August 2013

Transitioning to College

August is a highly anticipated time for rising college freshman. Whether teens are going to a local community college, attending a nearby college, or moving across the country, beginning undergraduate education can be a big change. This e-update provides tips on how parents, healthcare providers, and college staff can help teens have a positive and safe transition to college!

Taking the Reins in Healthcare Management

College may be the first time that some teens are responsible for managing their health care on their own.  If teens will be away from home, be sure he or she knows where to go for care and what insurance coverage they have. Some schools require certain vaccines before enrollment and, specifically, the Advisory Committee on Immunization Practices (ACIP) recommends four in adolescence. Read about ACIP’s recommendations for MenACWY, the meningococcal vaccine, and the Human Papillomavirus (HPV) vaccine. Also, a yearly flu shot is recommended for everyone six months or older and the Tetanus, diphtheria, and pertussis (Tdap) vaccine is recommended for adolescents aged 11-18.

Scheduling regular check-ups is important for teens and young adults. For youth living away from home, discuss whether it will be best to schedule those services at home or school. Help teens prepare for their doctors’ appointments with resources on making an appointment and questions doctors or nurses might ask. You can also check out the American Academy of Pediatrics’ Healthy Tips for College Freshman.

Learn more about managing health care

Mental Health 101

College can be stressful. Students may experience homesickness, new and difficult school work, loneliness, and worry over finances and making friends.2 Depression also typically emerges during adolescence,3 and  30%  of college students reported having ever felt "so depressed that it was difficult to function" in a 2011 survey.4 Depression can affect academic performance5 and increase the likelihood that students smoke and drink to get drunk. 6-7 Signs can include lack of interest in activities that they typically enjoy, lethargy, drastic changes in eating or sleeping habits, trouble focusing, and long-lasting headaches or digestive problems.

Encourage teens to build friendships by joining clubs, talking to classmates, and reaching out to other students in their dorm. Staying active is important to mental health too, so encourage teens to exercise regularly. If they are having trouble studying, encourage students to take advantage of professors’ office hours, review sessions, labs run by graduate students, or to talk to their advisor to brainstorm other ways to get help. If your teen is still struggling, learn about more ways to help.

Learn more about mental health

  • Encourage youth to talk to a counselor at an on-campus counseling center. Tell them that seeing a counselor will not appear on their transcript and what’s discussed will remain confidential so long as there is no threat of harm to themselves or to others.8 Many schools offer free counseling services without referrals; encourage your student to call their campus counseling center to learn about their policy. Learn more about stress and stress management.
  • Of course, mental health encompasses more than depression and stress. The eating disorders anorexia nervosa and bulimia have an average age of onset during typical college years (19 and 20 years of age respectively).9 Learn about the warning signs of anorexia nervosa and bulimia
  • If teens need help with an eating disorder or other mental disorder, visit OAH’s Access to Mental Health Care page for direct-service resources.
  • Learn more about depression among college students.
  • Find out about ways to handle stress.

Avoiding the "Freshman 15"

With new food options and freedoms, it’s no wonder that weight gain is common in the first year of college.10 Many may have heard of the “freshman 15”10 but there’s dispute about whether the average weight gain is quite that high (one study estimated 4.4 pounds as more accurate10). To avoid this, students should eat regular meals and maintain a balanced and nutritious diet.  For help guiding teens on what to eat, check out 10 tips for healthy eating in the dining hall.

Of course, healthy living isn’t just about what you eat—exercise is important too. Remind students that exercise can be fun and doesn’t have to be disruptive to studying or socializing—and that they should be active for at least two and a half hours a week. Encourage them to join an intramural team, walk or bike to class, take a fitness class at the gym, and take the stairs instead of the elevator in their dormitories.

Learn more about eating right and staying fit

Substance Free is the Way to Be

For many teens, heavy drinking dramatically increases during the transition from high school to college.11 In 2010, 42% of full-time college students reported binge drinking.12, [1] Also, in 2010, 22% of full-time college students reported currently using illicit drugs[2]  and 25% reported current cigarette smoking.12

The good news is that there’s a lot that parents can do to reduce substance use for first-year students—for example, parents should attend Parent’s Weekend or other campus events open to parents. Check out the Family Check-Up to learn how positive parenting can prevent drug abuse. Many colleges are addressing underage and dangerous drinking by implementing both individual-level and campus-wide strategies.

Learn more about substance use

  • Peer educators and RAs can make a difference when it comes to college drinking and may assist residents with problem solving or refer to other counseling services as needed.13
  • Check out these interactive worksheets on drinking decision making.
  • Visit OAH’s Illicit and Non-Illicit Drug Use page for direct service resources for teens that may need help.
  • Check out this resource on Marijuana Facts Parents Should Know.
  • If you suspect a teen has started smoking, check out this guide on How To Quit smoking for ideas on how to help.
  • Learn about the resources offered at each school from the health center, dean of student’s office, and from RAs.

Healthy Friendships and Romantic Partners

Peers play an important role in determining students’ identity in college, and they can also influence behaviors such as eating and exercise habits.14-16 And while friendships are beneficial to students, peer influence is also one of the leading predictors of initiation and maintenance of drinking in college as well as a predictor of marijuana use.17,18 It’s important to teach teens that they have the right to say “no”  and how to recognize good friends. You may point teens towards this interactive guide to learn the most effective ways to say no and this list of how to know if your friends really care about you.

Dating can be a source of companionship, support, and intimacy, but like friendships, they can sometimes be harmful.19 During their lifetime, more than one in three women and one in four men experienced rape, physical violence, and/or stalking by an intimate partner.20 College women are at an especially high risk of rape-- approximately 20-25% are victims of rape or attempted rape.21 Teens who experience dating violence are more likely to become pregnant, have lower grades, report substance abuse, report lower self-esteem and emotional well-being, have eating disorders, and report suicidal thoughts and attempts.22,23 Learn the signs of an unhealthy relationship.

Learn more about peer pressure and unhealthy relationships

  • Check out this resource to learn how to build your drink refusal skills.
  • Do you suspect that a teen is in an unhealthy relationship? Learn how to leave an abusive relationship.
  • If a teen is in an abusive relationship, encourage them to call the National Teen Dating Abuse Helpline  Call 1-866-331-9474 (1-866-331-8453 TTY) or text "loveis" to 77054. Peer advocates are available to talk 24 hours a day, seven days a week.
  • Learn about who is at risk for committing dating violence as well as other helpful information in this fact sheet.
  • The White House and Vice President’s office in conjunction with HHS held a phone app competition to inspire innovative ways to prevent dating violence. Colleges and universities should encourage students to use the winning phone apps OnWatch and Circle of 6 which make it quick, easy, and discreet for teens to get help if they are in danger of dating violence.
  • Learn about the resources offered at each school from the health center, dean of student’s office, and from RAs.


1Centers for Disease Control and Prevention. (2013). Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 62(RR02), 1-22. from

2 Mowbray, C. T., Mandiberg, J. M., Stein, C. H., Kopels, S., Curlin, C., Megivern, D., et al. (2006). Campus mental health services: Recommendations for change. American Journal of Orthopsychiatry, 76(2), 226-237.

3 Paus, T. Å., Keshavan, M., & Giedd, J. N. (2008). Why do many psychiatric disorders emerge during adolescence? Nature Reviews Neuroscience, 9(12), 947-957.

4 American College Health Association. (2012). American College Health Association- National College Health Assessment II: Reference group data report fall 2011. Hanover, MD: American College Health Association.

5 Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534-542.

6 Cranford, J. A., Eisenberg, D., & Serras, A. M. (2009). Substance use behaviors, mental health problems, and use of mental health services in a probability sample of college students. Addictive Behaviors, 34(2), 134-145.

7 Weitzman, E. R. (2004). Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college. The Journal of Nervous and Mental Disease, 192(4), 269-277.

8 Department of Health and Human Services and Department of Education. (2008). Joint guidance on the application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to student health records. Washington, D.C. Retrieved August 21, 2013, from

9 Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348-358.

10 Crombie, A. P., Ilich, J. Z., Dutton, G. R., Panton, L. B., & Abood, D. A. (2009). The freshman weight gain phenomenon revisited. Nutrition Reviews, 67(2), 83-94.

11 Park, A., Sher, K. J., & Krull, J. L. (2009). Selection and Socialization of Risky Drinking during the College Transition: The Importance of Micro-Environments Associated with Specific Living Units. Psychology of addictive behaviors: journal of the Society of Psychologists in Addictive Behaviors, 23(3), 404.

12 Substance Abuse and Mental Health Services Administration. (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: U.S. Department of Health and Human Services. Retrieved September 17, 2012, from

13 Bureau of Labor Statistics. (2013). Occupational employment and wages, May 2012: Residential advisors. Retrieved August 21, 2013, from

14 Cason, K. L., & Wenrich, T. R. (2002). Health and nutrition beliefs, attitudes, and practices of undergraduate college students: a needs assessment. Topics in Clinical Nutrition, 17(3), 52-70.

15 Borsari, B., Borsari, B., & Carey, K. B. (2006). How the quality of peer relationships influences college alcohol use. Drug and Alcohol Review, 25(4), 361-370.

16 Schulenberg, J. E., & Maggs, J. L. (2002). A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Journal of Studies on Alcohol and Drugs(14), 54.

17 Borsari, B., & Carey, K. B. (2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13(4), 391-424.

18 Pinchevsky, G. M., Arria, A. M., Caldeira, K. M., Garnier-Dykstra, L. M., Vincent, K. B., & O'Grady, K. E. (2013). Marijuana exposure opportunity and initiation during college: Parent and peer influences. Prevention Science, 13(1), 43-54.

19 Kuffel, S. W., & Katz, J. (2002). Preventing physical, psychological, and sexual aggression in college dating relationships. Journal of Primary Prevention, 22(4), 361-374.

20 Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., et al. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

21 Fisher, B., Cullen, F., & Turner, M. (2000). The sexual victimization of college women. Washington, DC: National Institute of Justice.

22 Offenhauer, P., & Buchalter, A. (2011). Teen dating violence: A literature review and annotated bibliography. Washington, DC: Library of Congress-Federal Research Division. Retrieved January 4, 2013, from

23 Banyard, V. L., & Cross, C. (2008). Consequences of teen dating violence: understanding intervening variables in ecological context. Violence Against Women, 14(9), 998-1013.

25 Centers for Disease Control and Prevention. (2013). Bicycling activity card. Retrieved April 23, 2013, from

26 Centers for Disease Control and Prevention. (2012). Preventing tick bites. Retrieved April 23, 2013, from

27 Heller, J. L. (2013). Tick Removal. Retrieved June 26, 2013, from

Last updated: March 10, 2016