(WASHINGTON) – The next time you consider getting a tattoo or borrowing a roommate’s toothbrush, you may want to think twice. Such behaviors put college students at risk for contracting Hepatitis C, according to a new study from Eastern Michigan University.

The study also shows that students are unaware that many of their behaviors put them at especially high risk of contracting Hepatitis C, a disease of the liver that has no cure and can lead to chronic liver disease, cirrhosis and death.

Activities that can spread the disease include sharing needles during drug use, sexual contact, sharing earrings or having blood-to-blood contact with any object, like a toothbrush, carrying the blood of an infected person.

Symptoms of the disease include jaundice, fatigue, loss of appetite, nausea and vomiting.

Although almost 4 million Americans have Hepatitis C, almost four times the number infected with HIV, most college students know very little about the disease.

Many university health service programs do not focus on Hepatitis C specifically because the disease is contracted in many of the same ways as HIV, said Pat Johnston, adviser for the Student Health Advisory Committee at the University of Maryland.

“Hepatitis C is a co-occurring disease with HIV,” Johnston said. “Hepatitis C fits in with many of the same behaviors associated with contracting HIV.”

University health programs respond to health concerns based on the demands of the student body, said Alli Matson, the Coordinator of Sexual Health Education Programs at the University of Maryland at College Park.

“There hasn’t been a lot of demand for information on Hepatitis C,” said Matson. “However, this department is a resource for all student health concerns.”

Some universities, including the University of Maryland, have taken steps to educate the student body on all types of diseases, including Hepatitis C.

After-hours hotlines, peer education groups, pamphlets, and open-door policies provide students with all types of health information and assistance.

Other universities have little to no information available on Hepatitis C, instead choosing to focus on diseases and conditions more well-known to the student body.