The primary purpose of this case study was to determine if the university under study had adequate health-related programs, services, and supports in place to develop health-literate young adults. A secondary purpose was to identify strengths and gaps in these university health-related programs, services, and supports, which, if addressed, could increase the likelihood that college graduates would be health-literate. This research study served to answer three broad research questions: 1) What are the health-related needs and concerns among selected university undergraduates? 2) What is the level of awareness and utilization of health-related programs, services, and supports by university undergraduate students? 3) What are the strengths and gaps among health-related programs, services, and supports? As more and more young adults come to colleges and universities seeking an education, they bring with them high-risk health behaviors that can impede their academic success. Post-secondary institutions have programs, services, and supports in place specifically designed to ease the transition into college, provide academic assistance services, promote a safe learning and living environment as well as facilities and departments dedicated to raising awareness of and maintaining physical and mental health. The effectiveness with which these health-related programs, services, and supports are meeting their goals and reaching their target audience can be assessed by collecting student feedback regarding their attitudes, perceptions and usage. The first part of the study involved personal interviews with preselected representatives of Student Affairs, the President of the university, the Provost, Captain of Public Safety, and the Senior Athletic Director. Interview questions were designed to determine how, if any, of the programs, services, or supports under study supported the six dimensions of health and wellness, or the IOM skill set for health literacy. After all interviews were conducted, transcripts were reviewed and coding was conducted to determine the connection between the selected programs, services, and supports, and the IOM health literacy skill set and the six dimensions of health and wellness. Additionally, transcript review allowed for the identification of strengths and weakness among each of the programs, services, and supports. The second part of the study engaged students who volunteered to participate in focus groups in an open discussion about what they perceived health to be (as a concept) and to determine what, if any, personal health-related issues or concerns they felt at the present time, how health-related issues or concerns created barriers to their academic success, and their level of awareness about the programs, services, and supports available. In addition to conducting personal interviews and focus groups, I analyzed documents and material (i.e. web-pages, brochures, student handbook, under graduate bulletin) related to each department under study. This document analysis was also coded for connections to the six dimensions of health and wellness or the IOM's health literacy skill set. Web-pages were further analyzed for strengths and gaps related to each program, service, or support. An embedded analysis was conducted and themes were interpreted. Discussion and recommendations were stated at the conclusion of the case study; increasing health-literacy among college students and raising awareness of and attempting to reduce high-risk, health-related behaviors are consistent with goals and characteristics of a graduate from the university under study. Not surprisingly, when asked, most students only identified the physical aspect of "health" and sometimes, as a mental aspect with regards to stress. Feedback from focus group discussions indicated that students could make a connection between all six dimensions of health and how they might impede academic performance. Unfortunately, however, they did not seem to possess the skills or the knowledge on to how correct negative health behaviors themselves, or how to seek out various health-related programs, services, and supports that are available. By in large, students seemed very interested in learning more about many of these programs, services, and supports and indicated that they wished they had been made aware of such opportunities at the beginning of their college careers. Students also communicated lack of knowledge and awareness about the available health-related programs, services, and supports. Focus group discussions indicated that students felt as though the campus under study had not really taken the time to discover which methods of communication were successful; further indicating that current delivery methods were outdated and ineffective.

Literature reveals that college freshmen that reside on American campuses partake in many risky health behaviors, but little is known on the effects of housing on these risk behaviors. The purpose of this study was to examine the health risk behaviors of college freshmen that lived in either traditional, non-themed housing or in wellness themed housing (WELL) and if there was a difference between the two. Four research questions guided this study: (1). What are the risk behaviors of freshmen college students? (2). What are the risk behaviors of students in the WELL LC? (3). What are the risk behaviors of freshman residing in traditional housing? (4). What are the differences in risk behaviors between the freshmen living in the WELL LC and traditionally housed freshmen? The health risk behaviors that were determined for testing were injury-related behaviors, substance use behaviors, sexual behaviors, dietary behaviors, physical activity and sleep. The instrument used was a combination of the National College Health Risk Behavior Survey and Epworth Sleep Survey. The Traditional and the WELL completed the surveys in the beginning of the fall semester and again at the end of the spring semester of the same academic year. There were a higher percentage of alcohol-related injury behaviors, substance use and sexual activity in traditional residents. Dietary behaviors, physical activity and sleep behaviors were not significantly different between Traditional and WELL residents. The conclusion of this study indicated that the WELL housing may have had a positive effect on abstaining from alcohol, drugs, and sexual behaviors. Further research is needed to explore the root cause of these behavioral differences. / Ph. D.

Health behaviors, positive and negative, can support or reduce risk for multiple chronic diseases, such as substance use disorder and obesity. These diseases are marked by overconsuming commodities that offer predictable short-term benefits, and neglecting other behaviors with variable long-term benefits (e.g., fast food is enjoyable in the moment; exercise may have delayed benefits, but moment-to-moment may not be as reinforcing as fast food). An individual's valuation of these fast food or exercise may depend on how far out into the future these benefits are considered, their temporal window. The first study shows that the temporal window is constricted among high-risk substance users than people who do not have substance problems, especially when considering higher-value choices. The second study shows that the temporal window can change depending on the environment. Specifically, engaging with stories of job loss can constrict the temporal window. The third study shows that engaging with job loss can specifically constrict the temporal window and increase the value of fast food among obese individuals. The final study shows that a similar hardship scenario, natural disasters, can constrict the temporal window, increase demand for alcohol and cigarettes, and decrease the valuation of more temporally extended reinforcers (e.g., employment, savings, and seatbelt wearing) among smoking drinkers. Together, these studies support a model, reinforcer pathology; wherein the temporal window, which can differ both between individuals and environments, drives valuation of reinforcers that impact health. / Doctor of Philosophy / Health behaviors, positive and negative, can support or reduce risk for multiple chronic diseases, such as substance use disorder and obesity. These diseases are marked by overconsuming commodities that offer predictable short-term benefits, and neglecting other behaviors with variable long-term benefits (e.g., fast food is enjoyable in the moment; exercise may have delayed benefits, but moment-to-moment may not be as reinforcing as fast food). An individual’s valuation of these fast food or exercise may depend on how far out into the future these benefits are considered, their temporal window. The first study shows that the temporal window is constricted among high-risk substance users than people who do not have substance problems, especially when considering higher-value choices. The second study shows that the temporal window can change depending on the environment. Specifically, engaging with stories of job loss can constrict the temporal window. The third study shows that engaging with job loss can specifically constrict the temporal window and increase the value of fast food among obese individuals. The final study shows that a similar hardship scenario, natural disasters, can constrict the temporal window, increase demand for alcohol and cigarettes, and decrease the valuation of more temporally extended reinforcers (e.g., employment, savings, and seatbelt wearing) among smoking drinkers. Together, these studies support a model, reinforcer pathology; wherein the temporal window, which can differ both between individuals and environments, drives valuation of reinforcers that impact health.

It is estimated that US children 2 to 18 years of age spend an average of 5.5 hours, daily, using media of all types. 1 During these years, it is estimated they will have viewed over 200,000 acts of violence just on television. 2 In this issue of the Southern Medical Journal, Dr. Robert DuRant and colleagues reported on their findings that an increased frequency of watching professional wrestling on television was associated with an increase in reported date fighting and other violent behaviors, risky sexual behavior, and smoking cigarettes, among a multistate random sample of adolescents aged 16 to 20 years. 3 In this cross-sectional study, 22.4% of males and 13.6% of females reported watching professional wrestling on television during the 2 weeks before the survey. Prior research, including experimental and longitudinal studies, has consistently demonstrated strong associations between exposure to media violence and desensitization to violence, greater acceptance of violence as a means of solving problems, and violent behavior, as well as depression, anxiety, and sleep disturbance. 4

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Abstract available in the Annals of Behavioral Medicine.

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A sample of 656 undergraduate students from multiple sections of an introductory nutrition course, a personal health course, and a physical fitness course at a large Midwestern University completed one of four surveys. Using matrix sampling, each participant completed a survey measuring one of four personal and social competence constructs; coping skills, interpersonal skills, intrapersonal skills, or judgment skills; 11 health risk behaviors, and college grade point average (GPA). Descriptive statistics, correlations, and multiple regression analyses were calculated to determine relationships among these variables. Thirteen statistically significant correlations were found among personal and social competence constructs and health risk behaviors. Health risk behaviors statistically significantly correlated with one or more constructs of personal and social competence included: frequency of marijuana use, number of days cigarettes were smoked, number of days alcohol was consumed, incidences of binge drinking, incidences of driving and drinking alcohol, alcohol or drug use prior to last incidence of sexual intercourse, non-use of condoms during sexual intercourse, feelings of sadness or hopelessness for two weeks or more that resulted in ceasing some usual activities, and number of physically inactive days. Statistically significant correlations were found most often among perceived judgment skills and health risk behaviors and perceived intrapersonal skills and health risk behaviors. Variance in academic success due to perceived personal and social competence and health risk behaviors was limited. Only a small percentage of variance in self-reported, college GPA could be attributed to perceived coping skills and judgment skills, while no variance could be attributed to perceived intrapersonal skills or interpersonal personal skills. Also, few health risk behaviors accounted for any variance in self-reported, college GPA. Results suggest strategies to improve undergraduates' personal and social skills may reduce engagement in some health risk behaviors.

Background: Adolescence is a period of immense behavioral, psychological and social changes and challenges and characterized as a stage of increased imitation and exploration with a range of health-risk behaviors (HRBs). Although there is no uniform definition of HRB worldwide, it is generally considered as behavior that negatively affects health. Prior studies reported that HRBs among adolescents mainly include substances use that consist of the use of alcohol, tobacco, psychoactive drugs; behaviors that contribute to unintentional injuries and violence; sleep behaviors that mainly consist of sleep disturbance and insomnia; mental health including depression, suicidal behaviors and so on. Since the 1980s, with the Open Up policy, living conditions and annual incomes have improved dramatically in both urban and rural households in China, and Chinese adolescents are becoming more and more easily exposed to HRBs. Adolescent HRB has been a major public health problem in China. However, to our knowledge, there are only few small scale studies on HRBs among Chinese adolescents: A previous study in Zhejiang province indicated that approximately 40.0% of Chinese adolescent smokers started smoking before 10 years of age; previous studies in Beijing reported that approximately 70.0% of the study adolescents reporting prior alcohol consumption, about 15.9% of juvenile school students and 1.1% of secondary vocational school students admitted illicit drugs use; 20.8% of Chinese adolescents in Guangdong province reported being involved in bullying behaviors; 16.9% of the Chinese adolescents in Shandong province was troubled with sleep disturbance; 15.8% of adolescents in Guangzhou reported having depressive symptoms; 19.0% of Chinese rural adolescents in Shandong province reported having had suicidal ideation, and 7.0% reported having made a suicidal attempt during the past 6 months. It is necessary to conduct large scale survey studies to determine the sheer number of adolescents with HRBs in mainland China and whether HRBs and their correlates occur in Chinese adolescents in similar way to their manifestation in Western countries. Additionally, although HRBs among Chinese adolescents are prevalent, there is few existing policies for preventing or controlling HRBs in China. For example, although China has signed the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2003 and ratified the treaty in 2005, there is no national smoke-free law in China. So far, only 13 cities of China revise or formulate local smoke-free regulations in accordance with FCTC Article 8 Guidelines. Therefore, we conducted a large-scale survey study using a multistage, stratified cluster, random sampling method to obtain a representative sample of high school students and a scoping review summarizing and accessing the existing policies in China to prevent or control adolescent HRBs, in order to estimate the prevalence of current drinking, current smoking, sleep disturbance, depressive symptoms, nonmedical use of prescription drug, illicit drugs use, being bullied, bullying others, both being bullied and bullying others, suicidal ideation, and suicidal attempts among Chinese adolescents; to explore the relationships between sociodemographic, family, school, psychosocial characteristics and each type of HRBs; to examine the internal associations between the HRBs, including the association between sleep disturbance and depressive symptoms, the association between depressive symptoms, bullying and current smoking, and the association between non-medical use of prescription drugs and suicidal behaviors; and to make suggestions for helping develop prevention and intervention programs to reduce adolescent HRBs in China.Methods: A large-scale cross-sectional study was conducted in three provinces of China, and a multistage, stratified cluster, random sampling method was used to a representative sample of junior and senior high school students. Data were collected from a structured questionnaire between 2011 and 2012. Additionally, we conducted a scoping review to summarize the existing policy strategies relating to adolescent HRBs in China. The framework outlines a five-stage approach including identifying the research question; searching for relevant studies; selecting studies; charting data; and collating, summarizing, and reporting the results. Findings: Our survey study findings demonstrated that substance use was prevalent among Chinese adolescents, adolescents’ alcohol use was the highest substance use, and illicit drugs use among Chinese adolescents was lower than other countries; the prevalence rates of bullying behaviors, depressive symptoms, and suicidal behaviors were similar with other previous reports. Moreover, our study found that gender differences were significant in the extent of alcohol use, cigarette use, and drugs use; boys had a higher level of substance use than girls. Students who reported below average family economic status were at a higher risk of HRBs, and poor classmate relations, poor relationships, and below average academic performance were positively associated with most of the HRBs. Furthermore, our scoping review demonstrated that current Chinese national and local efforts focus on expanding smoke-free environments by restricting smoking in schools, hospitals, workplaces, or public places; many of these environments have limited or no restrictions on smoking. Moreover, although more and more public are aware of the problems (e.g. liver and cardiovascular disease, mental disorders, and unintentional injuries) caused by alcohol drinking, there is almost no alcohol control policy in China. Additionally, although the Chinese public are aware of the negative consequences of school bullying behaviors, there is no existing law related to anti-school bullying in China now.Conclusions: In conclusion, Chinese adolescent HRB is a major public health problem nationally, and an adolescent’s family, school, and psychosocial factors have influences on their substance use habits. We suggest that effective prevention and intervention programs should be established and the role of the government, school, family, and individual should be considered. Our study recommends strengthening regulations to limit the sale of substances to adolescents, establishing a surveillance system to monitor and control the adolescent substances use, and providing health services to promote resilience among adolescents involved in mental health problems or bullying behaviors. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

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