The Kids Are Not Alright

The Kids Are Not Alright / Robert Meenan, MD, MPH, MBA / July 12, 2016

Why the health and wellness of today’s college students need further examination.

Every generation understands that the future belongs to the young; that the youth of today are the leaders of tomorrow. My boomer generation believed so strongly in our future as leaders that we looked suspiciously at those over thirty and thought songs such as “Our Day Will Come” and “The Kids are Alright” said it all.

Today, our young people live in a more insecure time when even the kids themselves doubt how alright they really are. The youth of today, who will be the leaders of tomorrow, are facing challenges that in many ways are more difficult and more daunting than those faced by prior generations.

The prominent sociologist Robert Putnam (Bowling Alone) has documented this difficult new reality in his latest book Our Kids: The American Dream in Crisis. His book describes how the social context for today’s young people has been fundamentally altered by major changes in the economy, in family structure and in technology.

While the youth of today are far safer than were prior generations from the classic four horsemen of famine, pestilence, war and death, they are more anxious and less resilient. They are also more depressed and more financially indebted that any previous generation of American youth. In a recent edition of The Economist the youth of today were labelled “Generation Uphill.” We’ve come a long way – in the wrong direction - from “The Kids are Alright.”

Having served for two decades as Dean at Boston University’s School of Public Health, I continue to be inspired by today’s students, and I am committed to helping them develop into the leaders that they want to be and that we need.

However, as a public health expert I recognize how little attention has been paid to the health and wellness of this seemingly robust segment of our population. For some time the health and wellness of young adults has been a low priority for both public health experts and for the kids themselves. That has to change.

As a nation, we need to focus more attention and resources on understanding the health and wellness needs of people entering adulthood.

The Mary Christie Foundation, which publishes this Quarterly, is dedicated to gathering and sharing information that assesses and addresses the health and wellness needs of young people which, as Robert Putnam makes clear, are being played out in a social environment that is increasing fraught with risk and stress.

The Foundation is particularly interested in the physical, behavioral and emotional health of college students as they are truly our future leaders.

Institutions of higher education offer unique environments and opportunities for addressing student health and wellness issues as part of an overall learning and maturation experience.

However, higher education is not one system but rather a diverse set of independent entities with their own approaches and agendas. Ivy League universities and community colleges have many similarities and many differences.

The Mary Christie Foundation will strive to create common platforms for discussion and problem solving that can foster health and wellness insights and interventions across a range of campus settings for all types of students – high-achieving students, college athletes, students with disabilities, students of color, community college students, foreign students and those most at risk of addiction, unhealthy behaviors and self-harm.

Attention to mental health and behavioral health will be a critical component of the Mary Christie Foundation’s focus on the health and wellness of young adults, particularly college students. According to the Center for Collegiate Mental Health, college health centers saw a steady and substantial increase in students seeking mental health services over the last three school years, and college counseling centers now report having wait times of two to three weeks for appointments. A 2013 American College Health Study found that over 50% of college students felt overwhelming anxiety at some point in the previous 12 months.

There are a number of factors that contribute to the increased importance of mental and behavioral health issues for college students, including “good news” drivers like the lessening of stigma around mental health and the fact that many students with mental health diagnoses who have been well supported throughout their teens are healthy enough to attend college.

There are also a number of “bad news” drivers including societal changes, parenting trends, and dramatic advances in technology and communication. We are also putting increasingly high expectations on students, and they in turn are putting higher expectations on themselves. Today’s college students are also dealing with the challenging double-whammy of high student debt and a difficult employment environment.

Stress and anxiety have become a modern epidemic in today’s college populations. According to a study by the American Psychological Association, young adults in America (ages 18 to 33) are significantly more stressed than other age groups.

For college students, typically the youngest members of this cohort, transitional issues compounded by academic or athletic pressures and relationship problems can be overwhelming.

For an already anxious individual, often on his or her own for the first time, the stress can be profoundly unhealthy.

Stress can have an especially unhealthy impact on students with pre-existing conditions and on minority students, including Black or GLTQ students, who additionally have to deal with stress from overt or subtle racism and bigotry on campus.

A recent study by the Jedd Foundation and the Steve Foundation shows that fewer black students rated their college experience as “good” or “excellent” and were almost twice as likely to say they seriously considered transferring in their first semester. The report also showed that 75% of Black student responders preferred to keep their feelings of discomfort about college to themselves.

Chronic stress can lead to a variety of health problems including depression. According to the 2014-2015 ACHA National College Health Assessment, 34.5% of college students felt so depressed it was difficult to function at some point in the past year, and 13.1% of college students have been diagnosed or treated for depression in the past 12 months.

The most extreme and tragic of these statistics is, of course, suicide, a leading cause of death for college students. The most recent annual report from the Center for Collegiate Mental Health found that 10% of college students visiting campus counseling centers have made a suicide attempt, 25% have self-harmed, and 33% have seriously considered suicide.

Binge drinking, drug use, unprotected sex and other risky behaviors continue to challenge administrators in ways that are far beyond the purview of campus security. As a contributor from the Hazelden Betty Ford Foundation writes in this inaugural issue of the MCF Quarterly, “What starts as maladaptive coping (to college stress) can spiral into a constant need. And once control is lost, substance use becomes a full-blown addiction or disorder.”

Earlier this year, the MCF partnered with Hazelden Betty Ford’s Center for Public Advocacy on a survey of college students and opioid use. Of the 1,200 young adults surveyed, almost 16% report having used pain pills not prescribed to them, while over 37 % said they would not know where to go for help in the event of an overdose.

The survey also found that opioid painkillers are readily accessible and that young people do not appreciate the lethal nature or addictive power of the drugs. The numbers were virtually the same for those who identified as college students and those who did not.

Risky behaviors can quickly lead to criminal actions, opening up a new set of demands and challenges that colleges and universities are not equipped to adequately address. In the spring of last year, the Campus Climate Survey on Sexual Assault and Sexual Misconduct found that 11.7% of students at 27 universities reported experiencing nonconsensual sexual contact by physical force, threats of physical force, or incapacitation since enrolling at their college. Drugs and alcohol were involved in a significant percentage of the nonconsensual sexual conduct. Colleges are struggling mightily to reduce sexual misconduct and to deal with its consequences.

For college administrators, addressing the behavioral and emotional health of students has become a priority at the highest level and involves a myriad of issues from liability and confidentiality to capacity and cost to student safety and campus culture.

Responses to these issues have ranged from trigger warnings on sensitive course materials to mental health kiosks to suicide prevention efforts like NYU’s “The Reality Show.” The Mary Christie Foundation will be looking at all of these approaches in an effort to expand best practices and identify areas where more work is needed.

While today’s college students may not be “alright,” they are a remarkable and inspiring group that deserves attention and support. They are approaching a more complex and challenging future than did my boomer generation, and they are doings so with an impressive set of strengths.

They are well educated and technologically savvy. They are open and sharing and willing to explore the issues that confront and challenge them with the promise that they, their nation and their world will be the stronger for it. And they are humble and realistic. Not for them the misplaced overconfidence of the boomer generation that ended up falling far short of its audacious expectations.

I look forward to engaging in the important work of the Mary Christie Foundation with its founder, Fred Chicos; its chairman, John Sexton; its impressive collection of board members, expert advisors and staff; and you, dear readers – our audience of thought leaders and difference makers.

Robert Meenan, MD, MPH, MBA, is the President of the Mary Christie Foundation, and serves on the Board of Directors. He served as Dean at Boston University School of Public Health from 1992 to 2014, has been on the BU faculty since 1977, and remains Professor of Health Policy and Management in the School of Public Health and Professor of Medicine in the School of Medicine.