eating disorders have more recently been attributed in part to body image issues stemming from the unrealistic portrayal of men and women on social media and on television. many students entering post-secondary institutions will already be experimenting with safe dieting methods; however, 35% will progress to pathological dieting, and of those, 20-25% develop partial or full-syndrome eating disorders. cases of partial-eating disorders may become spontaneously remised, while a subset transition into a full disorder. according to a report by the national eating disorders association, eating disorders typically occur between the ages of 18–21, with 10-20% and 4-10% of american college women and men being affected, respectively. students experiencing symptoms of eating disorders are also more likely to experience psychiatric comorbidity. members of certain groups within college are more likely to report and experience symptoms of eating disorders, including athletes and transgender students. the national association of anorexia nervosa and associating disorders states that 16% of american transgender students reported having an eating disorder. another report published by the national center on addiction and substance abuse found that 35% of female and 10% of male athletes were at risk for anorexia nervosa, while 58% of female and 38% of male athletes were at risk for bulimia nervosa. effective interventions given that eating disorders have the highest mortality rate of all mental illnesses, early detection, prevention and treatment is of utmost importance when discussing effective recovery. research shows that receipt of treatment for eating disorders is globally very low, creating a gap wherein individuals in need of care are not receiving proper treatment. several studies investigating eating disorder prevalence on college campuses in the united states found that less than 20% of students who screened positive for an eating disorder received treatment for their diagnosis. another study found that 30-70% of north american students seeking treatment for an eating disorder receive medical intervention for a perceived weight problem as opposed to a mental health problem. this is not ideal, as early detection and subsequent management significantly increases the chances of full recovery. it has been found that seeking help is disincentivized when students are not aware of the options available. therefore, post-secondary institutions have a responsibility to reach out to students, provide tailored feedback on potential symptoms, aid in creating suggestions for future goals, and facilitate the recovery process. post-secondary campuses in north america already provide accessibility to some programs that are both feasible to deliver and facilitate comprehensive screening. the healthy body image program is an online platform intended to screen and deliver tailored interventions to students on campuses. the program labels students as low- or high-risk, or identifies those with a possible clinical/subclinical eating disorder. it subsequently offers suitable evidence-based online interventions or a referral to a specialized physician in order to address risks and clinical status. educational campaigns intended to deliver factual knowledge regarding eating disorders and helpful resources have proven to be most successful when targeting students. although many colleges in the united states offer annual or bi-annual education programs, very few do so on a monthly or weekly basis, which can impact students’ ability to access proper services. efficacy of treatments are also reported when there is an emphasis on holistic health and interactive components. increasing media literacy, specifically concerning distorted media representation of body image, and promoting body satisfaction can improve management skills and encourage positive relationship building. interventions that aid students in recognizing risk factors, such as sociocultural pressure for certain body types, body dissatisfaction, poor self esteem, and challenges with weight management deliver improvements in regards to body satisfaction. additionally, interventions that promote weight control through healthy dietary techniques, utilize persuasion principles (e.g. foot-in-the-door method), and include motivational enhancement exercises have been reported to improve weight gain and functional impairment. treatment gaps although there are a number of helpful online and in-person detection services offered by post-secondary institutions, there is still a significant gap in regards to treatment of eating disorders on campuses. the national eating disorder association found that therapeutic and counseling services were reported to be of highest importance; however, availability is scarce among staff who are specifically trained in counseling and nutritional services. furthermore, there exists a lack of detection and treatment options to match the unique needs of sexual minority students, racial minority students, and college athletes, who appear to be at higher risk for eating disorders or related behaviours. as such, it is imperative for personnel to be properly trained in order to provide culturally and socially tailored help. alcohol and other drug use the most common college health key performance indicator relates to levels and the management of alcohol and other drug (aod) misuse and abuse. substance abuse has been shown to peak in early adulthood. in college and university students, substance use is predicted by many factors including sensation seeking behavioural tendencies, perceived use of substances by peers, biological markers, and habits prior to post-secondary education. in north america, alcohol, marijuana, and tobacco are the most frequently used and misused substances. alcohol alcohol is the most heavily-consumed substance globally, accounting for 4.6% of the global burden of disease with young adults disproportionately affected. according to the 2018 national college health assessment (ncha) administered to college and university students in north america, 60.6% of males and 62.5% of females reported consuming alcohol within the last 30 days. student perceptions about the frequency of alcohol use by their peers proved to be higher than reality, with ncha results indicating that students perceived 93.2% of their peers to have consumed alcohol within 30 days. the national institute on alcohol abuse and alcoholism suggests that around 1,400 college students between the ages of 18-24 die annually as a result of alcohol consumption, and around half a million students sustain injuries under the influence of alcohol. according to alan dennington, a researcher on the topic of mental health on college campuses, 1 in 4 college students experience a decline in their academics due to the use of alcohol. many post-secondary institutions have introduced harm reduction programs with the goal of reducing problematic alcohol consumption habits among students. as of 2010, 98% of colleges in the united states used programming in order to reduce the risk of student drinking. in 2002, the national institute on alcohol abuse and alcoholism's task force on college drinking published a set of recommendations for colleges and universities to reduce dangerous drinking behaviours. these guidelines included both individual-level and population-level strategies, including restricting alcohol consumption on campus, campaigns addressing social norms, and targeted educational initiatives. however, research suggests that these recommendations are not followed properly in american colleges, and updated approaches may be required. some emerging strategies focus on the role of social media in propagating alcohol culture on post-secondary campuses. it has been found that increased marketing of alcoholic products is positively correlated with consumption by youth, a problem which has been exacerbated in recent years through the growing popularity of social media advertisements. tobacco tobacco can be consumed in a variety of forms with popular options for post-secondary students including cigarettes, e-cigarettes, and waterpipes. tobacco consumption rates in post-secondary students vary dependent on the geographical location and gender of student. in north america, the national college health assessment (ncha) for spring 2019 reported that 6.4% of students used cigarettes within the last 30 days, 12.6% used e-cigarettes, and 2.1% used water pipes (also known as shisha or hookah). in each category, use of tobacco products by men was more frequent. north american college students vastly overestimate the use of tobacco products by their peers, with cigarette use estimated at 70.2%, e-cigarettes estimated at 83.1%, and water pipes estimated at 58.2%. initially, e-cigarettes (also known as 'vapes') were viewed as a safer alternative to cigarettes, but are known to have expanded the tobacco market due to their appeal to youth. college students have been found to underestimate the dangers and addictiveness of e-cigarettes as compared to conventional cigarettes. while e-cigarettes contain lower levels of carcinogens than cigarettes, they still expose the user to ultrafine particles and other toxins that can increase risk of chronic disease. many post-secondary institutions in north america implement anti-smoking programs, exemplified by around 2000 smoke-free college sites in the united states and at least 65 in canada. many of these programs are expanded to all tobacco products, and aim to reduce student exposure to second-hand smoke, discourage use of tobacco products, and eliminate litter created by cigarette butts. cannabis marijuana is one of the most widely used drugs among young adults. according to the u.s. department of health & human services, 22% of college students and young adults report consuming marijuana within the past month. data has shown that the proportion of young individuals who perceive marijuana as dangerous is decreasing, which may hinder prevention efforts, such as those against the emerging and popular administration route of vaping. frequent use of marijuana by young people may be associated with poor health outcomes. additional drugs include other substances used by post-secondary students vary by geographic location, gender, socioeconomic status, and other factors. substances used by college students include prescription opioids, amphetamines and other stimulants, hallucinogens, and sedatives. opioids are a class of drugs that can relax the body and relieve pain. in the united states, the national institute on drug abuse (nida) reported that misuse of prescription opioids has dropped from 5.4% of college students in 2013 to 2.7% in 2018. examples of prescription opioids include hydrocodone (vicodin®), codeine, oxycodone (oxycontin®, percocet®), and fentanyl. misuse of opioids has resulted in the opioid epidemic affecting primarily north american countries. amphetamine and dextroamphetamine (adderall) is a medication used to treat attention deficit hyperactivity disorder (adhd). adderall falls under the drug class called stimulants. over 2.5 million americans are prescribed adderall, and roughly 50% of college students that were prescribed this drug have been asked by their peers if they can buy some. adderall is linked to aggression, restlessness, increased blood pressure and heart rate, paranoia, psychosis, seizures, heart attack, and stroke. adderall is known to only improve the cognitive processing in those who have conditions such as adhd; for individuals with no cognitive condition, the drug should have no effect and taking this drug can result in negative effects. other prescription stimulant drugs include concerta® and ritalin®, which are both brand names for methylphenidate hydrochloride. non-prescription stimulant drugs include cocaine and methamphetamine (commonly known as meth). the nida has reported that 11.4% of young adults aged 18–25 have used cocaine in their lifetime. hallucinogens alter one's perceptions of reality as well as their thoughts and emotions. this class of drugs include psilocybin (commonly known as magic mushrooms or shrooms), d-lysergic acid diethylamide (lsd), salvia, and ketamine. the nida reports that over two hundred thousand americans over the age of 12 reported use of lsd within the past month. sedative drugs, such as benzodiazepines, are often used to relieve anxiety or induce sleep. this class of drugs includes diazepam (valium®), lorazepam (ativan), and alprazolam (xanax). a 2001 study of college students from 119 american 4-year college programs found that 7.8% of students had tried benzodiazepines in their lifetime. sexually transmitted infections college health key performance indicator relating to levels harm from sexual activity are common. although anyone engaging in sexual activity can contract a sexually transmitted infection (sti), adolescents are particularly susceptible and account for increased prevalence rates compared to the general population. the centers for disease control and prevention reported that youth aged 15–24 account for the highest incidence of combined total cases of gonorrhea, chlamydia and syphilis in 2015. this age group made up 65% of chlamydia cases, and 53% of gonorrhea cases. additionally, a study found that 15% of respondents in a sample of 2000 current and former american college students report never using a condom, and 4% only do so when their partner asks. given college students fall within the age range of 15–24, and are more inclined to engage in casual sexual encounters without proper protection, post-secondary institutions hold a responsibility to ensure adequate sti screening and education prevention. one study investigated the prevalence of chlamydia among college students in the united states, and found that routine screening is not available, or easily accessible, at most post-secondary institutions. common services, programs and policies included in advancing the health and wellbeing