Comprehensive Stress Management Textbook PDF

# Stress and the College Student Jack's best friend put a gun to his own head and pulled the trigger. Aside from feeling a deep sense of loss, Jack was angry and disappointed. "I was his best friend. Why didn't he talk with me about this? Why did he have to kill himself?" It seemed that much of Jac...

# Stress and the College Student Jack's best friend put a gun to his own head and pulled the trigger. Aside from feeling a deep sense of loss, Jack was angry and disappointed. "I was his best friend. Why didn't he talk with me about this? Why did he have to kill himself?" It seemed that much of Jack's day was preoccupied by such questions. His school-work and his job outside of school were both affected. Kim was a student from Taiwan who was sent, at great expense to her family, to the United States to attend college. With the difficulty she had with studying in a second language and the pressure she felt to succeed in school her parents sacrificed to send her to school in the United States, she was just keeping her head above water. She barely passed several courses and had to take incompletes in others. Her concern and frustration about her schoolwork overflowed into her social life. She found herself being angry and argumentative with friends and devoting so much time to her studies that she soon had no friends. Alone and lonely in a foreign country, not doing well in school, Kim was experiencing a great deal of stress. Bill was a mail carrier who was attending college at night to prepare for another career when he retired from the postal service. He was having problems with his marriage, his job, and his schooling. There never seemed enough time for any of these. His wife and daughter complained that with being at work and school he was seldom home, and, when he was, he was always doing schoolwork. His supervisor at the post office claimed he always seemed tired and grouchy, and this was affecting his job performance. His professors told Bill that he was not turning in his work on time, nor was it of sufficient quality to pass his courses. When Bill finally left his family his domestic problems became more and more serious, he brooded so much that he had less time, instead of more, to concentrate on the other aspects of his life. These are but a few of the students enrolled in my stress management classes during one semester. They came to me to discuss these problems and to get guidance regarding how to manage them. Too often the life of the college student is depicted as "rah-rah," fraternity row, and football games. These are carefree and fun years for many students. For many others, though, college is just another life change to which they must adapt. They may be young and experiencing the growing and de-veloping pains of youth; they may be older students with too many other responsi-bilities to enjoy their schooling; or they may experience unique situations during the time they are supposed to be concentrating on their studies. In any case, college is very stressful for a large number of students. There is plenty of evidence that chronic stress is often a companion of college students. As they observed college students, researchers concluded that college students are particularly prone to chronic stress as a result of their experiencing and having to manage developmental transitions. To make matters worse, the stress experienced by college students can interfere with the learning processes necessary for academic success. Having difficulties academically then feeds back into the stress loop as a life-situation stressor to create even more stress. Other stress researchers have noted students' concerns such as finances, living arrangements, safety, and their weight' to be significant stressors. On my own campus, a survey of the top health issues found stress to be second only to fitness and exercise. What do you think students on your campus would rate as the top-three health issues? I'll bet stress is one of them. (See Table 4.1.) ## The Younger College Student The younger college student-one who enters college from high school or shortly thereafter-experiences stressors such as the dramatic lifestyle change from high school to college, grades, course overload, managing finances, making friends, love and sex stressors, shyness, jealousy, and breakups. ## Lifestyle Change The more life changes you experience, the more stress you will feel and the more likely it is that illness and disease will result. Just imagine all the life changes associated with attending college for the first time! You attend high school while living at home, under the supervision of your parents, and usually without the need to work. There is plenty of time to meet friends after school, to do homework, and to relax. After all, the laundry is done by someone else, the meals are prepared by someone else, and the car may even be filled with gas by someone else. Food somehow, miraculously, appears in the refrigerator and cupboards, and the dust on the furniture and floors periodically vanishes. Although many high school students do take on household responsibilities and do have jobs, generally the high school years are comfortable ones. When college begins, however, a dramatic change takes place. Time must be set aside for shopping, cooking, cleaning, doing the laundry, and myriad other routine chores. For the first time in many students' lives, they must assume responsibilities they never had to assume before. Further, no one keeps asking if they've done their homework. They must remember to fit this in between all their other activities. However, in addition to all of these, other changes are dictated by college life. Usually it requires finding an apartment or choosing a dormitory in which to live. A whole new network of same-sex and opposite-sex friends must be established. Schoolwork seems excessive, and it seems that not enough time is available to accomplish it. The fear of flunking permeates the air. As though all of this wasn't enough, the younger college student is confronted with several important tasks during that time of his or her life: - Achieving competence - Managing emotions - Becoming autonomous - Establishing identity - Freeing interpersonal relationships - Clarifying purposes - Developing integrity Managing these transitional changes requires college students to develop new roles and modify old ones, and that can result in a great deal of stress. Considering all these changes and the effects of stress on the immunological system, it is no small wonder that influenza epidemics and bouts of mononucleosis are frequent visitors to college campuses. Of course, the close living quarters exacerbate this situation. We also should not be surprised to learn that suicide is the second leading cause of death on college campuses accidents being number one. ## Grades The old story of the college professor who tossed the term papers down the stairs and graded those landing on the top three steps an A, those on the next three steps a B, and so on emphasizes the confusion about grading. Grades-students have to get them and professors have to give them. Unfortunately, both groups seem to gear too much of their behavior toward them. Students see their goal as getting good grades instead of learning as much as they can. Professors see their goal as accurately differentiating between an A student and a B student rather than teaching as much as they can. As with all such generalizations, there are numerous exceptions. However, I think anyone associated with a college campus will agree that too much emphasis is placed upon grades. Students may even link their self-worth with their grades-for example, "Boy, am I dumb. I flunked English." Instead, they'd be better off saying, "Boy, I guess I didn't study long enough or well enough. I'll have to remember that for the next test." Let's not kid ourselves, though. Grades are very important. They are important to students who want to go to graduate school or whose prospective employers consider them prior to hiring. They are also important to the university that wants its graduates considered competent and well educated. The university will use grades to weed out those who will not reflect well upon it. However, I have seen students so preoccupied by grades that they have let their physical health deteriorate. They give up exercise, don't have enough time to prepare balanced meals, or pull "all-nighters" so frequently that they walk around with bags under their eyes. I have seen other students so grade-conscious that they don't have a social life-they're always studying. Although college is fraught with stress, many students believe the reward at the end makes it all worthwhile. What do you believe? ## Course Overload Related to the issue of grades is course overload. Course overload is having too many courses or courses that are too difficult to do well during any one semester. In today's goal-oriented, rush-rush society, the more you accomplish in the shortest period of time, the better. The result is people rushing through their lives and experiencing very little. They achieve a lot of goals but don't enjoy the trip to those goals. Course overload results in a similar predicament. If I had a dollar for every student who, upon graduation, told me "I wish I had taken more courses I enjoyed" or "I wish I had devoted more time to my studies" or "I wish I had taken fewer courses each semester and learned more in the ones I did enroll in," I'd be wealthy today. Hoping to graduate in the shortest time possible, too many students overload themselves and suffer physically, psychologically, socially, and educationally for it. In a study of American college freshmen, 29 percent reported feeling frequently overwhelmed by all they had to do; 18 percent of males and 39 percent of females. They may get physically ill, their emotions may be ready to explode, they may not have time for friends, and while taking more courses, they actually learn less. In this case, more is less. ## Finances Some of the most significant stressors that college students experience relate to money. To begin with, paying for college is a challenge for many students and their families. As can be seen in Figure 4.1, when tuition and fees, room and board, books and supplies, and other expenses such as travel are added up, college is beyond the reach of many students. In fact, the Advisory Committee on Student Financial Assistance estimates costs prevent 3.2 million college-qualified high school graduates from attending any college at all, and 62 percent of entering freshmen stated that their financial situation led them to not attend their first-choice college. ## Education Loans for College Students There are several sources of loans for college students and their parents to help pay for the costs associated with attending college. Some of these sources are sponsored by the federal government whereas others are private. ### Federal Loans - Federal Stafford loans are fixed-rate, low-interest loans available to at least half-time students attending schools that participate in the federal financial aid system. There are two types of Stafford loans: Subsidized Stafford loans are need-based, and interest does not accrue while students are still in school. Unsubsidized Stafford loans are not need-based, and interest that accrues on the loan is due even while attending school. - Federal Perkins loans are low-interest (5 percent) loans for undergraduate and graduate students with exceptional financial need. Perkins loans have no fees and offer a longer grace period for repayment than do Stafford loans. - Federal Parent PLUS loans are low-interest student loans for parents of undergraduate, dependent students. With a Parent PLUS loan, families can fund the entire cost of a child's education less other financial aid. - Federal Graduate PLUS loans are federally sponsored loans for students attending graduate school. With a Grad PLUS loan, students may borrow up to the full cost of their education, less other financial aid received. ### Private Loans - With the Sallie Mae Smart Option Student Loan, students can borrow up to the full cost of a college education, less other aid received. The Smart Option Student Loan requires making interest-only payments while in school. A creditworthy cosigner can help students qualify and/or receive a lower interest rate. - There are grants, scholarships, and work-study programs that provide financial assistance for college. A financial aid advisor on campus can help direct students toward these sources of funding. Given these figures, it is no surprise that many students graduate with a good deal of debt. As shown in Table 4.2 and the box entitled "Facts About College Student Debt," not only do students incur loan debt from public sources, but many need to get financial assistance from private sources as well. In addition, many students have to work while attending school to afford their college education. Forty-six percent of all full-time working students work 25 or more hours per week, with 42 percent reporting that working hurt their grades. One in five full-time working students actually hold a full-time job, working 35 or more hours per week. Fifty-three percent of all full-time working students who work 25 or more hours per week report that employment limits their class schedule, and 38 percent said that work limits their class choice. Furthermore, 64 percent of students who work while attending school report they frequently or occasionally overslept or missed classes or appointments, and 45 percent did not have time to study due to job responsibilities. However, 63 percent of all full-time working students who work 25 or more hours per week state that they would not be able to afford college if they did not work. Of course, that is not the only debt college students incur. In addition to student loans, credit card debt plagues many college students. As shown in the box entitled "College Students and Credit Card Statistics," college students incur an excessive amount of credit card debt, and that situation has gotten worse over the years. ## Facts About College Student Debt In 2012, 71 percent of all students graduating from four-year colleges had student loan debt. That represents 1.3 million students graduating with debt, up from 1.1 million in 2008 and 0.9 million in 2004. In 2012: - 66 percent of graduates from public colleges had student loans. - 75 percent of graduates from private nonprofit colleges had student loans. - 88 percent of graduates from for-profit colleges had student loans. Average debt levels for all graduating seniors with student loans rose to $29,400 in 2012-a 25 percent increase from $23,450 in 2008. In 2012: - At public colleges, average debt was $25,550-25 percent higher than in 2008, when the average was $20,450. - At private nonprofit colleges, average debt was $32,300-15 percent higher than in 2008, when the average was $28,200. - At for-profit colleges, average debt was $39,950-26 percent higher than in 2008, when the average was $31,800. About one-fifth (20 percent) of 2012 graduates' debt was comprised of private loans. Private loans nonfederal are typically more costly and provide fewer consumer protections and repayment options than safer federal loans. To better manage their use of credit cards, the College Board recommends students adhere to the following: - Consider using a debit card instead of a credit card. Money is deducted directly from your checking account, so you can't spend more than you actually have. - Read all application materials carefully-especially the fine print. What happens after the "teaser rate" expires? What happens to your interest rate if you're late with a payment or fail to make a payment? What's the interest rate for a cash advance? - Pay bills promptly to keep finance and other charges to a minimum; pay the balance off if you can. - Use credit only if you're certain you are able to repay the debt. - Avoid impulse shopping on your credit card. - Save your credit card for a money emergency. How to use a credit card appropriately is not the only financial skill that gets college students into financial hot water and thereby causes them stress. In a study of more than 1,000 college students from 27 universities in 19 states, it was found that 92 percent knew how to balance a checkbook but only 62 percent actually did it. Developing a budget and adhering to it would help these students a great deal. Yet only 38 percent prepared a monthly budget, and only 28 percent of those that did so stuck to it. To develop a budget for the semester, complete Lab 4.1. ## The Credit Card Accountability, Responsibility, and Disclosure (CARD) Act of 2009 The Credit Card Accountability, Responsibility, and Disclosure (CARD) Act of 2009 took effect in 2010. The law is designed to help consumers avoid unfair fees, penalties, interest rate increases, and other unwarranted changes from credit card companies, and includes provisions aimed at protecting students. It also imposes new requirements on colleges and alumni groups that offer credit cards. The student-focused provisions in the Credit CARD Act include the following: 1. Restrictions on credit cards for those under 21. Any new credit card application for someone under 21 must contain either (1) a co-signer over 21 who has the ability to make payments on the debts from the account and who will be jointly liable for debts incurred by the applicant until he or she is age 21, or (2) supporting information showing that the applicant would have the independent ability to make payments on any debt incurred from the use of the card (an "ability to pay"). 2. Protection from prescreened offers. Card issuers must not obtain a credit report for someone under 21 to use to make an unsolicited prescreened credit offer. 3. Gift/inducements prohibited. Card issuers and creditors must not offer a student any tangible item to induce the student to apply for or participate in a credit card on or near the campus of the institution of higher education or at an event sponsored by or related to an institution of higher education. 4. College affinity card provisions/reports by creditors. The act also requires credit card issuers to submit to the Bureau of Consumer Financial Protection, also known as the Consumer Financial Protection Bureau CFPB, each year the terms and conditions of any college affinity credit card agreement between the issuer and an institution of higher education or an affiliated organization in effect at any time during the preceding calendar year. In addition to a copy of any college credit card agreement to which the issuer was a party, issuers also must submit summary information for each agreement, such as the number of cardholders covered with accounts open at year-end regardless of when the account was opened and the payments made by the issuer to the institution or organization during the year. CFPB must submit to Congress, and make available to the public, an annual report that contains the information submitted by the card issuers to CFPB. 5. Sense of Congress resolution on institution of higher education policies. Each institution is encouraged to consider adopting the following policies: (a) requiring credit issuers to notify the institution of any location they will market credit cards on campus; (b) limiting the number of locations on campus where marketing of credit cards may take place; and (c) offering credit card and debt education sessions as a regular part of new student orientation programs. ## Friendship Giving up or changing old friendships and developing new ones is often a stressful activity associated with college life. Will people like me? Will I find someone with similar interests? How about boyfriends and girlfriends? Will people want to date me? All of these questions and many others are of concern during this phase of life. Old friends were accompanied by old routines-you knew just how much you could tell whom. Since friendship is a function of the degree of self-disclosure friends are willing to share, new friends require a period of testing to see just how much self-disclosure feels comfortable with this new person. To demonstrate this point, complete Lab 4.2 at the end of this chapter on friendship and "acquaintanceship." ## Love With old friends and family back home, many students fill the void with new love relationships. These relationships themselves, however, may create new stresses. Any new relationship requires a new set of rules and standards. How often do we see each other? How often do we telephone? Where should we go on dates? Who should pay? With whose friends should we hang out? In addition, some love relationships involve two people who are different types of lovers. Erotic love eros is a passionate, all-enveloping love. The heart races, a fluttering appears in the stomach, and there's a shortness of breath when erotic lovers meet. Ludic love ludus is a playful, flirtatious love. It involves no long-term commitment and is basically for amusement. Ludic love is usually played with several partners at once. Storgic love storge is a calm, companionate love. Storgic lovers are quietly affectionate and have goals of marriage and children for the relationship. Manic love mania is a combination of erotic and ludic love. A manic lover's needs for affection are insatiable. He or she is often racked with highs of irrational joy, lows of anxiety and depression, and bouts of extreme jealousy. Manic attachments seldom develop into lasting love. Imagine that a ludic lover is in a love relationship with a storgic lover. One is playing games with no intention of a lasting or exclusive relationship, and the other is thinking marriage and children. Love relationships on college campuses may be stressful because of misunderstandings regarding the types of love involved. What is your love style? If you are presently in a love relationship, is your love style compatible with that of your lover? Recognizing that love styles may change during different stages of your life, when do you think you will adopt a different love style from the one you have now? Do you look forward to this transition, or not? Why? As with other aspects of your life, you are in control of the types of relationships that you enter, and you can choose compatible ones or ones that can result in stress. There are online "love tests" that match people on a variety of characteristics and personality traits. Some of the variables they measure are adventurousness, communication style, relationship role, temperament, romanticism, importance of wealth, and need for independence. During one month it is estimated approximately 20 million people use online matching services such as Match.com, Americansingles .com, and Date.com. Online personal ads generated over $2 billion in 2015 up from $72 million in 2001. It seems that a lot of people are looking for love and are willing to pay for it. ## Sex One of the assignments in my undergraduate stress management class is for students to keep a journal of stressors they encounter. Invariably, several female students describe the pressure they are receiving-from their female friends as well as their boyfriends-to engage in sexual intercourse. It's the talk of the dorm or sorority house. Although no male student has ever described a similar stressor, I'm convinced that the pressure to be sexually active is at least as great for male students as it is for female students. Why else would young males feel compelled to exaggerate their sexual experiences or describe an enjoyable, relaxing evening as a Roman orgy? I believe that males are just less apt to admit that they feel stressed by pressure to be sexually active. To compound this stressor, the older public looks at college students as a promiscuous, pill-popping, irresponsible group of rascals and tolerates them only because they are young and soon will learn better. At age 19, however, many females have never experienced sexual intercourse, yet even college students tend to exaggerate the sexual experience of their compatriots. To determine just how much you really know about sexuality and about the sexual behavior of your peers, and how any misconceptions affect the degree of stress you experience, answer the following true/false questions: 1. By the time they graduate from college, all students have masturbated. 2. Almost all college students have experienced sexual intercourse several times. 3. Masturbation is a habit of the young and is eliminated as one becomes an adult. 4. As long as "safer sex" is practiced, both pregnancy and sexually transmitted diseases can be prevented. 5. Masturbation can result in either physical illness or psychological harm. 6. Sexual fantasies are wishes you have for participation in sex. 7. Oral-genital sex is abnormal and perverse. All of the previous statements are false. Let's look more closely at them one at a time. 1. Most researchers have found that approximately 90 percent of men and 60 percent of women have masturbated at some time. Stated another way, approximately 10 percent of men and 40 percent of women have not had masturbatory experience. In a landmark study of sex in America, Laumann and his colleagues found that both males and females masturbate, although 85 percent of men as opposed to 45 percent of women masturbated in the year prior to the study. 2. Forty-three percent of males and 48 percent of females who are 15 to 19 years old have never had sexual intercourse. Fourteen percent of males and 13 percent of females who are 20 to 24 years old have never had sexual intercourse. Even 4 percent of males and 3 percent of females who are 24 to 29 years old have never had sexual intercourse. In another study, 53 percent of males and 62 percent of females ages 18 to 19, 63 percent of males and 80 percent of females ages 20 to 24, and 86 percent of males and 87 percent of females ages 25 to 29 engaged in sexual intercourse within the past 12 months. Obviously, not everyone is doing "it," and when they are, it isn't with everyone on campus. 3. Masturbation is engaged in throughout one's life. Whether it's because one's sexual partner is unavailable, pregnant, or ill, or just for the pleasure of it, masturbation is practiced by adults at all ages. 4. We shall discuss sexually transmitted diseases, and AIDS in particular, shortly. For now, you should know that there is no such thing as safe sex. Anytime coitus occurs, for instance, there is the chance of a pregnancy resulting there is no 100 percent effective means of birth control and the possibility of contracting one of several sexually transmitted infections STIs. However, there are ways to engage in "safer" sex-that is, decreasing the chances of conception or of infection occurring-for example, using a condom. 5. Experts agree that the only danger of masturbation is the psychological harm resulting from guilt, shame, or embarrassment one associates with it. If people were to learn how prevalent masturbation is, how it doesn't interfere with normal relationships or the ability to later be sexually functional, and that it usually continues throughout one's life albeit at a lesser frequency, masturbation might not be associated with guilt and other negative feelings and thereby not create any harm at all. 6. Because you fantasize about something doesn't necessarily mean you would actually like to experience that fantasy. For example, when you become angry with a professor, you might dream about slashing the tires on his or her car. However, most of us would not do that even if we knew we wouldn't get caught at least I hope my students reading this agree. Likewise, sexual thoughts and fantasies may or may not be events we would like to experience. We shouldn't feel guilty or embarrassed about our sexual thoughts; that can only do us harm. However, we should be held accountable for our sexual behavior. 7. Many men and women have engaged in oral sex. A survey of 20- to 24-year-old females and males found that 75 percent of 20- to 24-year-old females had given oral sex and 78 percent received oral sex; whereas 66 percent of 20- to 24-year-old males had given oral sex and 81 percent received oral sex. Whether one chooses to view oral-genital sex as perverse depends on one's values. However, given its frequency, it certainly cannot be considered abnormal. Does the information regarding sexual myths surprise you? If so, don't worry. You are probably in good company, with significant numbers of your classmates also believing many of the same myths about the sexual behavior of college students. Given the misconceptions you have regarding how sexually active you "would be" if you were "normal," the pressure for you to engage in sex can be intense. This pressure comes from outside yourself and from within. The pressure might lead to stress that interferes with your health, grades, and interper-sonal relationships. Hopefully, a more realistic perception of the sexual behavior of your classmates will help you see yourself as not unusual in your own sexual behavior and thereby help you to better deal with the pressure to be sexually active, whether you are sexually experienced or inexperienced. (Remember, in either case you are in the company of a large number of other college students.) ## HIV/AIDS There is a good deal of concern both on and off college campuses regarding the spread of sexually transmitted infections-in particular, acquired immune deficiency syndrome AIDS. This section describes the causes, treatments, and means of prevention of AIDS, with the hope that knowledge will aid in alleviating undue stress regarding your sexual behavior and will help you prevent AIDS from developing in the first place. Acquired immune deficiency syndrome is caused by a virus called the human immunodeficiency virus HIV. AIDS results in an ineffectiveness of the immunologi-cal system so that its victims develop opportunistic infections that eventually lead to death. The Centers for Disease Control and Prevention reports that, between 2009 and 2012, an estimated 535,758 Americans died of AIDS. In 2013, there were an estimated 37,887 new cases of HIV infection. There is no known cure for AIDS, although there are some drugs that can slow the course of the disease and prolong the life of the AIDS victim. The most effective of these drugs is azidothymidine AZT used in combination with other drugs such as protease inhibitors called combination therapy or "drug cocktail. HIV is transmitted through bodily fluids such as blood and semen. High-risk groups are homosexuals, intravenous drug users, and infants born to women with the virus in their bloodstream. However, public health officials would rather direct attention to high-risk behaviors than to high-risk groups, since membership in the group is immaterial-it's what you do that can give you AIDS, not what group you belong to. If you share needles with others as IV drug users are prone to do, if you engage in oral or genital sex without using a condom or in anal sex even if you do use a condom, or if you have multiple sex partners, you are more likely to contract AIDS than if you don't engage in these high-risk behaviors. In spite of some widespread misconceptions, AIDS is not transmitted casually. It cannot be contracted by touching a person with AIDS, sharing eating utensils, swimming in the same swimming pool, being in the same classroom, being stung by a mosquito, or kissing. You also cannot acquire AIDS by giving blood; since 1985, the blood supply has been screened so that contracting AIDS through a blood transfusion is only a remote possibility. AIDS is classified as a sexually transmitted infection, even though it can be transmitted in nonsexual ways e.g., when a health care worker accidentally comes in contact with HIV-infected blood. ## Other Sexually Transmitted Infections Other sexually transmitted infections include chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus, pelvic inflammatory infection, trichomoniasis, vaginosis, hepatitis B, and genital warts. These STIs are caused by parasites, bacteria, or viruses, all transmitted through sexual activity. As with HIV infection, the only 100 percent effective prevention involves abstaining from sexual activities that can transmit the causative agent. The prevalence, causes, and treatment for these STIs are presented in Table 4.3. ## Prevention of Sexually Transmitted Infections To alleviate some distress you may have regarding STIs, engage in behaviors that can make you less prone to contracting it. There are several things you can do to protect yourself. The best approach in terms of prevention is to abstain from sex: oral sex, coitus, and anal sex. If you decide that alternative is not acceptable to you, the next best approach is to maintain a monogamous sexual relationship with someone you know to be STI-free. The problem here, though, is determining that someone is STI-free. The test for AIDS, for example, actually tests for the presence of antibodies that you develop after coming in contact with HIV. Since the test may not identify the presence of these antibodies for up to six or eight months after exposure, even if someone has a negative AIDS test today, if that person had sex with someone else within the past eight months, he or she may still possess the virus. What the experts say is really true: When you sleep with someone, you are sleeping with that person's previous sexual partners and those previous partners' sexual partners. If you engage in sex, always use a condom made of latex rather than animal skin such as lambskin, since the animal skin condom may be too porous to prevent the disease-causing organism from penetrating. Unfortunately, too many college students do not use condoms, or do not use them often enough, even though they engage in sexual behaviors that put them at risk of contracting an STI. In a study of almost 65,000 sexually active women ages 20 through 44, 22 percent had two or more sexual partners, yet only 19 percent reported always using condoms, and 27 percent never used condoms. In a national study of 20-24 year old males, only 30 percent used a condom every time they had intercourse, and 20 percent never used a condom. Alarmingly, in a study of adolescents, researchers found condoms were used in only 59 percent of sexual intercourse experiences. Even if these subjects used another method of contraception, they did not get the benefit and protection from sexually transmitted infections that a condom can provide. ## Acquaintance Rape As if the threat of contracting a sexually transmitted infection such as AIDS is not stressful enough, imagine the feelings evoked when sex is forced upon someone. That is precisely what is happening on college campuses. It is most often the male forcing sex on his female date: "She said NO but I knew she really wanted it. It just took a little coercion." Well, that is RAPE! Anytime sex is forced on someone else, that is legally defined as rape. Acquaintance rape, forcible sex between people who know one another such as dates, occurs more frequently among college students, particularly freshmen, than any other age group. One in four women report being victims of rape; 84 percent of their assailants were dating partners or acquaintances. One in four college men have admitted to using sexual aggression with women. Victims of date rape may feel ashamed, guilty, betrayed, and frightened. The psychological effects can be devastating and last for a long time. Date rape is a serious matter and needs to be prevented. Interestingly, experts recognize that rape is more about violence and control than it is about sex. Rapists may want to act out violently against the person being raped because of some past experiences. The rapist may believe that a history of rejection or feeling inferior can, for the moment, be forgotten through this violent behavior. Alternatively, the rapist may wish to demonstrate control over someone else in the most intimate part of that person's life. Not to be lost in this discussion is the role that sex plays in our society. Look at ads in magazines and on television, and you will note that sex is used to sell even the most remote of products. Pay attention in movies, and you will undoubtedly see sex portrayed in one way or another. The Internet makes pornographic images and films readily available. The behavior portrayed in these films is anything but sensitive, romantic, or respectful. It is shameful when people use these actions as models for what they think will be exciting sex. That can lead to forceful sex, which is rape. Below you will read some suggestions for protecting yourself from being forced to engage in sexual activity or from forcing another to do so. As you read these helpful suggestions, keep in mind that it is not your responsibility to prevent yourself from being raped. It doesn't matter what you wear, how you act, or the setting you are in. None of this excuses rape-none of it! The National Child Traumatic Stress Network recommends the following to prevent acquaintance rape: - Expect respect and keep away from people who don't show you respect. - Be clear about your limits: let the other person know what you want and don't want to do. You have the right to change your mind, to say "no," or to agree to some sexual activities and not to others. - Don't allow a person to touch you if it makes you uncomfortable. If your limits are reached or you sense danger, speak your mind and act immediately. Make a scene if necessary. - Pour your own beverage and keep it in sight. Date rape drugs can be put into drinks and are often undetectable. - Don't hang out in places that keep you isolated from others. Although you may feel you can take care of yourself, it is always wise to be careful. - Trust your instincts. If you feel that a person is not trustworthy or a situation is unsafe, leave. - Have a back-up plan. For example, if you're going out to a party in a different neighborhood, make sure someone you trust knows where you're going. Have a person you can call to come and get you if you need to leave without your original ride. In addition, avoid excessive use of alcohol or other drugs that may cloud your ability to make decisions in your best interest. The American College Health Association reminds us that consenting sex requires sober, verbal communication without intimidation or threats. Many states have laws acknowledging that someone who is drunk is not capable of consenting to sex. Several colleges have developed guidelines to help limit date rape. Perhaps the most controversial of these was produced at Antioch College. At Antioch, students were required to verbally request permission to proceed sexually. They had to ask if they could kiss their partner, then if they could touch their partner, then if they could sleep with their partner, and so on. Permission had to be explicit. Proceeding without verbal permission placed a student at risk of being accused of date rape. The intent was to prevent miscommunication-that is, a student believing that "no" really means "yes." Some opponents of this policy described