A national survey reveals insights into how the habits and health of Duke undergraduates differ from their peers nationally and Duke graduate students.

Organized by the American College Health Association, the health assessment was taken by 378 Duke undergraduate and 508 graduate students during Fall 2016. The survey taken at Duke was part of a national undergraduate health assessment, which included responses from 27,787 students of 51 different universities, about half of which were private. Tom Szigethy, associate dean and director of Duke Student Wellness Center, said that Duke’s Institutional Research administers the survey every other year in the fall. 

“There's always the question of does like attract like?” Szigethy noted. “Does a campus like Duke attract a certain persona of people that are more likely to be the numbers that we have on here? If we want the numbers to change, how do we shift the community so that we encourage people to shift?”

Sex and protection

One interesting trend from the survey is that Duke undergraduate students had less sex than undergraduates nationally and Duke graduate students. Whereas more than 45 percent of Duke undergraduates hadn’t had sex in the 12 months prior to taking the survey, less than 35 percent of undergraduates nationally and just 20.6 percent of Duke graduate students hadn’t been sexually active within the prior year.

“There's a lot of people that don't get into the hook-up behavior, or if they want to have sex, they want to have it with one partner who they're dating and who they're in a relationship with,” Szigethy said. “That has been consistent over the years. It tends to be a pocket of students that tend to be sexually active, but the majority are not.”

Szigethy added that undergrads at Duke choose not to have sex for a multitude of reasons, including their religious and family background. However, he also noted that many students are monogamous, which meant that they were only sexually active when they were in a relationship.

Whereas about 45 percent of respondents of the national survey were in a relationship, only about 26 percent of respondents of the Duke undergraduate survey were in a relationship. Whether that's because there are fewer couples at Duke at the undergraduate level or the sample for the Duke survey was not representative is unclear. 

However, it may explain why Duke undergraduates  felt “very lonely” at a much higher rate compared to their counterparts nationally. Whereas about 60 percent of college students reported feeling very lonely at least once during the 12 months, nearly 80 percent of Duke undergrads felt the same.

But for those who were sexually active during that year, a higher percentage of Duke undergraduate students—particularly women—had more partners. Nationally, 15.1 percent of college women had three or more sexual partners. At Duke, that number rose to 22 percent. Amongst graduate women, that number hovered at less than 10 percent.

Duke undergraduates also use contraception less than undergrads nationally and Duke graduate students. In their last instance of vaginal intercourse, 51.8 percent of college students nationally used a method of contraception. Only 41.5 percent of Duke undergraduate students used contraception, which Szigethy noted was a “huge risk.”

However, more than 65 percent of Duke graduate students used a method of contraception during their last vaginal intercourse. Szigethy attributed to this discrepancy to the additional experience and different lifestyle of graduate students.

“It is because they are older. You have a number of grad students that are married as well,” he said. “A lot of times it's all about family planning. They're not being as cavalier about the decision.”

On the bright side, Duke undergraduates have less unprotected sex when drinking alcohol than their peers. Only 14.5 percent of Duke undergraduates reported having unprotected sex during the last year when drinking alcohol, compared to 22 percent nationally.

Drinking and drugs

Duke undergraduates drank more than the national average. Nationally, about 63 percent of undergraduates consumed alcohol within the last month of when the survey was administered. That number rose to 72.2 percent for Duke undergraduates.

However, when they did drink, Duke undergrads consumed about the same number of drinks on average compared to other undergrads. Duke undergrads and undergrads nationally both consumed an average of about five drinks. Duke graduate students on average consumed two less drinks than the undergrads. 

Women, at Duke and nationally, consumed fewer drinks than men. Szigethy explained the differences in the drinking habits of men and women by referencing the survey data and data from AlcoholEdu, an online education program about alcohol assigned to Duke students. 

“The women are feeling safer in the pregaming area to be drinking and then they go out," he said. "The men are drinking because they want to hook up with up somebody." 

He also said that once women have had one bad experience with drinking too much, they tend to adjust their behavior quickly. However, men typically require multiple unpleasant experiences with drinking before choosing to amend their behavior.

For college students who drank alcohol in the last 12 months of when the survey was administered, 31.3 percent of undergraduate men nationally experienced forgetting where they were or what they did. However, at Duke, that number shot up to 40 percent.

Duke undergraduates also smoked marijuana slightly more than their counterparts across the country. Nationally, 19.8 percent of college students used marijuana within the last 30 days of when the survey was administered. At Duke, that number was 24.6 percent. Szigethy noted that some of the students smoking marijuana are using it as a sleep aid.

“This year, I've seen more people coming in who are using pot towards the end of the night in order to get themselves to go to sleep, which is another concerning piece," Szigethy said. "Can't even fall asleep without assistance from a drug? With it being a street drug, you never know exactly what's in it.”

Mental health

Women—nationally and at Duke—more frequently reported experiencing a variety of mental health issues. However, Duke graduate students reported lower rates of every mental health issue. Whereas 64.1 percent of Duke undergraduate women have “felt things were hopeless” at some point within the last 12 months of the survey, only 44.7 percent of undergraduate men reported the same.

One of the greatest disparities is amongst feelings of “overwhelming anxiety” and intense sadness. Whereas about two-thirds of Duke men reported feeling very sad some time during the year of the survey, four-fifths of Duke women reported feeling the same. Regarding anxiety, less than half of Duke undergraduate men reported feeling overwhelmingly anxiety, yet nearly three-quarters of Duke women experienced intense anxiety.

Another discrepancy was the percentages of men and women feeling “so depressed that it was difficult to function.” Within the year prior to taking the survey, almost half of Duke undergraduate women reported feeling very depressed at some point. However, just 30 percent of Duke undergrad men reported the same.

Duke undergraduate women also reported seriously considering suicide, attempting suicide and intentionally injuring themselves at twice the rate of undergraduate men. More than 15 percent of women reported seriously considering suicide, 2.8 percent reported attempting suicide and almost 10 percent reported intentionally injuring themselves.

Danielle Oakley, director of Counseling and Psychological Services, wrote in an email higher rates of women than utilize CAPS compared to men, which is consistent with counseling centers across the country. She also explained how mental health is impacted by societal factors, especially for women of color.

"Less social stigma exists for women to express emotions and to ask for help, therefore we see them in higher numbers," Oakley wrote. "There are also cultural factors in which women are much more likely to be sexually abused or sexually assaulted, as well as experience sexual harassment, discrimination and sexism. For women of color and other marginalized identities, the reality is worse based on intersectionality. The reality of women's lived experiences often result in mental health concerns that need professional help, especially if attempts to get support in their academic, social and work communities are met with invalidation."

Szigethy noted that there are a number of resources at Duke for students who feel that they are at risk of harming themselves, including the Counseling and Psychological Services and DukeReach.

“It's a high-end school. We do recruit a lot of Type A personality students, who are very driven people,” Szigethy said. “The question becomes how many people wrestle with the idea of failure or dealt with it prior to coming here? When they do come here and the heat is turned up somewhat, how do they react and respond, and do they have the resources? A lot of times, students have not had to ask for help before they come to Duke.”

Stress and sleep

During the previous year of the survey, a greater percentage of Duke undergraduates rated their overall level of stress as “more than average” or “tremendous” compared to college students nationally. More than 55 percent nationally ranked their stress at that level, yet almost 65 percent of Duke students felt the same.

Szigethy noted that some of this stress stems from Duke students' strong performance and reputation of excelling in high school. In the months leading up to their first days at Duke, many new students feel that they will finally feel at home with similarly capable peers, he explained.

“Then, when people get here, they add the pressure of 'I better fit in because these are my peers,’" Szigethy said. "Now, I'm also not seen as special because everyone here is bright. How do I define who I am?”

Participants of the survey were asked to identify what factors had been traumatic or very difficult to handle within the prior year. Whereas “academics” and “career-related issues” had a higher percentage of Duke undergraduates concerned, “family problems” and “finances” were less of a concern to Duke undergrads.

One peculiar difference was related to the “death of family member or friend” as a factor for trauma or stress. Nationally, more than 16 percent of college students reported this issue as very difficult to handle. However, at Duke, eight percent of undergraduates reported the same. Szigethy explained that there could be a number of explanations for this difference.

“It's interesting factor. In some ways, you wonder if finance has something to do with it. People have more resources, probably more health care, so therefore addressing things earlier on, any kind of illness,” he said. “It may depend on where people live. There's a lot of different rationales that can tie into this.”

At Duke, 38.6 percent of undergraduates reported “stress” as a factor affecting academic performance, and 21.5 percent of undergraduates reported “sleep difficulties” as a factor. A smaller percentage of Duke graduate students reported both of those factors as affecting their academic performances—18 percent reported “stress” and less than 10 percent reported “sleep difficulties.”

Compared to undergrads nationally, a lower percentage of Duke undergraduate students reported not getting enough sleep most days of the week. However, a higher percentage of Duke students also reported feeling tired, dragged out or sleepy during the day for most of the week.

“If a lot of them feel rested in the morning, but they're feeling sleepy and groggy during the day, my question there would be self-care,” Szigethy said. “How much wellness and self-care are people doing? So, they're feeling sleepy and groggy during the day. Are they eating right? Are they balancing their meals? Are they pushing too hard and not giving themselves a break to rest?”

Nutrition and exercise

Duke undergraduates tend to have better eating and exercise habits than their counterparts nationally. Whereas more than two-fifths of Duke undergraduate women reported getting three or more servings of fruits and vegetables per day, the percentage for college women nationally was closer to one-fourth.

Female Duke undergraduates also got more exercise than their counterparts nationally, with higher percentages of Duke females doing moderate-intensity and vigorous intensity cardio or aerobic exercise for more days during the week. Szigethy, however, said to be cautious with high percentages of students doing vigorous exercise five to seven days a week, noting that it might be “extreme behavior.”

“It's fine to do two to three times a week of cardio and off lay it with some other kind of exercise, but not necessarily the extreme factor," he said. "If we have higher numbers here, is it people who are doing extreme behavior? Is it the same people who aren't eating all that much and might have a disorderly eating problem?”

Most Duke students had a healthy weight based on their Body Mass Index. Almost three-quarters of Duke undergraduates fell in the healthy weight category compared to 58 percent nationally. Sixty percent of Duke graduate students fell into the healthy weight category.

“When you take an eye-scan of the Duke campus, we are a pretty healthy campus overall,” Szigethy said. “People do eat healthy overall. You don't see an enormous amount of overweight student, but what we do see is good number of underweight students. How do we get the entire student body to be moderate?”

Duke undergraduate women reported being “diagnosed or treated by a professional” for anorexia within the prior year at twice the rate of their counterparts nationally. The number was greater than four percent at Duke compared to less than two percent nationally.

Additionally, there was a higher percentage of male Duke undergraduates in the underweight category than there were college men nationally—7.1 percent for the former and 4.4 percent for the latter. Szigethy noted that body image was becoming just as much a concern for men as it is for women.

“I think nationally, it's changing. Men are becoming just as affected by body image as women are,” Szigethy said. “You're seeing people spending more and more time in the gym. If you go to the gym here at five o'clock on Friday, you're going to see it packed. So, I think that there's just as much concern.”