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Mental Health Among Collegiate Athletes, Stella Elise Fairbanks May 2024

Mental Health Among Collegiate Athletes, Stella Elise Fairbanks

Honors Thesis

Mental health has become increasingly more linked with athletics, especially collegiate athletics. There has been an increase in public acknowledgment of the presence of mental health in sports, specifically, more athletes are speaking about their mental health struggles as well as more research is being conducted in order to gain a greater understanding of the relationship between mental health and athletics. This literature review discusses athletes’ personal experiences of their mental health struggles, the presence of stigma associated with mental health and athletics, and the results of the recent NCAA, National Collegiate Athletic Association, research. This thesis aims to uncover …


Caregiver’S Perspectives Of Community Acceptance Before And After Surgical Treatment For Their Child’S Disability, Kali Johnson May 2023

Caregiver’S Perspectives Of Community Acceptance Before And After Surgical Treatment For Their Child’S Disability, Kali Johnson

Graduate Projects & Research

Background: In Tanzania, about 600,000 children and adolescents between the ages of five and twenty-four years old have a disability. Individuals with disabilities in Tanzania face numerous obstacles due to the social stigma and exclusion they face. The purpose of this formative evaluation is to assess how caregivers of children with correctable disabilities in Tanzania perceive their community’s acceptance of their child before and after surgical treatment.

Methods: A qualitative study was conducted. Interviews from 86 caregivers of children (ages … with disabilities treated at The Plaster House in Arusha, Tanzania were qualitatively analyzed using content analysis to assess for …


Addressing The Opioid Epidemic In Minnesota: Improving Health Outcomes By Expanding Harm Reduction Strategies A Prospective Policy Analysis, Lisa Lau Heller May 2023

Addressing The Opioid Epidemic In Minnesota: Improving Health Outcomes By Expanding Harm Reduction Strategies A Prospective Policy Analysis, Lisa Lau Heller

Graduate Projects & Research

Background: Morbidity and mortality from opioid misuse is worsening in Minnesota, and synthetic opioids have exacerbated the public health problem for vulnerable communities. People who inject drugs (PWID) due to social, health, economic and environmental factors are experiencing increased fatal overdoses. Minnesota has a broad approach to tackling the opioid crisis, but policies are needed, using new harm reduction strategies, to address the existing gaps.

Methods: A prospective policy analysis was conducted using a public health and trauma informed approach using an extensive literature review to understand ways to improve health outcomes in PWID. A Center for Disease Control policy …


Surviving The Stigma: Incorporating Mental Health Literacy To Increase Help-Seeking In California First Responders, Yvonne C. Newson May 2023

Surviving The Stigma: Incorporating Mental Health Literacy To Increase Help-Seeking In California First Responders, Yvonne C. Newson

Master's Projects and Capstones

First responders are at risk of developing mental health problems due to repeated exposure to traumatic incidents, increasing their chance of developing Post Traumatic Stress Disorder, substance abuse, suicidal ideation, and suicide. Unfortunately, first responders do not recognize that they may have a mental illness and are reluctant to seek help. This paper will discuss the prevalence of mental health problems among first responders and the barriers to their help-seeking. These barriers include the stigma around mental illness within the culture, the assessability of professional help, and the lack of mental health literacy regarding their well-being. Further discussion will focus …


Hiv Stalks Bodies Like Mine: An Autoethnography Of Self-Disclosure, Stigmatized Identity, And (In)Visibility In Queer Lived Experience, Steven Ryder Mar 2023

Hiv Stalks Bodies Like Mine: An Autoethnography Of Self-Disclosure, Stigmatized Identity, And (In)Visibility In Queer Lived Experience, Steven Ryder

USF Tampa Graduate Theses and Dissertations

This dissertation examines self-disclosure of Human Immunodeficiency Virus (HIV) status within the context of communication between long-standing friends. For the purposes of my study, I define this type of friendship as those who have known me for at least two years and with whom I communicate regularly. These are friends who tend to know a variety of personal details about me, ranging from superficial to private and trivial to essential. I use autoethnography to ground the study in my lived experience. By doing so, I present intimate accounts of my communication with others across my lifespan to function as background …


Examination Of Exposure Types Association With Stigma And Impacts On Sharps Injury Reporting In Ambulatory Surgical Centers, Timothy William Lynch Jan 2023

Examination Of Exposure Types Association With Stigma And Impacts On Sharps Injury Reporting In Ambulatory Surgical Centers, Timothy William Lynch

Walden Dissertations and Doctoral Studies

Public health depends on the efficiency of work delivery among healthcare workers (HCWs) and their positive goal orientation in healthcare. Effective minimizing of needlestick and sharp injuries (NSSIs) and timely reporting are fundamental to meeting public health goals. The specific research problem addressed through this study is whether the independent variable of exposure type (needle stick injury, splash exposure injury, other sharp injuries) has an association with stigma associated with sharps injury reporting (dependent variable) among HCWs in ambulatory surgical centers. A quantitative, cross-sectional design involving secondary data analysis was used. Regression was used to analyze pre- and post-workshop survey …


Examination Of Exposure Types Association With Stigma And Impacts On Sharps Injury Reporting In Ambulatory Surgical Centers, Timothy William Lynch Jan 2023

Examination Of Exposure Types Association With Stigma And Impacts On Sharps Injury Reporting In Ambulatory Surgical Centers, Timothy William Lynch

Walden Dissertations and Doctoral Studies

Public health depends on the efficiency of work delivery among healthcare workers (HCWs) and their positive goal orientation in healthcare. Effective minimizing of needlestick and sharp injuries (NSSIs) and timely reporting are fundamental to meeting public health goals. The specific research problem addressed through this study is whether the independent variable of exposure type (needle stick injury, splash exposure injury, other sharp injuries) has an association with stigma associated with sharps injury reporting (dependent variable) among HCWs in ambulatory surgical centers. A quantitative, cross-sectional design involving secondary data analysis was used. Regression was used to analyze pre- and post-workshop survey …


“The Worst Part About My Pregnancy Was Stuff That Didn’T Have To Do With My Pregnancy”: Medicaid Beneficiaries’ Pregnancy Intentions & Experiences In South Carolina, Andrew Michael Chen Jul 2022

“The Worst Part About My Pregnancy Was Stuff That Didn’T Have To Do With My Pregnancy”: Medicaid Beneficiaries’ Pregnancy Intentions & Experiences In South Carolina, Andrew Michael Chen

Senior Theses

Low-income women and women of color experience adverse birth outcomes at disproportionately higher rates in the United States than most people who give birth. This thesis examines individual interviews conducted with 30 low-income women whose most recent birth was covered by Medicaid, the United States’ largest means-tested public health insurance program. The aim of this thesis is to examine how the women in the study thought about pregnancy, and how they described their intentions to become or avoid becoming pregnant at various times in their life. While public health researchers often frame pregnancy as an event that is either intended …


Identification Of Individual And Regional Features Impacting Hiv/Aids Knowledge And Sentiment, Stetson Ledbetter May 2022

Identification Of Individual And Regional Features Impacting Hiv/Aids Knowledge And Sentiment, Stetson Ledbetter

Health, Human Performance and Recreation Undergraduate Honors Theses

Despite constant media coverage and public interest in current epidemics, the prevalence and lack of awareness of HIV/AIDS is often overlooked on campuses and communities associated with colleges and universities. Several interrelated factors, such as LGBTQ+ status, being a college student, gender, coming from a rural area, ethnicity, and educational attainment are known to contribute to behaviors regarding sexual health, especially non-curable diseases such as HIV/AIDS. Consequently, it is imperative to explore trends in both the HIV/AIDS knowledge and sentiments towards individuals with HIV/AIDS in college environments. Current work utilizes a nonprobability sample recruited through media platforms, representing individuals that …


The Complexities Of Guilt, Shame, Stigma, And Substance Use Among A Sample Of United States Substance Using Adults, Nicole A. Doyle May 2022

The Complexities Of Guilt, Shame, Stigma, And Substance Use Among A Sample Of United States Substance Using Adults, Nicole A. Doyle

Graduate Theses and Dissertations

Background: Guilt, shame, stigma, substance use (problematic/nonproblematic), and help-seeking intention, are complex interrelated constructs that have not been collectively examined in community substance using adults, with mere pieces of each construct previously studied in various populations. Guilt pertains to an action (i.e., I did something bad) whereas shame pertains to the person (i.e., I am bad). Guilt has been shown to function adaptively by prompting individuals to repair transgressive behavior where shame has been shown to function maladaptively by prompting individuals to withdraw and compound the global negative feelings of the self. Stigma of substance use is pervasive and leads …


Helping Our Heroes: An Evaluation Of Mental Health And Organizational Policies Surrounding Suicide Prevention And Postvention Strategies For Nebraska First Responders, Maria S. Mickles May 2022

Helping Our Heroes: An Evaluation Of Mental Health And Organizational Policies Surrounding Suicide Prevention And Postvention Strategies For Nebraska First Responders, Maria S. Mickles

Capstone Experience

Suicide is ranked as one of the leading causes of death in the United States. Over 40,000 individuals die by suicide each year (Stanley, Hom, & Joiner, 2016; Vigil et al, 2021), and, in 2020, it was ranked in the top 9 causes of death for all ages (10-64), and second for those 10-14 and 25-34 years of age (Centers for Disease Control and Prevention, 2022). These statistics disproportionately reflect first responders (i.e., firefighters, dispatchers, law enforcement, EMS, paramedics, etc.), as they die by suicide more than the general public (National EMS Management Association, 2016). Within their line of work …


Training And Individual Predictors Of Attitudes Toward Serious Mental Illness Amongst Clinical Psychology Doctoral Students, Lauren K. O'Connor Sep 2021

Training And Individual Predictors Of Attitudes Toward Serious Mental Illness Amongst Clinical Psychology Doctoral Students, Lauren K. O'Connor

Dissertations, Theses, and Capstone Projects

Clinical psychologists are grossly underrepresented in treatment provision for individuals with serious mental illness (SMI; Roe, Yanos, Lysaker, 2006). Systemic (e.g., emergence of managed care) and training-based (e.g., limitations to SMI specific training) factors contribute to the establishment of this underrepresentation, while mental health stigma amongst psychologists may play a role in perpetuating it. Many individual and experiential factors have been found to impact clinicians’ attitudes toward those with SMI (Henderson et al., 2014; Schulzes, 2007). Though many of these factors are present and relevant from the beginning of one’s career and may involve elements related to training, little research …


Applying Health Stigma Framework To Examine The Mechanisms Of Hiv-Related Stigma On Clinical Outcomes, Chengbo Zeng Jul 2021

Applying Health Stigma Framework To Examine The Mechanisms Of Hiv-Related Stigma On Clinical Outcomes, Chengbo Zeng

Theses and Dissertations

Background: HIV clinical outcomes including CD4 count, viral suppression, and health-related quality of life (HRQoL), are important indicators reflecting immunologic functioning, treatment efficacy, and overall health quality. However, due, in part, to HIV-related stigma, many people living with HIV (PLWH) experience suboptimal clinical outcomes. The Health Stigma Framework introduced the potentially distinct mechanisms underlying internalized, anticipated, enacted stigma and health outcomes through psycho-behavioral pathways. Based on this framework, this dissertation investigated the impacts and mechanisms of HIV-related stigma on clinical outcomes among PLWH in Guangxi, China from a longitudinal perspective. Methods: Data at baseline, 6-, 12-, 18- month follow-ups …


Exploring The Mental Health Experiences Of African, Caribbean, And Black Youth In London, Ontario, Lily Yosieph Mar 2021

Exploring The Mental Health Experiences Of African, Caribbean, And Black Youth In London, Ontario, Lily Yosieph

Electronic Thesis and Dissertation Repository

This qualitative study explores the mental health experiences of African, Caribbean, and Black (ACB) youth in London, Ontario, investigating how the factors of race, gender, culture, and place have shaped their perceptions and experiences of mental health. The data collection and analysis were conducted using a phenomenological approach and a critical lens informed by feminist, intersectionality, and critical race theories. These data illuminate the ways in which these young people’s attitudes toward mental health and help-seeking strategies are impacted by broader social constructs and community expectations, which they navigate and often resist in their everyday lives. Their insights can provide …


Move For A Healthy Mind: A Program Of Peer-Led Physical Activity For Adolescents With Depression And Anxiety, Emily Edwards Dec 2020

Move For A Healthy Mind: A Program Of Peer-Led Physical Activity For Adolescents With Depression And Anxiety, Emily Edwards

Master's Projects and Capstones

The following discusses adolescent depression and anxiety and the utilization of physical activity as an intervention or coping mechanism. Adolescents have been experiencing increased rates of anxiety or depression diagnoses over the past roughly two decades. Adolescence is, physiologically, a formative period in the developmental stage from childhood to adulthood. Current barriers to achieving optimal mental health among the adolescent population include the stigmatization of mental health issues, lack of education, socioeconomic status and healthcare access. Further, physical activity has been studied and identified to be an effective treatment for individuals experiencing depression and anxiety. In an effort to treat …


Measuring Tb Stigma In Kampala, Uganda, Amber James Jan 2020

Measuring Tb Stigma In Kampala, Uganda, Amber James

Public Health Theses

Tuberculosis (TB) is one of the leading causes of death worldwide and adversely affects persons living with HIV. TB is a highly stigmatizing disease and has been shown to interfere in household TB contact investigation. The objective of this study was to investigate the severity and characteristics of TB stigma through a multiple methods approach. Quantitative methods involved distributing Van Rie Stigma Scales validated in Southeast to household contacts of Index TB patients during routine household TB contact investigation. Qualitative methods involved interviewing household contacts about their attitudes towards household contact investigation, knowledge of TB transmission and treatment, and perceptions …


Health In The Musical Profession: A Human Rights Investigation At The Intersections Of Identity, Reputation, And Resources, Jillian P. Reed Jan 2020

Health In The Musical Profession: A Human Rights Investigation At The Intersections Of Identity, Reputation, And Resources, Jillian P. Reed

Senior Projects Spring 2020

This project investigates the effects of illness, injury, and disability on professional musicians. Issues of the musician’s identity, importance of reputation, and disability stigma are explored through firsthand accounts of 15 musicians who faced health challenges during their careers. My original research also includes the data from 200 responses to my musicians’ health survey. The patchwork of resources available to these musicians is examined through the lenses of human rights claiming and humanitarian charity, with a focus on healthcare, interpersonal accommodations, and the currently insufficient legal protections for this population.

On a micro scale, this paper is about the experiences …


Predictors Of Hiv Testing Among African American Men Who Have Sex With Men, Jeanette Marie Higgins Jan 2020

Predictors Of Hiv Testing Among African American Men Who Have Sex With Men, Jeanette Marie Higgins

Walden Dissertations and Doctoral Studies

Human immunodeficiency virus (HIV) infections affect more than 1.2 million people living in the United States and disproportionately affect African Americans (AA) men who have sex with men (MSM). The numbers of those who have HIV infections are likely higher due to lack of HIV testing by all individuals living at risk for HIV in the United States. Prior research has been inconclusive in determining the exact cause of the disparity among AA MSM. Therefore, the purpose of this quantitative secondary data study was to explore barriers to HIV testing within the AA MSM population. The sample for this study …


Offering Medical Providers Capacity And Competence In Caring For Transgender And Non-Binary Patients: Evaluation Of A Pilot Digital Training Program, Lexis Manzara Dec 2019

Offering Medical Providers Capacity And Competence In Caring For Transgender And Non-Binary Patients: Evaluation Of A Pilot Digital Training Program, Lexis Manzara

Master's Projects and Capstones

Purpose: Stigma and discrimination in health care settings contribute to health disparities for transgender and non-binary (TGNB) people. Evidence suggests that a lack of training on the care for transgender and non-binary TGNB patients in medical school curricula has contributed to providers feeling unprepared to provide quality care for this population. Health care providers have the opportunity to play a key role in the reduction of health disparities for TGNB patients.

Methods: Twenty-five health care providers completed the eight-module digital training program. Pre- and post-tests assessed provider knowledge, self-efficacy, preparedness, and behavior. Paired samples t-tests were conducted to compare pre-and …


The Suffering Of Schizophrenia: Stigma, Enigma And The Search For A Cure, Fatima Sheikh Jun 2019

The Suffering Of Schizophrenia: Stigma, Enigma And The Search For A Cure, Fatima Sheikh

MSJ Capstone Projects

Patients suffering from Schizophrenia, a severe mental illness, firmly believe in their delusions due to a loss of connection with reality and creation of an imaginary world. Generally, diagnosis and treatment of the mental disorder have been ignored due to cultural and social setup in Karachi. Schizophrenia cannot be cured but manageable with lifetime medicines and rehabilitation after each lapse. The purpose of my investigative piece is to highlight the stigma attached to Schizophrenia along with a search for its treatment.


The Effects Of A Dementia Simulation Experience On Attitudes Towards People With Dementia, Micah Huckabee May 2019

The Effects Of A Dementia Simulation Experience On Attitudes Towards People With Dementia, Micah Huckabee

Health, Human Performance and Recreation Undergraduate Honors Theses

Introduction: The neurodegenerative effects of dementia resulting in cognitive and behavioral impairments is plausibly one of the reasons for a societal stigma towards individuals with dementia. Societal stigmas are associated with decreased life satisfaction, depressive symptoms, and decreased psychological well-being for stigmatized individuals. In an effort to improve attitudes towards individuals with dementia, this study utilized a dementia simulation to measure attitudinal changes after a dementia simulation. Methods: There were 33 participants in this study (13 male and 20 female) between the ages of 18 and 25. Participants completed a Dementia Attitudes Scale (DAS) survey, and then they dressed in …


“What I Hadn’T Realized Is How Difficult It Is, You Know?”: Examining The Protective Factors And Barriers To Breastfeeding In The Uk, Cheyenne R. Wagi Mar 2019

“What I Hadn’T Realized Is How Difficult It Is, You Know?”: Examining The Protective Factors And Barriers To Breastfeeding In The Uk, Cheyenne R. Wagi

USF Tampa Graduate Theses and Dissertations

The international recommendation for breastfeeding is that a baby should be exclusively breastfed for six months. Breastfeeding should be continued for up to two years and beyond with complementary foods (WHO, 2016). The United Kingdom exhibits some of the lowest breastfeeding rates in the world (HSCIC, 2012). The percentage of mothers who breastfed in the United Kingdom falls below 34% at six months, with only 1% of mothers breastfeeding exclusively at this point (HSCIC, 2012:31). This study sought to examine the protective factors and barriers for breastfeeding in the UK. Mums (n=28), their partners (n=6), and facilitators at breastfeeding support …


Old & Sexy: Investigating And Reducing Stigmatization Of Sexually-Active Older Persons, Samantha Nicole Levy Jan 2019

Old & Sexy: Investigating And Reducing Stigmatization Of Sexually-Active Older Persons, Samantha Nicole Levy

Public Health Theses

Media often portrays older persons as asexual or perversely sexual. This stigmatization may harm older persons’ sexual, mental, and physical health and well-being. As such, our study aimed to investigate the stigmatization of sexuality in later life and see if it can be reversed. Our four hypotheses included: (1) sexually-active older persons would be more stigmatized than sexually-inactive older persons; (2) negative age beliefs would predict stigmatization of sexually-active older adults; (3) participants would think more negatively about sexually-active older men compared to sexually-active older women; and (4) a brief writing intervention would help improve participants’ views towards sexually-active old …


Females, Perceptions, And Strength Training, Victoria Kanel, Alexandria Rellinger Jan 2019

Females, Perceptions, And Strength Training, Victoria Kanel, Alexandria Rellinger

Williams Honors College, Honors Research Projects

Performing a regular strength training routine leads to a plethora of beneficial physiological and psychological changes. A gender disparity exists with participation rates of strength training. There is a possible discrepancy in knowledge and education provided to males and females based on their physical activity and exercise backgrounds. The design of this study is an effort to better understand potential barriers females may experience and serve as a needs-assessment tool to identify females’ views of strength training participation. This study sought to explore views of strength training among females and to determine if consensus exists and how views may aid …


Stress Urinary Incontinence In Collegiate Female Athletes: Prevalence And Impact, Marie Bouchard May 2018

Stress Urinary Incontinence In Collegiate Female Athletes: Prevalence And Impact, Marie Bouchard

Master's Projects and Capstones

Abstract

Introduction, definition: Urinary incontinence is the involuntary leaking of urine (a few drops to a few milliliters). It can happen while exercising with no urge to urinate (stress urinary incontinence), with a sudden urge to urinate (overactive bladder or urgency urinary incontinence), or a combination of the two (mixed urinary incontinence). This issue is very common among female athletes. However, because of the reluctance to discuss this problem, it remains underdiagnosed and undertreated.

Methods:An anonymous and confidential survey was distributed to the 90 University of San Francisco female student athletes from seven different varsity sports in December 2017. …


Culture Care Needs Of Puerto Rican Women Receiving Hiv Care From Nurse Practitioners In New York City, Michele Crespo-Fierro May 2018

Culture Care Needs Of Puerto Rican Women Receiving Hiv Care From Nurse Practitioners In New York City, Michele Crespo-Fierro

Dissertations, Theses, and Capstone Projects

The purpose of this mini-ethnonursing research study was to discover, describe, and interpret culture care values, beliefs, expressions, practices and needs of Puerto Rican women receiving HIV care from nurse practitioners (NPs) and other providers in New York City. The emic, or insider, perspective of Puerto Rican women living with HIV was the focus of this study and Leininger’s Culture Care Theory (CCT) provided the theoretical framework. Various enablers of the CCT, including Leininger’s Sunrise Enabler to Discover Culture Care, guided the design andimplementation of the study. Six key and twelve general informantswere interviewed and data from the interviews were …


Hiv-Related Knowledge, Attitudes, And Behaviors In Two Low Resource Settings, Candice Lynn Collins May 2018

Hiv-Related Knowledge, Attitudes, And Behaviors In Two Low Resource Settings, Candice Lynn Collins

Electronic Theses and Dissertations

Two Human Immunodeficiency Virus (HIV) outbreaks occurred almost simultaneously in the United States (US) (2014-2015) and in Cambodia (2015). Information is lacking on HIV-related knowledge, stigmatizing attitudes, and high-risk behaviors (KAB) among the general population, which may affect the transmission of HIV and lead to outbreaks. The current study aimed to: 1) assess KAB among the general population in a high-risk county in the US, 2) analyze KAB among the general population of Cambodia, and 3) compare KAB across samples from a high-risk county in Northeast Tennessee and a province in Cambodia. Tennessee data were collected in 2017 and Cambodian …


Knowledge, Beliefs, And Perceptions About Tuberculosis Among Haitian Immigrants And Haitian Americans Living In Miami-Dade County, Florida, Leslie Barbour Jan 2018

Knowledge, Beliefs, And Perceptions About Tuberculosis Among Haitian Immigrants And Haitian Americans Living In Miami-Dade County, Florida, Leslie Barbour

Walden Dissertations and Doctoral Studies

Tuberculosis (TB) kills 1.7 million people each year, and 1/3rd of the world's population is estimated to have latent TB. It was once the deadliest disease in the United States but is now relatively rare and, if treated properly, it is curable. Migrants from TB-endemic countries, such as Haiti, are one source of TB transmission to the US, and the prevalence of TB remains high and is increasing in Little Haiti, Florida. Data on the knowledge and perceptions of Haitian immigrants and Haitian Americans about TB is inadequate. The purpose of this qualitative research was to study the TB-related knowledge, …


Discrimination And Health: Measurement And Impacts On Ontario’S Transgender Communities, Ayden I. Scheim Aug 2017

Discrimination And Health: Measurement And Impacts On Ontario’S Transgender Communities, Ayden I. Scheim

Electronic Thesis and Dissertation Repository

Discrimination may contribute to poorer health outcomes experienced by non-dominant social groups. While discrimination and health research has flourished over the past two decades, little attention has been paid to the assessment of multiple forms of discrimination, nor to the health effects of discrimination for transgender persons in Canada. Therefore, this thesis examines the impacts of discrimination on health behaviours among transgender persons in Ontario and develops a new instrument set for evaluating self-reported discrimination irrespective of attribution, the Intersectional Discrimination Index (InDI). The first four manuscripts draw on data from the Trans PULSE Project, a respondent-driven sampling survey of …


Understanding Increasing College Anxiety: The Need For Anxiety Awareness Campaigns, Taylor Mosher Mar 2017

Understanding Increasing College Anxiety: The Need For Anxiety Awareness Campaigns, Taylor Mosher

Journalism

The following study investigates national trends toward increasing anxiety among the college student demographic with particular attention paid to the ways in which public awareness campaigns may be implemented as a method for reducing stigma, increasing awareness of anxiety conditions, and connecting students to critical resources.

In order to improve understanding surrounding student anxiety, the following research was conducted in two parts. First, secondary national research was conducted analyzing relevant literature surrounding anxiety trends among college students, the response of universities across the nation, and potential methods by which to relieve student anxiety. Following the conclusion of this research, primary …