BACKGROUND: In the U.S., more than two-thirds of college and university students report gambling in the past year. Although most U.S. college students gamble without experiencing clinically significant symptoms, they do experience more problems compared to more mature adult populations. It is estimated that 16.3% of U.S. college students experience clinical or subclinical gambling disorder. Gambling disorder is a serious mental health problem on college campuses with the potential for negative academic, financial, and mental health outcomes. This study is only the second to assess college gambling policies in the U.S. and the first to assess college gambling policies at two time-points. METHODS: To gather gambling policies and supporting web-based materials, I completed extensive searches of websites for 117 U.S. colleges and universities. I assessed each school’s policies and supporting web-based materials using a modified version of Shaffer et al.’s (2005) gambling policy assessment. The policy-coding instrument includes questions about state-level gambling characteristics, school-level characteristics, school gambling policies, and implementation of the Task Force on College Gambling Policy’s 2009 recommendations. RESULTS: A previous assessment of gambling policies among this sample of U.S. colleges and universities found that only 25 had a gambling policy. By the beginning of the 2016-17 academic year, a review of each college and university’s policies revealed that 82 colleges and universities (70.1%) now have a gambling policy, representing a 228% increase. This follow-up assessment further explores college and university gambling policies by reviewing the location and scope of those policies, plus whether certain state or college/university characteristics are associated with having a gambling policy in 2017. CONTRIBUTION: In addition to the study findings, I provide college and university health practitioners with a guide to assess, select, and implement problem gambling policies and programs that are responsive to their campus needs based on SAMHSA’s Strategic Prevention Framework.

Like other adults in the U.S., college students, have high rates of obesity and overweight, and they have a pattern of poor diet and physical inactivity. Emerging adulthood is a key developmental period for building life-long habits and behaviors, and health theory suggests that one’s social environment and amount of social support affects health behaviors, particularly among women. With the technological advances of Web 2.0, or social media, the opportunity for providing social support for health behaviors through the online social environment now exists; social media is a game changer for both research and practice related to understanding the social environment. The purpose of this descriptive qualitative study was to describe the ways in which social networking sites (SNS) provide college females with social support for their diet and/or physical activity goals. The social cognitive theory and previous research on the construct of social support, provided a conceptual framework for this study. With a purposive sample of 12 college females, data from three sources were collected over the course of four weeks. Journal responses and daily observations of each participant’s social networking site activity via Facebook, Instagram, Twitter and Pinterest were collected the first three weeks, and interviews were conducted the fourth week. Qualitative analysis was conducted at both the participant and group level, and results inform how the women engage with the topics of diet and physical activity during their daily SNS usage the ways in which their SNS experience provides them with support for diet and/or physical activity goals. Of the five functional measures of social support, participants most often indicated receiving emotional support, informational support and validation support from SNS usage. The findings of this study highlight current social media practices in college females, which can better inform the planning and implementation of health behavior programs that include an online, social component. Furthermore, the results serve to highlight examples of social support naturally occurring in the online environment, thereby adding to the body of literature about ways in which social support influence health outcomes.

Hitherto, students have not evaluated the importance and performance of services provided by the student health service (SHS) at East Tennessee State University. An evaluation could provide valuable feedback to providers and administration. In 2001, there were 944 student visits in the summer sessions. Approximately 256 students were offered a survey containing an Importance-Performance scale of which 151 (59.0%) responded. The I-P scale rates the importance students place on healthcare services and the performance of the SHS in delivering services (i.e., patient satisfaction). Based on mean scores, students reported high importance, high performance on urgent care, pharmacy and patient education. Contraception education, laboratory and nutrition education were rated as low importance, high performance. Alcohol education was rated as low importance, low performance. The student health service at ETSU may use the results of this study to expand, reduce or modify services. Further research of students in other semesters is needed.

College students have been identified as at high risk for contracting Human Papillomavirus (HPV) due to engaging in risky behaviors, such as binge drinking and unprotected sex. Before preventative measures like vaccination and condom usage can be promoted, awareness must be evaluated. A random sample of 438 college students was surveyed on their awareness of HPV using both paper and online surveying methods. Using binary logistic regression, HPV awareness was predicted using demographic measures. The majority of the sample reported having heard of HPV before. Sexually active respondents and females were significantly more likely to report awareness. Non-whites and first-generation college students were also more likely to report awareness. These demographic predictors will help identify groups needing educational and HPV intervention programs. Implications and further research is discussed.

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The present study investigated high risk behaviors in a population of college students through the use of a large, national quantitative data set and individual qualitative interviews. Since millions of students are enrolled in higher education, which often comes at a great financial cost and sacrifice to them and their families (Henretta, Wolf, Van Voorhis & Soldo, 2012), this is a particularly important population to study. Additionally, despite being a time of optimal health, adolescence is also a time of increased mortality, particularly as it relates to social morbidities (Resnick et al., 1997). While risk taking amongst college students manifests itself in many ways, the primary focus of this research will be on alcohol use, drug use and sexual behavior. Recent research in the field, including the composite measure of psychosocial maturity (Steinberg, Cauffman, Woolard, Graham & Banich, 2009a), the social neuroscience perspective (Steinberg, 2008) and current trends in alcohol use, drug use and sexual behaviors amongst college students were examined. The American College Health Association National College Health Assessment II (ACHA-NCHA II) provided statistically significant evidence that students who drink more (frequency and quantity) have lower overall GPAs, experience more negative consequences as a result of their drinking and experience more impediments to academic success. Students who live on campus, are members of Greek fraternities and sororities and/or are varsity athletes engage in higher levels of binge drinking than their peers. Additionally, students who drink more (frequency and quantity) engage in other risky behaviors (unprotected sex, NMPD use, etc.) at higher rates than their peers. Qualitative interviews with high achieving students who engaged in various levels of risk taking resulted in the explication of six distinct themes: defining and conceptualizing risk taking, decision making, painting a picture of individual risk taking, academic achievement, peer perceptions and influence, and achieving both (what allows a high risk student to also be high achieving). In addition to the above analyses, the present study also examines implications for practitioners and directions for future research. / Educational Psychology

Information on the overall health risk behaviors of college students is limited and it is unknown if being enrolled in an elective or a required health course affects behavior change among the students. There are mixed reports on whether or not health education courses affect behavior change. Factors that may affect change are self-efficacy and the constructs that build the Health Belief Model (i.e. perceived susceptibility and perceived barriers). A sample of convenience was gathered for the current study using two universities in the state of Virginia. Virginia Tech students within the sample were enrolled in an elective health course (n = 375) and James Madison University students within the sample were enrolled in a required health course (n = 202). The National College Health Risk Behavior Survey (NCHRBS) and the Self-Efficacy Scale survey were used to gather information on overall health risk behaviors, health behavior changes, and self-efficacy levels of the students. To acquire health behavior change data, the NCHRBS was administered at the beginning of the Fall 2003 semester and again at the end of the semester. The results of the study indicated that, overall, the type of course a student was enrolled in and self-efficacy did not have a significant effect on health behavior change. However, possible trends were identified with alcohol use, tobacco use, and dietary behaviors, indicating that further research should be performed to analyze underlying factors, not analyzed in this study, which may be affecting health risk behaviors. / Ph. D.

The illicit use of prescription stimulants (IUPS) is a critical Public Health problem in the college population that represents a unique form of substance use. Namely, the primary motives for IUPS by college students are academic in nature (e.g., Teter, McCabe, LaGrange, Cranford, & Boyd, 2006), which may explain why usage rates as high as 43% have been reported on college campuses (Advokat, Guidry, & Martino, 2008). As the field of IUPS is in its infancy, the IUPS-literature lacks 1) a consistent definition of "illicit use of prescription stimulants", 2) an instrument designed to assess the multiple influences on IUPS behavior, and 3) a theoretical lens (Bavarian, 2010a). Accordingly, the goal of this study was to address these research gaps by examining IUPS at one university located in the Pacific Northwest using the theory of triadic influence (TTI; Flay & Petraitis, 1994; Flay, Snyder, & Petraitis, 2009), an integrated, ecological approach to explaining and predicting health behaviors. The study included five phases of research. The first phase began with a systematic approach to measurement development resulting in a 97-item preliminary instrument, the Behaviors, Expectancies, Attitudes and College Health Questionnaire (BEACH-Q). The measure was reviewed by the dissertation committee, leading to revisions in content and structure. During phase II, the BEACH-Q was evaluated by a convenience sample of five health and measurement professionals, and results suggested good content validity of the instrument (i.e. 35 of the 37 TTI-based covariates received a median rating between "agree" and "strongly agree", and 34 received a mean rating between "agree" and "strongly agree"). In phase III (instrument review by a convenience sample of six undergraduates), all 37 covariates received a median and mean rating between "agree" and "strongly agree", confirming good face validity. In phase IV, one undergraduate classroom was selected to participate in a pilot test of the BEACH-Q, using test-retest methodology. Results from the pilot (N = 39) showed that the instrument had moderate to high internal consistency reliability and modest to high stability reliability. In phase V, the final 96-item version of the BEACH-Q was administered throughout campus using one-stage cluster sampling, with classrooms as the sampling unit and students as the observation unit (N = 520 students in 20 classrooms, eligible student response rate = 96.30%). The prevalence of IUPS during college self-reported by the phase V sample was 25.58%, and the probability of engaging in IUPS did not differ between classrooms (Median Odds Ratio = 1.00). In crude logistic regressions, 24 out of 37 hypothesized theoretical covariates were significantly associated with IUPS in the expected direction, suggesting predictive validity of the BEACH-Q. Nested logistic regression analyses illustrated that, for the full multivariate model including ultimate, distal, and proximal covariates, the following measures in the intrapersonal stream were significantly associated with IUPS during college: race/ethnicity, year in school, academic concern, academic grades, diagnosis with Attention Deficit Disorder, and IUPS avoidance self-efficacy. Significant social situation/context stream covariates in the full model included: residence, varsity sports participation, perceptions of IUPS by friends, family, and faculty, endorsement of IUPS by friends, and perceived prevalence of IUPS among friends. With respect to the sociocultural environment stream, in the full multivariate model, the following covariates were found to be significantly associated with IUPS: financial-related stress, participation in religious activities, positive IUPS expectancies, prescription stimulant knowledge and perceived costs/benefits of IUPS. Lastly, intention to engage in IUPS (an immediate precursor) was positively associated with IUPS. Structural equation modeling was used to test models of IUPS for each of the three streams, as well as one integrated model that included covariates from each stream. The models all demonstrated good model fit, and provided insight into the factors that influence (and suggest the mechanisms of causation) intentions to engage in, and ultimately the behavior of, IUPS. In the intrapersonal stream model, inattention was positively associated with academic concern and inversely associated with avoidance self-efficacy, and avoidance self-efficacy was inversely associated with intentions to engage in IUPS. Moreover, intentions to engage in IUPS and avoidance self-efficacy were both significantly associated with IUPS. In the social situation/context stream model, living on-campus was negatively associated with friends' endorsement of IUPS which was positively associated with perceived prevalence of IUPS among friends, and perceived prevalence was positively associated with intentions to engage in IUPS; all of the direct paths to IUPS, excepting the path from perceived prevalence of IUPS among friends, were significant. In the sociocultural environment model, perception of course demand was significantly associated with both the perception that professors give the most attention to top academic students and attitudes about the impact of prescription stimulants on academics, and these attitudes had a positive association with intentions to engage in IUPS. Moreover, the direct paths from attitudes and intentions to IUPS were significant. The mixed model, including participation in religious activities (sociocultural environment stream), friends' endorsement of IUPS (social situation/context stream), and avoidance self-efficacy (intrapersonal stream), also had significant paths from ultimate to distal to proximal to immediate precursor, and significant direct paths to IUPS. This study successfully achieved its goals. First, the instrument developed was theory-driven, broadly defined IUPS, and was psychometrically strong. The cross-sectional study illustrated that IUPS was prevalent on the campus under investigation, as one in four students had engaged in the behavior during college. Associations of use with theoretical correlates were tested for, and structural equation modeling was used to support one premise of the TTI (i.e. that behavior is multifaceted, and covariates from different streams may interact to influence behavior). The findings also suggest that prevention and intervention plans should be multifaceted in nature. Given that this study's cross-sectional nature limited the ability to make causal inferences, future research involving the BEACH-Q should use longitudinal designs. / Graduation date: 2012