This article was downloaded by: [University of Reading] On: 01 January 2015, At: 03:47 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
Associations Between Physical Activity and HealthRelated Factors in a National Sample of College Students a
a
Mary K. Dinger PhD , Danielle R. Brittain PhD & Susan R. Hutchinson PhD a
b
Colorado School of Public Health , University of Northern Colorado , Greeley , Colorado
b
Department of Applied Statistics and Research Methods , University of Northern Colorado , Greeley , Colorado Accepted author version posted online: 03 Oct 2013.Published online: 07 Dec 2013.
Click for updates To cite this article: Mary K. Dinger PhD , Danielle R. Brittain PhD & Susan R. Hutchinson PhD (2014) Associations Between Physical Activity and Health-Related Factors in a National Sample of College Students, Journal of American College Health, 62:1, 67-74, DOI: 10.1080/07448481.2013.849710 To link to this article: http://dx.doi.org/10.1080/07448481.2013.849710
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JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 62, NO. 1
Major Article
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Associations Between Physical Activity and Health-Related Factors in a National Sample of College Students Mary K. Dinger, PhD; Danielle R. Brittain, PhD; Susan R. Hutchinson, PhD
Abstract. Objective: To examine associations between meeting the current moderate to vigorous physical activity (MVPA) recommendation and health-related factors in a national sample of college students. Participants: Participants (N = 67,861) completed the National College Health Assessment II during the Fall 2008/Spring 2009 academic year. Methods: Hierarchical binary logistic regression was used to examine the contribution of 19 variables in explaining whether or not participants met the MVPA recommendation. Results: Meeting the MVPA recommendation was associated with several protective factors among college students, including adequate daily fruit and vegetable consumption, positive perception of general health, healthy body mass index, consistent seatbelt use, not smoking cigarettes, less perceived depression, and adequate sleep. In addition, meeting the MVPA recommendation was also significantly associated with a few risky behaviors including binge drinking, physical fighting, and multiple sexual partners. Conclusions: College student PA interventions should consider also addressing fruit/vegetable consumption and binge drinking.
binge drinking) behaviors that impact their current and future health status. During this time of increased individual responsibility and independence, students are laying a foundation of behaviors that may last a lifetime.2 Among college students, one health behavior that has been shown to be associated with other health-related factors is physical activity (PA). Results from previous studies indicate PA is associated with several protective behaviors, including adequate daily fruit and vegetable consumption,1,3,4 not smoking cigarettes,1,4 and consistent seatbelt use.1 Furthermore, previous research also suggests a positive relationship between PA and mental health factors such as lower rates of depressive symptoms,5–7 less suicidal ideation,5 and less suicidal behavior.7 These associations between PA and other protective factors are supported by the results of previous studies that have reported healthy behaviors tend to cluster together within adults8,9 and college students.10 Findings from previous studies8–10 have also supported the clustering of unhealthy behaviors among adults and college students, which suggests that risky behaviors such as binge drinking, drug use, high-risk sexual behavior, etc, would be associated with sedentary behavior. However, several studies have reported that physically active college students were more likely to binge drink than their less active peers.11–13 Furthermore, the results from a recent literature review examining the association between alcohol consumption and PA indicate drinkers of all ages were more physically active than their nondrinking peers.14 Specifically among college students, the quantity of alcohol consumed per sitting was also positively associated with PA.14 This “incongruous alcohol-activity association”12 challenges previous findings that unhealthy behaviors cluster among adults and college students.8–10 In addition, the association between PA and alcohol consumption justifies the
Keywords: binge drinking, college students, physical activity, physical fighting, sexual behavior
T
he traditional college years are a time of transition from adolescence to adulthood.1 During this time, young adults gain increased control over their lifestyles and may engage in a variety of both protective (eg, daily consumption of fruits and vegetables) and risky (eg,
Dr Dinger and Dr Brittain are with the Colorado School of Public Health at the University of Northern Colorado in Greeley, Colorado. Dr Hutchinson is with the Department of Applied Statistics and Research Methods at the University of Northern Colorado in Greeley, Colorado. Copyright © 2014 Taylor & Francis Group, LLC
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investigation of additional potential counterintuitive associations between sufficient PA and health-related factors. Although several studies have been conducted to examine the relationship between PA and multiple health behaviors among college students, no study to date has simultaneously (1) utilized a large national sample of college students, (2) used a measure of PA that reflects the current national PA aerobic activity recommendation for moderate to vigorous PA (MVPA) (ie, ≥ 75 minutes of vigorous PA, ≥ 150 minutes of moderate PA, or ≥ 150 minutes of MVPA weekly),15 and (3) examined the association between MVPA and several protective and risky health-related factors while systematically controlling for other factors in the statistical model. Therefore, the purpose of this study was to examine the associations between meeting the current MVPA recommendation and health-related factors among a large national sample of college students. METHODS Participants and Procedures The American College Health Association (ACHA) administers the National College Health Assessment II (NCHA) at participating colleges and universities every fall and spring semester.16 The NCHA contains numerous items related to college student health-related factors and demographics.17 We obtained permission to access data pertaining to variables of interest from the Fall 2008 and Spring 2009 data collection by submitting a proposal to the ACHA-NCHA program office (for information, visit http://www.acha-ncha.org/research.html). The authors of this study received approval from the Institutional Review Board at their university to conduct this secondary analysis. Students enrolled at 157 campuses in the United States participated in the Fall 2008 and Spring 2009 NCHA data collection.18,19 These 157 institutions either surveyed all of their students, or used a random sampling technique to obtain student data. All participants provided informed consent prior to completing the survey. The final Fall 2008 and Spring 2009 sample included 113,790 college students.18,19 For the purposes of this study, we were interested in examining health-related factors among traditional college students. Therefore, participants who did not report age, race, sex, marital status, athletic team involvement, moderate PA, or vigorous PA were deleted (n = 11,097). The remaining participants were included in analyses if they were < 25 years of age, single (never married) and not a varsity athlete. The final sample size for analyses was 67,861. Measures Physical Activity The NCHA included 2 items to assess college student participation in moderate and vigorous aerobic PA.18,19 The moderate PA question was “On how many of the past 7 days did you do moderate-intensity cardio or aerobic exercise (caused a noticeable increase in heart rate, such as a brisk 68
walk) for at least 30 minutes?” The vigorous PA question was “On how many of the past 7 days did you do vigorousintensity cardio or aerobic exercise (caused large increases in breathing or heart rate, such as jogging) for at least 20 minutes?” Possible responses to the 2 items were 0 days to 7 days. Participants who reported ≥ 5 days of moderate PA, or ≥ 4 days of vigorous PA, or a total of ≥ 5 days of moderate plus vigorous PA were categorized as meeting the current MVPA recommendation for aerobic activity. Participants who did not meet the criteria were categorized as not meeting the current MVPA recommendation. Health-Related Factors Several health-related factor items from the NCHA18,19 were included in this study. The NCHA contains one item to assess general health status. Students responded to the following item, “How would you describe your general health?” Possible responses were on a Likert-type scale from excellent to poor. The specific items to determine depression and suicide ideation required students to report if “they ever felt so depressed that it was difficult to function” and if “they ever seriously considered suicide,” respectively. Possible responses to the 2 items ranged from no, never to yes, in the last 12 months. In addition, students reported their overall level of stress by responding to the following item: “Within the last 12 months, how would you rate the overall level of stress you have experienced?” Possible responses to the question ranged from no stress to tremendous stress. Students were also asked, “Within the last 12 months, how often did you wear a seatbelt when you rode in a car?” Possible responses were on a Likert-type scale and ranged from always to never. Sleep was assessed by asking, “On how many of the past 7 days did you get enough sleep so that you felt rested when you woke up in the morning?” Possible responses ranged from 0 days to 7 days. In addition, students reported their fruit and vegetable consumption by responding to the following item: “How many servings of fruits and vegetables do you usually have per day?” Possible responses ranged from 0 servings per day to 5 or more servings per day. Students also responded to items about drug use. They reported if they had used cigarettes or marijuana within the last 30 days by selecting either a yes or no response. In addition, prescription drug misuse was determined using the following item: “Within the last 12 months, have you taken any of the following prescription drugs that were not prescribed to you?” Students responded yes or no to having used antidepressants, erectile dysfunction drugs, pain killers, sedatives, and stimulants. The final drug use item assessed binge drinking using the item: “Over the last two weeks, how many times have you had five or more drinks of alcohol at a sitting?” Possible responses ranged from N/A, don’t drink to 10 or more times. The final 2 health-related behaviors of interest in this study were physical fighting and multiple sexual partners. Students were asked if they had been in a physical fight within the last 12 months and indicated their response by selecting either JOURNAL OF AMERICAN COLLEGE HEALTH
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Physical Activity and Health-Related Factors
yes or no. Students also were asked to respond to the following item: “Within the last 12 months, with how many partners have you had oral sex, vaginal intercourse, or anal intercourse?” Students were instructed to enter a number between 0 and 99. Student responses to the health-related factor items were dichotomized for analyses. Excellent, very good, and good responses to the general health item formed one group, whereas fair and poor responses formed the other group. Responses to the depression and suicide ideation items were categorized so that no, never and no, not in the last 12 months constituted one category and the remaining responses comprised the other category. Furthermore, student responses to the stress item were grouped with no stress, less than averages stress, and average stress forming one group. The more than average stress and tremendous stress responses formed the second group of responses to the stress question. The most of the time and always responses to the seatbelt use question were placed in one category for analyses, and the remaining responses to the item were placed in the second category. The 4 days to 7 days responses to the sleep item were placed in one group for analyses, whereas the 0 days to 3 days responses to the item formed the second group. Moreover, the possible responses to the fruit and vegetable question were categorized into 2 groups, with 1 group consisting of the 5 or more servings per day selections. The second fruit and vegetable consumption group for analyses consisted of all other responses to the item. Student responses to the cigarette and marijuana use items were categorized with the never used and have used, but not in the last 30 days responses forming one group and the remaining responses forming the other group. Those students who responded yes to any of the prescription drug categories were placed in one group, and those students who responded no to all of the prescription drug categories were placed into the other group. The N/A, don’t drink, and none responses to the binge item were placed into one group, whereas the remaining responses to the binge drinking item comprising the second group. Responses of 0 and 1 for the number of sexual partners during the last 12 months item were placed into a group, with all other responses to the item placed into a second group for analyses. All data analyses were conducted using IBM SPSS Statistics (version 20.0; IBM, Somers, New York). Descriptive statistics were calculated for all variables. Hierarchical binary logistic regression was used to examine the contribution of 19 variables in explaining whether or not participants met the current MVPA recommendation. Variables were entered in 3 steps with demographic variables (sex, age, and race) tested at step 1, followed by 2 variables added at step 2 indicating whether or not students had participated in intramural or club sports within the last 12 months. The latter 2 variables were included to control for the potentially extraneous effect of students’ participation in organized sports. Finally, the remaining 14 health-related factors, which were of primary interest in the current study, were tested at the third step. When assessing the statistical significance of each VOL 62, JANUARY 2014
of the 19 predictor variables, a Bonferroni-adjusted alpha of .0026 per test was used to maintain a familywise error rate of .05 across all 19 tests. Prior to interpreting the results of a logistic regression, assumptions of large sample size relative to the number of predictor variables and absence of extreme multicollinearity among predictor variables should be satisfied.20 Based on the largest variance inflation factor value of 1.26, which is well below the suggested cutoff of 10.0,21 there was no evidence of excessive collinearity among the predictor variables. Regarding the assumption of adequate sample size, although there is no consensus regarding sample size requirements for logistic regression, the sample size of 67,861 appeared to be sufficient for these analyses, considering even the most conservative sample size recommendations.22 RESULTS The sample of 67,861 students was approximately 68% female (n = 45,901) and 32% male (n = 21,960). The majority of participants were white, 18 to 20 years old, had healthy body mass indices (BMIs) (18.5 to 24.9 kg/m2), and did not participate in club or intramural sports (Table 1). In addition, the majority of respondents attended school full time (97.2%, n = 65,411), lived in a campus residence hall (45.5%, n = 30,842), and did not work for pay (44.1%, n = 29,790). Approximately half of the students (49.9%, n = 33,865) were meeting the current MVPA recommendation. The remaining students (n = 33,865) were not meeting the recommendation. Table 1 contains frequencies and proportions of the 2 groups by the variables that were included in the logistic regression models. The logistic regression model with sex, dichotomized age, and dichotomized race at step 1 produced a statistically significant likelihood ratio test, χ 2(3, N = 67,861) = 688.63, p < .001, Cox and Snell R2 = .01, indicating improvement in fit over the intercept-only model. Sex, age, and race were all individually, statistically significant, with the adjusted odds being 20.5% greater for males than females and 46.3% greater for white than nonwhite students of achieving recommended levels of MVPA. In addition, although age was statistically significant, the contribution of age appeared to be relatively minimal, with only 8.8% higher odds of attaining adequate MVPA for students in the 18- through 20-year-old age group compared with those over the age of 20. When the 2 variables representing participation in club and intramural sports were added to the model at step 2, the fit also improved significantly, after controlling for the 3 demographic variables, χ 2(2, N = 67,861) = 1975.34, p < .001, Cox and Snell R2 = .04. Not surprisingly, participation in either club or intramural sports was associated with higher odds of reaching recommended levels of MVPA. Specifically, the odds of meeting recommended MVPA levels for students who were in club sports or intramural sports were 2.10 and 1.81 times greater, respectively, than for students who did not report participating in either type of organized sport during the last 12 months. 69
Dinger, Brittain, & Hutchinson TABLE 1. Frequencies and Proportions of Those Meeting (n = 33,865) Versus Not Meeting (n = 33,996) the MVPA Recommendation by Participant Factors Meeting MVPA recommendation (n = 33,865) Factor
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Sex Female Male Age 18–20 years 21–24 years Race White Nonwhite Club sport (last 12 months) Yes No Intramural sport (last 12 months) Yes No General health Excellent, Very good, or Good Fair or Poor BMI Healthy BMI (18.5 to 24.9 kg/m2) Unhealthy BMI (< 18.5 and >24.9 kg/m2) Seatbelt use (last 12 months) Most of the time or Always Never, Rarely, or Sometimes Cigarette smoking (last 30 days) Never used or Not used in last 30 days Used 1–2 times/day to Used daily Marijuana use (last 30 days) Never used or Not used in last 30 days Used 1–2 times/day to Used daily Prescription drug misuse (last 12 months) No Yes Fruit and vegetable consumption (usual per day) ≥ 5 servings 0–4 servings Stress (last 12 months) None, Less than average, or Average More than average or Tremendous Depression (last 12 months) Never or Not in last 12 months Yes Suicide ideation (last 12 months) Never or Not in last 12 months Yes Sleep (past 7 days) ≥ 4 days < 3 days Physical fighting (last 12 months) No Yes Multiple sex partners (last 12 months) 0–1 partner ≥ 2 partners Binge drinking (last 2 weeks) No Yes
Not meeting MVPA recommendation (n = 33,996)
Total (N = 67,861)
n
%
n
%
n
%
22,075 11,790
48.1 53.7
23,826 10,170
51.9 46.3
45,901 21,960
67.6 32.4
20,731 13,134
50.6 48.9
20,273 13,723
49.4 51.1
41,004 26,857
60.4 39.6
25,942 7,923
52.4 43.1
23,525 10,471
47.6 56.9
49,467 18,394
72.9 27.1
4,986 28,879
68.9 47.6
2,251 31,745
31.1 53.4
7,237 60,624
10.7 89.3
9,425 24,440
63.9 46.0
5,318 28,678
36.1 54.0
14,743 53,118
21.7 78.3
32,126 1,739
51.3 33.1
30,481 3,515
48.7 66.9
62,607 5,254
92.3 7.7
22,679 11,186
51.7 46.6
21,202 12,794
48.3 53.4
43,881 23,980
64.7 35.3
32,406 1,459
50.0 47.0
32,348 1,648
50.0 53.0
64,754 3,107
95.4 4.6
28,493 5,372
50.5 47.1
27,964 6,032
49.5 52.9
56,457 11,404
83.2 16.8
28,153 5,712
49.6 51.6
28,628 5,368
50.4 48.4
56,781 11,080
83.7 16.3
29,083 4,782
49.9 49.7
29,162 4,834
50.1 50.3
58,245 9,616
85.8 14.2
2,509 31,356
73.3 48.7
915 33,081
26.7 51.3
3,424 64,437
5.0 95.0
17,547 16,318
52.0 47.8
16,187 17,809
48.0 52.2
33,734 34,127
49.7 50.3
23,924 9,941
51.5 46.4
22,535 11,461
48.5 53.6
46,459 21,402
68.5 31.5
31,954 1,911
50.2 45.1
31,669 2,327
49.8 54.9
63,623 4,238
93.8 6.2
15,502 18,363
54.5 46.6
12,962 21,034
45.5 53.4
28,464 39,397
41.9 58.1
31,129 2,736
49.3 57.3
31,960 2,036
50.7 42.7
63,089 4,772
93.0 7.0
24,273 9,592
48.7 53.4
25,610 8,386
51.3 46.6
49,883 17,978
73.5 26.5
20,205 13,660
47.5 53.9
22,312 11,684
52.5 46.1
42,517 25,344
62.7 37.3
Note. MVPA = moderate to vigorous physical activity; BMI = body mass index.
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Physical Activity and Health-Related Factors TABLE 2. Summary of Hierarchical Logistic Regression Analysis for Factors Associated With Meeting (n = 33,865) Versus Not Meeting (n = 33,996) the MVPA Recommendation
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Factor Step 1 Sex Female Male Age 18–20 years 21–24 years Race White Nonwhite Step 2 Club sport (last 12 months) Yes No Intramural sport (last 12 months) Yes No Step 3 General health Excellent, Very good, or Good Fair or Poor BMI Healthy BMI (18.5 to 24.9 kg/m2) Unhealthy BMI (< 18.5 and > 24.9 kg/m2) Seatbelt use (last 12 months) Most of the time or Always Never, Rarely, or Sometimes Cigarette smoking (last 30 days) Never used or Not used in last 30 days Used 1–2 times/day to Used daily Marijuana use (last 30 days) Never used or Not used in last 30 days Used 1–2 times/day to Used daily Prescription drug misuse (last 12 months) No Yes Fruit and vegetable consumption (usual per day) ≥ 5 servings 0–4 servings Stress (last 12 months) None, Less than average, or Average More than average or Tremendous Depression (last 12 months) Never or Not in last 12 months Yes Suicide ideation (last 12 months) Never or Not in last 12 months Yes Sleep (past 7 days) ≥ 4 days < 3 days Physical fighting (last 12 months) No Yes Multiple sex partners (last 12 months) 0–1 partner ≥ 2 partners Binge drinking (last 2 weeks) No Yes Constant
β
Adjusted OR
95% CI
p
−0.230 Reference
0.795
0.769, 0.821
< .001∗
0.084 Reference
1.088
1.055, 1.122
< .001∗
0.380 Reference
1.463
1.414, 1.514
< .001∗
0.742 Reference
2.100
1.990, 2.215
< .001∗
0.595 Reference
1.812
1.742, 1.885
< .001∗
0.560 Reference
1.750
1.645, 1.862
< .001∗
0.122 Reference
1.130
1.093, 1.168
< .001∗
0.131 Reference
1.140
1.057, 1.230
.001∗
0.197 Reference
1.218
1.162, 1.277
< .001∗
0.007 Reference
1.007
0.959, 1.057
.783
0.014 Reference
1.014
0.966, 1.065
.564
1.033 Reference
2.810
2.596, 3.041
0.039 Reference
1.040
1.005, 1.075
.024
0.062 Reference
1.064
1.024, 1.104
.001∗
0.019 Reference
1.019
0.951, 1.092
.599
0.228 Reference
1.257
1.216, 1.298
< .001∗
−0.234 Reference
0.791
0.742, 0.844
< .001∗
−0.143 Reference
0.867
0.834, 0.901
< .001∗
−0.142 Reference −1.105
0.867
0.836, 0.900
< .001∗
< .001∗
Note. MVPA = moderate to vigorous physical activity; CI = confidence interval; BMI = body mass index. χ 2 = 1779.23, df = 14 (step 3). ∗ Statistically significant based on a Bonferroni-adjusted alpha (α = .0026)
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At step 3, the addition of the 14 explanatory variables likewise resulted in a statistically significant improvement in fit over the model with demographic variables and organized sport participation, χ 2(14, N = 67,861) = 1779.23, p < .001, Cox and Snell R2 = .06. When controlling for all the other variables in the model, there were several statistically significant protective factors found at this step (Table 2). For example, those students who consumed 5 or more servings of fruits and vegetables per day had 2.81 greater odds of meeting the MVPA recommendation than those who ate fewer fruits and vegetables daily. Likewise, students who reported good to excellent general health had 1.75 greater odds of engaging in sufficient amounts of MVPA compared with those who reported fair or poor general health status (Table 2). In addition, there were also 3 statistically significant risky behaviors associated with PA in the third step of the model: physical fighting, binge drinking, and multiple sex partners. Students who had participated in 1 or more fights, engaged in 1 or more bouts of binge drinking, and/or indicated having 2 or more sex partners during the last year had higher odds of reaching recommended MVPA levels. The odds ranged from 20.9% higher (physical fighting) to 13.3% higher (multiple sex partners and binge drinking) (Table 2). The only variables not contributing significantly to the model included use of marijuana in the last 30 days, prescription drug misuse in the last 12 months, contemplating suicide in the last 12 months, and stress level in the last 12 months. The nonsignificant Hosmer and Lemeshow χ 2(8, N = 7) = 16.22, p = .04, suggested that the model adequately fit the data when all 19 variables were in the model. COMMENT Results of this study indicate that after controlling for all of the other variables in the model, meeting the current MVPA recommendation was positively associated with several protective factors among college students, including adequate daily fruit and vegetable consumption, positive perception of general health status, healthy BMI, consistent seatbelt use, not smoking cigarettes, less perceived depression, and adequate sleep most days of the week. Results of this study also indicate that when controlling for all of the other variables in the model, meeting the current MVPA recommendation was also associated with a few health risk behaviors, including binge drinking, physical fighting, and multiple sexual partners. The results of this study confirm the statistically significant associations between PA and several health promoting factors in college students, including fruit and vegetable consumption,1,3,23 not smoking cigarettes,1,4,11 consistent seatbelt use,1 and fewer feelings or symptoms of depression.5–7 In addition to being statistically significant, the magnitude of the adjusted association between meeting the MVPA recommendation and fruit and vegetable consumption suggests practical significance as well.24 These findings suggest that interventions targeting several of these factors may be warranted, which may be an important cost-effective approach to improving the health and well-being of college students.25 72
There were 3 risky behaviors significantly associated with meeting the MVPA recommendation in this study. We found students who were meeting the current MVPA recommendation were more likely to binge drink, be involved in a physical fight, and have multiple sexual partners. Although the effect sizes of these associations were relatively small,24 these associations are concerning, given the severity of health risks associated with these behaviors. Our findings regarding sufficient MVPA and binge drinking are consistent with several previous studies of college students with smaller sample sizes and fewer controlled variables.11–13,26,27 Our findings indicate that after controlling for all the other variables in the model and using the current MVPA recommendation to categorize students, the association between MVPA and binge drinking was still evident. Several hypotheses have been offered to explain this relationship, including “work hard, play hard,”12 “damage control,”12 “sensation-seeking lifestyle,”28 and “drunkorexia.”29 Although additional research is needed to fully understand this association, our findings imply that interventions designed to promote MVPA among college students should also address alcohol consumption and binge drinking. Novel findings of this study include the association between MVPA and the risky behaviors of multiple sex partners and physical fighting. Participants in this study who were meeting the current MVPA recommendation were more likely to have multiple sexual partners and to have been in a physical fight during the last 12 months, after controlling for all other factors in the model. To our knowledge, only one previous study has examined the association between PA, physical fighting, and multiple sexual partners in college students.1 After controlling for age, sex, and race, the associations between the variables in that study were not statistically significant.1 The significant associations between the health risk behaviors and MPVA found in this study are similar to findings reported in athletic populations and among organized sport participants. Previous studies have reported a positive association between being a member of a sports team and alcohol consumption.30 Furthermore, study results have indicated a positive relationship between being a college athlete and binge drinking,31 multiple sexual partners,32 and physical fighting.32 In the current study, we excluded varsity athletes from the sample, we controlled for organized sport participation in step 2 of the statistical model, and we controlled for all other variables in the model, yet the associations between sufficient MVPA and these risky behaviors remained statistically significant. These findings support the “work hard, play hard” hypothesis that has been suggested by previous researchers.12 Clearly additional research is needed to fully understand the association between sufficient MVPA and these risky behaviors in college students. Limitations There are several potential limitations to this study. First, data were collected via a self-report survey, which could have resulted in biased reporting by the participants.33 Second, the JOURNAL OF AMERICAN COLLEGE HEALTH
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sample utilized in this study contained a higher proportion of females (67.6% versus 57%) and whites (72.9% versus 63.2%) than the national college student population.34 Third, the cross-sectional design of the study does not allow for causal relationships to be determined. Fourth, although muscular strength and endurance is included as a part of the current PA recommendation,15 we examined participation in aerobic MVPA only. Fifth, single-item indicators were used to represent health-related factors, which may underrepresent the constructs of interest.35 Finally, artificial groups may have resulted due to the dichotomization of study variables. Conclusions After controlling for all of the variables in the model, meeting the current MVPA recommendation was significantly positively associated with several protective factors, and a few risky behaviors, in this large national sample of single, nonvarsity athlete, college students less than 25 years of age. Interventions designed to promote PA for college students should also address several of the variables associated with PA, including fruit and vegetable consumption and binge drinking. Future research should continue to explore the counterintuitive relationships between participation in sufficient PA and binge drinking, physical fighting, and multiple sexual partners. ROLE OF FUNDING SOURCES DISCLOSURE No funding was used to support this research and/or the preparation of the manuscript. CONFLICT OF INTEREST DISCLOSURE The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board at the University of Northern Colorado. NOTE For comments and further information, address correspondence to Mary K. Dinger, PhD, Community Health Program, School of Human Sciences, University of Northern Colorado Gunter Hall 1250B, Campus Box 132, Greeley, CO 80639, USA (e-mail: [email protected]). REFERENCES 1. Dinger MK, Vesely SK. Relationships between physical activity and other health-related behaviors in a representative sample of U.S. college students. Am J Health Educ. 2001;32:83–88. 2. Gordon-Larsen P, Nelson MC, Popkin BM. Longitudinal physical activity and sedentary behavior trends adolescence to adulthood. Am J Prev Med. 2004;27:277–283. 3. Lowry R, Galuska DA, Fulton JE, Wechsler H, Kann L, Collins JL. Physical activity, food choice, and weight management goals and practices among U.S. college students. Am J Prev Med. 2000;18:18–27. 4. Seo DC, Nehl E, Agley J, Ma SM. Relations between physical activity and behavioral and perceptual correlates among midwestern college students. J Am Coll Health. 2007;56:187–197. VOL 62, JANUARY 2014
5. Elliot CA, Kennedy C, Morgan G, Anderson SK, Morris D. Undergraduate physical activity and depressive symptoms: a national study. Am J Health Behav. 2012;36:230– 241. 6. Harbour VJ, Behrens TK, Kim HS, Kitchens CL. Vigorous physical activity and depressive symptoms in college students. J Phys Act Health. 2008;5:516–526. 7. Taliaferro LA, Rienzo BA, Pigg RM, Miller MD, Dodd VJ. Associations between physical activity and reduced rates of hopelessness, depression, and suicidal behavior among college students. J Am Coll Health. 2008;57:427–435. 8. de Vries H, van ’t Riet J, Spigt M, et al. Clusters of lifestyle behaviors: results from the Dutch SMILE study. Prev Med. 2008;46:203–208. 9. Pronk NP, Anderson LH, Crain AL, et al. Meeting recommendations for multiple healthy lifestyle factors: prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med. 2004;27(2S):25–33. 10. Keller S, Maddock JE, Hannover W, Thyrian JR, Basler HD. Multiple health risk behaviors in German first year university students. Prev Med. 2008;46:189–195. 11. Moore MJ, Werch C. Relationship between vigorous exercise frequency and substance use among first-year drinking college students. J Am Coll Health. 2008;56:686–690. 12. Musselman JRB, Rutledge PC. The incongruous alcoholactivity association: physical activity and alcohol consumption in college students. Psychol Sport Exerc. 2010;11:609– 618. 13. VanKim NA, Laska MN, Ehlinger E, Lust K, Story M. Understanding young adult physical activity, alcohol and tobacco use in community colleges and 4-year post-secondary institutions: a cross-sectional analysis of epidemiological surveillance data. BMC Public Health. 2010;10:Article 208. 14. Piazza-Gardner AK, Barry AE. Examining physical activity levels and alcohol consumption: are people who drink more active? Am J Health Promot. 2012;26:95–104. 15. US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: US Department of Health and Human Services; 2008. 16. American College Health Association. National College Health Assessment. Available at: http://www.achancha.org./ Accessed January 14, 2013. 17. American College Health Association. National College Health Assessment II sample. Available at: http://www.achancha.org/docs/ACHA-NCHAII sample.pdf. Accessed January 14, 2013. 18. American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Data Report Fall 2008. Baltimore, MD: American College Health Association; 2009. 19. American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Data Report Spring 2009. Linthicum, MD: American College Health Association; 2009. 20. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 5th ed. San Francisco, CA: Pearson Education, Inc.; 2007. 21. Meyers LS, Gamst G, Guarina AJ. Applied Multivariate Research: Design and Interpretation. Thousand Oaks, CA: Sage; 2006. 22. Pedhazur EJ. Multiple Regression in Behavioral Research. 3rd ed. New York, NY: Harcourt Brace College Publishers; 1997. 23. Adams TB, Colner W. The association of multiple risk factors with fruit and vegetable intake among a nationwide sample of college students. J Am Coll Health. 2008;56:455– 461. 24. Ferguson CJ. An effect size primer: a guide for clinicians and researchers. Prof Psychol Res Pr. 2009;40:532–538. 73
Dinger, Brittain, & Hutchinson 31. Martens MP, Dams-O’Connor K, Beck NC. A systematic review of college student-athlete drinking: prevalence rates, sport-related factors, and interventions. J Subst Abuse Treat. 2006;31:305–316. 32. Nattiv A, Puffer JC, Green GA. Lifestyles and health risks of collegiate athletes: a multi-center study. Clin J Sport Med. 1997;7:262–272. 33. van de Mortel L. Faking it: social desirability response bias in self-report research. Aust J Adv Nurs. 2008;25:40–48. 34. Snyder TD, Dillow SA. Digest of Education Statistics 2009. Washington, DC: US Department of Education, National Center for Education Statistics IoES; 2010. NCES 2010– 013. 35. Youngblut JM, Casper GR. Focus on psychometrics: single-item indicators in nursing research. Res Nurs Health. 1993;16:459–465. Received: 21 February 2013 Revised: 7 September 2013 Accepted: 15 September 2013
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25. Quintiliani L, Allen J, Marino M, Kelly-Weeder S. Multiple health behavior clusters among female college students. Patient Educ Couns. 2010;79:134–137. 26. Dunn MS, Wang MQ. Effects of physical activity on substance use among college students. Am J Health Stud. 2003;18:126–132. 27. Vickers KS, Patten CA, Bronars C, et al. Binge drinking in female college students: the association of physical activity, weight concern, and depressive symptoms. J Am Coll Health. 2004;53:133–140. 28. French MT, Popovici I, Maclean JC. Do alcohol consumers exercise more? Findings from a national survey. Am J Health Promot. 2009;24:2–10. 29. Barry AE, Piazza-Gardner AK. Drunkorexia: understanding the co-occurrence of alcohol consumption and eating/exercise weight management behaviors. J Am Coll Health. 2012;60:236–243. 30. Lisha NE, Sussman S. Relationship of high school and college sports participation with alcohol, tobacco, and illicit drug use: a review. Addict Behav. 2010;35:399–407.
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JOURNAL OF AMERICAN COLLEGE HEALTH
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
Associations Between Physical Activity and HealthRelated Factors in a National Sample of College Students a
a
Mary K. Dinger PhD , Danielle R. Brittain PhD & Susan R. Hutchinson PhD a
b
Colorado School of Public Health , University of Northern Colorado , Greeley , Colorado
b
Department of Applied Statistics and Research Methods , University of Northern Colorado , Greeley , Colorado Accepted author version posted online: 03 Oct 2013.Published online: 07 Dec 2013.
Click for updates To cite this article: Mary K. Dinger PhD , Danielle R. Brittain PhD & Susan R. Hutchinson PhD (2014) Associations Between Physical Activity and Health-Related Factors in a National Sample of College Students, Journal of American College Health, 62:1, 67-74, DOI: 10.1080/07448481.2013.849710 To link to this article: http://dx.doi.org/10.1080/07448481.2013.849710
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JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 62, NO. 1
Major Article
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Associations Between Physical Activity and Health-Related Factors in a National Sample of College Students Mary K. Dinger, PhD; Danielle R. Brittain, PhD; Susan R. Hutchinson, PhD
Abstract. Objective: To examine associations between meeting the current moderate to vigorous physical activity (MVPA) recommendation and health-related factors in a national sample of college students. Participants: Participants (N = 67,861) completed the National College Health Assessment II during the Fall 2008/Spring 2009 academic year. Methods: Hierarchical binary logistic regression was used to examine the contribution of 19 variables in explaining whether or not participants met the MVPA recommendation. Results: Meeting the MVPA recommendation was associated with several protective factors among college students, including adequate daily fruit and vegetable consumption, positive perception of general health, healthy body mass index, consistent seatbelt use, not smoking cigarettes, less perceived depression, and adequate sleep. In addition, meeting the MVPA recommendation was also significantly associated with a few risky behaviors including binge drinking, physical fighting, and multiple sexual partners. Conclusions: College student PA interventions should consider also addressing fruit/vegetable consumption and binge drinking.
binge drinking) behaviors that impact their current and future health status. During this time of increased individual responsibility and independence, students are laying a foundation of behaviors that may last a lifetime.2 Among college students, one health behavior that has been shown to be associated with other health-related factors is physical activity (PA). Results from previous studies indicate PA is associated with several protective behaviors, including adequate daily fruit and vegetable consumption,1,3,4 not smoking cigarettes,1,4 and consistent seatbelt use.1 Furthermore, previous research also suggests a positive relationship between PA and mental health factors such as lower rates of depressive symptoms,5–7 less suicidal ideation,5 and less suicidal behavior.7 These associations between PA and other protective factors are supported by the results of previous studies that have reported healthy behaviors tend to cluster together within adults8,9 and college students.10 Findings from previous studies8–10 have also supported the clustering of unhealthy behaviors among adults and college students, which suggests that risky behaviors such as binge drinking, drug use, high-risk sexual behavior, etc, would be associated with sedentary behavior. However, several studies have reported that physically active college students were more likely to binge drink than their less active peers.11–13 Furthermore, the results from a recent literature review examining the association between alcohol consumption and PA indicate drinkers of all ages were more physically active than their nondrinking peers.14 Specifically among college students, the quantity of alcohol consumed per sitting was also positively associated with PA.14 This “incongruous alcohol-activity association”12 challenges previous findings that unhealthy behaviors cluster among adults and college students.8–10 In addition, the association between PA and alcohol consumption justifies the
Keywords: binge drinking, college students, physical activity, physical fighting, sexual behavior
T
he traditional college years are a time of transition from adolescence to adulthood.1 During this time, young adults gain increased control over their lifestyles and may engage in a variety of both protective (eg, daily consumption of fruits and vegetables) and risky (eg,
Dr Dinger and Dr Brittain are with the Colorado School of Public Health at the University of Northern Colorado in Greeley, Colorado. Dr Hutchinson is with the Department of Applied Statistics and Research Methods at the University of Northern Colorado in Greeley, Colorado. Copyright © 2014 Taylor & Francis Group, LLC
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investigation of additional potential counterintuitive associations between sufficient PA and health-related factors. Although several studies have been conducted to examine the relationship between PA and multiple health behaviors among college students, no study to date has simultaneously (1) utilized a large national sample of college students, (2) used a measure of PA that reflects the current national PA aerobic activity recommendation for moderate to vigorous PA (MVPA) (ie, ≥ 75 minutes of vigorous PA, ≥ 150 minutes of moderate PA, or ≥ 150 minutes of MVPA weekly),15 and (3) examined the association between MVPA and several protective and risky health-related factors while systematically controlling for other factors in the statistical model. Therefore, the purpose of this study was to examine the associations between meeting the current MVPA recommendation and health-related factors among a large national sample of college students. METHODS Participants and Procedures The American College Health Association (ACHA) administers the National College Health Assessment II (NCHA) at participating colleges and universities every fall and spring semester.16 The NCHA contains numerous items related to college student health-related factors and demographics.17 We obtained permission to access data pertaining to variables of interest from the Fall 2008 and Spring 2009 data collection by submitting a proposal to the ACHA-NCHA program office (for information, visit http://www.acha-ncha.org/research.html). The authors of this study received approval from the Institutional Review Board at their university to conduct this secondary analysis. Students enrolled at 157 campuses in the United States participated in the Fall 2008 and Spring 2009 NCHA data collection.18,19 These 157 institutions either surveyed all of their students, or used a random sampling technique to obtain student data. All participants provided informed consent prior to completing the survey. The final Fall 2008 and Spring 2009 sample included 113,790 college students.18,19 For the purposes of this study, we were interested in examining health-related factors among traditional college students. Therefore, participants who did not report age, race, sex, marital status, athletic team involvement, moderate PA, or vigorous PA were deleted (n = 11,097). The remaining participants were included in analyses if they were < 25 years of age, single (never married) and not a varsity athlete. The final sample size for analyses was 67,861. Measures Physical Activity The NCHA included 2 items to assess college student participation in moderate and vigorous aerobic PA.18,19 The moderate PA question was “On how many of the past 7 days did you do moderate-intensity cardio or aerobic exercise (caused a noticeable increase in heart rate, such as a brisk 68
walk) for at least 30 minutes?” The vigorous PA question was “On how many of the past 7 days did you do vigorousintensity cardio or aerobic exercise (caused large increases in breathing or heart rate, such as jogging) for at least 20 minutes?” Possible responses to the 2 items were 0 days to 7 days. Participants who reported ≥ 5 days of moderate PA, or ≥ 4 days of vigorous PA, or a total of ≥ 5 days of moderate plus vigorous PA were categorized as meeting the current MVPA recommendation for aerobic activity. Participants who did not meet the criteria were categorized as not meeting the current MVPA recommendation. Health-Related Factors Several health-related factor items from the NCHA18,19 were included in this study. The NCHA contains one item to assess general health status. Students responded to the following item, “How would you describe your general health?” Possible responses were on a Likert-type scale from excellent to poor. The specific items to determine depression and suicide ideation required students to report if “they ever felt so depressed that it was difficult to function” and if “they ever seriously considered suicide,” respectively. Possible responses to the 2 items ranged from no, never to yes, in the last 12 months. In addition, students reported their overall level of stress by responding to the following item: “Within the last 12 months, how would you rate the overall level of stress you have experienced?” Possible responses to the question ranged from no stress to tremendous stress. Students were also asked, “Within the last 12 months, how often did you wear a seatbelt when you rode in a car?” Possible responses were on a Likert-type scale and ranged from always to never. Sleep was assessed by asking, “On how many of the past 7 days did you get enough sleep so that you felt rested when you woke up in the morning?” Possible responses ranged from 0 days to 7 days. In addition, students reported their fruit and vegetable consumption by responding to the following item: “How many servings of fruits and vegetables do you usually have per day?” Possible responses ranged from 0 servings per day to 5 or more servings per day. Students also responded to items about drug use. They reported if they had used cigarettes or marijuana within the last 30 days by selecting either a yes or no response. In addition, prescription drug misuse was determined using the following item: “Within the last 12 months, have you taken any of the following prescription drugs that were not prescribed to you?” Students responded yes or no to having used antidepressants, erectile dysfunction drugs, pain killers, sedatives, and stimulants. The final drug use item assessed binge drinking using the item: “Over the last two weeks, how many times have you had five or more drinks of alcohol at a sitting?” Possible responses ranged from N/A, don’t drink to 10 or more times. The final 2 health-related behaviors of interest in this study were physical fighting and multiple sexual partners. Students were asked if they had been in a physical fight within the last 12 months and indicated their response by selecting either JOURNAL OF AMERICAN COLLEGE HEALTH
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Physical Activity and Health-Related Factors
yes or no. Students also were asked to respond to the following item: “Within the last 12 months, with how many partners have you had oral sex, vaginal intercourse, or anal intercourse?” Students were instructed to enter a number between 0 and 99. Student responses to the health-related factor items were dichotomized for analyses. Excellent, very good, and good responses to the general health item formed one group, whereas fair and poor responses formed the other group. Responses to the depression and suicide ideation items were categorized so that no, never and no, not in the last 12 months constituted one category and the remaining responses comprised the other category. Furthermore, student responses to the stress item were grouped with no stress, less than averages stress, and average stress forming one group. The more than average stress and tremendous stress responses formed the second group of responses to the stress question. The most of the time and always responses to the seatbelt use question were placed in one category for analyses, and the remaining responses to the item were placed in the second category. The 4 days to 7 days responses to the sleep item were placed in one group for analyses, whereas the 0 days to 3 days responses to the item formed the second group. Moreover, the possible responses to the fruit and vegetable question were categorized into 2 groups, with 1 group consisting of the 5 or more servings per day selections. The second fruit and vegetable consumption group for analyses consisted of all other responses to the item. Student responses to the cigarette and marijuana use items were categorized with the never used and have used, but not in the last 30 days responses forming one group and the remaining responses forming the other group. Those students who responded yes to any of the prescription drug categories were placed in one group, and those students who responded no to all of the prescription drug categories were placed into the other group. The N/A, don’t drink, and none responses to the binge item were placed into one group, whereas the remaining responses to the binge drinking item comprising the second group. Responses of 0 and 1 for the number of sexual partners during the last 12 months item were placed into a group, with all other responses to the item placed into a second group for analyses. All data analyses were conducted using IBM SPSS Statistics (version 20.0; IBM, Somers, New York). Descriptive statistics were calculated for all variables. Hierarchical binary logistic regression was used to examine the contribution of 19 variables in explaining whether or not participants met the current MVPA recommendation. Variables were entered in 3 steps with demographic variables (sex, age, and race) tested at step 1, followed by 2 variables added at step 2 indicating whether or not students had participated in intramural or club sports within the last 12 months. The latter 2 variables were included to control for the potentially extraneous effect of students’ participation in organized sports. Finally, the remaining 14 health-related factors, which were of primary interest in the current study, were tested at the third step. When assessing the statistical significance of each VOL 62, JANUARY 2014
of the 19 predictor variables, a Bonferroni-adjusted alpha of .0026 per test was used to maintain a familywise error rate of .05 across all 19 tests. Prior to interpreting the results of a logistic regression, assumptions of large sample size relative to the number of predictor variables and absence of extreme multicollinearity among predictor variables should be satisfied.20 Based on the largest variance inflation factor value of 1.26, which is well below the suggested cutoff of 10.0,21 there was no evidence of excessive collinearity among the predictor variables. Regarding the assumption of adequate sample size, although there is no consensus regarding sample size requirements for logistic regression, the sample size of 67,861 appeared to be sufficient for these analyses, considering even the most conservative sample size recommendations.22 RESULTS The sample of 67,861 students was approximately 68% female (n = 45,901) and 32% male (n = 21,960). The majority of participants were white, 18 to 20 years old, had healthy body mass indices (BMIs) (18.5 to 24.9 kg/m2), and did not participate in club or intramural sports (Table 1). In addition, the majority of respondents attended school full time (97.2%, n = 65,411), lived in a campus residence hall (45.5%, n = 30,842), and did not work for pay (44.1%, n = 29,790). Approximately half of the students (49.9%, n = 33,865) were meeting the current MVPA recommendation. The remaining students (n = 33,865) were not meeting the recommendation. Table 1 contains frequencies and proportions of the 2 groups by the variables that were included in the logistic regression models. The logistic regression model with sex, dichotomized age, and dichotomized race at step 1 produced a statistically significant likelihood ratio test, χ 2(3, N = 67,861) = 688.63, p < .001, Cox and Snell R2 = .01, indicating improvement in fit over the intercept-only model. Sex, age, and race were all individually, statistically significant, with the adjusted odds being 20.5% greater for males than females and 46.3% greater for white than nonwhite students of achieving recommended levels of MVPA. In addition, although age was statistically significant, the contribution of age appeared to be relatively minimal, with only 8.8% higher odds of attaining adequate MVPA for students in the 18- through 20-year-old age group compared with those over the age of 20. When the 2 variables representing participation in club and intramural sports were added to the model at step 2, the fit also improved significantly, after controlling for the 3 demographic variables, χ 2(2, N = 67,861) = 1975.34, p < .001, Cox and Snell R2 = .04. Not surprisingly, participation in either club or intramural sports was associated with higher odds of reaching recommended levels of MVPA. Specifically, the odds of meeting recommended MVPA levels for students who were in club sports or intramural sports were 2.10 and 1.81 times greater, respectively, than for students who did not report participating in either type of organized sport during the last 12 months. 69
Dinger, Brittain, & Hutchinson TABLE 1. Frequencies and Proportions of Those Meeting (n = 33,865) Versus Not Meeting (n = 33,996) the MVPA Recommendation by Participant Factors Meeting MVPA recommendation (n = 33,865) Factor
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Sex Female Male Age 18–20 years 21–24 years Race White Nonwhite Club sport (last 12 months) Yes No Intramural sport (last 12 months) Yes No General health Excellent, Very good, or Good Fair or Poor BMI Healthy BMI (18.5 to 24.9 kg/m2) Unhealthy BMI (< 18.5 and >24.9 kg/m2) Seatbelt use (last 12 months) Most of the time or Always Never, Rarely, or Sometimes Cigarette smoking (last 30 days) Never used or Not used in last 30 days Used 1–2 times/day to Used daily Marijuana use (last 30 days) Never used or Not used in last 30 days Used 1–2 times/day to Used daily Prescription drug misuse (last 12 months) No Yes Fruit and vegetable consumption (usual per day) ≥ 5 servings 0–4 servings Stress (last 12 months) None, Less than average, or Average More than average or Tremendous Depression (last 12 months) Never or Not in last 12 months Yes Suicide ideation (last 12 months) Never or Not in last 12 months Yes Sleep (past 7 days) ≥ 4 days < 3 days Physical fighting (last 12 months) No Yes Multiple sex partners (last 12 months) 0–1 partner ≥ 2 partners Binge drinking (last 2 weeks) No Yes
Not meeting MVPA recommendation (n = 33,996)
Total (N = 67,861)
n
%
n
%
n
%
22,075 11,790
48.1 53.7
23,826 10,170
51.9 46.3
45,901 21,960
67.6 32.4
20,731 13,134
50.6 48.9
20,273 13,723
49.4 51.1
41,004 26,857
60.4 39.6
25,942 7,923
52.4 43.1
23,525 10,471
47.6 56.9
49,467 18,394
72.9 27.1
4,986 28,879
68.9 47.6
2,251 31,745
31.1 53.4
7,237 60,624
10.7 89.3
9,425 24,440
63.9 46.0
5,318 28,678
36.1 54.0
14,743 53,118
21.7 78.3
32,126 1,739
51.3 33.1
30,481 3,515
48.7 66.9
62,607 5,254
92.3 7.7
22,679 11,186
51.7 46.6
21,202 12,794
48.3 53.4
43,881 23,980
64.7 35.3
32,406 1,459
50.0 47.0
32,348 1,648
50.0 53.0
64,754 3,107
95.4 4.6
28,493 5,372
50.5 47.1
27,964 6,032
49.5 52.9
56,457 11,404
83.2 16.8
28,153 5,712
49.6 51.6
28,628 5,368
50.4 48.4
56,781 11,080
83.7 16.3
29,083 4,782
49.9 49.7
29,162 4,834
50.1 50.3
58,245 9,616
85.8 14.2
2,509 31,356
73.3 48.7
915 33,081
26.7 51.3
3,424 64,437
5.0 95.0
17,547 16,318
52.0 47.8
16,187 17,809
48.0 52.2
33,734 34,127
49.7 50.3
23,924 9,941
51.5 46.4
22,535 11,461
48.5 53.6
46,459 21,402
68.5 31.5
31,954 1,911
50.2 45.1
31,669 2,327
49.8 54.9
63,623 4,238
93.8 6.2
15,502 18,363
54.5 46.6
12,962 21,034
45.5 53.4
28,464 39,397
41.9 58.1
31,129 2,736
49.3 57.3
31,960 2,036
50.7 42.7
63,089 4,772
93.0 7.0
24,273 9,592
48.7 53.4
25,610 8,386
51.3 46.6
49,883 17,978
73.5 26.5
20,205 13,660
47.5 53.9
22,312 11,684
52.5 46.1
42,517 25,344
62.7 37.3
Note. MVPA = moderate to vigorous physical activity; BMI = body mass index.
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JOURNAL OF AMERICAN COLLEGE HEALTH
Physical Activity and Health-Related Factors TABLE 2. Summary of Hierarchical Logistic Regression Analysis for Factors Associated With Meeting (n = 33,865) Versus Not Meeting (n = 33,996) the MVPA Recommendation
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Factor Step 1 Sex Female Male Age 18–20 years 21–24 years Race White Nonwhite Step 2 Club sport (last 12 months) Yes No Intramural sport (last 12 months) Yes No Step 3 General health Excellent, Very good, or Good Fair or Poor BMI Healthy BMI (18.5 to 24.9 kg/m2) Unhealthy BMI (< 18.5 and > 24.9 kg/m2) Seatbelt use (last 12 months) Most of the time or Always Never, Rarely, or Sometimes Cigarette smoking (last 30 days) Never used or Not used in last 30 days Used 1–2 times/day to Used daily Marijuana use (last 30 days) Never used or Not used in last 30 days Used 1–2 times/day to Used daily Prescription drug misuse (last 12 months) No Yes Fruit and vegetable consumption (usual per day) ≥ 5 servings 0–4 servings Stress (last 12 months) None, Less than average, or Average More than average or Tremendous Depression (last 12 months) Never or Not in last 12 months Yes Suicide ideation (last 12 months) Never or Not in last 12 months Yes Sleep (past 7 days) ≥ 4 days < 3 days Physical fighting (last 12 months) No Yes Multiple sex partners (last 12 months) 0–1 partner ≥ 2 partners Binge drinking (last 2 weeks) No Yes Constant
β
Adjusted OR
95% CI
p
−0.230 Reference
0.795
0.769, 0.821
< .001∗
0.084 Reference
1.088
1.055, 1.122
< .001∗
0.380 Reference
1.463
1.414, 1.514
< .001∗
0.742 Reference
2.100
1.990, 2.215
< .001∗
0.595 Reference
1.812
1.742, 1.885
< .001∗
0.560 Reference
1.750
1.645, 1.862
< .001∗
0.122 Reference
1.130
1.093, 1.168
< .001∗
0.131 Reference
1.140
1.057, 1.230
.001∗
0.197 Reference
1.218
1.162, 1.277
< .001∗
0.007 Reference
1.007
0.959, 1.057
.783
0.014 Reference
1.014
0.966, 1.065
.564
1.033 Reference
2.810
2.596, 3.041
0.039 Reference
1.040
1.005, 1.075
.024
0.062 Reference
1.064
1.024, 1.104
.001∗
0.019 Reference
1.019
0.951, 1.092
.599
0.228 Reference
1.257
1.216, 1.298
< .001∗
−0.234 Reference
0.791
0.742, 0.844
< .001∗
−0.143 Reference
0.867
0.834, 0.901
< .001∗
−0.142 Reference −1.105
0.867
0.836, 0.900
< .001∗
< .001∗
Note. MVPA = moderate to vigorous physical activity; CI = confidence interval; BMI = body mass index. χ 2 = 1779.23, df = 14 (step 3). ∗ Statistically significant based on a Bonferroni-adjusted alpha (α = .0026)
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At step 3, the addition of the 14 explanatory variables likewise resulted in a statistically significant improvement in fit over the model with demographic variables and organized sport participation, χ 2(14, N = 67,861) = 1779.23, p < .001, Cox and Snell R2 = .06. When controlling for all the other variables in the model, there were several statistically significant protective factors found at this step (Table 2). For example, those students who consumed 5 or more servings of fruits and vegetables per day had 2.81 greater odds of meeting the MVPA recommendation than those who ate fewer fruits and vegetables daily. Likewise, students who reported good to excellent general health had 1.75 greater odds of engaging in sufficient amounts of MVPA compared with those who reported fair or poor general health status (Table 2). In addition, there were also 3 statistically significant risky behaviors associated with PA in the third step of the model: physical fighting, binge drinking, and multiple sex partners. Students who had participated in 1 or more fights, engaged in 1 or more bouts of binge drinking, and/or indicated having 2 or more sex partners during the last year had higher odds of reaching recommended MVPA levels. The odds ranged from 20.9% higher (physical fighting) to 13.3% higher (multiple sex partners and binge drinking) (Table 2). The only variables not contributing significantly to the model included use of marijuana in the last 30 days, prescription drug misuse in the last 12 months, contemplating suicide in the last 12 months, and stress level in the last 12 months. The nonsignificant Hosmer and Lemeshow χ 2(8, N = 7) = 16.22, p = .04, suggested that the model adequately fit the data when all 19 variables were in the model. COMMENT Results of this study indicate that after controlling for all of the other variables in the model, meeting the current MVPA recommendation was positively associated with several protective factors among college students, including adequate daily fruit and vegetable consumption, positive perception of general health status, healthy BMI, consistent seatbelt use, not smoking cigarettes, less perceived depression, and adequate sleep most days of the week. Results of this study also indicate that when controlling for all of the other variables in the model, meeting the current MVPA recommendation was also associated with a few health risk behaviors, including binge drinking, physical fighting, and multiple sexual partners. The results of this study confirm the statistically significant associations between PA and several health promoting factors in college students, including fruit and vegetable consumption,1,3,23 not smoking cigarettes,1,4,11 consistent seatbelt use,1 and fewer feelings or symptoms of depression.5–7 In addition to being statistically significant, the magnitude of the adjusted association between meeting the MVPA recommendation and fruit and vegetable consumption suggests practical significance as well.24 These findings suggest that interventions targeting several of these factors may be warranted, which may be an important cost-effective approach to improving the health and well-being of college students.25 72
There were 3 risky behaviors significantly associated with meeting the MVPA recommendation in this study. We found students who were meeting the current MVPA recommendation were more likely to binge drink, be involved in a physical fight, and have multiple sexual partners. Although the effect sizes of these associations were relatively small,24 these associations are concerning, given the severity of health risks associated with these behaviors. Our findings regarding sufficient MVPA and binge drinking are consistent with several previous studies of college students with smaller sample sizes and fewer controlled variables.11–13,26,27 Our findings indicate that after controlling for all the other variables in the model and using the current MVPA recommendation to categorize students, the association between MVPA and binge drinking was still evident. Several hypotheses have been offered to explain this relationship, including “work hard, play hard,”12 “damage control,”12 “sensation-seeking lifestyle,”28 and “drunkorexia.”29 Although additional research is needed to fully understand this association, our findings imply that interventions designed to promote MVPA among college students should also address alcohol consumption and binge drinking. Novel findings of this study include the association between MVPA and the risky behaviors of multiple sex partners and physical fighting. Participants in this study who were meeting the current MVPA recommendation were more likely to have multiple sexual partners and to have been in a physical fight during the last 12 months, after controlling for all other factors in the model. To our knowledge, only one previous study has examined the association between PA, physical fighting, and multiple sexual partners in college students.1 After controlling for age, sex, and race, the associations between the variables in that study were not statistically significant.1 The significant associations between the health risk behaviors and MPVA found in this study are similar to findings reported in athletic populations and among organized sport participants. Previous studies have reported a positive association between being a member of a sports team and alcohol consumption.30 Furthermore, study results have indicated a positive relationship between being a college athlete and binge drinking,31 multiple sexual partners,32 and physical fighting.32 In the current study, we excluded varsity athletes from the sample, we controlled for organized sport participation in step 2 of the statistical model, and we controlled for all other variables in the model, yet the associations between sufficient MVPA and these risky behaviors remained statistically significant. These findings support the “work hard, play hard” hypothesis that has been suggested by previous researchers.12 Clearly additional research is needed to fully understand the association between sufficient MVPA and these risky behaviors in college students. Limitations There are several potential limitations to this study. First, data were collected via a self-report survey, which could have resulted in biased reporting by the participants.33 Second, the JOURNAL OF AMERICAN COLLEGE HEALTH
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sample utilized in this study contained a higher proportion of females (67.6% versus 57%) and whites (72.9% versus 63.2%) than the national college student population.34 Third, the cross-sectional design of the study does not allow for causal relationships to be determined. Fourth, although muscular strength and endurance is included as a part of the current PA recommendation,15 we examined participation in aerobic MVPA only. Fifth, single-item indicators were used to represent health-related factors, which may underrepresent the constructs of interest.35 Finally, artificial groups may have resulted due to the dichotomization of study variables. Conclusions After controlling for all of the variables in the model, meeting the current MVPA recommendation was significantly positively associated with several protective factors, and a few risky behaviors, in this large national sample of single, nonvarsity athlete, college students less than 25 years of age. Interventions designed to promote PA for college students should also address several of the variables associated with PA, including fruit and vegetable consumption and binge drinking. Future research should continue to explore the counterintuitive relationships between participation in sufficient PA and binge drinking, physical fighting, and multiple sexual partners. ROLE OF FUNDING SOURCES DISCLOSURE No funding was used to support this research and/or the preparation of the manuscript. CONFLICT OF INTEREST DISCLOSURE The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board at the University of Northern Colorado. NOTE For comments and further information, address correspondence to Mary K. Dinger, PhD, Community Health Program, School of Human Sciences, University of Northern Colorado Gunter Hall 1250B, Campus Box 132, Greeley, CO 80639, USA (e-mail: [email protected]). REFERENCES 1. Dinger MK, Vesely SK. Relationships between physical activity and other health-related behaviors in a representative sample of U.S. college students. Am J Health Educ. 2001;32:83–88. 2. Gordon-Larsen P, Nelson MC, Popkin BM. Longitudinal physical activity and sedentary behavior trends adolescence to adulthood. Am J Prev Med. 2004;27:277–283. 3. Lowry R, Galuska DA, Fulton JE, Wechsler H, Kann L, Collins JL. Physical activity, food choice, and weight management goals and practices among U.S. college students. Am J Prev Med. 2000;18:18–27. 4. Seo DC, Nehl E, Agley J, Ma SM. Relations between physical activity and behavioral and perceptual correlates among midwestern college students. J Am Coll Health. 2007;56:187–197. VOL 62, JANUARY 2014
5. Elliot CA, Kennedy C, Morgan G, Anderson SK, Morris D. Undergraduate physical activity and depressive symptoms: a national study. Am J Health Behav. 2012;36:230– 241. 6. Harbour VJ, Behrens TK, Kim HS, Kitchens CL. Vigorous physical activity and depressive symptoms in college students. J Phys Act Health. 2008;5:516–526. 7. Taliaferro LA, Rienzo BA, Pigg RM, Miller MD, Dodd VJ. Associations between physical activity and reduced rates of hopelessness, depression, and suicidal behavior among college students. J Am Coll Health. 2008;57:427–435. 8. de Vries H, van ’t Riet J, Spigt M, et al. Clusters of lifestyle behaviors: results from the Dutch SMILE study. Prev Med. 2008;46:203–208. 9. Pronk NP, Anderson LH, Crain AL, et al. Meeting recommendations for multiple healthy lifestyle factors: prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med. 2004;27(2S):25–33. 10. Keller S, Maddock JE, Hannover W, Thyrian JR, Basler HD. Multiple health risk behaviors in German first year university students. Prev Med. 2008;46:189–195. 11. Moore MJ, Werch C. Relationship between vigorous exercise frequency and substance use among first-year drinking college students. J Am Coll Health. 2008;56:686–690. 12. Musselman JRB, Rutledge PC. The incongruous alcoholactivity association: physical activity and alcohol consumption in college students. Psychol Sport Exerc. 2010;11:609– 618. 13. VanKim NA, Laska MN, Ehlinger E, Lust K, Story M. Understanding young adult physical activity, alcohol and tobacco use in community colleges and 4-year post-secondary institutions: a cross-sectional analysis of epidemiological surveillance data. BMC Public Health. 2010;10:Article 208. 14. Piazza-Gardner AK, Barry AE. Examining physical activity levels and alcohol consumption: are people who drink more active? Am J Health Promot. 2012;26:95–104. 15. US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: US Department of Health and Human Services; 2008. 16. American College Health Association. National College Health Assessment. Available at: http://www.achancha.org./ Accessed January 14, 2013. 17. American College Health Association. National College Health Assessment II sample. Available at: http://www.achancha.org/docs/ACHA-NCHAII sample.pdf. Accessed January 14, 2013. 18. American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Data Report Fall 2008. Baltimore, MD: American College Health Association; 2009. 19. American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Data Report Spring 2009. Linthicum, MD: American College Health Association; 2009. 20. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 5th ed. San Francisco, CA: Pearson Education, Inc.; 2007. 21. Meyers LS, Gamst G, Guarina AJ. Applied Multivariate Research: Design and Interpretation. Thousand Oaks, CA: Sage; 2006. 22. Pedhazur EJ. Multiple Regression in Behavioral Research. 3rd ed. New York, NY: Harcourt Brace College Publishers; 1997. 23. Adams TB, Colner W. The association of multiple risk factors with fruit and vegetable intake among a nationwide sample of college students. J Am Coll Health. 2008;56:455– 461. 24. Ferguson CJ. An effect size primer: a guide for clinicians and researchers. Prof Psychol Res Pr. 2009;40:532–538. 73
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