Andrew: What health issues do college students face that are different from those faced by the general population?

Jean: For most students it's a complete change from living at home-we're talking undergraduates here: having a support system in place; having parents that are monitoring sleep and food and general health issues. If someday you need to go to the doctor, that's not happening once students move into the dorm or an apartment, and are suddenly now responsible for themselves; not only for getting to school, getting into class, but for their food, for their sleep, for their finances. It is a huge change, and even when change is good, it can be a big stressor on the body.

Lu: Even taking things as easy as their allergy pills or vitamins is a stressor because they've never reminded themselves to do so.

Andrew: What types of situations do graduate students face?

Jean: First of all, the undergraduates are used to being in school. Most of them are coming directly from high school into the college setting, so the academics stays pretty much the same for them. With graduate students, they've probably been out of the academic setting for one year plus, so they have to learn to reintegrate the academic within their own-whether they have families or jobs, how are they supporting themselves? They have to bring the academic back into that situation; find a blend that works for them. But they go through the same kinds of issues, just in reverse because again they're going back to an academic setting; whereas they may have been in the work force or doing something different with family, etc.

Lu: They have to learn how to integrate time. If they're parents, they have to integrate children's time with their study time and their academic schedule and plan things around that. And sometimes they come back expecting more and wanting us to do more for them because they are paying students and graduate students and should be treated differently, or [they] have the assumption of being treated differently.

Andrew: What are the most common health problems that international students report?

Jean: Gastrointestinal (GI) problems like stomach aches. A lot of times it has to do with differences in the food or how they're eating, because food is definitely different here than most countries.

Lu: Part of that is if they gain weight or lose weight here, sometimes it's even a matter of honor before they will even report it. They hold a certain standard of pride, the women do, and if they gain weight the come in and they almost become anorexic because they're not supposed to be gaining weight and they don't realize that it will stabilize after they've gotten used to the particular diet.

Jean: We've seen a lot of sleep disturbances. They're in different surroundings, and they're not realizing they still need seven hours of sleep and thinking they can go on three or four hours of sleep and wondering why they have increasing fatigue and inability to think and function in the classroom. Stress-even the stress of mid-terms or finals-can throw their bodies all out of their normal schedule and the health issues become more prominent. They're more susceptible to respiratory infections, especially if the climate is different from their home. And if they're not dressing appropriately; if they're coming from a hot climate, and they have no cold weather clothing, and you've got a wet, cold winter, they're asking for health difficulties. We've seen a lot of loneliness and isolation. They're now living with strangers and trying to deal with that. Going back to the diet, we see anemia because they're not getting appropriate nutrients in the diet that they've been able to figure out that they can tolerate in American foods.

Lu: And yet even the fish that is so commonplace in Japan is different here and more costly here, so they might not access it We don't have fish as a general thing in our student cafeterias like they might have at home, so there are going to be all kinds of differences for them.

Andrew: What kinds of health problems are international students facing but not immediately reporting?

Jean: Sexuality issues, particularly for Japanese women. Saying "no" to an American male is very difficult for them to do, so we are seeing a lot of sexual activity-not necessarily assaults-that they're not prepared for; they're not using some form of birth control; they're not understanding that sexually-transmitted diseases are rampant. It's a whole different climate to explain to them that as a woman they have a right to say "no, I do not want to have sex," or, "no, we will not have unprotected sex." They are taught from early on not to say "no," and that creates a great deal of difficulty.

Lu: Even in some of the Asian or far east countries, where birth control is not acceptable, or in countries where it is the only thing that's acceptable, and the different methods are either acceptable or not acceptable. So if you're going to even venture into that area, it's one where the provider-someone like us-has to become at least somewhat familiar with what is acceptable with what is acceptable in the patient's country, if we're going to treat them. For a while, in the 80's, it was Iranians and what we could do with them, even in an examination. As a female provider I really wasn't supposed to be examining a male, and when I examined a female there were certain things that I could and could not do. So it also depends on what is acceptable in their culture, so we have to accept cultural differences too.

Andrew: What pieces of advice about staying healthy would you give to international students.

Jean: