When you think of a college student the first thought that comes to mind is probably not what they are most likely to die from. According to the study Causes of Mortality Among College Students, the three most common causes of death among college aged students, ages 18 -24, are accidents, including alcohol related injuries, suicide, and cancer. Here we examine the scientific, cultural, and ethical aspects of all of these, and how college students are affected by them.
Accidents are the most common cause of death among college age students and there are countless variations of these incidents, but the largest subgroup of accidents killing college age adults are alcohol related. Alcohol is a drug, specifically a depressant, consumed by over 60% of college students on at least a monthly basis. Depressants are drugs that reduce the function of some aspect of the nervous system to levels below what normally occur when the body is not under the influence of a drug. Alcohol in particular is a deadly depressant because it affects our brain’s ability to complete more highly integrated tasks like driving a car or performing some other skilled task. Even in the smallest of doses, an individual who consumes alcohol can be considered impaired because there is no threshold of Blood Alcohol Content, BAC, that once reached with induce impairment. BAC measures the amount of alcohol in grams of ethanol per 100 millimeters of blood, but it is not a perfect measure because level of impairment can depend on age, weight, time period of consumption and a number of other factors.
Alcohol can kill both actively, in the sense that the alcohol itself does the killing, and passively, meaning that impairment due to alcohol leads to the death of an individual. In the passive sense of a car crash, reduced ability to drive can be caused by a BAC of 0.03% or less, the equivalent of 1 to 2 drinks . At a BAC level of 0.05% drivers start to ignore rules and instructions on the road, and at a level of 0.08% or higher impairment is clearly demonstrated in drivers. In the active sense, alcohol can kill by impairing brain function to the point where actions that are necessary for survival, such as breathing or a functioning gag reflex, stop working, this condition, known as alcohol poisoning, can be brought about through binge drinking.
Binge drinking is considered 4 or more drinks for females, and 5 or more for males, in one sitting. Binge drinking has become the culture of many colleges in past decades, and continues to affect students across the nation. One study found that college students engage in binge drinking more than their same-age non-college peers, proving that alcohol is a central part of college culture. Another study done over 2 years found that over “500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/ assaulted by another drinking student”. In 2002, the National Institute of Heath sent a task force to research drinking across campuses, resulting in the article, A Call to Action: Changing the Culture of Drinking on U.S. College Campuses. Since then, there has been a downward trend in alcohol-related traffic deaths, but non-traffic deaths and hospitalizations for overdoses involving alcohol have risen significantly. What is it about the culture of college that leads to such dangerous engagement with alcohol?
A study that examined colleges in three countries (America, Argentina and Spain), determined that all three held similar beliefs about alcohol being central to the college experience, but important cultural differences create discrepancies in the expectations of how alcohol is consumed. In Europe (and Argentina), many students live at home, not ‘on campus’, which leads to different meanings of ‘college parties’. Furthermore, alcohol is deeply rooted in Argentinian and Spanish culture, but used more tamely for family gatherings, meals, and celebrations. While alcohol is perceived as ‘normal’ across college settings, the intent for which it is used has been found more dangerous in the US than some other cultures.
Our society and media has created the belief that binge drinking is a central focus of attending college. According to the author, Miller DeMond, “the focus of alcohol awareness explains to students as they are entering college that it is acceptable to drink, despite the illegality of underage drinking. Coming onto the college scene, where students experience freedom to act for themselves like adults, drinking is not only encouraged but expected in college culture”. The dangerous drinking culture created in colleges is encouraged outside of the universities themselves, and our society has a responsibility to change the way heavy drinking is perceived.
Currently, there seems to be an attitude of “we know you’re doing it but don’t let us catch you” around underage drinking in college. The National Institute on Alcohol Abuse and Alcoholism, one of the National Institutes of Health, said “Drinking at college has become a ritual that students often see as an integral part of their higher education experience.” In a survey, the NIAA found that over half of respondents (college students, age 18-22) had alcohol in the past month, and ⅔ had engaged in binge drinking. It is clear the colleges need to educate incoming students about alcohol, however alcohol education for college students seems to focus more on doing it safely rather than preventing it all together. Programs such as AlcoholEdu are often presented to first years as they enter college. The Everfi site, where you can access AlcoholEdu, describes it as “inspiring students to make healthier decisions related to alcohol and other drugs.”  Presenting programs like these to students as soon as they enter college gives the impression that drinking in college is expected, contributing to the drinking culture that surrounds college life. Giving students an online course also allows them to skip through the course without really paying attention to its message. Colleges could instead include education about alcohol in orientations, and make students aware of the drinking culture that exists on college campuses, as well as the consequences of underage drinking, including alcohol related accidents.
Suicide is the second most likely cause of death among college aged students. Suicide is a general term to describe a person that takes their own life, but it can be brought on by a myriad of factors including mental disorders, which themselves are also caused by a number of factors like stress or anxiety. In fact, over 90% of those who commit suicide have some sort of mental disorder at the time of their death, and depression is the most common of those mental illnesses. Depression is a mental illness that can be caused by disturbances in brain chemistry and it can be associated with genetic as well as environmental factors.
The brain is an amazingly complex organ responsible for every function of the human body. The brain is made up of cells called neurons which are in constant communication with each other via electrical impulses so that the body can react to the environment around it. Neurons communicate with each other through the use of neurotransmitters which travel the distance of the tiny gap between neurons, the synapse, so the message can continue to its destination. Depression can be caused by an imbalance of those chemical messengers within the synapse, specifically Glutamate, Serotonin, and Dopamine. Glutamate is responsible for getting the signals between neurons to transmit, serotonin helps to regulate functions like sleep, mood, and hunger, and dopamine is associated with feelings of pleasure and addiction, as well as movement. College can be a stressful and demanding time for young adults and there is no cookie cutter definition of depression or combination of factors that will lead to depression and therefore could be avoided. It is important to note that depression is not solely caused by an imbalance in neurotransmitters, this is just one of the many factors that can cause depression, which if untreated, can lead to suicide.
College creates a unique culture of pressure, expectations, and instability that can leave students prone to mental health problems. According to a New York Times article, anxiety and depression are the most common mental health diagnoses among college students. The culture of higher education can create an atmosphere of pressure from parents, teachers, and society to be flawless. The same NYT article cites, “[a] perception that one has to be perfect in every academic, co-curricular and social endeavor, can manifest as demoralization, alienation or conditions like anxiety or depression.” This culture poses potential danger to students, as they become afraid of failure, and sometimes define themselves by it. Unique to the university of Pennsylvania, but relatable to all college students, Penn Face, “describes the practice of acting happy and self-assured even when sad or stressed” and is, “a potentially life-threatening aspect of campus culture.”  The culture of perfectionism seen in many colleges creates concern for mental health issues, and self-harm.
Along with the pressure of perfectionism, the instability associated with college culture leaves students highly vulnerable. Dr. Uchida, of Fukushima University, quotes, “youths are expected to rapidly form their identities and are exposed to psychosocial risk factors such as academic stress and relationship troubles, which are associated with psychiatric difficulties and suicide.”  Being thrown into a culture of uncertainty while away from support systems can lead students to develop mental health issues they might not have at home. The American College Health Association administered a survey across the country and found that 28.4% of students, diagnosed or not, “felt so depressed that it was difficult to function.”  One Huffington Post headline says it all: In the Name of College! What Are We Doing to Our Children? 
While many college students today will experience a mental health crisis at some point, not all are aware of the resources available to them, or even the signs to look out for regarding their mental health and the mental health of their peers. According to a study done by the National Institute on Mental Illness (NAMI), of college students living with mental illness, 73% experienced a mental health crisis, yet 35% did not inform their school of the crisis. When students enter college their freshman year, there is a lot of emphasis put on things like drinking, drugs, and sexual assault. These are all important topics, but it is also important that students be made aware of mental health. Students need to be educated on signs of mental illness in themselves and others, what to do, and where they can go for help. When asked about what mental health resources are needed on campus, one of the top things students listed was “Mental health information during campus tours, orientation, health classes and other campus-wide events.”
According to the same NAMI study, over 45% of students who withdrew due to mental illness did not seek help for their conditions. The number one reason cited for not seeking help was fear of stigma. Despite a growing awareness, there is still a stigma surrounding mental illness and its treatment. This stigma is even more pronounced around illnesses such as schizophrenia. The onset of schizophrenia typically occurs in the late teens to twenties or thirties, so it is important it be included in college students’ mental health education. A study done in the United Kingdom showed that 70% of people viewed individuals with schizophrenia as “dangerous or unpredictable.” Another study showed that the stress caused by stigma may actually contribute to the transition to schizophrenia in young people who are at risk of a psychotic illness. Of the mental health education that is available to students, most of it is focused on illnesses like depression and anxiety. While it is important to reduce stigma around all forms of mental illness, it is especially important with more serious conditions such a schizophrenia. Increasing awareness and removing the stigma will allow students to feel more comfortable seeking treatment and support, and hopefully reduce the number of young adults that die by suicide.
Cancer is the third most likely cause of death for college aged students with some of the most common diagnosis’s being brain cancer, leukemia and liver cancer. Specific cancer such as the ones listed above have their own specific features and locations, but it is the basic function of the general cancer cell that can be associated with the majority of cancer related deaths. Cancers form in a complicated process that starts with the genetic mutation of just one cell within the body. Every cell operates on some sort of ‘cell clock’ that dictates when a cell should or should not replicate based on the presence or absence of specific hormones. If this process is disturbed by some sort of factor, the cell could over replicate and form the foundations of a cancerous tumor. Within the body of over-replicating cells, more genetic mutations can occur resulting in even more abnormal cells with broken replication functions. If the tumor remains in this state of abnormal replication without breaking the barriers within the tissue then it might never affect the individual, this is known as a situ cancer. It is when more mutations occur that cause the tumor to become malignant that puts a person at serious risk.
A tumor is considered malignant when it has mutated to the point where it has the ability to spread to other areas and organs within the body. The highly prolific cells of the original tumor can establish themselves within another part of the body creating another deadly tumor. What actually causes death in an individual is when one of these malignant tumors causes a disruption in the function of an organ like the liver without which we cannot survive. Cancers are categorized into grades and stages based on their type, size, location(s), and a variety of other factors to give doctors and patients an idea on the severity of their condition.
When someone is diagnosed with a terminal illness, they may wish to hasten their death in order to die with dignity or not prolong suffering for them and their family. This process is called assisted suicide or assisted death. Right now, there are only seven states that allow assisted death, and one that allows physician-assisted death. In the states where it is legal, assisted death is available to anyone who is over 18, a legal resident of the state, mentally competent, and diagnosed with an illness that will lead to death in six months or less.
There has been an improvement in cancer survival rates for children and adults in recent decades, but survival rates in young adults have not seen much of a change. Treatments such as chemotherapy and radiation therapy can have both short and long-term side effects on young adults. Cancer treatment is also expensive. It was found that patients receiving cancer treatment are 2.5 times more likely than healthy people to declare bankruptcy. Treatment can cost up to $150,000, and still runs around $4,000 with insurance. This can cause more stress for the patient and the family, especially in college-age people as they are already worrying about cost of schooling. College students have already been trusted to decide where they want to attend school, what they want to major in, and what they want the path of their life to look like. They should also be trusted to decide how they want their life to end in the face of a terminal illness.
In college, students are often victims of the invincibility fable: that nothing bad will happen to themselves, or they are in other words, invincible. However, college culture can make adolescents ages 18-24 more prone to cancer than they might think. The culture of college can be one filled with bad health decisions, such as unhealthy eating and drinking alcohol or smoking. According to the National Institute of Health, “Tobacco use and poor nutrition are widely acknowledged as cancer risks”. Furthermore, in a recent study, it was estimated that women who drink daily had a 13% increased risk for breast cancer. Additionally, breast cancer is the number one cause of cancer fatalities in college aged women. With all these risk factors, it is extremely important to educate students about cancer, and the ways in which college culture can put them at risk.
Here at UNC, we have a strong cultural presence of breast cancer awareness. The ZTA sorority promotes their national philanthropy, Think Pink, which seeks to raise awareness about breast cancer. They hold multiple events with the goal to, “spread education and awareness as ZTA members distribute ribbons, breast self-examination cards, and informational packets”. While breast cancer awareness is prevalent on the UNC campus, as “pink ribbons adorn the backpacks of hundreds of students”, there could definitely be more cancer education surrounding the multiple other kinds, and risk factors college students are prone to.
Despite all this talk about the most likely causes of death in college students, college itself is not a deadly environment. According to the original study, Causes of Mortality Among College Students, the numbers show that out of 100,000 college aged students, the mortality rates were 10.8 accident related deaths, 6.17 cancer related deaths, and 1.94 suicide related deaths. It is important to be aware of these numbers so as to no become another statistic, but with safety, college is a time of great exploration and development for any young adult ages 18-24.
 Turner, James C., E. Victor Leno, and Adrienne Keller. “Causes of Mortality Among American College Students: A Pilot Study.” Journal of College Student Psychotherapy 27, no. 1 (January 1, 2013): 31–42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4535338/.
 Delphi Behavioral Health Group. “College Alcoholism.” Alcohol Rehab Guide, December 10, 2018. https://www.alcoholrehabguide.org/resources/college-alcohol-abuse/.
 J.D. OGDEN, E., and H. MOSKOWITZ. “Effects of Alcohol and Other Drugs on Driver Performance.” Traffic Injury Prevention 5, no. 3 (August 11, 2010): 185–198. https://www.tandfonline.com/doi/full/10.1080/15389580490465201?scroll=top&needAccess=true
 Ibid., 185-198
 Ibid., 185-198
 Ibid., 185-198
 J.D. OGDEN and MOSKOWITZ, “Causes of Mortality”, 185-198.
 Stanford University Student Affairs. “Alcohol Overdose/Poisoning.” Office of Alcohol Policy and Education. Stanford University, n.d. https://alcohol.stanford.edu/alcohol-drug-info/staying-safe/alcohol-overdosepoisoning.
 Hingson, Ralph, Timothy Heeren, Michael Winter, and Henry Wechsler. “MAGNITUDE OF ALCOHOL-RELATED MORTALITY AND MORBIDITY AMONG U.S. COLLEGE STUDENTS AGES 18-24: Changes from 1998 to 2001.” Annual Review of Public Health 26 (2005): 259–179. https://search-proquest-com.libproxy.lib.unc.edu/docview/235227942?pq-origsite=summon.
 Ibid., 259-179
 Hingson, Ralph, Wenxing Zha, and Daniel Smyth. “Magnitude and Trends in Heavy Episodic Drinking, Alcohol-Impaired Driving, and Alcohol-Related Mortality and Overdose Hospitalizations Among Emerging Adults of College Ages 18–24 in the United States, 1998–2014.” Journal of Studies on Alcohol and Drugs 78, no. 4 (2017). https://www-jsad-com.libproxy.lib.unc.edu/doi/10.15288/jsad.2017.78.540.
 Bravo, Adrian, Matthew Pearson, Angelina Pilatti, Jennifer Read, Laura Mezquita, Manuel Ibáñez , and Generós Ortet. “Cross-Cultural Examination of College Drinking Culture in Spain, Argentina, and USA: Measurement Invariance Testing of the College Life Alcohol Salience Scale.” Drugs and Alcohol Dependence 180 (November 1, 2017): 349–55. https://www-sciencedirect-com.libproxy.lib.unc.edu/science/article/pii/S0376871617304477
 DeMond, Miller. Alcohol in Popular Culture : An Encyclopedia. Greenwood, 2010. http://vb3lk7eb4t.search.serialssolutions.com.libproxy.lib.unc.edu/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.title=Alcohol+in+Popular+Culture+%3A+An+Encyclopedia&rft.au=Miller%2C+DeMond&rft.au=Yelin%2C+Joel&rft.atitle=College+Drinking+Culture&rft.date=2010-01-01&rft.isbn=9780313380495&rft.spage=61&rft.epage=63&rft.externalDocID=CX1760300049¶mdict=en-US.
 “College Drinking.” National Institute on Alcohol Abuse and Alcoholism. Dec 2015. https://pubs.niaaa.nih.gov/publications/CollegeFactSheet/Collegefactsheet.pdf.
 “Alcohol Awareness, Prevention and Training for College Students.” Everfi. N.d. https://everfi.com/offerings/listing/alcoholedu-for-college/.
 National Institute of Mental Health. “Suicide in America: Frequently Asked Questions.” National Institute of Mental Health. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, n.d. https://www.nimh.nih.gov/health/publications/suicide-faq/index.shtml.
 Smith, Melinda, Lawrence Robinson, and Jeanne Segal. “Antidepressant Medication What You Need to Know About Depression Medication.” Help Guide, December 2018. https://www.helpguide.org/articles/depression/antidepressant-medication.htm/.
 Scelfo, Julia. “Suicide on Campus and the Pressure of Perfection.” The New York Times, July 27, 2015. https://www.nytimes.com/2015/08/02/education/edlife/stress-social-media-and-suicide-on-campus.html.
 Uchida, Chiyoko, and Mai Uchida. “Characteristics and Risk Factors for Suicide and Deaths Among College Students: A 23-Year Serial Prevalence Study of Data From 8.2 Million Japanese College Students.” The Journal of Clinical Psychiatry 78, no. 4. Accessed April 7, 2019. https://www-psychiatrist-com.libproxy.lib.unc.edu/jcp/article/Pages/2017/v78n04/v78n0406.aspx.
 Castillo, Linda. “Introduction to the Special Issue on College Student Mental Health.” Journal of Clinical Psychology 69, no. 4 (March 21, 2013). https://onlinelibrary-wiley-com.libproxy.lib.unc.edu/doi/full/10.1002/jclp.21972.
 Scelfo, Suicide on Campus
 Gruttadaro, Darcy and Crudo, Dana. “College Students Speak: A Survey Report on Mental Health.” National Alliance on Mental Health. (2012).
 “Schizophrenia.” National Institute of Mental Health. May 2018. https://www.nimh.nih.gov/health/statistics/schizophrenia.shtml.
 Silva, R., Albuquerque, S., Muniz, A. V., Filho, P., Ribeiro, S., Pinheiro, P. R., and Albuquerque, V. “Reducing the Schizophrenia Stigma: A New Approach Based on Augmented Reality.” Computational Intelligence and Neuroscience (November 2017). Doi: 10.1155/2017/2721846.
 National Cancer Institute, “Adolescents and Young Adults.”
 Cancer.net. “Stages of Cancer.” Cancer.net. ASCO, March 2018. https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/stages-cancer
 “How Death with Dignity Laws Work.” Death with Dignity. N.d. https://www.deathwithdignity.org/learn/access/.
 “Key Statistics for Cancers in Young Adults.” American Cancer Society. April 25, 2018. https://www.cancer.org/cancer/cancer-in-young-adults/key-statistics.html
 “How Are Cancers in Young Adults Treated?” American Cancer Society. April 25, 2018. https://www.cancer.org/cancer/cancer-in-young-adults/treating-cancers-in-young-adults.html
 Moore, Peter. “The High Cost of Cancer Treatment” The AARP Magazine
 Poon, Linda. “Can Fear Of Cancer Keep College Kids From Binge Drinking?” Radio. Public Health. National Public Radio, March 25, 2014.
 Turner, Leno, and Keller, “Causes of Mortality,” 31-42.
By: Nick Belk, Katharine Degolian, Katie Barham