Journal of American College Health
ISSN: 0744-8481 (Print) 1940-3208 (Online) Journal homepage: http://www.tandfonline.com/loi/vach20
Surveying University of Arizona Students' Health Kathlyn Smiley MS , Koreen Johannessen ACSW , Kenneth Marsh PhD & Carolyn Collins MS To cite this article: Kathlyn Smiley MS , Koreen Johannessen ACSW , Kenneth Marsh PhD & Carolyn Collins MS (1992) Surveying University of Arizona Students' Health, Journal of American College Health, 41:2, 75-77, DOI: 10.1080/07448481.1992.10392822 To link to this article: http://dx.doi.org/10.1080/07448481.1992.10392822
Published online: 07 Apr 2011.
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Date: 06 November 2015, At: 07:39
CLINICAL & PROGRAM NOTES
Downloaded by [York University Libraries] at 07:39 06 November 2015
Suweying University of Arizona Students’ Health Kathlyn Smiley, MS; Koreen Johannessen, ACSW; Kenneth Marsh, PhD; and Carolyn Collins, MS
Abstract. The authors sampled more than 600 University of Arizona students to determine how student attitudes, beliefs, and practices should be considered by healthcare personnel in planning campus health education programs. The survey found that students worried more about diet, exercise, and weight than they did about more serious health problems and that, although generally positive and optimistic, the students frequently felt anxious and overwhelmed. Two thirds of the students were sexually active, 74% of those who were active used various contraceptive methods. More than three quarters of those surveyed indicated they currently drank alcoholic beverages; one quarter of the drinkers said they frequently downed three or more drinks on one occasion, and 44% of the drinkers reported driving while under the influence of alcohol. Key Words. health promotion, program planning, student surveys
tion and the Centers for Disease Control in 1981 provided us with a literature review, gave case studies, and helped us establish a foundation for conceptualizing college health promotion issues. Our review of more recent college health surveys and age-related data was useful for choosing question categories, survey format, and These data’ bases, however, were difficult to compare because of variations in items and format, as well as regional, socioeconomic, cultural, and other population differences. Although many college health services have conducted surveys, few have been described in the literature in any detail. METHOD
or a college health service operating on a limited budget, acquiring the information necessary for making decisions and targeting scarce resources in a timely fashion may appear to be an overwhelming task. This report of our experience at the University of Arizona demonstrates the feasibility of assessing the health status of students on a large college campus by using a low-cost survey process to gain useful information for future program planning We estimate our total cost, not counting staff salaries, was about $1,500. The report “Health Education in College Health Services”’ published by the American Hospital AssociaThe authors are all with the University of Arizona Student Health Service in Tucson; Kathkjn Srniley b in nutrition education, Koreen Johannessen b coordinator of health promotion and preventive services, Kenneth Marsh b head of the mental health section, and Carolyn Collins deak with alcohol and other drug education. VOL 41, SEPTEMBER 1992
The student health service staff developed this survey in cooperation with representatives from mental health, health promotion, nutrition education, and social marketing programs. Our questionnaire included items on health attitudes and beliefs, frequency of health-related behaviors, use and perception of health services, and open-ended questions about the occurrence of traumatic events. Several volunteer student focus groups reviewed the format, content, and sensitivity of the survey items, and we then revised the questionnaire in light of their comments. We selected a random, computer-generated sample of 1,500 university students from the registrar’s total student mailing list. This type of simple random sample did not provide access to detailed population characteristics (sex, age, class), nor did it ensure that returned surveys would accurately reflect the various subgroups of the population. We chose this procedure, however, because it provided maximum randomization to reduce sampling error.6 75
Downloaded by [York University Libraries] at 07:39 06 November 2015
COLLEGE HEALTH
To get the best response rate, we followed a mailing procedure that was designed to reduce nonresponses.’ The survey packet included a questionnaire and an addressed, postage-paid return envelope. We sent reminder postcards to all participants 2 weeks after the initial mailing, and 2 weeks following that, we sent another complete survey packet to a random sample of the 100 students who had not responded. This second packet included a more strongly worded letter asking for their cooperation. The follow-up procedure was useful in determining whether the results from those who responded promptly (within the requested 10 days) differed from those who might not have responded (the late responders). For statistical analysis, we used the Statistical Package for the Social Sciences (SPSSX) computer program. We computed frequencies and cross-tabulations, comparing age, class, living status, and sex. We used Student’s t test to identify any significant differences between the prompt and late responders. RESULTS
Subjects returned 641 surveys, for a 48% return rate (10% were not deliverable). The Student’s t tests revealed insignificant differences between prompt and late responders, so we merged data from the two groups. Because of the large number of variables analyzed, we report only the significant results (p > .05) that were relevant for planning our healthcare programs. The profie of students who responded matched the profile of University of Arizona students, with three exceptions: Our percentage of female responders was greater than the percentage of women in the student body (67% of respondents v 47% in the total university population); proportionally fewer international students responded than the percentage enrolled (1% v 119’0); more responses were from sophomores, juniors, and seniors, and fewer from first-year and graduate students. The differences between those who responded to the survey and the U of A population may reflect a number of different problems in reaching specific groups, including possible language barriers for international students, lack of time and perceived importance of the survey for graduate students, and lack of commitment and connection for freshmen. Nonetheless, the response rate was adequate for statistical analysis. Psychological Health and Well-being
University of Arizona students appeared to be positive and optimistic overall (85% reported feeling this way on a daily or weekly basis), but approximately one half were frequently challenged by anxiety, tension, and stress. Just over two thirds of both men and women were concerned about the way they looked, and women, in particular, worried more about weight, dieting, and food than did men. Half of the students worried about getting enough exercise, yet 55% reported they were regularly involved in an aerobic activity. Students wor76
ried more frequently about their looks, weight, and exercise than they did about AIDS, sexually transmitted diseases (STDs), illness, overall health, and failing in academic courses. Almost all students reported feeling good about their relationships with family members and friends. Students with intimate partners were satisfied with those relationships, but one third of all respondents and more than half of the freshmen reported not having an intimate relationship at the time. Most (75%) were satisfied with their relationship with university faculty. One in five students and one in three freshmen had failed to connect with an advisor. Sexual Health
Two out of three of the students surveyed indicated they were sexually active, which in the context of the questionnaire and the time (1988) implied having intercourse. The questions concerned whether they discussed contraception with their partners, used contraceptive methods, discussed STDs before having sexual relations, or practiced safe sex (“use a condom or avoid intercourse”). Three fourths of this group reported they always used contraception, and more than half (58%) said they practiced safer sex, as defined above. A higher percentage of women than men reported they had discussed sexual health and practicing safer sex. In our sample, 12% of the students reported they or their partners had experienced an unplanned pregnancy. Neither men nor women indicated they worried frequently about contracting an STD, including AIDS (85% said they never or seldom worried about STDs, 83% reported they never or seldom worried about contracting AIDS). Nine percent of those who were sexually active, however, reported they had contracted a sexually transmitted disease while at the University of Arizona. Many of these students reported they frequently were preoccupied with sexual feelings. This was true of men more often than of women and of younger students more often than among those who were older. Health and Health-related Behaviors Most students (95%) were aware of the importance of good nutrition, but only 65% translated this knowledge into practice. More women than men reported trying to follow a nutritious diet and, in general, upperclassmen were more concerned about nutrition than were freshmen. Half of our students indicated they ate food from fast-food outlets at least once or twice a week, and 13% said they ate fast food daily. Several items inquired about safety-related behaviors. Most students (75%) reported using seat belts on a regular basis while riding in a car (either driving or as a passenger), but very few (5%) said they wore a helmet when they rode a bicycle. About half were careful about unprotected exposure to the sun. One out of five, however, reported extended periods of unprotected midday sun exposure at least once o r twice a week. This finding was JA CH
UNIVERSITY OF ARIZONA SURVEY
important for our healthcare planning because of the high incidence of skin cancer in the Southwest. Substance Use
Very few students reported they smoked cigarettes
Downloaded by [York University Libraries] at 07:39 06 November 2015
(lo%), and even fewer @Yo) used chewing tobacco. Approximately 80% reported they did not use illicit drugs; 18% of the students reported smoking marijuana, and 2% reported using cocaine. Most students (77%) reported currently drinking alcoholic beverages and, of those, one out of four drank enough at one time to be intoxicated at least once a week. Of those who drank, 44% said they drove under the influence. Men tended to drink more, more often, and were more likely than women to drink and drive; this level of drinking is consistent with national survey results.8s9The amount of alcohol consumed and the frequency of subsequent high-risk behaviors indicated that we need more program intervention in this area.
Stressful Events We used open-ended questions to ask about stressful and traumatic events. Half of our students said that they had experienced a significant loss, felt overwhelmed by family stress, confronted significant changes in life circumstances, or had fallen victim to accident, assault, or illness while at the university. These disruptions were primarily handled with the help of friends and family, and less frequently, with professional counseling. Student Health Service Use and Perception of Care Two thirds (65%) of the students had used the university student health service, and those who had used it had a positive reaction to the care they received. About one third had participated in health-enhancement activities such as Alcohol Awareness Week and ongoing support groups. Approximately 10% of the students used the campus mental health services and viewed the assistance they received there positively. Another important finding was that 16% of the students reported they had no health insurance coverage. We have no way of knowing at this time whether these students feel they do not need insurance or that they cannot afford it. We need to know more about this. DISCUSSION These are some of the programs in health promotion and treatment we developed as a direct result of our survey. Many of them seek to reach those U of A students who do not usually turn to more traditional one-on-one counseling or attend formal presentations.
A class on stress-reductiontechniques An “Assess Your Stress” day A “Friends Are Good Medicine” month Altered parent orientations to emphasize the need for families to encourage their college-student children to VOL 41, SEPTEMBER 1992
balance work and play, participate in club and service activities, and develop new on-campus networks Four new programs on weight loss that stressed healthy exercise choices and improved eating habits An “Eating Advocates Team” to identify sorority members who are at risk for eating disorders A “Right Bite” campaign developed in cooperation with the student union food service; it flags low-, medium-, and high-fat selections in the two largest cafeterias, which serve some 17,000 people each day “Stop Smoking” kits for students interested in a behavioral approach to quitting “Frisky Business” presentations that support peerbased activities in various campus settings and emphasize communication, risk reduction, and personal choices rather than abstinence in dealing with alcohol use and STDs Skin cancer screening and a sun-awareness event; 3 of the 135 students we screened were found to have precancerous conditions Surveys similar to that we carried out on our campus are helpful in monitoring local trends, identifying student needs, attitudes, and behaviors, and providing useful feedback for program evaluation and development. Timely reviews of these health issues every 4 or 5 years, coupled with smaller, more direct assessments that target specific areas in the years between, are feasible and cost effective. We believe consistent appraisals are essential for healthcare planning, providing a “snapshot” that is unique to the individual college or university, and establishing a valuable data base for the future. REFERENCES
1. AHA/CDC Health Education Project. Health education in college health services. Chicago, IL: Center for Health Promotion, American Hospital Association; October 1981. 2. Chervin DD, Martinez AM. Survey on the health of Stanford students. Palo Alto,’ CA: Cowell Student Health Center; unpublished report, 1987. 3. Hare1 Y. Priorities in promoting health behaviors of college students: Toward the 1990s. Presented at the 67th Annual Meeting of the American College Health Association, May 1989; Washington, DC. 4. Haberman SE. An instrument for assessing the health practices of college students. Presented at the 67th Annual Meeting of the American College Health Association, May 1989; Washington, DC. 5. Brigman SL, Roberts BA. Opinions, attitudes and needs of ASU students; Fall 1985. Tempe, AZ: Arizona State University; 1985. 6. Kalton G. Introduction to Survey Sampling. Beverly Hills, CA: Sage; 1983. 7. Fowler FJ, Jr. Survey Research Methods. Beverly Hills, CA: Sage; 1984. 8. Robbins C. Alcohol and drug use. J Health Soc Behav. 1989;30117. 9. Johnston LD, O’Malley PM, Bachman JG. Illicit Drug Use, Smoking and Drinking by America’s High School Students, College Students and Young Adults, 1975-1987. Rockville, MD: National Institute for Drug Abuse, US Dept of Health and Human Services; 1988. DHHS publication (ADM) 89-1602. 77
ISSN: 0744-8481 (Print) 1940-3208 (Online) Journal homepage: http://www.tandfonline.com/loi/vach20
Surveying University of Arizona Students' Health Kathlyn Smiley MS , Koreen Johannessen ACSW , Kenneth Marsh PhD & Carolyn Collins MS To cite this article: Kathlyn Smiley MS , Koreen Johannessen ACSW , Kenneth Marsh PhD & Carolyn Collins MS (1992) Surveying University of Arizona Students' Health, Journal of American College Health, 41:2, 75-77, DOI: 10.1080/07448481.1992.10392822 To link to this article: http://dx.doi.org/10.1080/07448481.1992.10392822
Published online: 07 Apr 2011.
Submit your article to this journal
Article views: 7
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=vach20 Download by: [York University Libraries]
Date: 06 November 2015, At: 07:39
CLINICAL & PROGRAM NOTES
Downloaded by [York University Libraries] at 07:39 06 November 2015
Suweying University of Arizona Students’ Health Kathlyn Smiley, MS; Koreen Johannessen, ACSW; Kenneth Marsh, PhD; and Carolyn Collins, MS
Abstract. The authors sampled more than 600 University of Arizona students to determine how student attitudes, beliefs, and practices should be considered by healthcare personnel in planning campus health education programs. The survey found that students worried more about diet, exercise, and weight than they did about more serious health problems and that, although generally positive and optimistic, the students frequently felt anxious and overwhelmed. Two thirds of the students were sexually active, 74% of those who were active used various contraceptive methods. More than three quarters of those surveyed indicated they currently drank alcoholic beverages; one quarter of the drinkers said they frequently downed three or more drinks on one occasion, and 44% of the drinkers reported driving while under the influence of alcohol. Key Words. health promotion, program planning, student surveys
tion and the Centers for Disease Control in 1981 provided us with a literature review, gave case studies, and helped us establish a foundation for conceptualizing college health promotion issues. Our review of more recent college health surveys and age-related data was useful for choosing question categories, survey format, and These data’ bases, however, were difficult to compare because of variations in items and format, as well as regional, socioeconomic, cultural, and other population differences. Although many college health services have conducted surveys, few have been described in the literature in any detail. METHOD
or a college health service operating on a limited budget, acquiring the information necessary for making decisions and targeting scarce resources in a timely fashion may appear to be an overwhelming task. This report of our experience at the University of Arizona demonstrates the feasibility of assessing the health status of students on a large college campus by using a low-cost survey process to gain useful information for future program planning We estimate our total cost, not counting staff salaries, was about $1,500. The report “Health Education in College Health Services”’ published by the American Hospital AssociaThe authors are all with the University of Arizona Student Health Service in Tucson; Kathkjn Srniley b in nutrition education, Koreen Johannessen b coordinator of health promotion and preventive services, Kenneth Marsh b head of the mental health section, and Carolyn Collins deak with alcohol and other drug education. VOL 41, SEPTEMBER 1992
The student health service staff developed this survey in cooperation with representatives from mental health, health promotion, nutrition education, and social marketing programs. Our questionnaire included items on health attitudes and beliefs, frequency of health-related behaviors, use and perception of health services, and open-ended questions about the occurrence of traumatic events. Several volunteer student focus groups reviewed the format, content, and sensitivity of the survey items, and we then revised the questionnaire in light of their comments. We selected a random, computer-generated sample of 1,500 university students from the registrar’s total student mailing list. This type of simple random sample did not provide access to detailed population characteristics (sex, age, class), nor did it ensure that returned surveys would accurately reflect the various subgroups of the population. We chose this procedure, however, because it provided maximum randomization to reduce sampling error.6 75
Downloaded by [York University Libraries] at 07:39 06 November 2015
COLLEGE HEALTH
To get the best response rate, we followed a mailing procedure that was designed to reduce nonresponses.’ The survey packet included a questionnaire and an addressed, postage-paid return envelope. We sent reminder postcards to all participants 2 weeks after the initial mailing, and 2 weeks following that, we sent another complete survey packet to a random sample of the 100 students who had not responded. This second packet included a more strongly worded letter asking for their cooperation. The follow-up procedure was useful in determining whether the results from those who responded promptly (within the requested 10 days) differed from those who might not have responded (the late responders). For statistical analysis, we used the Statistical Package for the Social Sciences (SPSSX) computer program. We computed frequencies and cross-tabulations, comparing age, class, living status, and sex. We used Student’s t test to identify any significant differences between the prompt and late responders. RESULTS
Subjects returned 641 surveys, for a 48% return rate (10% were not deliverable). The Student’s t tests revealed insignificant differences between prompt and late responders, so we merged data from the two groups. Because of the large number of variables analyzed, we report only the significant results (p > .05) that were relevant for planning our healthcare programs. The profie of students who responded matched the profile of University of Arizona students, with three exceptions: Our percentage of female responders was greater than the percentage of women in the student body (67% of respondents v 47% in the total university population); proportionally fewer international students responded than the percentage enrolled (1% v 119’0); more responses were from sophomores, juniors, and seniors, and fewer from first-year and graduate students. The differences between those who responded to the survey and the U of A population may reflect a number of different problems in reaching specific groups, including possible language barriers for international students, lack of time and perceived importance of the survey for graduate students, and lack of commitment and connection for freshmen. Nonetheless, the response rate was adequate for statistical analysis. Psychological Health and Well-being
University of Arizona students appeared to be positive and optimistic overall (85% reported feeling this way on a daily or weekly basis), but approximately one half were frequently challenged by anxiety, tension, and stress. Just over two thirds of both men and women were concerned about the way they looked, and women, in particular, worried more about weight, dieting, and food than did men. Half of the students worried about getting enough exercise, yet 55% reported they were regularly involved in an aerobic activity. Students wor76
ried more frequently about their looks, weight, and exercise than they did about AIDS, sexually transmitted diseases (STDs), illness, overall health, and failing in academic courses. Almost all students reported feeling good about their relationships with family members and friends. Students with intimate partners were satisfied with those relationships, but one third of all respondents and more than half of the freshmen reported not having an intimate relationship at the time. Most (75%) were satisfied with their relationship with university faculty. One in five students and one in three freshmen had failed to connect with an advisor. Sexual Health
Two out of three of the students surveyed indicated they were sexually active, which in the context of the questionnaire and the time (1988) implied having intercourse. The questions concerned whether they discussed contraception with their partners, used contraceptive methods, discussed STDs before having sexual relations, or practiced safe sex (“use a condom or avoid intercourse”). Three fourths of this group reported they always used contraception, and more than half (58%) said they practiced safer sex, as defined above. A higher percentage of women than men reported they had discussed sexual health and practicing safer sex. In our sample, 12% of the students reported they or their partners had experienced an unplanned pregnancy. Neither men nor women indicated they worried frequently about contracting an STD, including AIDS (85% said they never or seldom worried about STDs, 83% reported they never or seldom worried about contracting AIDS). Nine percent of those who were sexually active, however, reported they had contracted a sexually transmitted disease while at the University of Arizona. Many of these students reported they frequently were preoccupied with sexual feelings. This was true of men more often than of women and of younger students more often than among those who were older. Health and Health-related Behaviors Most students (95%) were aware of the importance of good nutrition, but only 65% translated this knowledge into practice. More women than men reported trying to follow a nutritious diet and, in general, upperclassmen were more concerned about nutrition than were freshmen. Half of our students indicated they ate food from fast-food outlets at least once or twice a week, and 13% said they ate fast food daily. Several items inquired about safety-related behaviors. Most students (75%) reported using seat belts on a regular basis while riding in a car (either driving or as a passenger), but very few (5%) said they wore a helmet when they rode a bicycle. About half were careful about unprotected exposure to the sun. One out of five, however, reported extended periods of unprotected midday sun exposure at least once o r twice a week. This finding was JA CH
UNIVERSITY OF ARIZONA SURVEY
important for our healthcare planning because of the high incidence of skin cancer in the Southwest. Substance Use
Very few students reported they smoked cigarettes
Downloaded by [York University Libraries] at 07:39 06 November 2015
(lo%), and even fewer @Yo) used chewing tobacco. Approximately 80% reported they did not use illicit drugs; 18% of the students reported smoking marijuana, and 2% reported using cocaine. Most students (77%) reported currently drinking alcoholic beverages and, of those, one out of four drank enough at one time to be intoxicated at least once a week. Of those who drank, 44% said they drove under the influence. Men tended to drink more, more often, and were more likely than women to drink and drive; this level of drinking is consistent with national survey results.8s9The amount of alcohol consumed and the frequency of subsequent high-risk behaviors indicated that we need more program intervention in this area.
Stressful Events We used open-ended questions to ask about stressful and traumatic events. Half of our students said that they had experienced a significant loss, felt overwhelmed by family stress, confronted significant changes in life circumstances, or had fallen victim to accident, assault, or illness while at the university. These disruptions were primarily handled with the help of friends and family, and less frequently, with professional counseling. Student Health Service Use and Perception of Care Two thirds (65%) of the students had used the university student health service, and those who had used it had a positive reaction to the care they received. About one third had participated in health-enhancement activities such as Alcohol Awareness Week and ongoing support groups. Approximately 10% of the students used the campus mental health services and viewed the assistance they received there positively. Another important finding was that 16% of the students reported they had no health insurance coverage. We have no way of knowing at this time whether these students feel they do not need insurance or that they cannot afford it. We need to know more about this. DISCUSSION These are some of the programs in health promotion and treatment we developed as a direct result of our survey. Many of them seek to reach those U of A students who do not usually turn to more traditional one-on-one counseling or attend formal presentations.
A class on stress-reductiontechniques An “Assess Your Stress” day A “Friends Are Good Medicine” month Altered parent orientations to emphasize the need for families to encourage their college-student children to VOL 41, SEPTEMBER 1992
balance work and play, participate in club and service activities, and develop new on-campus networks Four new programs on weight loss that stressed healthy exercise choices and improved eating habits An “Eating Advocates Team” to identify sorority members who are at risk for eating disorders A “Right Bite” campaign developed in cooperation with the student union food service; it flags low-, medium-, and high-fat selections in the two largest cafeterias, which serve some 17,000 people each day “Stop Smoking” kits for students interested in a behavioral approach to quitting “Frisky Business” presentations that support peerbased activities in various campus settings and emphasize communication, risk reduction, and personal choices rather than abstinence in dealing with alcohol use and STDs Skin cancer screening and a sun-awareness event; 3 of the 135 students we screened were found to have precancerous conditions Surveys similar to that we carried out on our campus are helpful in monitoring local trends, identifying student needs, attitudes, and behaviors, and providing useful feedback for program evaluation and development. Timely reviews of these health issues every 4 or 5 years, coupled with smaller, more direct assessments that target specific areas in the years between, are feasible and cost effective. We believe consistent appraisals are essential for healthcare planning, providing a “snapshot” that is unique to the individual college or university, and establishing a valuable data base for the future. REFERENCES
1. AHA/CDC Health Education Project. Health education in college health services. Chicago, IL: Center for Health Promotion, American Hospital Association; October 1981. 2. Chervin DD, Martinez AM. Survey on the health of Stanford students. Palo Alto,’ CA: Cowell Student Health Center; unpublished report, 1987. 3. Hare1 Y. Priorities in promoting health behaviors of college students: Toward the 1990s. Presented at the 67th Annual Meeting of the American College Health Association, May 1989; Washington, DC. 4. Haberman SE. An instrument for assessing the health practices of college students. Presented at the 67th Annual Meeting of the American College Health Association, May 1989; Washington, DC. 5. Brigman SL, Roberts BA. Opinions, attitudes and needs of ASU students; Fall 1985. Tempe, AZ: Arizona State University; 1985. 6. Kalton G. Introduction to Survey Sampling. Beverly Hills, CA: Sage; 1983. 7. Fowler FJ, Jr. Survey Research Methods. Beverly Hills, CA: Sage; 1984. 8. Robbins C. Alcohol and drug use. J Health Soc Behav. 1989;30117. 9. Johnston LD, O’Malley PM, Bachman JG. Illicit Drug Use, Smoking and Drinking by America’s High School Students, College Students and Young Adults, 1975-1987. Rockville, MD: National Institute for Drug Abuse, US Dept of Health and Human Services; 1988. DHHS publication (ADM) 89-1602. 77
