You're bound to worry when your kids go off to college for the first time. Will they keep up with the work? Will they socialize too much? Will they be safe? Will the pressure to use alcohol be great? Will they even manage to eat, go to sleep and wake up without your supervision?

With all these doubts keeping you up at night, the last thing you need is to worry about your son's or daughter's health. A thorough pre-college physical examination, updated vaccinations and familiarity with on- and off-campus health care options should decrease that particular anxiety. Here are some tips for helping your undergrad stay healthy.

Most universities and colleges require students to have a pre-college physical examination before going to school and to be up-to-date on their measles, mumps, rubella (MMR) and tetanus-diphtheria (Td) toxoid vaccinations.

At this appointment, the doctor will evaluate any problems or potential risks associated with your child's personal and family medical history. The doctor will also give your child a general physical examination to verify that he or she is healthy. The pre-college physical should include an external examination of the reproductive organs for males and a pelvic exam for females. If your college student needs ongoing or periodic treatment for a medical problem, ask your local doctor to help you make plans for your child to receive the necessary care at college. Colleges and universities may require additional tests for new students who are planning to participate in athletics or who have chronic health conditions.

College students are vulnerable to several infectious diseases. Although immunization against these diseases is not required, it's a sensible precaution.

Meningococcal disease. College students live, eat and study in close quarters and come into contact with many people every day. This setting favors the spread of meningococcal meningitis, a bacterial infection of the membranes and fluid surrounding the brain and spinal cord. The disease, caused by meningococcal bacteria, is highly contagious and may cause localized epidemics. Although fewer than 100 college students contract meningitis each year, each case has the potential to become a campus-wide epidemic.

A vaccine that offers some protection against most strains of meningococcal bacteria is currently available, though the immunity wears off in three to five years. The American College Health Association and Centers for Disease Control and Prevention (CDC) recommend that college students, especially those living on campus, be alerted about the risks of contracting meningitis and have access to the vaccine.

Hepatitis B. Because college students may be sexually active or live in close proximity to others with hepatitis B, they are at an increased risk of infection with hepatitis B virus. The virus is spread through the exchange of body fluids. Hepatitis B can become chronic or cause severe liver damage and liver failure, but is preventable with a vaccine. Adolescents getting immunized against hepatitis B for the first time receive two or three shots (depending on the manufacturer) with intervals of several weeks between shots. Because one out of 20 people contract hepatitis B at some point in their lives, the CDC recommends universal immunization. The risk is highest for people who inject street drugs or have more than one sex partner, but health care workers and family members of infected people may also contract the virus. The source of some cases of hepatitis B cannot be determined.

Influenza. A bad case of the flu can be an academic disaster for a college student. Influenza, a viral upper respiratory infection, causes muscle aches, fever, chills, coughing and severe fatigue, sometimes lasting well over a week. It can also progress to pneumonia, or infection of the lungs, which may be life-threatening and invariably slows recovery. The CDC encourages students, especially those who reside in dormitories, to get a flu shot. The vaccine changes yearly so that a new dose is needed each autumn.

Students who plan on studying abroad during college are also encouraged to be vaccinated for hepatitis A and tested for tuberculosis. Other conditions for which immunization is recommended for all adolescents are chickenpox (varicella) and rubella. Tetanus-diphtheria boosters are recommended every 10 years.

The switch from high school to college can be difficult. Students have a great deal to learn — not only in the classroom, but also in the dormitory and at campus social functions. To safeguard their health, they need to:

• Get enough sleep. Inadequate sleep leads to depression, anxiety, poor concentration, memory impairment, lowered resistance to illness, and increased drug and alcohol use. Encourage your college student to go to bed and get up at regular hours. Many students view all-night study sessions as normal for college, but often the practice stems from poor study habits or weak time-management skills — some students take on more tasks than they should. If noise or roommate conflicts create a sleep problem, student housing or student services could help mediate. Additional options to encourage sleep include using travel earplugs and eyeshades, or perhaps a fan for a steady background sound. Remember that an alarm clock is also an essential part of college life — no more relying on parents for awakening in time for class.

• Maintain good habits. Away from home, students may eat poorly and forgo exercise, a combination that saps energy and promotes weight gain. Late-night pizza, a tradition in many dorms, does nothing to help. At the other extreme, an eating disorder such as anorexia may appear when a youngster is away from home for the first time.

  Instead of nagging your college student about weight, offer help and support if he or she mentions a problem. If your child's weight changes dramatically over a school term, however, find out why. Don't hesitate to consult a doctor or mental health professional if you sense deeper trouble.

  Car and bicycle safety merit attention, too. Long before they go to college, young people should be in the habit of wearing seat belts in cars and helmets on bikes.

• Drugs and alcohol. Even though most college students are well below the legal drinking age, alcohol is a prominent feature of social life on most campuses. Make sure your son or daughter knows that underage drinking is against the law, as is the recreational use of drugs — and that police don't always turn a blind eye to violations. Also warn your son or daughter about the physical and emotional hazards of drugs and alcohol. Drinking and drug use can cause depression, anxiety, memory impairment, difficulty concentrating and a host of dangerous behaviors and destructive thought patterns. Students worried about their own or their friends' drinking and drug use should consult their campus student health service for treatment or referral.

  When your child decides on a school, ask what impressions he or she has gotten about drug and alcohol use on campus. Do a lot of the students drink and use drugs? Do the administration and local police condone it? Regardless of the answers, emphasize that you trust your son or daughter to stay safe, use good judgment and intervene if friends or acquaintances are in danger. Emphasize the rule, "If you drink, don't drive, and if you drive, don't drink." It has saved lives. Every time a group goes to a social event in a car, someone should be the designated driver. The practice is well accepted everywhere.

• Practice safe sex. Many young people are sexually active in college, and a few behave irresponsibly. Make sure your child knows where to go for information and services related to birth control and sexually transmitted diseases (STDs). Before your child goes to college, make sure you've discussed contraception and STD prevention.

Most colleges and universities have student health offices or clinics staffed with doctors and nurses who can treat acute illnesses or refer students to off-campus health providers. Talk with the college admissions staff about campus health and wellness resources, especially if your child has a learning disability or a medical condition.

Most kids in school get their health coverage through their parents, but they should know their health plan name and pertinent information they might need in an emergency — group number, parent member number and telephone numbers for preauthorization. Ask your health insurance company for an extra health card and tell your college student to carry it at all times. If you don't have health insurance, many colleges offer a low-cost insurance plan for students who need health insurance coverage.

Medical care is confidential, even if the parents pay the bills. Parents can emphasize that they will support their child getting medical help for any circumstances that arise including drug or alcohol concerns, sexual health issues or mental health problems.

You can help your child make a smooth and safe college transition by taking these measures:

• Give advice, but don't dictate dreams. College will broaden your child's outlook, perhaps in ways you can't anticipate. Try not to be judgmental if your child's aspirations are not exactly what you had in mind.
• Help your son or daughter learn from mistakes. It takes time to achieve independence, particularly for youngsters who have a history of learning things the hard way. Before you intervene in your child's college problems, ask yourself whether you need to get involved. It's not always easy to tell. Because college is both unstructured and academically challenging, youngsters easily get in over their heads. If you know your child well, though, you should be able to tell the difference between rough times and real crises.

• Establish academic and social standards of conduct. Although you can't control your child's behavior at college, you can emphasize the difference between appropriate and inappropriate behavior in the classroom, in the dorm and at social events.

  Colleges do not notify parents when students have academic problems. Parental intervention won't solve such problems. Instead, the student and school administration have to work things out. It's reasonable to let your youngster know that you expect to be informed if he or she runs into academic difficulties

Few jobs are more difficult than handing over the reins after you've steered your children through the first 18 years of life. When they leave home, though, young people need to rely on themselves. With luck, all your guidance and support will have prepared them to do just that.