The cognitive and emotional consequences of homesickness can be exacerbated by acculturation stress, the stress caused by the changes in values, beliefs, and behaviors that result from sustained contact with a new culture.11,33 In-115 deed, international students face additional challenges to adjustment, including language differences, which hinder self-expression; cultural differences (eg, food, humor, customs, religion); environmental differences (eg, climate, urban vs rural setting); governance structure and political dif-120 ferences; shifts in responsibilities and reputation; reduction in size of familiar peer group; uncomfortable stereotypes of one’s native country; racism or discrimination; and unfulfilled expectations of the United States or American universities