University of North Dakota Student Health & Wellness Data Summary Report

University of North Dakota Student Health & Wellness Data Summary Report

Data Analysis & Report was prepared and compiled by two UND Health & Wellness Assessment Coordinators: Brianna Crawford (M.A., Doctoral candidate Department of Counseling Psychology) and Masela Obade (M.Ed., Doctoral candidate Department of Teaching and Learning), with support from the Health & Wellness Assessment Team. For an electronic version of this report, please visit the University of North Dakota Health and Wellness website at http://und.edu/health-wellness. For more information, please contact: Jane Croeker, Health & Wellness Promotion Director Jane.Croeker@und.edu 701.777.2097

Introduction The health and wellness of college students remain important in supporting the mission of institutions of higher education. Here at the University of North Dakota (UND), the Health and Wellness Unit gathers information pertaining to a variety of student health behaviors. This report provides a summary of findings gleaned from two major assessments sources: 1) the 2010 National College Health Assessment (NCHA) survey, 2) the Core Alcohol and other Drug Survey (CORE 2010). Also included in this report is a brief analysis of the UND Counseling Center Data. Methods NCHA 2010 The National College Health Assessment (NCHA) is a survey instrument developed by the American College Health Association (ACHA). It is specifically designed to assist institutions of higher education in collecting data about the health of their students. It is used to generate data and self-reported rates of a variety of health issues, such as alcohol and tobacco use, sexual behavior, safety behaviors, and mental health. The NCHA survey has been administered at UND by the Student Health Services every other year dating back to the year 2000. Data collected have been used to plan student programs, prioritize campus needs, allocate resources, design strategies for interventions, and identify protective and risk factors associated with academic performance, as well as measure progress against national health objectives from Healthy People 2010, Healthy People 2020 (U.S. Dept. of Health and Human Services) and Healthy Campus 2010 (AHCA). Furthermore, the survey results have allowed for a comparative analysis with other institutions of higher education in the United States. In the spring of 2010, a random sample of 1,005 UND students responded the NCHA survey online after receiving invitations through their email. The results of this survey are compared to responses from students at 139 other institutions across the United States (Total N = 95,712). This group is referenced in the current report as 2010 National Reference Group (NRG). UND participants (N=1005) ranged in age from 18 to 58 years (M=23.18, SD=6.79). Regarding gender identity, 64.5% identified as female (N=648), 34.7% as male (N=349), 0.1% as Transgender (N=1), and 7 participants did not report their gender identity (0.7%). CORE 2010 The Core Alcohol and Drug Survey was developed in conjunction with the Core Institute of Southern Illinois University to measure alcohol and other drug usage, attitudes, and perceptions among college students at two and four-year institutions. Specifically, the North Dakota CORE Survey (NDCORE Survey) was developed to identify high-risk drinking predictors for North Dakota college students and used to develop evidence-based interventions specific to North Dakota and for each campus. The NDCORE Survey contains several items about alcohol and drugs, including questions specific to North Dakota culture. Included in the survey are questions regarding respondent demographics, alcohol and other drug use behaviors, and perceptions of alcohol and other drugs. Thirteen campus-specific questions were also included in UND s survey. All undergraduate students at UND had the opportunity to be included in this study through a stratified random sampling procedure, which included a total of 589 students. Students were drawn from all ethnic backgrounds, all colleges, and all classes (e.g. freshman, sophomore). 1

Findings Substance Use and Abuse Data on substance use and abuse among UND students was compiled from both the ACHA- NCHA-II and CORE surveys. As part of each survey, a national reference group was generated and matched to each sample and will be used herein for the purposes of comparison. Data on student use of alcohol, tobacco, illicit drugs, and prescription drugs are reported and discussed below. Alcohol Use and Abuse Self-Reported Alcohol Use In the past 30 days, 69.8% of students in the UND sample who completed the ACHA-NCHA-II survey reported using alcohol at least on one occasion. In the national reference group, 65.2% reported using alcohol at least once in the past 30 days. The following illustrates the frequency of alcohol use during a one month period for both groups (Table 1). Table 1 ACHA-NCHA-II Survey: Frequency of Alcohol use in the Past 30 Days Frequency % UND Students % National Reference Group Never used 16.4 20.9 Used, but not in past 30 days 13.8 13.9 1-9 days 59.0 49.7 10-29 days 10.4 14.3 Daily 0.4 1.1 Any use past 30 days 69.8 65.2 Similarly, results of the CORE survey indicate that 74.5% of UND respondents engaged in use of alcohol on at least one day during the past month, while 71.7% of the comparison group reported at least one use of alcohol in the past 30 days. The breakdown of the frequency of use is illustrated below (Table 2). Table 2 CORE Survey: Frequency of Alcohol Use in the Past 30 Days Frequency % UND Students 0 Days 25.5 1-9 Days 63.1 10-29 Days 11.1 Daily 0.3 Any use past 30 days 74.5 2

Figure 1 CORE AND ACHA-NCHA-II Surveys: Alcohol Use in the Last 30 Days 76.00% 74.00% 72.00% 70.00% 69.80% 74.50% UND Reference Group 68.00% 66.00% 65.20% 64.00% 62.00% 60.00% ACHA-NCHA-II Core The CORE survey also asked students to report on the average number of drinks they consumed in a one week period. The mean number of drinks consumed per week was 5.57 (SD = 8.2) for UND students and 5.2 for respondents in the national comparison group. Among UND students, males consumed a significantly greater number of alcoholic beverages per week than females (t(539) = 7.03, p = 000), with means of 8.29 (SD = 9.4) and 3.62 (SD = 6.0), respectively. The average number of drinks consumed per week did not differ significantly among individuals under age 21 versus individuals over age 21, freshman versus other undergraduates, or oncampus versus off-campus students. The ACHA-NCHA-II survey also asked students to indicate the number of drinks they consumed the last time they partied or socialized. Among those who reported engaging in alcohol use, UND students consumed an average of 3.96 (SD = 4.23) drinks the last time they partied or socialized while respondents from the national reference group consumed an average of 5.07 (SD = 4.21) alcoholic drinks the last time they partied or socialized. Significant differences in mean number of drinks consumed in a party or social setting emerged in terms of class status, year in school, residence, and approximate GPA (Table 3). First year undergraduates reported drinking significantly fewer drinks on average than other undergraduate students. More specifically, first year undergraduates consumed fewer drinks than fourth year undergraduates and graduate students consumed fewer drinks than third and fourth year undergraduates. On average, students living in Greek housing consumed a significantly greater number of alcoholic beverages while socializing or partying than students living in residence halls, other campus housing, or their parent/guardian s homes. Similarly, students living in other off-campus housing consumed a greater number of drinks than those living in other campus housing. Finally, students with a selfreported A grade point average (GPA) reported consuming significantly fewer alcoholic beverages while partying or socializing than students who reported having a B or C GPA. No significant differences were found in regard to age (under 18 versus over 18 years) or membership in a fraternity or sorority. 3

Table 3 ACHA-NCHA-II Survey: Average Number of Drinks Consumed Last Time Partied/Socialized UND Student Classification Mean Number Drinks SD Statistical Significance Class Status t(777) = -2.294; p = 0.022 Freshman Undergraduate 3.71 4.51 Other Undergraduate 4.54 4.51 Year in School F(7, 978) = 5.12; p = 0.000* 1st Year Undergraduate 3.71 4.51 2nd Year Undergraduate 3.93 4.622 3rd Year Undergraduate 4.61 3.96 4th Year Undergraduate 5.11 5.14 5th Year + Undergraduate 4.50 3.83 Graduate/Professional 2.73 2.68 Non-Degree Seeking 2.17 1.17 Other 3.50 4.55 Residence Campus Residence Hall 3.70 4.88 Fraternity/Sorority House 6.21 4.15 Other Campus Housing 2.62 2.92 Parent/Guardian's Home 2.56 3.45 Other Off-Campus Housing 4.42 3.84 Other 3.98 5.01 Approximate GPA A 3.19 3.25 B 4.59 4.24 C 5.61 7.43 D/F 4.89 3.37 N/A 2.58 3.06 F(5, 992) = 6.82; p = 0.000** F(4, 992) = 9.68; p = 0.000 ⱡ Age Group t (996) = -1.54; p = 0.125 18-20 Years 3.74 4.21 21+ Years 4.15 4.26 Fraternity/Sorority Membership t (990) = -1.74; p = 0.081 Yes 4.73 4.14 No 3.88 4.24 4

* First year undergraduates differed significantly from fourth year undergraduates. Graduate students differed significantly from third and fourth year undergraduates. ** Greek housing differed significantly from residence halls, other campus housing, and parent/guardian home; Other campus housing differed from other off-campus housing. ⱡ Students earning As differed significantly from students earning Bs and Cs. The CORE Survey asked students to indicate the places where they engage in alcohol use. Table 4 provides a breakdown on the places where students reported using alcohol. Table 4 CORE Survey: Location of Alcohol Use Location % UND Students On Campus 18.0 Residence Hall 44.0 Fraternity or Sorority House 47.2 Bar or Restaurant 36.0 Where Live 55.7 In Car 20.2 Private Parties 64.9 5

Abstaining from Alcohol Use According to the CORE survey results, 34.5% of UND students sampled reported that they do not engage in drinking on a weekly basis, while 25.5% of the sample indicated that they did not drink during the last 30 days. The CORE results also suggest that 13.8% of the UND student respondents have never used alcohol. Among them, more freshmen choose not to use alcohol than other undergraduate students (χ2 = 8.30; p = 0.004), more students under the age of 21 choose not to use alcohol when compared to those over age 21 (χ2 = 10.78; p = 0.001), and a larger percentage of students with a higher GPA choose not to use alcohol (χ2 = 7.95; p = 0.047). According to ACHA-NCHA-II survey results, 16.4% of UND students have never used alcohol, as compared to 20.9% of the national reference group. Additionally, 24.4% of UND students did not engage in alcohol use the last time they partied or socialized as compared to 26.9% of students in the national reference group. Over the last year, 22.3% of ACHA-NCHA-II respondents at UND always or most of the time choose not to drink alcohol and 18.8% reported never having binged on alcohol. High Risk Alcohol Use and Binge Drinking Binge drinking has been defined as consuming five or more drinks in one sitting (CORE Institute). Both the ACHA-NCHA-II and CORE surveys gather information about binge drinking among UND students. According to the ACHA-NCHA-II, 36.1% of UND students had engaged in binge drinking in the past two weeks; comparatively, 35.1% of students comprising the national reference group reported binge drinking over the same period. In 2000, 59.6% of UND students, and 38.2% of students in the national reference group acknowledged at least one episode of binge drinking over the course of two weeks. Thus, the past ten years represent a considerable decline (23% decrease) in binge drinking episodes among the students at UND (Figure 1 illustrates this change over time). Results from the CORE survey indicate that 49.9% of UND respondents reported binge drinking over the past two weeks. Frequency of binge drinking, as reported by students in the ACHA- NCHA-II and CORE survey samples, is illustrated in Table 5. Table 5 ACHA-NCHA-II and CORE Surveys: Frequency of Binge Drinking in the Past Two Weeks % UND Students - ACHA-NCHA-II Survey % Reference Group Students - ACHA- NCHA-II Survey % UND Students - CORE Survey None 63.9 64.9 50.1 Once 15.6 14.4 16.5 Twice 9.8 8.6 11.8 3-5 Times 9.4 9.6 16.1 6-9 Times 1.2 1.9 4.5 10+ Times 0.1 0.5 1 6

Based on the ACHA-NCHA-II data, differences in the presence of binge drinking were observed among students living at different residences (χ 2 = 47.11; p = 0.000), in different years in school (χ 2 = 47.14; p = 0.000), in graduate versus undergraduate enrollment (χ 2 = 29.82; p = 0.000), freshman versus other undergraduate class status (χ 2 = 4.57; p = 0.032) gender (χ 2 = 28.14; p = 0.000), GPA (χ 2 = 19.31; p = 0.001), and membership in a sorority or fraternity (χ 2 = 13.12; p = 0.000). No differences in binge drinking emerged as a result of age group (younger than 21 vs. older than 21; χ 2 = 0.86, p = 0.354). CORE survey data suggests that there are differences in frequency of binge drinking among different groups of UND students based on GPA, age group, and on-campus versus off-campus residence (Table 6). Table 6 CORE Survey: Differences in Frequency of Binge Drinking among Different Student Groups Student Group Frequency of Binge Drinking - Mean Standard Deviation Statistical Significance GPA F (3,560) = 3.818; p = 0.10* D 2.40 2.19 C 2.37 1.52 B 2.21 1.34 A 1.86 1.20 Age Group F(1,573) = 7.98; p = 0.005 Under 21 2.22 1.42 Over 21 1.89 1.45 Residence F(1,514) = 5.67; p = 0.018 On Campus 2.26 1.46 Off Campus 1.97 1.24 * Mean differences were significant for students with an "A" GPA versus those with a "B" GPA. 7

The ACHA-NCHA-II survey also addressed high risk behaviors such as drinking and driving. Among those who engaged in alcohol use in the last 30 days, 21.5% of the UND respondents reported driving after drinking any alcohol, while 17.9% of the comparison group acknowledged driving after drinking. Within the last 30 days, 2.9% of UND students and 2.8% of reference group respondents reported that they drove after having consumed five or more drinks (Figure 3). Figure 3 ACHA-NCHA-II Survey: Drinking and Driving 25 21.5 20 17.9 15 10 UND Students Reference Group 5 2.9 2.8 0 Drinking and Driving Binge Drinking and Driving 8

Consequences of Alcohol Use and Abuse The CORE survey inquired about negative consequences of alcohol and drug use. Figure 4 highlights the frequency of negative consequences reported by UND students as compared to respondents in the National Reference Group. Figure 4 CORE Survey: Negative Consequences of Alcohol and/or Drug Use 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 68.4 58.8 41.8 40.3 35.6 33.2 27.927.8 22.3 15.0 16.2 10.2 9.7 UND Student 5.5 4.2 2.4 3.5 0.3 0.2 Reference Group 9

The CORE survey also addressed the impact of others drinking on the respondent. Notably, 61.3% of UND respondents noted that others drinking does not interfere with their life. Figure 5 illustrates the type and frequency of interference due to others alcohol use. Figure 5 CORE Survey Impact of Others Drinking 70 61.3 60 50 40 30 20 10 0 Others' drinking does not interfere 21.4 Interrupts studying 18.5 Messes up the living space 14.6 Enjoyment of events % UND Students 4.1 Involvement in team or group In terms of the impact of others drinking, differences were found among groups of UND students. Females were more likely than males to report that others drinking interrupted their studying (χ 2 = 4.09; p = 0.043), while a greater number of other undergraduates as compared to freshman indicated that others drinking messed up their living space (χ 2 = 4.76; p = 0.029). Additionally, more freshman than other undergraduates felt unsafe due to others drinking (χ 2 = 4.54; p = 0.033), as did students younger than 21 (χ 2 = 8.37; p = 0.004), and students living on campus rather than off campus (χ 2 = 4.203; p = 0.040). The CORE survey also assessed for legal ramifications of alcohol use. Figure 6 illustrates the percentage of legal citations reported by UND students. Figure 6 CORE Survey: Legal Ramifications of Alcohol Use 18 16 14 12 10 8 6 4 2 0 16.3 1.9 1.4 0.7 % UND Students Minor in Possession DUI Disorderly Conduct Assault 10

Protective Behaviors Although these two surveys address high risk behaviors related to alcohol use, the ACHA- NCHA-II also seeks information about students use of protective behaviors in relation to using alcohol. Figure 7 illustrates protective behaviors that are always or most of the time reportedly implemented by UND students who engage in alcohol use (students who do not drink were excluded from analysis). Figure 7 ACHA-NCHA-II Survey: Protective Behaviors Related to Alcohol Use 100.0 90.0 80.0 UND Students Reference Group 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 11

Attitudes Regarding Alcohol Use The CORE survey also relates information on attitudes and perceptions regarding alcohol and other substance use at UND. Among UND students, 89.7% believe that alcohol is not required for a good time and 75.7% believe that alcohol should be available in social settings; 46.4% of respondents indicated that there are enough alcohol-free activities where they live. A majority (93.5%) of students reported their familiarity with campus alcohol and drug policies, and 55.3% reported having knowledge of alcohol and drug prevention programs on campus. In regard to prevention programs targeting alcohol and drug use, 76.3% of CORE survey respondents ascribed to the belief that UND is concerned about substance abuse prevention and 7.5% of these students reported active involvement in such prevention efforts. Tobacco Use Self-Reported Tobacco Use The CORE survey provides information regarding students self-reported average tobacco use within the past year. It also asks students to indicate their perception of average tobacco use among other students. Actual tobacco use versus perceived tobacco use is compared in Figure 8; discrepancies between actual and perceived use are evident in these data, as students attribute greater use of tobacco to their peers than the frequency of actually use reported. Figure 8 CORE Survey UND Students Self-Reported Tobacco Use vs. Perceived Student Use 70 60 50 60.2 % Self-Reported Use % Perceived Use 40 30 23.1 22.6 20 10 0 4.8 6.9 9.4 2.1 2.9 6.7 2.4 8.8 4.6 3.1 2.9 3.9 12.8 6.5 16.1 12

The ACHA-NCHA-II survey also asks students to describe their average use of tobacco products within the past 30 days (Table 7). This survey distinguishes among various forms of tobacco such as cigarettes, hookah (i.e. tobacco from a water pipe), cigar/clove cigarettes, and smokeless tobacco products. Table 7 ACHA-NCHA-II Survey: Average Tobacco Use in Past Month % UND Students Cigarettes Hooka Cigars/Clove Cigarette Smokeless Tobacco % Reference Group % UND Students % Reference Group % UND Students % Reference Group % UND Students % Reference Group Never Used 66.2 66.4 77.1 69.2 71.9 72.4 86.8 88.9 Past Use* 20.4 17.6 16.7 22.6 23.0 20.9 8.6 7.2 1-9 Days 7.5 8.1 6.0 7.2 4.9 5.8 2.0 2.1 10-29 Days 1.7 2.7 0.2 0.7 0.2 0.6 1.4 0.9 Daily Use 4.2 5.2 0.0 0.2 0.0 0.3 1.2 0.9 * Have used, but not in last 30 days The ACHA-NCHA-II Survey revealed significant differences in self-reported tobacco use among males and females (Table 8). There were also significant differences in tobacco use across different categories of self-reported GPA, with individuals with a higher GPA (i.e. A ) generally endorsing lower past and current tobacco use than those with a lower GPA (i.e. B or C ). Table 8 ACHA-NCHA-II Survey: Gender Differences in Tobacco Use Cigarettes Hooka Cigars/Clove Cigarette Smokeless Tobacco % Females % Males % Females % Males % Females % Males % Females % Males Never Used 69.0 61.2 82.5 67.0 80.8 55.0 95.0 71.6 Past Use* 19.4 21.8 12.9 23.8 17.5 33.5 4.3 16.3 Current Use 11.6 17.0 4.7 9.2 1.7 11.5 0.6 12.0 Significance χ 2 = 11.42, p = 0.022 χ 2 = 30.42, p = 0.000 χ 2 = 88.74, p = 0.000 χ 2 = 116.4, p = 0.000 * Have used, but not in last 30 days 13

Like the CORE Survey, the ACHA-NCHA-II Survey asked students to indicate their perceptions of tobacco use among their peers. UND student respondents reported on average that 33% (SD = 18.9) of their fellow students used cigarettes in the past 30 days. As 13.4% students actually reported use of cigarettes within the past month, this again represents a large discrepancy between perceived use among peers and actual use reported by students. The CORE survey further characterizes patterns of substance use, including age at first use (Figure 9) and the location of tobacco use (Table 9). The most common places for students to engage in tobacco use are at private parties (31.2%), where they live (26.8%), and in a car (26.3%). Figure 9 CORE Survey Age at First Use of Alcohol, Tobacco, and Marijuana 70.0 60.0 50.0 40.0 Alcohol Tobacco Marijuana 30.0 20.0 10.0 0.0 Never Used Under 10 10 to 11 12 to 13 14 to 15 16 to 17 18 to 20 21 to 25 26+ Table 9 CORE Survey: Location of Tobacco Use % UND Location* Students Residence Hall 12.5 Fraternity or Sorority House 15.3 Bar or Restaurant 12.7 Where Live 26.8 In Car 26.3 Private Parties 31.2 14

Abstaining from Tobacco Use According to the CORE Survey results, 51.9% of UND student respondents reported that they have never used tobacco. Additionally, 60.2% of the sample indicated that they did not engage in tobacco use within the past year and 73.6% reported no use within the past month. The ACHA- NCHA-II Survey results suggest somewhat higher abstinence from tobacco products, with 66.2% of student respondents denying use of cigarettes, 77.1% denying use of a hookah, 71.9% denying use of cigars or clove cigarettes, and 86.8% denying use of smokeless tobacco. Reference group abstinence rates for the ACHA-NCHA-II Survey are comparable to the rates of abstinence reported by UND students (Table 7). Illicit Drug Use Self-Reported Drug Use Both the CORE and ACHA-NCHA-II Surveys asked students to report on their frequency of drug use within the past 30 days. Table 10 illustrates the self-reported frequency of drug use in the past one month for each survey and provides the reference group comparison for each sample. Table 10 CORE and ACHA-NCHA-II Surveys Frequency of Drug Use in the Past 30 Days ACHA-NCHA-II Survey % UND Students % Reference Group CORE Survey % UND Students Marijuana None 94.4 83.1 86.0 1-9 Days 4.5 10.5 8.1 10-29 Days 0.9 3.8 3.6 Daily 0.2 2.6 2.2 Cocaine None 98.8 99.7 1-9 Days 0.9 0.4 10-29 Days 0.1 0.0 Daily 0.1 0.0 Methamphetamine* None 99.7 N/A 1-9 Days 0.2 N/A 10-29 Days 0.0 N/A Daily 0.1 N/A Other Amphetamines None 97.6 98.5 1-9 Days 1.4 0.8 10-29 Days 0.5 0.4 Daily 0.5 0.3 Sedatives None 98.0 100.0 1-9 Days 1.5 0.0 15

10-29 Days 0.3 0.0 Daily 0.2 0.0 Hallucinogens None 99.0 99.5 1-9 Days 0.8 0.5 10-29 Days 0.0 0.0 Daily 0.1 0.0 Steroids** None 99.7 99.7 1-9 Days 0.1 0.3 10-29 Days 0.0 0.0 Daily 0.1 0.0 Opiates None 99.4 100.0 1-9 Days 0.4 0.0 10-29 Days 0.1 0.0 Daily 0.1 0.0 Inhalants None 99.6 99.8 1-9 Days 0.3 0.2 10-29 Days 0.0 0.0 Daily 0.1 0.0 Ecstasy/MDMA None 98.8 99.3 1-9 Days 1.1 0.7 10-29 Days 0.0 0.0 Daily 0.1 0.0 Other Club Drugsⱡ None 99.7 N/A 1-9 Days 0.2 N/A 10-29 Days 0.0 N/A Daily 0.1 N/A Other Illegal Drugs None 98.8 N/A 1-9 Days 0.8 N/A 10-29 Days 0.2 N/A Daily 0.2 N/A * CORE Survey did not distinguish methamphetamine from amphetamines ** ACHA-NCHA-II Survey specifies anabolic steroids ⱡ Other Club Drugs include GHB, Ketamine, Rohypnol. Not queried in CORE Survey Other Illegal Drugs no queried in CORE Survey None specifies no use within the past 30 days; it may include past use or no history of use 16

Based on the data from both the CORE and ACHA-NCHA-II Surveys, marijuana was the most common illicit drug abused. Table 11 provides information from the CORE Survey related to the frequency of marijuana use over the past year among UND students. Table 11 CORE Survey: Frequency of Marijuana Use in the Last Year % UND Students Never Used 76.5 Once/Year 5.3 Six Times/Year 5.5 Once/Month 2.1 Twice/Month 2.9 Once/Week 0.9 Three Times/Week 2.4 Five Times/Week 1.9 Daily 2.6 Further analysis of the ACHA-NCHA-II data suggests that marijuana use (in the past month) is more common among undergraduate students when compared to graduate students (χ 2 = 7.52, p = 0.006). Additionally, there were differences in use of marijuana in regard to students current residence (χ 2 = 11.39, p = 0.04). Among those who reported marijuana use (5.6% of ACHA- NCHA-II UND student sample), 35.2% lived in a residence hall; 33.3% lived off campus; 9.26% lived in their parents home; and 7.41% lived in other campus housing, off campus, and in other housing, respectively (note: sample sizes of residence were not equally represented in this sample thus, a higher percentage of students participating overall lived in residence halls). In regard to frequency of marijuana use, differences were found in regard to approximate GPA (Welch F(4, 34.63) = 5.66, p = 0.001). Specifically, students with an A average were found to engage in less frequent marijuana use than students with a B and C GPA. 17

The CORE Survey provides specific data on patterns of drug use among UND students; in regard to marijuana, age at first use (Figure 9), location of use (Table 12), and sources of acquiring the drug (Table 13) are reported here. Table 12 CORE Survey: Location of Marijuana Use Location* % UND Students On Campus 1.9 In Residence Hall 6.2 Fraternity or Sorority 4.1 Bar or Restaurant 1.2 Where Live 12.0 In Car 16.2 Private Parties 19.0 Table 13 CORE Survey: Sources of Marijuana Source % UND Students Friends at School 63.0 Friends at Home 48.8 Self 4.9 Drug Dealer 24.7 Acquaintances 30.2 Parents 0.6 18

Abstaining from Drug Use Results from the CORE Survey suggest that the vast majority of UND students have abstained from the use of illicit drugs (Figure 11). Figure 11 CORE Survey: UND Students Abstaining from Drug Use 120.0 100.0 % UND Students 95.1 93.5 96.3 94.7 97.4 97.0 94.4 97.9 95.4 80.0 60.0 66.8 40.0 20.0 0.0 19

Prescription Drug Abuse Self-Reported Prescription Drug Abuse Both the CORE and ACHA-NCHA-II Surveys inquired about abuse of prescription medications among UND students. Overall, results from the CORE Survey indicate that 7.4% of UND students engaged in abuse of prescription drugs within the last year; Table 14 provides data related to the frequency of prescription drug use among UND students in the past year and over the past 30 days. Table 14 CORE Survey: Frequency of Prescription Drug Abuse in the Past Year and Month % UND Students Use in Past Year None 92.6 Once/Year 3.1 6 Times/Year 2.1 Once/Month 0.7 Twice/Month 1.0 Once/Week 0.5 Use in Past 30 Days None 97.2 1-2 Days 1.6 3-5 Days 0.9 6-9 Days 0.3 10-29 Days 0.0 Daily 0.0 20

The ACHA-NCHA-II Survey distinguishes between various forms of prescription drug abuse, including use of unprescribed antidepressants, erectile dysfunction drugs, pain killers, sedatives, and stimulants. Table 15 provides the results from the ACHA-NCHA-II Survey regarding UND students abuse of prescription drugs over the past year in comparison to abuse of prescription medication among the national reference group. Table 15 ACHA-NCHA-II Survey: Abuse of Prescription Drugs in the Past Year % UND Students % Reference Group Unprescribed Antidepressants 3.5 3.2 Unprescribed Erectile Dysfunction Drugs 1.4 1.0 Unprescribed Pain Killers 5.9 9.3 Unprescribed Sedatives 2.9 4.5 Unprescribed Stimulants 4.3 7.0 Further analyses of the ACHA-NCHA-II data reveal significant differences in use of stimulants among freshman versus other undergraduate (i.e. sophomore and higher) students, with freshman reporting lower use of unprescribed stimulant medications (χ 2 = 4.48, p = 0.034). Abstaining from Prescription Drug Abuse According to the CORE Survey, 90.8% of UND students reported that over the course of their life, they have never abused prescription drugs. Furthermore, 97.2% denied abuse of prescription drugs within the past 30 days and 92.6% denied use of unprescribed medication within the past year. 21

Social Relationships and Sexual Health The ACHA-NCHA-II Survey asks students to report on violence within intimate and social relationships as well as a variety of behaviors relating to sexual health, including number of sexual partners, sexual behaviors, and use of protection when engaging in sexual activity. Harassment and Violence in Intimate and Social Relationships Intimate Relationships and Self-Reported Trauma In regard to relationship status, 42.8% of UND student respondents of the ACHA-NCHA-II Survey indicated that they are not in a relationship; 34.8% reported that they are in relationship, but not living with their partner, while 22.4% reported that they are in a relationship and living with their partner. In terms of marital status, 15.2% indicated that they are married and 2.4% reported that they are divorced. Student respondents also indicated whether or not they had experienced physical, sexual, and/or emotional abuse in an intimate relationship within the past 12 months (Figure 12). Males and females did differ significantly in their experience of sexually abusive relationships (χ 2 = 5.50; p = 0.019); females were more likely to have experienced a sexually abusive relationship. No significant differences were found between the males and females in regard to the experience of a physically (χ 2 = 0.028; p = 0.868) or emotionally (χ 2 = 3.02; p = 0.082) abusive relationship. Additionally, there were no significant differences in experience of an abusive relationship in regard to one s current residence or membership in a fraternity or sorority. Table 15 ACHA-NCHA-II Survey: Abusive Relationships % Reference % UND Students Group Physically Abusive Relationship 1.8 2.5 Males 1.7 2.0 Females 1.9 2.0 Emotionally Abusive Relationship 7.7 10.0 Males 5.7 7.0 Females 8.8 11.0 Sexually Abusive Relationship * 1.0 1.6 Males 0.0 1.0 Females 1.6 2.0 *Statistically significant difference between males and females at p = 0.019. 22

Violence and Harassment within Social Relationships The ACHA-NCHA-II Survey also examined issues of violence and harassment within other social relationships. Table 16 provides the percentage of UND students reporting instances of physical, verbal, and sexual violence and stalking behavior in comparison to those comprising the national reference group. Gender differences in experiences of violence were examined among UND students. Statistically significant differences between males and females and their experience of physical fighting, verbal threats, attempts at sexual penetration without consent, and stalking were evident. A greater number of males reported being involved in a physical fight (χ 2 = 20.84; p = 0.000) and receiving verbal threats (χ 2 = 18.87; p = 0.000) than females. A larger percentage of females reported being the victim of stalking (χ 2 = 6.05; p = 0.014) and attempted sexual penetration without consent (χ 2 = 8.62; p = 0.003) than males. Table 16 ACHA-NCHA-II Survey: Experiences of Violence and Harassment % UND Students % Reference Group In a Physical Fight* 5.1 7.7 Male 9.5 Female 2.8 Victim of Physical Assault 3.1 4.7 Male 4.0 Female 2.6 Verbally Threatened* 18.7 20.9 Male 26.1 Female 14.8 Touched Sexually without Consent 4.2 6.0 Male 3.2 Female 4.6 Sexual Penetration Attempted without Consent** 2.1 2.3 Male 0.3 Female 3.1 Sexually Penetrated without Consent 1.1 1.5 Male 0.3 Female 1.5 Victim of Stalking ** 6.3 6.6 Male 3.7 Female 7.7 * Statistically significant gender differences among UND students; higher among males. ** Statistically significant gender differences among UND students; higher among females. 23

Sexual Health The ACHA-NCHA-II Survey asked students to report on their average number of sexual partners, sexual experiences in the past month, and their use of various forms of contraception and protection. Sexual Partners UND students reported having an average of 1.23 (SD = 1.69) sexual partners within the past 12 months. Students comprising the national reference group reported an average of 1.49 (SD = 3.03) sexual partners during the past year. Differences in number of sex partners was examined by gender, membership in a fraternity or sorority, relationship status, year in school, and approximate GPA for UND students (Table 17). Table 17 ACHA-NCHA-II Survey: Average Number of Sexual Partners in the Past 12 Months UND Students Mean (SD) Statistical Significance Number Sexual Partners 1.23 (1.69) Gender t(994) = -3.07; p = 0.002* Male 1.46 (2.36) Female 1.12 (1.17) Fraternity/Sorority Membership t(990) = -0.830; p = 0.407 Yes 1.39(1.34) No 1.22(1.72) Relationship Status t(992) = 0.760; p = 0.45 Not in a Relationship 1.26(2.18) In a Relationship 1.19(0.92) Year in School F(5, 362.19) = 1.221; p = 0.299 1st Year Undergraduate 1.13(1.49) 2nd Year Undergraduate 1.30(1.75) 3rd Year Undergraduate 1.14(1.15) 4th Year Undergraduate 1.38(1.58) 5th Year Undergraduate and Higher 1.51(1.91) Graduate Student 1.09(1.76) GPA F(4, 35.6) = 5.93; p = 0.001*ⱡ A 0.98(1.06) B 1.50(2.21) C 1.36(1.30) D/F 2.22(2.17) N/A 1.00(0.853) * Statistically significant at p < 0.05 ⱡ Students with an "A" average differ significantly from those with a "B" average Significant differences in number of sex partners in the past year were evident in regard to both gender and approximate GPA; specifically, males tended to have a greater number of sexual partners than females (t(994) = -3.07; p = 0.002) and students with a B average reported more sexual partners than students with an A average (F(4, 35.6) = 5.93; p = 0.001). 24

Sexual Activity In regard to sexual activity, students were also asked to specify whether or not they had engaged in oral sex, vaginal intercourse, or anal intercourse in the past 30 days. Table 18 ACHA-NCHA-II Survey: Sexual Activity among UND Students in the Past Month % UND Students % Reference Group % UND Males % UND Females Significance* Vaginal Intercourse χ 2 = 8.91; p = 0.012ⱡ Never 27.9 30.1 30.3 26.6 Have Done in Past 19.2 20.1 22.8 17.0 Current 53.0 49.8 47.0 56.5 Anal Intercourse χ 2 = 2.57; p = 0.276 Never 77.8 76.0 75.8 78.9 Have Done in Past 17.3 19.1 17.8 16.8 Current 4.9 4.9 6.4 4.2 Oral Sex χ 2 = 7.42; p = 0.025ⱡ Never 26.5 27.2 28.8 25.2 Have Done in Past 29.1 27.7 32.6 27.2 Current 44.4 45.1 38.6 47.6 * Statistical significance calculated for UND males versus females ⱡ Significant at p < 0.05 Gender differences were examined in regard to oral sex and anal and vaginal intercourse. Based on the data in Table 18, gender differences were observed for both oral sex and vaginal intercourse, but not anal intercourse. 25

Use of Protection Student respondents of the ACHA-NCHA-II Survey were asked whether or not they had used a condom or other protective barrier (i.e. male condom, female condom, dam, glove) during sexual activity in the past 30 days. Table 19 provides data on the frequency of use of a protective barrier reported by UND students as compared to the national reference group. Table 19 ACHA-NCHA-II Survey: Use of Protective Barrier during Sexual Activity in the Past Month % UND Students % Reference Group Vaginal Intercourse N/A* 45.4 46.2 Never 15.7 15.7 Rarely/Sometimes 8.4 10.7 Most of Time/Always 30.4 27.4 Anal Intercourse N/A* 90.0 88.6 Never 5.4 6.7 Rarely/Sometimes 1.5 1.5 Most of Time/Always 3.0 3.3 Oral Sex N/A* 50.1 48.7 Never 44.8 45.4 Rarely/Sometimes 3 3.3 Most of Time/Always 2.1 2.6 * Never did activity OR have done activity, but not in past month. Among students who did report sexual activity in the past month, differences in frequency of condom or other protective barrier use were examined in relation to gender, age group (age 18-20 vs. 21+), and membership in a fraternity or sorority. In regard to vaginal intercourse, significant gender differences emerged (χ 2 = 6.31; p = 0.043), with males generally reporting more frequent use of protective barriers than women. Significant differences in frequency of barrier use with vaginal intercourse were also found for the 18-20 versus 21+ age groups; individuals in the 18-20 age range reported more frequent use (most of the time or always) of a protective barrier than individuals in the 21+ age category (χ 2 = 42.88; p = 0.000). No other significant differences were observed. 26

Student respondents were also asked whether they used contraception during the last time they engaged in vaginal intercourse and, if applicable, which method(s) of birth control they employed. Table 20 provides data on the percentage of UND students who did or did not engage in use of contraceptives in comparison to students comprising the reference group, as well as the percentage of students choosing to use various forms of birth control. Table 20 ACHA-NCHA-II Survey: Use and Methods of Contraception Use of Contraception % UND Students % Reference Group Yes 61.8 56.6 N/A, have not had vaginal intercourse 26.4 28.0 No, did not have vaginal intercourse that could result in pregnancy 2.8 3.2 No, didn't want to prevent pregnancy 1.9 1.3 No, did not use any birth control method 5.9 8.4 Don't know 1.2 2.6 Method of Contraception* % UND Students % Reference Group Birth Control Pills 65.2 60.9 Birth Control Shots 2.7 3.0 Birth Control Implants 0.5 1.1 Birth Control Patch 1.7 1.3 Cervical Ring 3.3 4.9 Intrauterine Device (IUD) 3.3 4.3 Male Condom 66.3 61.2 Female Condom 0.7 0.7 Diaphragm or Cervical Cap 0.5 0.5 Contraceptive Sponge 0.3 0.4 Spermicide (foam, jelly, cream) 5.8 5.0 Fertility Awareness (calendar, mucous, basal body temperature) 8.2 5.4 Withdrawal 29.4 26.3 Sterilization (hysterectomy, tubes tied, vasectomy) 5.5 2.8 Other Method 2.3 2.3 * Methods of contraception are not mutually exclusive; multiple methods may have been employed. Among UND students, male condoms and birth control pills were the most common forms of contraception, followed by withdrawal (29.4%), which is not an effective method of contraception. 27

Among the UND student respondents who reported engaging in sexual intercourse in the past 12 months (N = 692 of 1005 respondents), 14.7% (N = 102) reported use of emergency contraception. Use of emergency contraceptives was further explored in regard to membership in fraternity or sorority, binge drinking, class status (i.e. freshman versus other undergraduate), age group (i.e. 18-20 vs. 21+), and undergraduate versus graduate status (Table 21). Table 21 ACHA-NCHA-II Survey: Use of Emergency Contraception among UND Students UND Student Classification % UND Students Endorsing Emergency Contraception Use Statistical Significance Fraternity/Sorority Membership χ 2 = 4.026; p = 0.045* Yes 27.8 No 15.0 Binge Drinking (Past 2 Weeks) χ 2 = 24.52; p = 0.000* Yes 27.7 No 9.9 Undergraduate Status χ 2 = 0.736; p = 0.391 Freshman 23.2 Other Undergraduate 18.8 Age Group χ 2 = 12.22; p = 0.000* 18-20 Years 23.1 21+ Years 10.9 Student Status χ 2 = 14.23; p = 0.000* Undergraduate 19.9 Graduate 4.6 * Statistically Significant at p 0.05 The results in Table 21 suggest that use of emergency contraception differs among students based on their membership in a fraternity or sorority, binge drinking behaviors, age group, and student status, with a greater likelihood of use among individuals reporting fraternity/sorority membership, binge drinking behavior, younger age, and undergraduate status. 28

Finally, UND student respondents of the ACHA-NCHA-II Survey reported on whether or not they or their partner became pregnant within the preceding 12 months; UND student responses to this question are compared with responses of the national reference group in Table 22. Table 22 ACHA-NCHA-II Survey: Pregnancy % UND Students % Reference Group N/A* 30.0 31.0 No 1.5 65.8 Yes, unintentionally 0.8 1.5 Yes, intentionally 1.4 0.8 Don't know 1.0 0.8 *Did not have vaginal intercourse in last 12 months. 29

Mental Health The ACHA-NCHA-II Survey inquires about students mental health; specifically, the survey asks students to report on their overall level of stress and various events or experiences that they find difficult to cope with or perceive as traumatic. It also asked students to acknowledge specific mental health symptoms and to indicate whether or not they have been diagnosed or treated for a mental health condition in the past year. Finally, the ACHA-NCHA-II Survey asked students if they have ever or would ever consider seeking mental health services from a variety of resources. In addition to the ACHA-NCHA-II Survey, data collected in the University of North Dakota Counseling Center has also informed an understanding of UND students mental health concerns and is presented here. Stress Level Student respondents of the ACHA-NCHA-II Survey indicated their overall stress level during the past 12 months; UND student responses are compared to those provided by students comprising the national reference group in Table 23. Based on this data, a majority of students appear to experience average to more than average levels of stress throughout the year. Table 23 ACHA-NCHA-II Survey: Stress Level over the Past 12 Months Stress Level % UND Students % Reference Group No Stress 1.0 1.9 Less than Average Stress 6.8 8.6 Average Stress 43.1 38.8 More than Average Stress 43.4 41.1 Tremendous Stress 5.7 9.6 30

Level of stress among UND students was further examined in relation to gender, employment, transfer student status, international student status, membership in a fraternity or sorority, GPA, and relationship status (Table 24). Table 24 ACHA-NCHA-II Survey: Mean Stress Level Examined by Student Characteristics Mean (SD) Statistical Significance Gender t(993) = 4.34; p = 0.000* Male 3.32 (0.71) Female 3.54 (0.80) Employment Status Employed 3.50 (0.72) t(994) = -2.09; p = 0.037* Unemployed 3.39 (0.81) Transfer Student Status t(985) = 0.023; p = 0.985 Yes 3.46 (0.77) No 3.46 (0.74) International Student Status t(987) = 1.88; p = 0.061 Yes 3.33 (0.81) No 3.48 (0.74) Fraternity/Sorority Membership t(989) = -1.34; p = 0.181 Yes 3.57 (0.67) No 3.45 (0.75) GPA F(3, 980) = 0.63; p = 0.595 A 3.46 (0.71) B 3.45 (0.76) C 3.42 (0.86) D/F 3.78 (0.83) Relationship Status t(853.39) = -0.48; p = 0.635 In a Relationship 3.47 (0.71) Not in a Relationship 3.45 (0.80) Statistically Significant at p < 0.05. Significant differences in mean level of stress were observed in regard to gender, as females appear to experience a greater level of stress than males, and employment status, as students who are employed appear to experience a greater level of stress than those students who are not. 31

The ACHA-NCHA-II Survey inquired about specific stressors that students found difficult to cope with or perceived as traumatic during the past year. Figure 12 provides the percentage of UND students that reported each of the stressors and the reference group comparisons. Figure 12 ACHA-NCHA-II Survey: Stressors that are Difficult to Cope with or Perceived as Traumatic 50 45 43.9 %UND Students 40 35 38 32.6 35.2 32.7 30 25 20 15 21 24.6 15.8 14.5 20.9 27.7 28.1 19.7 24.4 14.5 18.4 21.6 19.2 17.5 15.8 25.4 24.2 10 5 0 32

Mental Health Indicators The ACHA-NCHA-II Survey asked students to indicate if they have ever experienced a variety of mental health issues (i.e. felt things were hopeless, felt overwhelming anger or considered suicide). Figure 13 illustrates the percentage of UND students that reported such mental health indicators within the past one year and provides the percentage of reference group students who also acknowledged these issues for the purpose of comparison (note: data labels are provided for UND students in Figure 13 to indicate exact percentages). Figure 13 ACHA-NCHA-II Survey: Mental Health Issues Experienced within the Past Year 100 90 87.3 % UND Students 80 76.7 70 60 50 40 39.4 50.8 53.4 42.8 32.5 30 23.8 20 10 0 5.6 5.7 1.2 33

In addition to reporting on indicators of mental illness, student respondents of the ACHA- NCHA-II Survey also answered questions related to diagnosis and treatment of mental health conditions within the past 12 months. Table 24 lists the percentage of UND and reference group students who reported being diagnosed and/or treated for a mental health disorder within the past 12 months. Table 24 ACHA-NCHA-II Survey: Mental Health Diagnosis and/or Treatment within the Past 12 Months Mental Health Condition % UND Students - Diagnosed or Treated % Reference Group - Diagnosed or Treated Anorexia 0.6 0.9 Anxiety 8.9 10.4 ADHD 2.6 3.8 Bipolar Disorder 0.7 1.5 Bulimia 0.5 0.9 Depression 9.1 9.7 Insomnia 3.5 3.7 Other Sleep Disorder 1.7 2.2 Obsessive Compulsive Disorder 0.8 2.1 Panic Attacks 2.6 5.0 Phobia 0.5 1.0 Schizophrenia 0.0 0.4 Substance Abuse/Addiction 0.6 1.2 Other Addiction 0.4 0.6 Other Mental Health Condition 1.9 2.0 34

Help-Seeking for Mental Health The ACHA-NCHA-II Survey also inquired about history of help-seeking behavior for mental health; specifically, the survey asked student respondents to indicate if they ever sought mental health services from a counselor/psychologist, psychiatrist, other medical provider, member of the clergy, or from the University Health/Counseling Center (Table 25). Table 25 ACHA-NCHA-II Survey: Students Seeking Mental Health Services Mental Health Services % UND Students % Reference Group Counselor/Psychologist 30.2 33.5 Psychiatrist 10.6 12.6 Other Medical Provider 14.5 13.8 Clergy 6.6 7.1 University Health/Counseling Center 13.0 13.4 * Mental health services sought are not mutually exclusive; students may have visited multiple. Additionally, 67.7% of UND student respondents and 68.7% of the reference group respondents reported that they would consider seeking help from a mental health professional if they were to experience a personal problem in the future. Notably, statistically significant gender differences among UND students emerged in regard to previous help-seeking behavior and willingness to seek help for a personal problem in the future. A significantly greater percentage of women than men (33.9% and 23.1%, respectively) had sought mental health services from a counselor/psychologist (χ 2 = 12.32; p = 0.000). Similarly, a significantly greater percentage of women (17.8%) than men (8.4%) had also visited a medical provider for mental health issues (χ 2 = 16.31; p = 0.000). Finally, more female (71.9%) than male (59.5%) students reported that they would be willing to seek help from a mental health professional in the future if a personal problem were to arise (χ 2 = 15.84; p = 0.000). 35

University Counseling Center Data The University Counseling Center at UND (UCC) integrates ongoing clinical assessment into its general clinical practice; student clients who visit the UCC for services are regularly asked to complete an assessment measure known as the CCAPS-34 over the course of their treatment. The CCAPS-34 is an assessment measure designed for college counseling centers with the purpose of providing relevant clinical, research, and administrative information regarding symptom presentation and treatment progress over time allowing for comparison to a nationally generated peer group (http://ccmh.squarespace.com). The CCAPS-34 data will be used briefly here to describe the presenting issues of many UND students. Table 26 lists the average score (score range: 1-4) for each content area of the CCAPS-34 and compares it to the national average generated from the peer group data; data here represent students mean scores in each content area on the CCAPS-34 from 7/31/2010 through 6/30/2011. Table 26 CCAPS-34: UCC Average SCOREs within Symptom Sub-Scales UND Average score National Average score National SD UND SD* Depression 1.26 1.51 1.04-0.24 Generalized Anxiety 1.51 1.69 1.01-0.18 Social Anxiety 1.58 1.73 1.01-0.15 Academic Distress 1.72 1.92 1.13-0.18 Eating Concerns 0.75 0.92 1.14-0.15 Family Distress 0.00 0.00 0.00 0.00 Hostility 0.73 0.89 0.86-0.19 Substance Use 0.71 0.71 0.93 0.00 * Difference between UCC average and national average in SD units, which allows for direct comparison. A score of ± 1 indicates a significant deviation from national norms. No significant Differences are found in this UCC data. Based on the data in Table 26, UND students appear to share similar mental health concerns as students represented within the national reference group. No statistically significant differences exist in regard to mean symptom sub-scale scores, thus suggesting that UND students score similarly on measures of distress or symptom presentation as students in other counseling centers around the nation. 36

Physical Health and Health Prevention The ACHA-NCHA-II Survey asked students to report on perceptions of their overall health status and on behaviors related to the prevention of physical health problems (i.e. dental cleaning, use of sunscreen, STD testing). When asked to describe their general health, a majority of UND student respondents (93.5%) indicated that they were in good, very good, or excellent health. A breakdown of UND student responses is provided in Table 27 and is compared to those of students comprising the national reference group. Table 27 ACHA-NCHA-II Survey: Perceptions of Overall Health % UND Students % Reference Group Excellent 15.1 14.9 Very Good 44.6 44.5 Good 34.1 32.2 Fair 5.6 7.0 Poor 0.4 1.0 Don't Know 0.3 0.3 Among the UND students, differences between males and females were found in regard to perception of overall health, as males reported a significantly more favorable perception of their overall health than females (t(990) = 4.40, p = 0.000). 37

Respondents of the ACHA-NCHA were asked to indicate whether or not they had been diagnosed or treated by a professional for a variety of medical illnesses or conditions in the last 12 months. Table 28 provides the percentage of UND students who responded affirmatively for each condition and allows for a comparison to the national reference group. Table 28 ACHA-NCHA-II Survey: Medical Illnesses/Conditions within the Past 12 Months Medical Illness/Condition % UND Students % Reference Group Allergies 15.3 19.5 Asthma 7.0 8.8 Back Pain 14.1 12.5 Broken Bone/Sprain 7.5 7.7 Bronchitis 5.7 6.9 Chlamydia 0.3 1.1 Diabetes 0.9 1.1 Ear Infection 6.3 7.2 Endometriosis 0.7 0.8 Genital Herpes 0.2 0.8 Genital Warts/HPV 1.0 1.9 Gonorrhea 0.1 0.4 Hepatitis B or C 0.1 0.4 High Blood Pressure 2.7 3.3 High Cholesterol 2.6 3.1 HIV 0.1 0.3 Irritable Bowel Syndrome 2.7 2.6 Migraines 7.3 7.6 Mononucleosis 3.3 2.0 Pelvic Inflammatory Disease 0.1 0.3 Repetitive Stress Injury 1.7 1.9 Sinus Infection 19.3 18.2 Strep Throat 11.0 10.6 Tuberculosis 0.2 0.4 Urinary Tract Infection 9.5 9.8 38