the case among low-income and students of color.
Nevertheless, nearly half of the nation’s young adults do attend an institution of higher education part- or full-time. Health services are present on many college and university campuses, but little information is available about the scope and usage of health services beyond what is self-reported. Verifying self-reports with existing administrative data would provide a much more complete picture of the health services provided to students and enable better campus health service planning and administration, Schneider said.
Many students who are less well prepared and from lower socioeconomic backgrounds attend 2-year institutions with the expectation of eventually earning a bachelor’s degree, Schneider said. But within a 6-year period, only about 12 percent of them earn a 2-year degree, much less a 4-year degree (Schneider, 2013). Because of their lack of preparation, many find themselves in remedial courses, said Schneider. Two-year students also may be working, have families, or be uninsured, and the health care facilities at 2-year institutions tend to be worse than those at not only 4-year institutions, but high schools. Many of these students also take out loans to support their education, and many then have trouble paying back. Programs are being put in place to help 2-year students achieve their degrees, but getting students through 2-year colleges remains “a big problem,” according to Schneider.
In 4-year institutions, the number of slots for students at higher ranking universities has remained more or less constant while the number of college-eligible students has risen, creating increased competition at many schools. Many young adults in 4-year institutions do not know how to achieve their academic goals or make successful occupational choices, said Schneider. Of course, some college students are motivated, directed, do well in school, and graduate on time, but “the spectrum of [students] in 4-year institutions is quite large,” said Schneider.
One in five 4-year college students will not graduate within a 6-year period, which can leave them with severe financial difficulties. Those who do graduate can face their own sets of problems. They may have difficulty finding full-time work that pays a decent wage, even though many have debts to pay off. “It is very hard to get a very well-paying job when you
are 22 years old,” Schneider observed. Many are unclear about what they want to do. They may take unpaid internships or plan to return to school, perhaps even to get a certificate in an area where jobs are more available. It can be a vulnerable and anxious time for both young adults and their parents, Schneider observed. Schneider identified several areas in need of further research; these were included in Chapter 14.
HEALTH AND SAFETY OF YOUNG ADULTS IN HIGHER EDUCATION SETTINGS
College is a time of testing limits, which can include engaging in risky behaviors, often while under the influence of alcohol and other drugs. Shannon Bailie, director of health and wellness in the Division of Student Life at the University of Washington, focused on three issues associated with these behaviors: alcohol use, mental health disorders, and sexual violence.
To the statistics on alcohol use and mental health disorders summarized in Part II of this report, Bailie added several data points on sexual violence. According to estimates, nearly 20 percent of women and 6 percent of men are victims of sexual assault during their college careers (Krebs et al., 2007). Among college women surveyed, only about 12 percent of rapes were reported to law enforcement (Kilpatrick et al., 2007). Victims of drug-facilitated or incapacitated rape were less likely than victims of forcible rape to go to authorities, said Bailie.
A number of studies provide evidence for gender-specific interventions and education for sexual assault (Morrison et al., 2004). When the audience is younger and the curriculum content is more focused on healthy relationships than on avoiding rape, mixed-gender groups may be more appropriate, Bailie said. Interventions that spend more time exposing students to material seem to be more effective than shorter interventions in altering rape-related attitudes (Anderson and Whiston, 2005). The content of programming, the type of presenter (professional as opposed to peer), the gender of the audience, and the type of audience also may be associated with greater program effectiveness, said Bailie.
The University of Washington often conducts outreach on sexual assault at group-specific locations, said Bailie, such as residence halls, fraternities and sororities, athletics, and student government. General education on the topic is made available to all students through orientation, “but we recognize that we have a lot more engagement and impact when we are talking to those specific groups.”
Identifying gaps in health services is an important issue on college campuses. For example, almost 80 percent of suicides on college campuses involve students who were never clients in campus counseling centers (Gallagher, 2012). Approximately three-quarters of students with depres-
sion feel that they need help, but only one-third of the students meeting criteria for depression actually receive help (Eisenberg et al., 2007). Nearly all (96 percent) of students with an alcohol use disorder receive no alcohol services of any kind (Wu et al., 2007).
These gaps emphasize the fact that screening is essential, said Bailie. Screening in health centers and mental health centers can catch students who might not otherwise be identified. In addition, “brief interventions with college students, including skills-based interventions, motivational interviewing, and personalized normative feedback, are effective methods for reducing drinking by college students” (Blanco et al., 2008; Cronce and Larimer, 2011).
One effective strategy is known as Brief Alcohol Screening and Intervention for College Students (BASICS), which is a harm reduction approach using motivational interviewing to elicit personally relevant reasons to change and reduce harms of drinking. “What do [students] like about drinking, and what don’t they like?” Bailie said. You then let students identify strategies for drinking in a less dangerous or less risky way. High-risk drinkers who participated in the BASICS program significantly reduced both drinking problems and alcohol consumption rates, compared with control group participants, at both the 2-year follow-up (Marlatt et al., 1998) and 4-year outcome assessment periods (Baer et al., 2001).
Another program Bailie described is the National College Depression Partnership. In an application of this program at New York University, more than 58,000 students in 8 different schools were screened and 801 students were identified, more than 35 percent of whom were students from underrepresented racial and ethnic groups (Klein and Chung, 2008). The program improved clinical outcomes for at-risk, underserved college students by early detection, coordinated proactive follow-up, and better adherence to outcomes-based treatment.
The health and wellness program at the University of Washington seeks to reach students not caught by screening or those not accessing services on their own. The program utilizes outreach to connect to students who come to the attention of faculty, staff, or other students. Health and wellness gives students an access point for a wide range of services on and off campus that are different from the services offered by the health center, the judicial system, or the police. Health and wellness programs include a student care program, which is linked with its consultation and assessment team; a suicide prevention program; a sexual assault and relationship violence information service; and an alcohol and other drug education and intervention service.
Eric Lulow, during the presentations by young adults, noted that programs at colleges and universities that identify and support young people with special challenges can make the difference between success and fail-
ure in college. Such programs can help students adjust to college life and provide them with supports both on and off campus. Youth peer-to-peer workers also can achieve a buy-in, trust, and rapport hard to achieve in any other way. Three of the major reasons why students do not succeed in college are stress, anxiety, and depression, he said, and these programs can help students overcome those problems. In turn, successful programs could be replicated elsewhere to increase the number of students who benefit from them.
Another valuable approach both on college campuses and elsewhere is asset mapping, where youth study their communities and the services available in those communities. “They are telling police officers, ‘Hey, this is where, if you come into contact with a young person at 3:00 a.m., these are places where they can get services if they are in a mental health crisis.’” This kind of information also can be adapted for technology, so that, for example, an emergency department doctor could pull out a smartphone and learn about services that are available right at that moment rather than releasing a young person back to the street. “Where can they take young people, where are the resources that are available, who are the right people they can call to get them linked up with services? So this trend of cycling through the system doesn’t continue.”
Jackie Malasky emphasized not punishing people for bad behavior, but rewarding them for good behavior. Many colleges now have rules that if someone helps a person who is in trouble because of drinking or drug use, the person offering help will not get in trouble. “It shouldn’t be about punishing people. It should be about making sure that they are getting access to health care.” Young people need to learn that when they see others engaging in risky behaviors, the reason may be depression. Young adults are not psychologists, but they need to be able to provide resources to their friends.
