Cardiovascular Disease Prevention in College Students
Thank you to Keri Barron, PhD, RN, CNE for authoring this article on cardiovascular health in college students.
Cardiovascular Health in Young Adults
National data statistics demonstrate the impact that cardiovascular disease (CVD) has on our nation, as it is the leading cause of death in the United States. Previous research1,2 has explicated the importance of initiating health-promoting behaviors at an early age, as symptoms of CVD are presenting in young adults–and even earlier in some populations.3 Additionally, previous research4 has also indicated that young adults may not be aware of their risk for CVD. The National Heart, Lung, and Blood Institute (NHLBI)5 has recognized the necessity of increasing cardiovascular health promotion in the young adult population. NHLBI recommends engaging young adults in CVD research, and tailoring evidence-based treatments to integrate sociotechnical6 (e.g., Facebook or YouTube) approaches. College students would be an ideal population to begin the integration of positive health behaviors aimed at the prevention of CVD, as college is a pivotal time in which students engage in negative health behaviors and actively utilize sociotechnical approaches.
College Student Health and Risk Factors for Cardiovascular Disease
As in all age groups, cardiovascular health in young adults is impacted by alcohol use, nicotine, physical activity, eating habits, and stress. Previous reports7 have revealed that college students engage in negative health behaviors, such as increased alcohol and nicotine use, decreased physical activity, inadequate nutrition, and are exposed to high amounts of stress. A study by Manchester (2021)8 utilized National College Health Assessment (NCHA) data to examine the health changes of college students over the last 50 years. The study revealed there were significant changes in student health behaviors; data from the 2000 and 2019 surveys were primarily used to examine these changes.
The obesity rate in the 2000 survey was 8%. Nineteen years later the reported obesity rate was 16%, while 37% was the reported rate for overweight individuals. Respondents indicated that cigarette use decreased from 25% to 8.5% from 2000 to 2019, however, 15% of participants reported using e-cigarettes in the 2019 survey.
A total of 68% of the participants in the 2000 survey indicated they used alcohol one or more days during the previous month. While the wording of the survey questions changed between 2000 and 2019, yielding a different interpretation of results: weekly alcohol use was reported at a rate of 40% by respondents to the 2019 survey. Stress was not examined as a specific component of the survey series, but participants reported an increase in a diagnosis of depression from 10.3% to 19% and anxiety from 6.7% to 23.6% between 2000 and 2019. Nutrition and physical activity were not examined in this study.
Data from the fall 2021 American College of Health Association – National College Health Assessment (ACHA – NCHA)9 revealed that these negative health behaviors in college students should still be of concern. Twenty-two percent of the students reported being overweight, while 14.3% reported being obese. A total of 63% of respondents reported alcohol use within the last 3 months, and 19.3% reported both tobacco and nicotine use. There was a 16.5% response rate for eating 3 or more servings of fruit in the last 7 days and a 30.1% response rate for eating 3 or more servings of vegetables in the last 7 days. The majority of the respondents (69.1%) reported meeting guidelines for aerobic exercise only, while 39.7% of respondents reported meeting the guidelines for an active adult, which is the combination of national physical activity and strength training guidelines.
What sources of information should clinicians who work with college students utilize in identifying potential risk factors for this population? The American Heart Association (AHA)10 provides details on the eight risk factors that put an individual at an increased risk for heart disease. Based on this information, college students need continued prevention efforts in the areas of physical activity, nutrition, tobacco and alcohol use, and weight.
Implications for Future Research
Lederer and Oswalt11 provide further support for efforts to improve cardiovascular health in young adults by reporting the necessity of health promotion in college students, and the uniqueness of these efforts taking place in institutions of higher learning. These efforts will not only have the capacity to improve the health of the institutions of higher education but also the health of the nation. Additionally, these efforts coincide with the health promotion efforts described in the Healthy Campus Framework12 and Healthy People 2030.13 As nurse researchers employed at institutions of higher learning, we are uniquely positioned to initiate efforts that focus on CVD awareness in college students. We may also have opportunities to initiate the engagement of college students in CVD research, and tailor evidence-based treatments to integrate sociotechnical approaches. A study by Collins et al. (2018)14 revealed that student participation in research had positive outcomes for students. The authors revealed several ideas for engaging students in research, including offering incentives, expanding academic fields that offer research opportunities, and offering research participation opportunities to lower-division students. Additionally, a study by Goldestein et al. (2015)15 examined literature on negative health behaviors in college students and interventions designed to modify those behaviors and prevent CVD. Within that study, recommendations were provided on ways to improve CVD research in college students. Some of these recommendations included:
- Utilizing group format interventions
- Examining the effectiveness of technology and different modes of delivery in various settings
- Conducting long-term, tailored studies that target one health behavior at a time
- Addressing self-efficacy in interventions that focus on behavior modification
- Utilizing peer–mentorship programs
More research is needed to determine what evidence-based approaches are best to utilize or translate in the prevention of CVD in college students. Additionally, collaboration will also be necessary among faculty in public health and other allied fields to provide an interprofessional approach to preventing CVD in college students. Together, we can make an impact by improving the cardiovascular health of the young adults on campuses of all sizes and in every region.
- Arts J, Fernandez ML, Lofgren IE. Coronary heart disease risk factors in college students. Adv Nutr. 2014;5(2):177-187. Published 2014 Mar 1. doi:10.3945/an.113.005447
- Liu K, Daviglus ML, Loria CM, et al. Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: the Coronary Artery Risk Development in (Young) Adults (CARDIA) study. Circulation. 2012;125(8):996-1004. doi:10.1161/CIRCULATIONAHA.111.060681
- Abrignani MG, Lucà F, Favilli S, et al. Lifestyles and Cardiovascular Prevention in Childhood and Adolescence. Pediatr Cardiol. 2019;40(6):1113-1125. doi:10.1007/s00246-019-02152-w
- Bucholz EM, Gooding HC, de Ferranti SD. Awareness of Cardiovascular Risk Factors in U.S. Young Adults Aged 18-39 Years. Am J Prev Med. 2018;54(4):e67-e77. doi:10.1016/j.amepre.2018.01.022
- Gooding HC, Gidding SS, Moran AE, et al. Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group. J Am Heart Assoc. 2020;9(19):e016115. doi:10.1161/JAHA.120.016115
- Socio-Technical System Design. Accessed June 6, 2022.
- Reports_ACHA-NCHAIII. Accessed June 6, 2022.
- Manchester R. How has the health of college students changed in the last 50 years?. J Am Coll Health. 2020;68(8):795-797. doi:10.1080/07448481.2020.1859853
- Reference Group Executive Summary, Fall 2021. American College Health Association National College Health Assessment. Accessed June 4, 2022.
- My Life Check | Life’s Essential 8. www.heart.org. Accessed June 6, 2022.
- Lederer AM, Oswalt SB. The Value of College Health Promotion: A Critical Population and Setting for Improving the Public’s Health. Am J Health Educ. 2017;48(4):215-218. doi:10.1080/19325037.2017.1316692
- The healthy campus framework. American College Health Association. Accessed June 6, 2022.
- Healthy People 2030. U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. Accessed June 6, 2022.
- Collins TW, Grineski SE, Shenberger J, Morales X, Morera OF, Echegoyen LE. Undergraduate Research Participation Is Associated With Improved Student Outcomes at a Hispanic-Serving Institution. J Coll Stud Dev. 2017;58(4):583-600. doi:10.1353/csd.2017.0044
- Goldstein CM, Xie SS, Hawkins MAW, Hughes JW. Reducing Risk for Cardiovascular Disease: Negative Health Behaviors in College Students. Emerg Adulthood. 2015;3(1):24-36. doi:10.1177/2167696814536894