A comparison of health risk behaviors among Virginia Tech and James Madison University students enrolled in a personal health course.

Smith, Theresa M. Enyeart ; Skaggs, Gary E. ; Redican, Kerry J. 等

Abstract

Research on whether health education, specifically personal health classes can affect behavior change has so far been inconclusive. In this study, a sample of students from James Madison University and Virginia Tech enrolled in personal health classes were administered the National College Health Risk Behavior Survey (NCHRBS) (Douglas et al., 1997) and the Self-Efficacy Scale (Sherer et al., 1982). These surveys provided information on the overall health risk behaviors, health behavior changes, and self-efficacy levels of the student participants. Proportionate differences and significant results were found within the descriptive and multiple regression analyses of riding in a vehicle with a driver who has been drinking alcohol, tobacco use, and dietary behaviors. However, the small effect sizes indicated that the differences between the two schools were not large. Further research is needed to determine how consistent these findings are.

Introduction

Many premature deaths are due to poor individual health behavior choices, such as overeating, using tobacco products, and not participating in physical activities (Services, 2002). Some of these health behavior ideas and choices are often incorporated in the early adulthood years of life, which can affect the risk levels of chronic diseases that can occur later in life. As a result, knowing that poor individual health behavior choices can affect one's lifespan has the potential to be vitally important in preventing health problems, especially in the early adulthood years. Although major sources of health education are the health education courses offered in colleges and universities, the value of these courses is not known due to the poor documentation of health knowledge among the students taking these courses (Price & Nicholson, 1991).

Documentation of college students' health behaviors is also limited. Research has indicated that it is common for studies to focus on one or two behaviors at a time and not take a comprehensive look at overall health risk behaviors of college students. The Center for Disease Control and Prevention (CDC) conducted a national survey analyzing college students' overall health risk behaviors in 1995 (Douglas et al., 1997). By analyzing college students enrolled in four and two-year institutions, Douglas et al. (1997) found that "many college students' behaviors jeopardize their current and future health status" (p. 66). The results indicated that college students showed risky behaviors when it came to the use of alcohol and tobacco, failing to protect themselves from sexually transmitted diseases during sexual intercourse and using contraceptives inconsistently, having poor dietary habits, and participating in physical fights (Douglas et al., 1997). Although this information is important to understanding health behaviors among young adults, it is important to note that this study was performed nearly ten years ago and health behavior trends may have changed over the years.

Significance

Measuring the health risk behaviors among the enrolled students will give the colleges and universities a better idea of current behaviors and trends among the students. Professors may therefore be better able to direct the course material to the lifestyles the students are leading in today's era. Comparing the health behavior differences among the students enrolled at James Madison University versus the students enrolled at Virginia Tech and looking at the differences in self-efficacy levels may also allow the schools to see if there are people with varied lifestyles entering into the classes, and whether the differences between the two schools are related to measures of behavior change.

Review of Selected Literature

Many factors can affect the behavior changes of students enrolled in college and university level health education courses and programs. Some of these factors include: the types of non-curriculum programs offered by the college or university (Haines & Spear, 1996; Lindsey, 1997; Lipnickey, 1998; Ramsey, Greenberg, & Hale, 1989; Schwitzer, Bergholz, Dore, & Salimi, 1998; Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994; Ziemelis, Bucknam, & Elfessi, 2002), the teaching methods used to teach university and college level health education courses (Cleary & Birch, 1996; Petosa, 1984; Springer, Winzelberg, Perkins, & Taylor, 1999), and the self-ef.cacy of the students (Bandura, 1997; Stretcher, DeVellis, Becker, & Rosenstock, 1986).

Colleges and universities have incorporated different programs and information into their curriculum and campuses to help educate the students in making healthy behavior choices and leading a healthier lifestyle. Incorporating alcohol/binge-drinking programs, eat disorder programs, AIDS awareness programs, stress management programs, and health education courses are a few methods colleges and universities have taken to improve the students' health and educate them about health and wellness, as well as improving the accuracy of the perceptions of college student behaviors (Haines & Spear, 1996; Ramsey et al., 1989; Rehnberg & Barabasz, 1994).

Teaching methods used in the health education courses may also impact the effectiveness of the course on the students. Many different methods have been incorporated into the higher education health courses, above and beyond lecture, with an attempt to increase the students' knowledge about health and health behavior changes. When looking at overall health behavior changes, journals (Lottes, 1995), health portfolio (Cleary & Birch, 1996), and behavior change contracts (Petosa, 1984; Wilson & Eisenhauer, 1982) are a few examples that have been incorporated into the health education courses to enhance the knowledge and behavior changes of the students. These instruments are being used to enable the students to reflect and apply their health knowledge to their everyday life and make healthy choices.

Along with external factors that may effect health behavior change among students enrolled in a health education course, internal factors, such as self-efficacy, may also play an important roll in health behavior change. Self-efficacy is the internal feeling that one has that he or she can successfully perform a health behavior and achieve the desired outcomes (Rosenstock, Stretcher, & Becker, 1988). Self-efficacy is defined by Bandura (1977) as "the conviction that one can successfully execute the behavior required to produce the outcomes" (p. 79). Low self-efficacy or a lack of self-efficacy can be a perceived barrier to performing or changing a health behavior. In order to create positive lifelong changes in one's health behavior lifestyle, a great deal of self-efficacy is necessary before any positive change can occur (Glanz, Lewis, & Rimer, 1997; Rosenstock et al., 1988; Stretcher, Champion, & Rosenstock, 1997).

Methodology

The target population for this study was undergraduate college students enrolled in the freshman level personal health courses at Virginia Tech (VT) and James Madison University (JMU). Upon the approval of the Virginia Tech and James Madison University Institutional Review Board, the National College Health Risk Behavior Survey (NCHRBS) (Douglas et al., 1997), was administered once at the beginning of the Fall 2003 semester to acquire baseline data and a second time at the end of the Fall 2003 semester to acquire health behavior data once the students were about to complete the personal health course. The NCHRBS was created by the CDC to analyze six main health risk behaviors: 1) behaviors that contribute to unintentional and intentional injuries, 2) tobacco use, 3) alcohol and other drug use, 4) sexual behaviors related to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection, 5) unhealthy dietary behaviors, and 6) physical inactivity of college students, was used as a pre/post test. The Self-Efficacy Scale (Sherer et al., 1982) was also used to acquire baseline data of the students' general self-efficacy. This survey was administered one time at the beginning of the Fall 2003 semester.

Limitations

There were several limitations associated with this study. The most important limitation is that pre-existing conditions may exist between Virginia Tech and James Madison University. These conditions include acceptance requirements for each university, the location of the school and the socioeconomic status of the students enrolled in the school. These pre-existing conditions make it difficult to know the reason for why the schools differed. Another limitation is the difference of teaching styles between the two classes. The two courses have the same objectives, namely to enhance the health behavior knowledge and self-confidence of the students, and their content is nearly identical. Nevertheless, other differences exist. The VT course has an approximate total of 700 enrolled students and is taught by lecture, video, and classroom discussion. On the other hand, the JMU course has an approximate total of 300 enrolled students and is taught using lecture, video, and classroom discussion, similar to VT, but also incorporates many activities to complete outside of the classroom, such as passport activities.

Finally, the current study was limited to the two schools used in the study, VT and JMU. If more schools in the state of Virginia were used in this study, the results may also be generalized to describe the behaviors of college students in Virginia. Findings

Overall, 891 students voluntarily completed the pre NCHRBS and the self-efficacy surveys (VT: n = 622; JMU: n = 269) and 829 students completed the post NCHRBS (VT: n = 593; JMU: n = 236). Once all of the data were collected, it was edited to include only those students who completed both the pre and post NCHRBS and the self-efficacy survey. This reduced the sample size to a total of 577 (VT: n= 375; JMU: n= 202) students. When examining specific health risk behaviors and differences between the two groups of students, the results indicated that JMU students had proportionately less risky behaviors than VT students with behaviors related to: 1) consuming alcohol while boating or swimming; 2) consuming alcohol while operating a vehicle; 3) using any form of cocaine; 4) engaging in sexual intercourse with males or females; 5) using condoms; and 6) performing exercise and stretching activities. Virginia Tech students had proportionately less risky behaviors than JMU students on behaviors related to: 1) smoking cigarettes on less days out of a seven day period; 2) eating green salads with greater frequency; and 3) participating in more college sports teams.

Multiple regression analyses were completed to look at the possible relationship between the two schools and the students' health risk behaviors while controlling for the students' overall levels of self-efficacy. Statistically significant results were obtained for the health risk behaviors of riding in a vehicle with a driver who has been drinking alcohol (p = 0.034) and the dietary behaviors of eating fruits and vegetables (p = 0.014) and high fat foods (p = 0.006). When comparing the posttest frequencies to the pretest frequencies of both schools combined, the results showed that at the end of the semester students tended to ride in vehicles with a driver who has been drinking with less frequency; fruits and vegetables were consumed with less frequency; and high fat foods were consumed with greater frequency. However, it is important to note since the effect sizes were small with these variables, further investigation should be performed to see if there are other underlying factors that might affect the students' health risk behaviors.

Recommendations

Other factors may very well affect the health behaviors of college students. Therefore, several recommendations have been made for future research:

* Investigate the schools' policies on allowing student vehicles on the campus. These policies may not allow freshman students to have vehicles on campus, therefore, possibly affecting their choice in taking a ride from another person.

* Examine the availability of "healthy" foods by the schools' eateries. The options provided to the students may affect their choices in what they eat on a daily basis.

* Observe the availability of exercise facilities, physical education courses, and intramural/extramural sports. The availability of these physical activity options and the students' knowledge of what is available to them may affect their daily choices of an exercise regimen.

* Administer the surveys to a wider variety of schools in the state of Virginia to gain more of a generalized view of the health risk behaviors of students in Virginia.

The information acquired from this study will be beneficial to higher education health educators. Current trends should be observed allowing for the course curriculum to be altered. This may allow the students to learn, understand, and relate to health risk behaviors that they may have or their peers may have.

Author Note

Theresa M. Enyeart Smith, Kerry J. Redican, and James A. Krouscas, Jr., Department of Teaching and Learning, Virginia Polytechnic Institute and State University;

Gary E. Skaggs, Educational Leadership and Policy Studies Department, Virginia Polytechnic Institute and State University.

Thank you to Kurt Eschenmann of Virginia Polytechnic Institute and State University and Stephen Stewart of James Madison University for your assistance with the organization and critiquing of this manuscript.

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Dr. Theresa M. Enyeart Smith, Dr. Gary E. Skaggs,

Dr. Kerry J. Redican, and Dr. James A. Krouscas Jr.

Virginia Polytechnic Institute and State University

Correspondence concerning this article should be addressed to Theresa Enyeart Smith, Department of Teaching and Learning (0313), 220 War Memorial Hall, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061. E-mail: tenyeart2@cox.net