Chapter 10 Taking Control of Your Health

Why Are So Many Americans Overweight?

Americans are eating too much—much more so than in the past. One-third of all Americans twenty years or older are obese. Another third of all adults are overweight. That means that two-thirds of us are not eating well or getting enough exercise for how we eat. There are many intertwined causes of this problem in American culture.

Why are being overweightHaving more body fat than is optimally healthy, often defined as a body mass index between 25 and 29.9. and obesityCondition in which body fat has accumulated to the point of having adverse health effects, often defined as a body mass index of 30 or greater. a problem? Obesity is associated with many medical conditions, including diabetes, cardiovascular disease, and some cancers. Although some health problems may not appear until later in life, diabetes is increasing rapidly in children and teenagers. Worse, the habits young adults may already have or may form during their college years generally continue into later years.

But it’s not just about body weight. Good nutrition is still important even if you don’t have a health problem. What you eat affects how you feel and how well you function mentally and physically. Food affects how well you study and how you do on tests. Doughnuts for breakfast can lower your grades!

Why Do Students Find It So Tough to Eat Healthily?

If Americans have trouble eating well in an environment that encourages overeating, college students often have it even worse. It seems like food is everywhere, and students are always snacking between classes. Fast food restaurants abound. There may not be time to get back to your dorm or apartment for lunch, and it’s just so easy to grab a quick pastry at the coffee spot as you pass by between classes.

It’s the eating by habit, or mindlessly, that usually gets us in trouble. If we’re mindful instead, however, it’s easy to develop better habits. Take the Nutrition Self-Assessment to evaluate your present eating habits.

Eating Well: It’s Not So Difficult

The key to a good diet is to eat a varied diet with lots of vegetables, fruits, and whole grains and to minimize fats, sugar, and salt. The exact amounts depend on your calorie requirements and activity levels, but you don’t have to count caloriesThe basic unit of food energy; consuming more calories in one’s diet than are used leads to weight gain. or measure and weigh your food to eat well. Following are the U.S. Department of Agriculture’s (USDA) general daily guidelines for a two-thousand-calorie diet.

• Grains (6 ounces)

  • Eat whole grain cereals, breads, rice, or pasta.

• Vegetables (2.5 cups)

  • Eat more dark green veggies like broccoli and spinach
  • Eat more orange vegetables like carrots and sweet potatoes
  • Eat more beans and peas

• Fruits (2 cups)

  • Eat a variety of fruit
  • Minimize fruit juices

• Milk (3 cups)

  • Choose low-fat or fat-free milk, yogurt, and other milk products
  • If you don’t drink milk, chose lactose-free products or other calcium sources such as fortified foods

• Meat and beans (5.5 ounces)

  • Choose low-fat or lean meats and poultry
  • Roast, broil, or grill the meat
  • Vary protein sources, including more fish, beans, peas, and nuts

• Minimize these (check food labels):

  • Solid fats like butter and margarine and foods that contain them (avoid saturated and trans fats)
  • Watch out for high-sodium foods
  • Minimize added sugars

• Exercise

  • Be physically active for at least thirty minutes most days of the week.

Figure 10.2 The USDA MyPyramid emphasizes healthful food choices.United States Department of Agriculture, “MyPyramid: Steps to a Healthier You,” http://www.mypyramid.gov/downloads/MiniPoster.pdf (accessed July 13, 2010).

If You Need to Lose Weight

If you need to lose weight, don’t try to starve yourself. Gradual steady weight loss is healthier and easier. Try these guidelines:

1. Check your body mass index (BMI)A measure of a person’s weight in relation to height, used medically to determine whether a person is underweight, of normal weight, overweight, or obese. to see the normal weight range for your height (see “Additional Resources” below for more information).
2. Go to http://www.MyPyramid.gov for help determining your ideal caloric intake for gradual weight loss.
3. Set your goals and make a plan you can live with. Start by avoiding snacks and fast foods. Try to choose foods that meet the guidelines listed earlier.
4. Stay active and try to exercise frequently.
5. Keep a daily food journal and write down what you eat. Simply writing it down helps people be more aware of their habits and motivated to eat better.
6. Visit the student health center on your campus and ask for more information about weight loss programs.
7. Remember, no one plan works for everyone. Visit the online resources listed later for a variety of approaches for weight loss.

Avoiding the Freshman Fifteen

The “freshman fifteen” refers to the weight gain many students experience in their first year of college. Even those whose weight was at an appropriate level often gained unwanted pounds because of changes in their eating habits.

Start by looking back at the boxes you checked in the Nutrition Self-Assessment. Be honest with yourself. If your first choice for a snack is cookies, ice cream, or chips, think about that. If your first choice for lunch is a burger and fries, have you considered other choices?

Eating Disorders

The most common eating disorders are anorexia, bulimia, and binge eating.

AnorexiaAn eating disorder involving a loss of the desire to eat, often as a result of psychological problems related to how a person perceives her or his appearance. is characterized by excessive weight loss and self-starvation. The individual usually feels “fat” regardless of how thin she or he becomes and may continue to eat less and less. If your BMI is lower than the bottom of the normal range, you may be developing anorexia.

BulimiaAn eating disorder involving frequent binge eating followed by compensatory behaviors such as vomiting. is characterized by frequent binge eating followed by an attempt to compensate for or “undo” the overeating with a behavior such as self-induced vomiting or laxative abuse.

Binge eatingAn eating disorder involving frequent binge eating not followed by compensatory behaviors. disorder is characterized by frequent binge eating without compensatory behavior to “undo” the overeating. Binge eating usually leads to weight gain and eventual obesity.

More than ten million Americans suffer from an eating disorder. The causes are complex, and the individual usually needs help to overcome their obsession. Eating disorders hurt one’s health in a variety of ways and can become life threatening. The signs of a possible eating disorder include the following:

• Eating secretly when others can’t see
• Having a strong fear of being overweight or gaining weight
• Only eating a limited number of foods
• Exercising obsessively
• Lacking a monthly menstrual period

Does Exercise Really Matter?

Exercise is good for both body and mind. Indeed, physical activity is almost essential for good health and student success. The physical benefits of regular exercise include the following:

• Improved fitness for the whole body, not just the muscles
• Greater cardiovascular fitnessHaving a healthy heart and blood vessels. and reduced disease risk
• Increased physical endurance
• Stronger immune systemThe body system, involving many different organs and body tissues, responsible for defending the body against infection and disease., providing more resistance to disease
• Lower cholesterolA fat-like substance, made by the body and found naturally in animal foods, that when in excess levels in the body contributes to cardiovascular disease. levels, reducing the risks of cardiovascular disease
• Lowered risk of developing diabetesA disease in which the body has high levels of sugar in the blood because of an inability to manage blood glucose; diabetes is associated with a range of serious health problems.
• Weight maintenance or loss

Perhaps more important to students are the mental and psychological benefits:

• Stress reduction
• Improved mood, with less anxiety and depression
• Improved ability to focus mentally
• Better sleep
• Feeling better about oneself

For all of these reasons, it’s important for college students to regularly exercise or engage in physical activity. Like good nutrition and getting enough sleep, exercise is a key habit that contributes to overall wellnessA state of physical, emotional, mental, and social well-being, not merely the absence of disease. that promotes college success. First, use the Exercise and Activity Self-Assessment to consider your current habits and attitudes.

How Much Exercise and What Kind?

With aerobic exerciseBrisk physical activity that requires the heart and lungs to work harder to meet the body’s increased oxygen needs., your heart and lungs are working hard enough to improve your cardiovascular fitness. This generally means moving fast enough to increase your heart rate and breathing. For health and stress-reducing benefits, try to exercise at least three days a week for at least twenty to thirty minutes at a time. If you really enjoy exercise and are motivated, you may exercise as often as six days a week, but take at least one day of rest. When you’re first starting out, or if you’ve been inactive for a while, take it gradually, and let your body adjust between sessions. But the old expression “No pain, no gain” is not true, regardless of what some past gym teacher may have said! If you feel pain in any activity, stop or cut back. The way to build up strength and endurance is through a plan that is consistent and gradual.

For exercise to have aerobic benefits, try to keep your heart rate in the target heart rateThe level of heartbeat that gives you the best workout: about 60 to 85 percent of your maximum heart rate, which is typically calculated as 220 minus your age. zone for at least twenty to thirty minutes. The target heart rate is 60 percent to 85 percent of your maximum heart rate, which can be calculated as 220 minus your age. For example, if you are 24 years old, your maximum heart rate is calculated as 196, and your target heart rate is 118 to 166 beats per minute. If you are just starting an exercise program, stay at the lower end of this range and gradually work up over a few weeks. “Additional Resources” below includes an online calculator that estimates your target heart rate depending on your present level of fitness.

Campus Activities Can Help

Most campuses have resources to make exercise easier and more enjoyable for their students. Take a look around and think about what you might enjoy. A fitness center may offer exercise equipment. There may be regularly scheduled aerobic or spin classes. You don’t have to be an athlete to enjoy casual sports such as playing tennis or shooting hoops with a friend. If you like more organized team sports, try intramural sports.

The Importance of a Good Night’s Sleep

You may not realize the benefits of sleep, or the problems associated with being sleep deprived, because most likely you’ve had the same sleep habits for a long time. Or maybe you know you’re getting less sleep now, but with all the changes in your life, how can you tell if some of your stress or problems studying are related to not enough sleep?

On the positive side, a healthy amount of sleep has the following benefits:

• Improves your mood during the day
• Improves your memory and learning abilities
• Gives you more energy
• Strengthens your immune system
• Promotes wellness of body, mind, and spirit

In contrast, not getting enough sleep over time can lead to a wide range of health issues and student problems. Sleep deprivationA chronic lack of sufficient restorative sleep. can have the following consequences:

• Affects mental health and contributes to stressA natural response of the body and mind to a demand or challenge, often associated with feelings of tension and negative emotions. and feelings of anxiety, depression, and general unhappiness
• Causes sleepiness, difficulty paying attention in class, and ineffective studying
• Weakens the immune system, making it more likely to catch colds and other infections
• Increases the risk of accidents (such as while driving)
• Contributes to weight gain

How Much Sleep Is Enough?

College students are the most sleep-deprived population group in the country. With so much to do, who has time for sleep?

Most people need seven to nine hours of sleep a night, and the average is around eight. Some say they need much less than that, but often their behavior during the day shows they are actually sleep deprived. Some genuinely need only about six hours a night. New research indicates there may be a “sleep gene” that determines how much sleep a person needs. So how much sleep do you actually need?

There is no simple answer, in part because the quality of sleep is just as important as the number of hours a person sleeps. Sleeping fitfully for nine hours and waking during the night is usually worse than seven or eight hours of good sleep, so you can’t simply count the hours. Do you usually feel rested and alert all day long? Do you rise from bed easily in the morning without struggling with the alarm clock? Do you have no trouble paying attention to your instructors and never feel sleepy in a lecture class? Are you not continually driven to drink more coffee or caffeine-heavy “power drinks” to stay attentive? Are you able to get through work without feeling exhausted? If you answered yes to all of these, you likely are in that 10 percent to 15 percent of college students who consistently get enough sleep.

How to Get More and Better Sleep

You have to allow yourself enough time for a good night’s sleep. Using the time management strategies discussed in Chapter 2 "Staying Motivated, Organized, and On Track", schedule at least eight hours for sleeping every night. If you still don’t feel alert and energetic during the day, try increasing this to nine hours. Keep a sleep journal, and within a couple weeks you’ll know how much sleep you need and will be on the road to making new habits to ensure you get it.

If you can’t fall asleep after ten to fifteen minutes in bed, it’s better to get up and do something else rather than lie there fitfully for hours. Do something you find restful (or boring). Read, or listen to a recorded book. Go back to bed when you’re sleepy.

If you frequently cannot get to sleep or are often awake for a long time during the night, you may be suffering from insomniaAn inability to sleep; chronic sleeplessness., a medical condition. Resist the temptation to try over-the-counter sleep aids. If you have tried the tips listed here and still cannot sleep, talk with your health-care provider or visit the student health clinic. Many remedies are available for those with a true sleep problem.

Smoking and Tobacco: Why Start, and Why Is It So Hard to Stop?

Everyone knows smoking is harmful to one’s health. Smoking causes cancer and lung and heart disease. Most adult smokers continue smoking not because they really think it won’t harm them but because it’s very difficult to stop.

If you have never smoked or used smokeless tobacco, feel good about your choices. But read this section anyway because you may have friends now or in the future who smoke, and it’s important to understand this behavior. If you do smoke, even only rarely as a “social smoker,” be honest with yourself—wouldn’t you like to stop if you thought you could without suffering? Simply by being in college now, you’ve shown that you care about your future and your life. You likely care about your health, too.

Many young smokers think there is plenty of time to quit later. Social smokers, who may have a cigarette only occasionally with a friend, usually think they won’t develop a habit. But smokers are fooling themselves. NicotineA habit-forming stimulant found in tobacco, which raises blood pressure, increases heart rate, and has toxic effects throughout the body. is one of the most addictive drugs in our society today. Admitting this to yourself is the first step toward becoming smoke free.

First, the good news. Stopping smoking brings immediate health benefits, and the benefits get better over time. Just twenty minutes after quitting, your heart rate drops. After two weeks to three months, your heart attack risk begins to drop and your lung function begins to improve. After one year, your added risk of coronary heart diseaseA heart disease caused by damage to the arteries that supply blood and oxygen to the heart. is half that of a smoker’s. And every year your health continues to improve.

Tips for Stopping Smoking

Stopping isn’t easy. Many ex-smokers say it was the hardest thing they ever did. Still, over 45 million adults in the United States once smoked and then successfully stopped.

You know it’s worth the effort. And it’s easier if you think it through and make a good plan. There’s lots of help available. Before you quit, the National Cancer Institute suggests you START with these five important steps:

1. S = Set a quit date.
2. T = Tell family, friends, and coworkers that you plan to quit.
3. A = Anticipate and plan for the challenges you’ll face while quitting.
4. R = Remove cigarettes and other tobacco products from your home, car, and work.
5. T = Talk to your doctor about getting help to quit.

To get ready, download the booklet “Clearing the Air: Quit Smoking Today” at http://www.smokefree.gov. The table of contents of that booklet (Figure 10.3) outlines the basic steps that will help you be successful.

Figure 10.3

“Clearing the Air,” a downloadable booklet available at http://www.smokefree.gov, presents a plan for stopping smoking that works for many smokers.

When You Really Crave a Cigarette

Remember that the urge to smoke will come and go. Try to wait it out. Use these tips:

• Keep other things around instead of cigarettes. Try carrots, pickles, sunflower seeds, apples, celery, raisins, or sugar-free gum.
• Wash your hands or the dishes when you want a cigarette very badly. Or take a shower.

• Learn to relax quickly by taking deep breaths.

  • Take ten slow, deep breaths and hold the last one.
  • Then breathe out slowly.
  • Relax all of your muscles.
  • Picture a soothing, pleasant scene.
  • Just get away from it all for a moment.
  • Think only about that peaceful image and nothing else.
• Light incense or a candle instead of a cigarette.
• Where you are and what is going on can make you crave a cigarette. A change of scene can really help. Go outside or go to a different room. You can also try changing what you are doing.
• No matter what, don’t think, “Just one won’t hurt.” It will hurt. It will undo your work so far.
• Remember that trying something to beat the urge is always better than trying nothing.Smokefree.gov, “Quit Guide: Quitting,” http://www.smokefree.gov (accessed July 13, 2010).

What’s the Big Deal about Alcohol?

Of all the issues that can affect a student’s health and success in college, drinking causes more problems than anything else. Everyone knows what happens when you drink too much. Your judgment is impaired and you may behave in risky ways. Your health may be affected. Your studies likely are affected.

Most college students report drinking at least some alcohol at some time—and even those who do not drink are often affected by others who do. Here are a few facts about alcohol use among college students from the National Institute on Alcohol Abuse and Alcoholism:

• Death. Each year, 1,700 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, and 599,000 students are injured.
• Assault. More than 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
• Sexual abuse. More than 97,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape.
• Academic problems. About 25 percent of college students report academic consequences of their drinking, including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall.
• Health problems. More than 150,000 students develop an alcohol-related health problem.
• Alcohol abuse and dependence. In the past twelve months, 31 percent of college students met criteria for a diagnosis of alcohol abuse and 6 percent for a diagnosis of alcohol dependenceBeing abnormally tolerant to and dependent on something that is psychologically or physically habit forming (especially alcohol or narcotic drugs); addiction..National Institute on Alcohol Abuse and Alcoholism, “A Snapshot of Annual High-Risk College Drinking Consequences,” College Drinking—Changing the Culture, http://www.collegedrinkingprevention.gov/StatsSummaries/snapshot.aspx (accessed July 13, 2010).

So why is drinking so popular if it causes so many problems? You probably already know the answer to that: most college students say they have more fun when drinking. They’re not going to stop drinking just because someone lectures them about it.

Like everything else that affects your health and happiness—eating, exercise, use of other substances—drinking is a matter of personal choice. Like most decisions we all face, there are trade-offs. The most that anyone can reasonably ask of you is to be smart in your decisions. That means understanding the effects of alcohol and deciding to take control.

College Alcohol Awareness Programs

Colleges have recognized the problems resulting from underage and excessive alcohol use, and in recent years they have designed programs to help students become more aware of the problems. If you are a new student, you may be in such a program now. Two popular online programs, AlcoholEdu and My Student Body, are used at many schools.

Figure 10.4 The AlcoholEdu Online Alcohol Awareness Program from Outside the Classroom

The goal of these courses is not to preach against drinking. You’ll learn more about the effects of alcohol on the body and mind. You’ll learn about responsible drinking versus high-risk drinking. You’ll think about your own attitudes and learn coping strategies to help prevent or manage a problem. These courses are designed for you—to help you succeed in college and life. They’re worth taking seriously.

Prescription and Illegal Drugs

People use drugs for the same reasons people use alcohol. They say they enjoy getting high. They may say a drug helps them relax or unwind, have fun, enjoy the company of others, or escape the pressures of being a student. While alcohol is a legal drug for those above the drinking age, most other drugs—including the use of many prescription drugsA drug prescribed to a specific person for a specific medical condition by a health-care provider; many prescription drugs are illegal when used by someone other than the person for whom it was prescribed. not prescribed for the person taking them—are illegal. They usually involve more serious legal consequences if the user is caught. Some people may feel there’s safety in numbers: if a lot of people are using a drug, or drinking, then how can it be too bad? But other drugs carry the same risks as alcohol for health problems, a risk of death or injury, and a serious impact on your ability to do well as a student.

As with alcohol, the choice is yours. What’s important is to understand what you’re doing and make smart choices. What’s the gain, and what are the risks and costs?

While society may seem to condone drinking, and the laws regarding underage drinking or being drunk in public may not seem too harsh, the legal reality of being caught with an illegal drug can impact the rest of your life. Arrest and conviction may result in being expelled from college—even with a first offense. A conviction is a permanent legal record that can keep you from getting the job you may be going to college for.

Although the effects of different drugs vary widely, a single use of a drug can have serious effects and consequences. Even if you’re told that a pill is a prescription medication whose effects are mild or safe, can you really be sure of the exact ingredients and strength of that pill? Do you fully understand how it can affect you with repeated use? Can it be addictive? Could it show up on an unexpected random drug test at work?

Table 10.1 "Common Prescription and Illegal Drugs on Campuses" lists some of the possible effects of drugs used by college students. Good decisions also involve being honest with oneself. Why do I use (or am thinking about using) this drug? Am I trying to escape some aspect of my life (stress, a bad job, a boring class)? Could the effects of using this drug be worse than what I’m trying to escape?

What Causes Stress?

Not all stressors are bad things. Exciting, positive things also cause a type of stress, called eustressA positive and stimulating kind or level of stress.. Falling in love, getting an unexpected sum of money, acing an exam you’d worried about—all of these are positive things that affect the body and mind in ways similar to negative stress: you can’t help thinking about it, you may lose your appetite and lie awake at night, and your routine life may be momentarily disrupted.

But the kind of stress that causes most trouble results from negative stressors. Life events that usually cause significant stress include the following:

• Serious illness or injury
• Serious illness, injury, or death of a family member or loved one
• Losing a job or sudden financial catastrophe
• Unwanted pregnancy
• Divorce or ending a long-term relationship (including parents’ divorce)
• Being arrested or convicted of a crime
• Being put on academic probation or suspended

Life events like these usually cause a lot of stress that may begin suddenly and disrupt one’s life in many ways. Fortunately, these stressors do not occur every day and eventually end—though they can be very severe and disruptive when experienced. Some major life stresses, such as having a parent or family member with a serious illness, can last a long time and may require professional help to cope with them.

Everyday kinds of stressors are far more common but can add up and produce as much stress as a major life event:

• Anxiety about not having enough time for classes, job, studies, and social life
• Worries about grades, an upcoming test, or an assignment
• Money concerns
• Conflict with a roommate, someone at work, or family member
• Anxiety or doubts about one’s future or difficulty choosing a major or career
• Frequent colds, allergy attacks, other continuing health issues
• Concerns about one’s appearance, weight, eating habits, and so on.
• Relationship tensions, poor social life, loneliness
• Time-consuming hassles such as a broken-down car or the need to find a new apartment
• _______________________________________
• _______________________________________
• _______________________________________

Take a moment and reflect on the list above. How many of these stressors have you experienced in the last month? The last year? Circle all the ones that you have experienced. Now go back to your Stress Self-Assessment and look at what you wrote there for causes of your stress. Write any additional things that cause you stress on the blank lines above.

How many stressors have you circled and written in? There is no magic number of stressors that an “average” or “normal” college student experiences—because everyone is unique. In addition, stressors come and go: the stress caused by a midterm exam tomorrow morning may be gone by noon, replaced by feeling good about how you did. Still, most college students are likely to circle about half the items on this list.

But it’s not the number of stressors that counts. You might have circled only one item on that list—but it could produce so much stress for you that you’re just as stressed out as someone else who circled all of them. The point of this exercise is to start by understanding what causes your own stress as a base for learning what to do about it.

What’s Wrong with Stress?

Physically, stress prepares us for action: the classic “fight-or-flight” reaction when confronted with a danger. Our heart is pumping fast, and we’re breathing faster to supply the muscles with energy to fight or flee. Many physical effects in the body prepare us for whatever actions we may need to take to survive a threat.

But what about nonphysical stressors, like worrying about grades? Are there any positive effects there? Imagine what life would feel like if you never had worries, never felt any stress at all. If you never worried about grades or doing well on a test, how much studying would you do for it? If you never thought at all about money, would you make any effort to save it or make it? Obviously, stress can be a good thing when it motivates us to do something, whether it’s study, work, resolving a conflict with another, and so on. So it’s not stress itself that’s negative—it’s unresolved or persistent stress that starts to have unhealthy effects. Chronic (long-term) stress is associated with many physical changes and illnesses, including the following:

• Weakened immune systemThe body system, involving many different organs and body tissues, responsible for defending the body against infection and disease., making you more likely to catch a cold and to suffer from any illness longer
• More frequent digestive system problems, including constipation or diarrhea, ulcers, and indigestion
• Elevated blood pressureThe pressure blood exerts on the walls of blood vessels, resulting from complex processes in the body; high blood pressure is associated with several diseases and health problems.
• Increased risk of diabetesA disease in which the body has high levels of sugar in the blood because of an inability to manage blood glucose; diabetes is associated with a range of serious health problems.
• Muscle and back pain
• More frequent headaches, fatigue, and insomniaAn inability to sleep; chronic sleeplessness.
• Greater risk of heart attack and other cardiovascular problems over the long term

Chronic or acute (intense short-term) stress also affects our minds and emotions in many ways:

• Difficulty thinking clearly or concentrating
• Poor memory
• More frequent negative emotions such as anxiety, depression, frustration, powerlessness, resentment, or nervousness—and a general negative outlook on life
• Greater difficulty dealing with others because of irritability, anger, or avoidance

No wonder we view stress as such a negative thing! As much as we’d like to eliminate all stressors,however, it just can’t happen. Too many things in the real world cause stress and always will.

Unhealthy Responses to Stress

Since many stressors are unavoidable, the question is what to do about the resulting stress. A person can try to ignore or deny stress for a while, but then it keeps building and starts causing all those problems. So we have to do something.

Consider first what you have typically done in the past when you felt most stressed; use the Past Stress-Reduction Habits Self-Assessment.

What’s wrong with those stress-reduction behaviors listed first? Why not watch television or get a lot of sleep when you’re feeling stressed, if that makes you feel better? While it may feel better temporarily to escape feelings of stress in those ways, ultimately they may cause more stress themselves. If you’re worried about grades and being too busy to study as much as you need to, then letting an hour or two slip by watching television will make you even more worried later because then you have even less time. Eating too much may make you sluggish and less able to focus, and if you’re trying to lose weight, you’ll now feel just that much more stressed by what you’ve done. Alcohol, caffeine, smoking, and drugs all generally increase one’s stress over time. Complaining to friends? Over time, your friends will tire of hearing it or tire of arguing with you because a complaining person isn’t much fun to be around. So eventually you may find yourself even more alone and stressed.

Yet there is a bright side: there are lots of very positive ways to cope with stress that will also improve your health, make it easier to concentrate on your studies, and make you a happier person overall.

Coping with Stress

Look back at your list of stressors that you circled earlier. For each, consider whether it is external (like bad job hours or not having enough money) or internal, originating in your attitudes and thoughts. Mark each item with an E (external) or an I (internal).

You may be able to eliminate many external stressors. Talk to your boss about changing your work hours. If you have money problems, work on a budget you can live with (see Chapter 11 "Taking Control of Your Finances"), look for a new job, or reduce your expenses by finding a cheaper apartment, selling your car, and using public transportation.

What about other external stressors? Taking so many classes that you don’t have the time to study for all of them? Keep working on your time management skills (Chapter 2 "Staying Motivated, Organized, and On Track"). Schedule your days carefully and stick to the schedule. Take fewer classes next term if necessary. What else can you do to eliminate external stressors? Change apartments, get a new roommate, find better child care—consider all your options. And don’t hesitate to talk things over with a college counselor, who may offer other solutions.

Internal stressors, however, are often not easily resolved. We can’t make all stressors go away, but we can learn how to cope so that we don’t feel so stressed out most of the time. We can take control of our lives. We can find healthy coping strategies.

All the topics in this chapter involve stress one way or another. Many of the healthy habits that contribute to our wellness and happiness also reduce stress and minimize its effects.

Problematic Emotions

When is an emotion problematic? Is it bad to feel anxious about a big test coming up or to feel sad after breaking up a romantic relationship?

It is normal to experience negative emotions. College students face so many demands and stressful situations that many naturally report often feeling anxious, depressed, or lonely. These emotions become problematic only when they persist and begin to affect your life in negative ways. That’s when it’s time to work on your emotional health—just as you’d work on your physical health when illness strikes.

Achieving Emotional Balance

Emotional balance is an essential element of wellnessA state of physical, emotional, mental, and social well-being, not merely the absence of disease.—and for succeeding in college. Emotional balance doesn’t mean that you never experience a negative emotion, because these emotions are usually natural and normal. Emotional balance means we balance the negative with the positive, that we can be generally happy even if we’re saddened by some things.

Emotional balance starts with being aware of our emotions and understanding them. If you’re feeling angry, stop and think about the real cause of your anger. Are you really angry because your friend said something about one of your bad habits, or are you angry because you haven’t been able to break that habit? Are you feeling anxiety because you’re worried you might not be cut out for college, or are you just anxious about that test tomorrow?

See the “Tips for Success” for other ways you can achieve and maintain a healthy emotional balance.

Relationships

Romantic relationships are often as much a part of a rich emotional life for college students as for anyone else. But the added challenges of college, especially while also working and maintaining a family life, often stress these relationships. You may have to give extra attention to a relationship to keep it healthy and avoid conflicts that lead to unhappiness and other problems.

Sexual Values and Decisions

It’s often difficult to talk about sexuality and sex. Not only is it a very private matter for most people, but the words themselves are often used loosely, resulting in misunderstandings. Surveys have shown, for example, that about three-fourths of college students say they are “sexually active”—but survey questions rarely specify exactly what that phrase means. To some, sexual activity includes passionate kissing and fondling, while to others the phrase means sexual intercourse. Manual and oral sexual stimulation may or may not be included in an individual’s own definition of being sexually active.

We should therefore begin by defining these terms. First, sexuality is not the same as sex. Human sexualityA general term for how people experience and express themselves as sexual beings, including feelings, thoughts, and actions. is a general term for how people experience and express themselves as sexual beings. Since all people are sexual beings, everyone has a dimension of human sexuality regardless of their behavior. Someone who practices complete abstinence from sexual behavior still has the human dimension of sexuality.

Sexuality involves gender identityA person’s sense of self in terms of being male or female., or how we see ourselves in terms of maleness and femaleness, as well as sexual orientationA sexual preference or choice that determines whether one chooses a member of the same or the opposite sex, or both, for sexual satisfaction., which refers to the gender qualities of those to whom we are attracted. The phrase sexual activityAny behavior involving genital stimulation, including vaginal, oral, and anal intercourse, that carries the risk of acquiring a sexually transmitted disease. is usually used to refer to behaviors between two (or more) people involving the genitals—but the term may also refer to solo practices such as masturbation or to partner activities that are sexually stimulating but may not involve the genitals. For the purposes of this chapter, with its focus on personal health, the term sexual activity refers to any behavior that carries a risk of acquiring a sexually transmitted disease. This includes vaginal, oral, and anal intercourseAn act of physical sexual contact between individuals that involves the genitalia of at least one person, typically with penetration of the vagina, mouth, or anus.. The term sexual intercourseAs used here, referring to heterosexual intercourse in which the penis penetrates the vagina. will be used to refer to vaginal intercourse, which also carries the risk of unwanted pregnancy. We’ll avoid the most confusing term, sex, which in strict biological terms refers to reproduction but is used loosely to refer to many different behaviors.

There is a stereotype that sexual activity is very prominent among college students. One survey found that most college students think that other students have had an average of three sexual partners in the past year, yet 80 percent of those answering said that they themselves had zero or one sexual partner. In other words, college students as a whole are not engaging in sexual activity nearly as much as they think they are. Another study revealed that about 20 percent of eighteen- to twenty-four-year-old college students had never been sexually active and about half had not been during the preceding month.

In sum, some college students are sexually active and some are not. Misperceptions of what others are doing may lead to unrealistic expectations or feelings. What’s important, however, is to be aware of your own values and to make responsible decisions that protect your sexual health.

Information and preparation are the focus of this section of the chapter. People who engage in sexual activity in the heat of the moment—often under the influence of alcohol—without having protection and information for making good decisions are at risk for disease, unwanted pregnancy, or abuse.

Alcohol and Sexual Activity

Figure 10.5

Drinking alcohol increases the likelihood of having unprotected sexual activity.

© Thinkstock

Almost all college students know the importance of protection against sexually transmitted infections and unwanted pregnancy. So why then do these problems occur so often? Part of the answer is that we don’t always do the right thing even when we know it—especially in the heat of the moment, particularly when drinking or using drugs. Some four hundred thousand eighteen- to twenty-four-year-old college students a year engage in unprotected sexual activity after drinking, and one hundred thousand report having been too intoxicated to know if they had consented to the sexual activity.

What’s “Safe Sex”?

It has been said that no sexual activity is safe because there is always some risk, even if very small, of protections failing. The phrase “safer sexThe use of protective actions or devices during sexual activity to minimize the risk of sexually transmitted infections and unwanted pregnancy.” better describes actions one can take to reduce the risk of sexually transmitted infections and unwanted pregnancy.

Sexual Assault and Date Rape

Sexual assault is a serious problem in America generally and among college students in particular:

• About a third of all dating relationships involve some physical violence.
• One in six women and one in ten men will be sexually assaulted in their lifetimes.
• About a fourth of sexual assault victims are in the typical college age range of eighteen to twenty-four years old.
• As many as one in four women experience unwanted sexual intercourse while attending college.
• In more than three fourths of rape cases, the victim knows the perpetrator.

Sexual assaultAny form of coerced sexual contact or sexual activity without the other person’s voluntary consent. is any form of sexual contact without voluntary consent. RapeUnlawful sexual intercourse with or sexual penetration of another person without that person’s consent, typically with force or threat of force. is usually more narrowly legally defined as forced sexual intercourse, a specific type of sexual assault. Both are significant problems among college students. Although men can also be victims of sexual assault and rape, the problem usually involves women, so this section focuses primarily on the issue for women in college. Men must also understand what is involved in sexual assault and help build greater awareness of the problem and how to prevent it.

Sexual assault is so common in our society in part because many people believe in myths about certain kinds of male-female interaction. Common myths include “It’s not really rape if the woman was flirting first” and “It’s not rape unless the woman is seriously injured.” Both statements are not legally correct. Another myth or source of confusion is the idea that “Saying no is just playing hard to get, not really no.” Men who really believe these myths may not think that they are committing assault, especially if their judgment is impaired by alcohol. Other perpetrators of sexual assault and rape, however, know exactly what they’re doing and in fact may plan to overcome their victim by using alcohol or a date rape drug.

College administrators and educators have worked very hard to promote better awareness of sexual assault and to help students learn how to protect themselves. Yet colleges cannot prevent things that happen at parties and behind closed doors. Students must understand how to protect themselves.

Perpetrators of sexual assault fall into three categories:

1. Strangers
2. Acquaintances
3. Dating partners

Among college students, assault by a stranger is the least common because campus police departments take many measures to help keep students safe on campus. Nonetheless, use common sense to avoid situations where you might be alone in a vulnerable place. Walk with a friend if you must pass through a quiet place after dark. Don’t open your door to a stranger. Don’t take chances. For more information and ways to reduce your risk of sexual assault, see http://www.rainn.org/get-information/sexual-assault-prevention.

Most sexual assaults are perpetrated by acquaintances or date partners. Typically, an acquaintance assault begins at a party. Typically, both the man and the woman are drinking—although assault can happen to sober victims as well. The interaction may begin innocently, perhaps with dancing or flirting. The perpetrator may misinterpret the victim’s behavior as a willingness to share sexual activity, or a perpetrator intent on sexual activity may simply pick out a likely target. Either way, the situation may gradually or suddenly change and lead to sexual assault.

Prevention of acquaintance rape begins with the awareness of its likelihood and then taking deliberate steps to ensure you stay safe at and after the party:

• Go with a friend and don’t let someone separate you from your friend. Agree to stick together and help each other if it looks like things are getting out of hand. If your friend has too much to drink, don’t leave her or him alone. Plan to leave together and stick to the plan.
• Be especially alert if you become separated from your friend, even if you are only going off alone to look for the bathroom. You may be followed.
• Be cautious if someone is pressuring you to drink heavily.
• Trust your instincts if someone seems to be coming on too aggressively. Get back to your friends.
• Know where you are and have a plan to get home if you have to leave abruptly.

These preventions can work well at a party or in other social situations, but they don’t apply to most dating situations when you are alone with another person. About half of sexual assaults on college students are date rapeThe rape of a person by someone whom the person is dating.. An assault may occur after the first date, when you feel you know the person better and perhaps are not concerned about the risk. This may actually make you more vulnerable, however. Until you really get to know the person well and have a trusting relationship, follow these guidelines to lower the risk of sexual assault:

• Make it clear that you have limits on sexual activity. Take care that your body language or appearance does not send a message that you might be “easy.” If there is any question that your date may not understand your limits, talk about your values and limits.
• If your date initiates unwanted sexual activity of any sort, do not resist passively. The other may misinterpret passive behavior as consent.
• Be careful if your date is drinking heavily or using drugs. Avoid drinking yourself, or drink very moderately.
• Stay in public places where there are other people. Do not invite your date to your home before your relationship is well established.
• Trust your instincts if your date seems to be coming on too strong. End the date if necessary.
• Pay attention for signs of an unhealthy relationship (described in Chapter 10 "Taking Control of Your Health", Section 10.6 "Emotional Health and Happiness").

If you are sexually assaulted, always talk to someone. Call a rape crisis center, your student health center, or the National Sexual Assault Hotline at 1-800-656-HOPE for a confidential conversation. Even if you do not report the assault to law enforcement, it’s important to talk through your feelings and seek help if needed to prevent an emotional crisis.