Running head: STUDENT PERCEPTIONS OF COLLEGIATE HEALTH Student Perceptions of Collegiate Health and Wellness Programming, its Impact on Academic Success, and Motivation to Change Health Behaviors: A Qualitative Study Submitted to the Faculty of the School of Graduate Studies and Research of California University of Pennsylvania in partial fulfillment of the requirements for the degree of Doctor of Health Science (DHSc) in Health Science and Exercise Leadership by Ryan B. Barnhart Dr. Brian Oddi California, Pennsylvania 2019 CALIFORNIA UNIVERSITY of PENNSYLVANIA CALIFORNIA, PA STUDENT PERCEPTIONS OF COLLEGIATE HEALTH DISSERTATION APPROVAL Health Science and Exercise Leadership We hereby approve the Dissertation of Ryan B. Barnhart Candidate for the degree of Doctor of Health Science (DHSc) Date 12/2/2019 ____ 12/2/2019 12/2/2019__ Faculty STUDENT PERCEPTIONS OF COLLEGIATE HEALTH Acknowledgements This is not my dissertation - it is ours. Without the help, love, and support of a great many people, I would have been lost in space and time and floundering in this whole thing. Specifically, I would like to acknowledge and thank the many people who have influenced this journey: Dr. Brian Oddi who has helped to steer this ship from the research phase onward. I hope to be a credit to your legacy in the profession and the field. Drs. Federico, Hatton, McGlumphy, E. West, T. West, Hess, and Meyer – thank you for your knowledge and support over the last three years. Drs. Hatton and Miller, specifically, for agreeing to put up with me through the research design, proposal, and dissertation phases. Dr. Wood for putting this thought into my brain way back in undergrad. My family. I hope to live up to the bar you set. Last but not least, Jess, Lexie, Tony, Rita, Bailey, and Louie…without you I’d be lost. STUDENT PERCEPTIONS OF COLLEGIATE HEALTH I. Table of Contents List of Figures………………………………………………………………………….i II. List of Tables………………………………………………………………………….ii III. Abstract……………………………………………………………………………….iii IV. Chapter I: Introduction……………………………………………………………......1 a. b. c. d. e. f. g. Problem Statement……………………………………..........................................5 Purpose of Study………………………………………………………………….7 Instruments………………………………………………………………………..8 Research Questions………………………………………………………………11 Study Significance……………………………………….....................................13 Assumptions, Limitations, and Delimitations……………………………………14 Conclusion……………………………………………………………………….15 V. Chapter II: Review of the Literature…………………………………………………17 VI. Chapter III: Methodology…………………................................................................53 a. b. c. d. e. VII. Chapter IV: Research Findings……………………………………………………...63 a. b. c. d. VIII. Research Design………………………………………………………………….54 Setting……………………………………………………………………………55 Participants………………………………………………………………………55 Data Collection…………………………………………………………………..58 Data Analysis…………………………………………………………………….59 Integrity of the Data……………………………………………………………..63 Results…………………………………………………………………………...64 Evaluation of Findings…………………………………………………………..94 Summary…………………………………………………………………………95 Chapter V: Conclusion, Discussion, and Suggestions for Future Research…………96 a. Implications………………………………………………………………………96 b. Recommendations for Practice and Future Research……..…..…………………98 c. Conclusion……………………………………………………………………….99 IX. Appendices: Additional Methodology…………………...........................................101 STUDENT PERCEPTIONS OF COLLEGIATE HEALTH a. b. c. d. e. f. g. A: Electronic Recruitment Messaging.……………............................................102 B: Informed Consent ……..………………………………………….....………104 C: Demographic Data Sheet…………………………………………………….110 D: Initial Interview Protocol…...……………………………………………….113 E: Follow up Interview Protocol………….…………………………………….116 F: Completed IRB Forms………...……………………………………………..119 G: CITI Training Form…………………………………………………………135 X. References………………………………………………………………………….136 XI. Curriculum Vitae…………………………………………………………………..153 XII. Supporting Materials………………………………………………………………157 i COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR List of Figures Figure 2.1…………………………………………………………………………………….20 Figure 4.1…………………………………………………………………………………….67 Figure 4.2…………………………………………………………………………………….68 Figure 4.3…………………………………………………………………………………….70 Figure 4.4…………………………………………………………………………………….71 Figure 4.5…………………………………………………………………………………….73 Figure 4.6…………………………………………………………………………………….74 Figure 4.7…………………………………………………………………………………….75 Figure 4.8…………………………………………………………………………………….79 Figure 4.9…………………………………………………………………………………….82 Figure 4.10…………………………………………………………………………………...84 Figure 4.11…………………………………………………………………………………...86 Figure 4.12………………………………………………………………..………………….87 Figure 4.13…………………………………………………………………………………...88 Figure 4.14…………………………………………………………………..……………….93 ii COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR List of Tables Table 1.1…………………………………………………………………………………………9 iii COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Abstract Health and wellness have been shown to have direct and indirect impact on academic performance in college students. Perception of health behaviors, as well as access to resources and facilities for student health and wellness are impactful in college student recruitment and retention processes as well. College students are mindful of their health and total wellness, and face both motivation and challenges to health behavior change. The main purpose of this study was to examine the perceptions of college students regarding their self-identified health behaviors and how those behaviors impacted or influenced their academic performance, as well as their motivations to change health behaviors. Participants in this study were 8 college students (4 males, 4 females) ranging in ages from 19 to 23. Two semi-structured interviews, along with a demographic information tool were conducted over a 16-week academic semester. Discovery from qualitative analysis of interview transcripts and field notes revealed a number of themes regarding health behavior perceptions, academic performance, and behavior change. These qualitative findings indicate that college students are somewhat aware of how certain health behaviors impact academic performance. The qualitative findings also posit student stress plays a large factor in how health behaviors are engaged in by college students. In conclusion, college students’ perception about their health and wellness, how those perceptions and the resultant influence on health behaviors affects their academic performance, and the motivators and challenges to changing their health behavior are similar across gender, age, and other demographic factors. Keywords: college students, health behaviors, wellness, perceptions, behavior change 1 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR CHAPTER I INTRODUCTION Colleges and universities continue to spend significant financial and additional time and human resources to address student retention and academic performance (Hillman, Tandberg, & Fryar, 2015). Additionally, post-secondary institutions continue to compete for enrollment and have, based on changing student preferences, invested substantial financial resources into campus recreation facilities and health programming to attract new students (Roemmich, Balantekin, & Beeler, 2014). Further, the U.S. Department of Education made college student health a top priority in terms of promoting academic success, retention, and has supported this with millions in grant funding (U.S. Department of Education, 2008). Evidence of the role recreational sports facilities play in academic success and retention has been extensively reviewed and has been determined to have a positive effect on student success in that students who utilized their memberships had significantly higher GPAs and student-members of campus recreation facilities had a higher two-year retention rate than non-users by nearly four percent (Danbert, Pivarnik, McNeil, & Washington, 2014). As data on student health behaviors has become essential for institutions to take action, the American College Health Association (ACHA), which was established in 1920, created the National College Health Assessment (NCHA), the first comprehensive population-level health status assessment tool for college students. The NCHA data, since its inception in 2000, became the first comprehensive study of 792 unique institutions with 1.4 million participants to collect data on a variety of health behaviors and their measurement on academic impacts, including 2 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR health behaviors ranging from disease, violence, alcohol and other substance use, sexual behavior, nutrition, exercise, mental health, and sleep, among others. The benefit of positive health behaviors and quality of life in general populations has been an extensive and an essential field of study within the health sciences. Millions of dollars in both private and government-funded research have been spent for over a century on both qualitative and quantitative experimental, longitudinal, and systematic research (Center for Disease Control and Prevention, 2017). Identification of how positive health behaviors in areas such as physical activity, nutrition, substance use and abuse, and stress management, affects chronic disease prevention has been studied at length and clearly defined (Center for Disease Control, 2015). Beyond this identification, further resources have been spent on developing recommended guidelines that promote positive health behavior change which have been found to be relational to decreased chronic disease incidence, increased cognitive performance, and other health and quality of life benefits (Bravo, Tasigchana, Orea, Gomez, Garcia, Artalejo, & Castillon, 2017; Department of Health and Human Services, 2008; Rezende, Lopes, Lopez, Matsudo, & Luiz, 2014). Of special interest within the field for the last half-century has been health behavior intervention within the academic setting. As adolescent and young adult obesity rates have increased, and physical activity programming and promotion in classrooms from primary to postsecondary settings has decreased (Schwarz and Peterson, 2010), identifying the benefits of healthy behavior toward educational outcomes has naturally progressed in importance to health science researchers as an important arm of the field. For over 50 years a growing body of literature on the influence of health behavior on academic performance has emerged. Primary focus in the research field dates back to 1967, the starting point at which research in the relationship between physical activity and academic 3 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR performance was first developed (Castelli et al., 2014). However, as the field has progressed, exploration into the effects of other health behaviors, such as nutrition and drug and alcohol use and their interaction with college student academic performance has emerged. Research on physical activity interventions show support for a positive relationship between physical activity levels and improved college student academic performance (Brock, Wallace Carr, & Todd, 2015; Calestine, Bopp, Bopp, & Papalia, 2017; Pronk & Kottke, 2009). Research on nutrition behavior and academic performance indicates that better eating habits correlate with academic achievement, specifically positive associations among proper diet including regular meal consumption, meeting national recommendation for health foods, and regular breakfast consumption with increased academic performance (Burrows, Whatnall, Patterson, & Hutchesson, 2017). Additionally, certain health behaviors have been found to have a negative effect on college student academic performance. The National Center on Addiction and Substance Abuse (2015) and the U.S. Department of Education (2008) report that government spending on substance abuse education in grant funding to colleges and universities totals over $7 million since 1999. This figure does not include the individual institutions’ discretionary budget spending on substance use and abuse awareness. With drug and alcohol use common across college campuses, studies on the effect of substance use on academic performance is essential in the creation of educational programming on the dangers of substance use and abuse. Longitudinal studies have shown statistical significance for drug and alcohol use and abuse and decreased academic performance (Arria, Caldeira, Bugbee, Vincent, & O’Grady, 2015; Blavos, Glassman, Sheu, Thompson, DeNardo, & Diehr, 2017; Piazza-Gardner, Barry, & Merrianos, 2016). While this vast body of research across many areas of health behavior exists, a gap in the 4 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR research exists connecting student perceptions of health behavior and how it can be applicable to individual students’ academic performance. Understanding the perceptions of college students in regard to how their health behaviors affect their individual academic performance is essential for researchers as well as college and university administrators to better understand the perceptions of how real health behavior, and health behavior educational programming, impact academic performance. This is essential to the mission of most colleges and universities, which is to support students toward academic success by providing quality programming and resources. This aspect of support toward students is a self-identified mission of the host institution for this proposed research, and the proposed research may help benefit the types of programming and other resources that will become available to students at the host institution. A significant aspect of those resources include positive health education and programming resources which is essential for the growth and development of young adults. Additionally, understanding these perceptions can help colleges and universities to design and implement effective health behavior programming. Existing qualitative studies show that many college student health behaviors can be grounded in the tenets Social Cognitive Theory including physical activity (PA) (Gowin, Cheney, Gwin, & Wann, 2015), healthy eating and nutrition (Osborn, Naquin, Gillan, & Bowers, 2016), and drug and alcohol use and perceptions (Marley, Bekker, & Bewick, 2016). Examining these perceptions in the framework of Social Cognitive Theory (SCT) as described by Bandura (1986), which posits that an individual’s knowledge acquisition is directly related to observing others within the context of social interactions and experiences, will allow a better understanding of how college student health behaviors are formed and may be relevant to effective health behavior change. The use of SCT and exploration of physical activity is well documented. 5 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Research in college-aged students indicate that SCT can aid in understanding their motivations of collegiate students and PA behaviors, and have identified certain social cognitive factors, such as self-efficacy, social support, positive experience, and other factors as being essential for influencing health behaviors in college students (Nehl et al., 2012; Petosa, Suminski, & Hortz, 2003). Additionally, a number of studies (Choi, Chang, & Choi, 2015; Magoc, Tomaka, Shamaley, Angelee, & Bridges, 2016) have identified gender differences, specifically in the differences in factors that motivate males and females, including physical activity (PA) levels, greater self-efficacy in males, and greater perceived ability to set goals and make plans for PA in males (Magoc, Tomaka, Shamaley, Angelee, & Bridges, 2016) within this SCT construct for motivation in health behavior change. The application of these observed differences may also help to influence college and university development of health behavior programming to better influence positive health behavior change and effective use of university resources toward that end. Problem Statement Colleges and universities in the United States allocate significant financial, time, and human resources to address student retention and academic performance in the hopes of keeping students at their institutions, and ensuring those students succeed (Hillman, Tandberg, & Fryar, 2015). Nate Johnson of the Lumina Foundation (2017) estimates that public four-year colleges spend an average of $14,000 USD per year, per student, to provide undergraduate education (Johnson, 2017). Post-secondary institutions continue to compete for enrollment and have, based on changing student preferences, invested substantial financial resources into campus recreation facilities and health programming to attract new students (Roemmich, Balantekin, & Beeler, 2014). Further, the U.S. Department of Education has made college student health a top priority 6 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR in terms of promoting academic success, retention, and has supported this with millions in grant funding (U.S. Department of Education, 2008). As evidenced by both the NCHA data on student health behaviors, and experimental research findings from the likes of MacDonald et al., Henry et al., and others, there is evidence that positive health behaviors affect academic performance. However, there is a need to understand how students perceive their health behaviors to affect their academic performance, how effective health education programming at colleges and universities is perceived by students, and what factors both influence changes in health behaviors or prevent barriers to adoption of positive health behaviors in college students. The existing literature provides a number of theoretical and observational perceptions about the individualized health behaviors of college students. Through this proposed qualitative research, the author seeks to: further identify how health behaviors and health education programming are perceived across campuses from the student perspective; determine what factors influence and impact student health behaviors; and lastly, examining student health perceptions in the framework of Social Cognitive Theory (SCT) as described by Bandura (1986) better understand how college student health behaviors are formed and may be relevant to effective health behavior change. The primary problem examined within this study is to determine if the investment of time, money, and human resources in college student health programming toward academic success and health behavior change is working. Examining of this problem is essential due to the amount of resources invested in college student recruitment, retention, and success programming as well as the investment on health programming for student outcomes, and to determine if can be effective in student health behavior change. Additional problems to be addressed in this study include: investigating a lack of individual understanding of the behavioral factors that shape or 7 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR change these individual health behaviors of college students; the perceptions of college students regarding the making of their individual health behaviors; and the student perceptions of efficacy of institutional health and wellness programming. By examining these student perceptions, understanding of the importance of effective health and wellness programming applied to college students’ specific wellness needs may help institutions in enrollment management, retention, recruitment, and other important areas of operation. Purpose of Study The main purpose of this dissertation research is to explore the perceptions of college students in regard to their self-identified health behaviors and how those behaviors impacted or influenced their academic performance, as well as their motivations to change health behaviors. Additionally, this research will explore student perceptions on the efficacy of a university’s health education programming, and the student perceptions of factors that shape the behaviors of, or create barriers to, student health decisions and wellness. Lastly, examining the role that SCT plays in the health behavior patterns of college students including social determinants present will be examined. While this study is multipurpose, the existing literature indicates the significance and importance of the connection between health and wellness of college students and academic performance. Additionally, there is literature indicating a similar relationship between college student wellness and other enrollment management functions, primarily in student mental health (Slavin, Schindler, & Chibnall, 2014). As the field of applied exercise science grows there is a need for qualitative research examining phenomena in the field that quantitative research provides an incomplete picture of. This study was designed to be one such qualitative design 8 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR examining the phenomenon of the unique interplay of college student wellness and health, academic performance, and health education. The proposed study will use a qualitative inductive grounded theory approach. Typically, grounded theory research designs provide a way to “ground” a research theory within rationale observation and allows for the discovery of emerging patterns in data with the generation of theories from that data. Grounded theory is often used in examining behaviors, and the perception of subjects and their actions. Grounded theory design is particularly well suited for behavioral research in that it provides ecological validity with representation of real-world observation (Strauss & Corbin, 1998). Behaviors such as physical activity levels, eating habits, drug and alcohol use behaviors, and stress management techniques will be explored using an interview process. Instruments This grounded theory qualitative design employed various instruments in order to collect the required data for analysis. Due to the nature of qualitative research, qualitative researchers tend to use a more broadly implied research or interview protocol as a data collection method (Yin, 2016). In addition to this proposed research protocol that will use an open-ended, semistructured interview process, additional demographic information on subjects is needed for qualitative review to better assist with future data analysis. As such, the proposed research will include both a Demographic Data Sheet and a semi-structured interview protocol. Establishing these instruments will be key in the future data collection process, and essential to data analysis for a more thorough analysis of potential differences in the data based on demographic factors. 9 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Demographic Data Sheet The Demographic Data Sheet (Appendix C3) will collect the following information from subjects: age in years; undergraduate class standing (i.e. sophomore, junior, etc.); ethnicity; living situation to include place of living and information on if living alone or with roommates/family; if the subject has previously taken a college-level health and/or wellness course; and gender. To establish trustworthiness in the demographic data, member checking with participants during the interview process will be used. Member checks offer an opportunity for the participants to correct errors or wrong interpretations, and this will be critical in establishment of the trustworthiness, legitimacy, and consistency of the demographic data (Angen, 2000). The demographic data will be interpreted and analyzed through frequency and means and averages. This demographic data will specifically be utilized in the presentation of data as well as identifying gender-based differences during the coding process. Demographic data of the study participants is presented in Table 1.1 below, and depicts a wide variety of attributes amongst participant demographics. Table 1.1 Frequencies and Percentages of Demographic Characteristics Variable n % Male Female 4 4 50.0 50.0 18-19 20-21 22-23 Class Standing 1 5 2 12.5 62.5 25.0 Gender Age 10 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR So. Jr. Sr. Ethnicity White Black or African American Living Situation At home with family (commute) Off campus w/roommate On campus alone Clubs/Orgs 0-2 3-5 Greek Life Y N Previous Health/Wellness Course Y N Attended University-sponsored Health Programming Y N 3 2 3 37.5 25.0 37.5 6 2 75.0 25.0 3 4 1 37.5 50.0 12.5 2 6 25.0 75.0 4 4 50.0 50.0 8 0 100.0 0.0 8 0 100.0 0.0 Table 1.1 Research Subject Participant Demographic Information Interview protocols Both the initial interview protocol (Appendix C4) and secondary interview protocol (Appendix C5) used to collect the qualitative data will focus on the open-ended, semi-structured interview questions that will include, in this order: asking subjects to describe themselves as college students including major, interests, and activities; questions regarding physical activity behaviors; questions regarding their eating behaviors; questions regarding their drug and alcohol use behaviors; questions regarding their mental health and stress management approaches; questions regarding their use or attendance of university health programming or other university health services; questions regarding their perception of improving university health programming and education; questions regarding their perceptions of how their health behaviors affect their academic performance; questions regarding how they perceive their health behaviors to have 11 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR been formed; and questions regarding their peers’ health behaviors. To determine trustworthiness of the qualitative data for this interview protocol, the author utilized several techniques including member checking, triangulation, and attempted data saturation to ascertain a level of veracity within the data. Credibility and reliability in the data will be determined through triangulation and member-checking. Lincoln and Guba (1985) identify both triangulation and member-checking as an accepted measure of establishing the worthiness of the data in qualitative studies (Lincoln & Guba, 1985). Triangulation may be the most important measure of internal validity for this study. Ideally, triangulation of sources will be the type of triangulation best suited for this study, specifically in examining the consistency of data gained at different points in time as in comparison of the student participants who will have differing viewpoints (Patton, 2001). In this study, triangulation of data sources will be achieved through the two interview protocols and field notes, as well as the verbatim transcription of the interview recordings. Transferability of the interview protocol will be evidenced through data saturation (Yin, 2016). The interview protocol will be audio recorded, and administered in a one-to-one setting in a comfortable, classroom environment. The initial semi-structured interview will be conducted within two weeks of the informational/consent meeting and will be conducted in a one-to-one format following the initial interview protocol described in Appendix C4. The semi-structured interview protocol will be conducted in a well-lit, warm, and inviting conference room on the university campus. The interview protocol will be audio-recorded for accuracy and will be later transcribed for data analysis. Once the initial interview has been conducted, the secondary or follow-up interview will be scheduled for approximately 8-10 weeks in the future. The purpose for the 8-10 week 12 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR interval is to assess any changes in perceptions of health behaviors and university health behavior programming. This secondary interview will utilize a similar interview protocol (Appendix C5) as the initial interview with additional questions regarding perceptions of behavior change. The secondary, follow-up interview will be conducted in the same manner as the initial interview and audio-recorded for future transcription. Research Questions Four main research questions emerged through this research and include the following: RQ:1 What internal or external factors shape college student health behavior perceptions and attitudes? This basic tenet of the dissertation study formulated additional research questions to better support the grounded theory investigation, including the following. RQ:2 How do students perceive their health behaviors to impact academic performance? RQ:3 How do students perceive university health programming resources and their efficacy? RQ:4 What are the obstacles, barriers, and motivators that influence student perceptions of health behaviors? The four primary research questions above guided the qualitative investigation and formulation of the interview protocols, demographic data collection tool, and helped to frame the analysis of the data once it was collected and transcribed. Specifically, these research questions helped to determine and reinforced the type of research to be completed. As such, a qualitative, grounded theory approach was chosen to better understand how student health behaviors and 13 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR attitudes are formed and why. These questions also helped to inform the creation of the two-part interview protocol to better understand how certain areas of student health and wellness are impacted. The questions asked guided the investigator through the research framework design, and were central to the formulation of the interview protocol. Through the protocol design, the researcher was able to gain valuable qualitative insight toward specific dimensions of wellness, identify factors that shaped, influenced, and prevented health behaviors and attitudes among college students, and utilize the data procured to better understand and answer the supplemental research questions. The grounded theory design proved to be exact in providing quality data to help frame the response to the research questions that is accurate, valid, and saturated. Study Significance The significance of this dissertation research is important for several reasons. As the field and body of research in evidence-based, applied exercise science grows, non-traditional, qualitative studies in exercise science are needed (Baldwin & Haddad, 2010). This dissertation study serves to help grow qualitative study design utilization across the applied exercise science field. This study also is significant in contributing applied qualitative research for institutions of higher education to better understand student health behaviors and how university health programming and related resources can contribute to possible enrollment management goals including retention, academic performance, and in some instances, recruitment (Hillman, Tandberg, & Fryar, 2015). This study, and others like it, also support U.S. Department of Education goals of student health promotion in terms of promoting academic success and retention (U.S. Department of Education, 2008), which may contribute to future additional grant 14 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR funding and further experimental research in examining health behaviors and attitudes of students, interactions with academic performance, and other factors. This study is also significant in that it builds off of the long-running, comprehensive National Collegiate Health Assessment (NCHA) (ACHA, 2017), and further examines some of the qualitative outcomes of motivations, attitudes, and behaviors behind several areas that are examined quantitatively by the NCHA. Further development of studies such as this dissertation can help to better understand and analyze quantitative tools like the NCHA for application in programming, resource allocation, and other areas for college administrators and allied health professionals. All of these factors contribute to the significance of this dissertation study in better understanding how college students value and approach their health and wellness, how it interacts with academic performance, and how administrators and those working to provide health and wellness education and information to college students can better align their goals and objectives with college students’ wellness needs. Assumptions, Limitations, and Delimitations Within any research-based study, such as this grounded theory design, there are certain assumptions, limitations, and delimitations. These aspects of research are necessary throughout the study design and proposal process. In this particular study, the researcher assumed that the subjects would answer each question through the interview protocols honestly and factually. Additional assumptions of this study included: participants would approach the interview protocols from the mindset of an average, traditional-aged college student, and that students would be willing to engage in discussion about personal behaviors and attitudes. Through the proposal and the actual research conducting, steps were taken, including individual interviews in a private yet inviting setting to encourage confidentiality of answers, allowing participants to 15 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR provide honest and factual representation in their responses. Additionally, the inclusion criteria for the study helped to select students that would be representative of the targeted mindset. Certain limitations also exist within every research study. Typically they are restrictions that exist beyond the researcher’s scope of control, which have the ability to effect the outcome of the study, and qualitative research in applied health sciences is no different (Puhan, Akl, Bryant, Xie, Apolone, & ter Riet, 2012). Present in this study, there are specific limitations to cogency and trustworthiness as in any qualitative study. However, the researcher has taken precautions to ensure validity and reliability through various measures, including attempted data saturation through the sample size of the study, as well as certain steps in data analysis including triangulation of field notes, interview transcriptions, and audio recordings, across two separate interview protocols. Another potential limitation is the limited access to sample size. The researcher attempted to negate this limitation by using a sample size that accurately reflects the total institutional undergraduate student profile in terms of demographics. Lastly, certain delimitations also exist inherent to the study. Specifically for this study, the delimitations focus around the specific health and wellness aspects covered in the interview protocol and identified in the research problem and purpose statements of the study. These delimitations center on the dimensions of wellness not covered by the study. The researcher believed that examining other wellness dimensions outside of physical activity, nutrition, drugs and alcohol, and stress, would be too problematic to ascertain from the sample population as other concepts of the additional dimensions of wellness may be too abstract for the population to understand or apply to their individual behaviors. It was also not feasible to examine all dimensions of wellness in the study due to time constraints and applicability to the main tenants of routine health behaviors and their interactions with academic performance. Even with these 16 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR noted delimitations, the study was designed to fit the research problem and research purpose, while still allowing for future research to examine these delimitations in future study iterations. Conclusion As evidenced through this introduction to the study, the advancement of evidence-based studies examining college student health attitudes and behaviors is key to a number of constituents including students themselves, university administrators, and government health officials, among others. This study proposed to examine the relationship of and the adoption of health behaviors, as well as their relationship to and influence on academic performance, while approaching the research in a grounded theory design. The study has used a methodical, two-part interview protocol to gain valuable qualitative insight to that end. The study is significant to the further examination of qualitative reasoning in understanding college student health behaviors, attitudes towards health, and understanding how academic performance may be affected by health behaviors and attitudes. It also seeks to add qualitative findings to the existing body of quantitative research on the matter, such as the NCHA. The study acknowledges certain assumptions, limitations, and delimitations as would be found in similar studies, and the researcher has taken a number of steps in the study design, participant sample, and other areas to eliminate bias and skewed data. Furthermore, the body of existing research around the topic, as discussed in the Review of the Literature, warrants the need for studies such as this to continue to help evidence-based practitioners in applied exercise science, as well as in various aspects of higher education administration, understand and apply concepts, theories, and resources towards better assisting 17 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR college students in understanding their health behaviors and attitudes, and meeting the health needs of those same students. The implications for implementation as well as further research from this study are important to the continuous growth of the area of applied exercise science research, particularly qualitative studies in applied exercise science. It is the hope of the author this study will serve as a basis for continued examination of student health behaviors and attitudes towards making college campuses across the globe more cognizant and attuned to the health needs of college students. 18 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR CHAPTER II REVIEW OF THE LITERATURE The growing field of qualitative and quantitative research over the latter half of the twentieth century and into the new millennium has provided the basis for this literature review concerning health behaviors and their relationship with college student academic performance. The particular segment of the field of health behavior interventions and college student academic achievement has particularly grown in the last two decades and has become significantly important. Colleges and universities continue to spend significant financial and additional resources to address student retention and academic performance (Hillman, Tandberg, & Fryar, 2015). Additionally, post-secondary institutions continue to compete for enrollment and have, based on changing student preferences, invested substantial financial resources into campus recreation facilities and health programming to attract new students (Roemmich, Balantekin, & Beeler, 2014). Further, the U.S. Department of Education has made college student health a top priority in terms of promoting academic success, retention, and has supported this with millions in grant funding (U.S. Department of Education, 2008). Evidence of the role that recreational sports facilities play in academic success and retention has been extensively reviewed by Danbert, Pivarnik, McNeil, & Washington (2014). This particular study focused on recreational facility usage in a large Midwestern university in the U.S. and found that in students who utilized their memberships had significantly higher GPAs and student-members of campus recreation facilities had a higher two-year retention rate than non-users by nearly four percent (Danbert et al., 2014). This type of evidence is crucial for further qualitative and quantitative research in the 19 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR field to be completed to better understand the relationships between health behaviors and college student academic performance. Colleges and universities are in need of significant, evidence-based research to continue to justify spending on physical activity and health programming, as well as to determine the potential return on investment for such expenditures. This evidence-based research will help to better identify potential benefits of and relationship between health behaviors and college student academic performance. Research exists to help support these endeavors, however, there is a continued need of both high level of evidence qualitative and quantitative research to further the knowledge base of the field and to better determine the extent, and relationships of, the effects of health behaviors on college student academic achievement. This review of the existing literature will help to identify several areas of content. The review will explore empirical research on health behaviors and academic performance, including foundational research, college student health behaviors, and health behavior interventions on academic performance. The interventions reviewed include areas of physical activity, nutrition, the effect of drugs and alcohol, and stress management. Search Process The search process included use of the electronic Health Science Database collection through Cal U’s Manderino Library. The specific databases searched included SPORTDiscus, MEDLINE Complete, CINAHL Complete, and Health Source, as well as PubMed outside of the Database collection. Search terms utilized included: “Physical Activity” and “Academic Achievement” and “College Students”, “Physical Activity” and “Academic Performance” and “College Students”, “Health Behaviors” and “Academic Performance” and “College Students”, “Nutrition” and “Academic Performance” and “College Students”, “Alcohol” and “Academic 20 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Performance” and “College Students”, “Marijuana” and “Academic Performance” and “College Students”, and “Stress” and “Academic Performance” and “College Students”. The search timeline was within the last decade, January 2007 to February 2018. Peer-reviewed articles only were included in the search process and selected for review. The usage of research that scores highly in regard to level of evidence is key. Utilizing the Oxford Centre for Evidence-Based Medicine Levels of Evidence (2011), the vast majority of included studies in the literature review are either experimental cohort studies, systematic reviews and meta-analyses of randomized controlled trials, or other examples of Level I, II, and III evidence. Additionally, the Health Science Database was used to find landmark empirical research prior to the selected search criteria based off of review of included systematic reviews. This landmark criteria dated back to 1967 and parameters around search terms including “Academic Performance” and “Physical Activity”, “Academic Performance” and “Nutrition”, “Academic Performance” and “Drugs and Alcohol”, and “Academic Performance” and “Stress” were utilized, as these particular areas contain the foundation for research in the field. Empirical Research in Health Behaviors and Academic Performance Throughout the literature, the vast majority of research focusing on health behavior interventions and academic performance comprises of experimental and quasi-experimental, quantitative data. However, the most comprehensive examination of health behavior data and college students exists as a mixed-methods model, the National Collegiate Health Assessment (NCHA) (ACHA, 2017). The NCHA is a highly utilized tool in this particular aspect of the field, as it provides a framework for further experimental qualitative as well as quantitative exploration of health behaviors and their potential relationship with academic performance in college students. The 21 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR wealth and breadth of empirical research within the research has allowed for higher level of evidence, systematic reviews of the literature to help better reflect the intervention efficacy across many of the numerous health behavior variables that are studied throughout the field of research. This translates to a wealth of highly scientific, minimally biased body of work that supports further growth and exploration of replication of these studies for continued application. Figure 2.1 below highlights the academic impacts of health behaviors from the 2018 NCHA data. Figure 2.1. NCHA Academic Impacts. This figure illustrates the findings of academic impacts of health in college students (ACHA, 2018). Foundational Research The research on the benefits of positive health behaviors has been an extensive and essential field of study within the health sciences. Millions of dollars in both private and government-funded research have been spent for over a century on both qualitative and quantitative experimental, longitudinal, and systematic research (Center for Disease Control and 22 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Prevention, 2017). Identification of how positive health behaviors in areas such as physical activity, nutrition, substance use and abuse, and stress management, affects chronic disease prevention has been studied at length and clearly defined (Center for Disease Control, 2015). Beyond this identification, further resources have been spent on developing recommended guidelines that promote positive health behavior change which have been found to be relational to decreased chronic disease incidence, increased cognitive performance, and other health and quality of life benefits (Department of Health and Human Services, 2008). Due to these empirical findings and their implementation across the lifespan, a natural curiosity to study the effects of health behaviors and interventions among other populations has grown. Of special interest within the field for the last half-century has been health behavior intervention within the academic setting. As adolescent and young adult obesity rates have increased, and physical activity programming and promotion in classrooms from primary to postsecondary settings has decreased (Schwarz and Peterson, 2010), identifying the benefits of healthy behavior toward educational outcomes has naturally progressed in importance to health science researchers as an important arm of the field. For over 50 years a growing body of literature on the influence of health behavior on academic performance has emerged. Primary focus in the research field dates back to 1967, the starting point at which research in the relationship between physical activity and academic performance was first developed (Castelli et al., 2014). The primary focus of empirical research upon academic performance in much of the earlier development of the research field was directed toward the earlier stages of development in adolescent, primary, and secondary school subjects, with some limited experimental research focusing on college student subjects. Ismail’s (1967) landmark study, identified positive correlation between physical education programming 23 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR and intellectual performance, began an evolution in the field over the next 30 years leading to a divergence in the research body to study these health interventions and student outcomes, with a landmark systematic review by Keays and Allison in 1995, particularly academic performance outcomes. The Keays and Allison review (1995) also is one of the first studies to include measurement of additional health behavior interactions with physical activity. This systematic review laid the groundwork for study and “measurement of intensity, duration, and frequency of physical activity for academic performance benefit” (Keays & Allison, 1995, p. 65), which helped to further develop later studies on physical activity intervention and academic performance. Much of the later development of this field of research builds on many of the studies included in the Keays and Allison review. Independently, study of health behavior interventions on cognition and work performance in adults further developed into the 2000s with Pronk and Kottke (2009), among others. These studies showed that physical activity promotion in the worksite improved the health of workers, and, in an additional benefit, improved cognitive function and performance. It must be noted, however, that while a movement of research in exploring intervention effectiveness on college student academic performance outcomes has emerged and grown exponentially, the concentration on college student academic performance interventions finds its beginnings in the concentrated study and experimental research from study of primary and secondary students using academic performance measures at those levels. Overall, these studies suggest a positive relationship with health behavior interventions and improved academic performance. As is evident in the development of the field of research focusing on college student outcomes, a majority of the experimental design has focused on physical activity intervention. Davis et al. (2011), Mead, Scibora, Gardner, and Dunn (2016), and Donnelly et al. 24 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR (2017), among others, utilized high level, randomized controlled trials concentrating on physical activity interventions in primary and secondary classrooms. These studies indicate a statistically significant, positive correlation to improved academic performance due to implementation of moderate to vigorous physical activity interventions. The success of this type of intervention experimentation further supported the need to explore and potentially replicate outcomes on college student subjects. Simultaneous to the development of the research field focusing on physical activity and academic performance, exploration of health behavior intervention in other areas, including nutrition, weight behaviors, and their effect on college students, particularly in academic achievement outcomes, also developed (Plotnikoff et al., 2015). Only nine years after Ismail’s study, Musgrave and Thornbury (1976) began exploring nutrition behaviors and their effect on college students, with one of the outcomes assessed being academic achievement. As the field progressed, a lack of a standardized health assessment database on college students was realized. In order to help fulfill this gap, the American College Health Association (ACHA), which was established in 1920, undertook in the year 2000 to create the National College Health Assessment (NCHA), the first comprehensive population-level health status assessment tool for college students. The NCHA data, since its inception in 2000, became the first comprehensive study of 792 unique institutions with 1.4 million participants to collect data on a variety of health behaviors and their measurement on academic impacts, including health behaviors ranging from disease, violence, alcohol and other substance use, sexual behavior, nutrition, exercise, mental health, and sleep, among others. Data collection through the NCHA provided the research field with new opportunity to further the study of health behavior interventions, in experimental design, and the possible 25 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR relationships those health behavior interventions may have with college student academic performance. The ACHA then continued to collect data regularly through the same survey tool through 2008. Following that, in fall of 2008, the NCHA was rewritten and the NCHA II was launched. In 2011, a revised version of the NCHA II was launched, the NCHA IIb. Again, in fall 2015, the most current version of the NCHA, IIC, was launched and continues to remain in use. Due to the longevity of the NCHA and the comprehensive nature of its contents, data collection, and vast collection of data in health behaviors, it has become the primary basis and a highly cited resource in nearly all future studies of college student health behaviors. Thus, we see a proliferation of experimental research testing health behavior interventions on academic achievement in college students from the mid-2000s to the present time. This increase in experimental research after the initial launch of the NCHA delves into the impact of other health behaviors on college student academic achievement outside of physical activity, including exploration of student health behaviors such as sleep habits and stress management interventions (Strawbridge, Shema, Cohen, & Kaplan, 2001; Trockel, Barnes, & Egget, 2000). Beyond these initial landmark studies, and with the continued growth and expansion of the NCHA, the field diversifies further throughout the mid-2000s through the present in examination of a range of health behaviors on a variety of types of college student outcomes, from student health risks (Weinstock, 2010), to student nutrition behaviors (Brown, Wengreen, Vitale, & Anderson, 2011) among others. However, even as the field of research continued to diversify, the overwhelming body of research focused primarily on four health behavior interventions: physical activity, nutrition, drugs and alcohol, and stress management. Within these health behavior interventions, the primary focus of the main body of research and the existing literature focuses mainly on one 26 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR college student outcome, academic performance. The foundational research in examination of physical activity intervention, as well as the development of the research on other health behavior interventions and their measurement of college student academic performance, in general, shows a positive relationship between “good” health behaviors and positive academic performance (Castelli et al., 2014). This literature review will examine the primary health behaviors, the experimental research in implementing these health behavior interventions, the efficacy of the research design, and their resultant effect on college student outcomes via examination of their relationship with college student academic performance, and the results thereof. The main purpose of the paper will serve to function as an analysis of the significance of the existing literature to the author’s dissertation topic of choice and lend a groundwork of evidence for further development of study design for the dissertation research as well as for further, original research studying health behaviors and college student academic performance within a small-to-mid size Mid-Atlantic, 4year, public institution. In order to better understand the evolution of particular health behavior interventions on college student academic performance, understanding of the development of experimental research investigating the efficacy of health behavior interventions on college students, particularly in lifestyle change outcomes, is essential. It is from these health behavior intervention studies that examination of health behavior interventions on academic performance derive. Social Cognitive Theory (SCT) As described by Bandura (1986) as an extension of social learning theory, SCT posits an individual’s knowledge acquisition is directly related to the observation of others, including 27 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR peers, within social interaction, social, cognitive, and functional experiences, and through other outside influences, including media. Essentially, the theory explains how an individual observing a performed behavior and consequences of said behavior, the individual processes and remembers the sequence of events and then utilizes this information to guide subsequent and future behaviors. It is also a common tenet in this theory that individuals do not learn new behaviors through trial and error solely, but also upon the replication of the actions of others. This is important in the discussion of health behaviors of college students since peer influence is common throughout other behaviors of college students, such as study habits (Dweck, Walton, & Cohen, 2014). Health Behaviors and College Students The derivation of the study of health behavior interventions on academic performance shares much in terms of experimental design and other research outcomes with the general study of health behavior change in college students. This part of the field is vital for exploratory research focusing primarily or exclusively on academic performance as many of these studies are interrelated. Additionally, much of the health behavior research also measured academic performance in some manner, or found academic performance measurements to be associated to other primary outcomes studied. Evidence of this interrelation can be found in a number of experimentally designed studies as well as systematic reviews that have been conducted within the last decade. Within this particular period, the scope of research in this field as well as refinement of experimentation has grown significantly. 28 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Additionally, in these foundational studies on health behaviors additional, pertinent statistical data is evidenced, particularly data that reinforces demographic characteristics that are typically prevalent in the majority of other studies, including percentages of respondents based by gender, race, and age. In the vast majority of these studies, the data collected on sample populations reflects national statistics on demographic characteristics of college students. The National Center for Education Statistics (NCES) produces the industry-recognized standard data report, the Integrated Postsecondary Education Data System, commonly referred to as IPEDS. IPEDS demographic data shows that, on a national level, female students make up approximately 5 percent of the entire college student population (NCES, 2017). Furthermore, IPEDS data indicates that 58 percent of the entire college student population is white. Lastly, the most recent IPEDS data reflects the average college student age to be 20.9 years old (NCES, 2017). These data points can be seen reflected in the majority of studies on health behavior interventions as in Colby et al. (2017), Harrington and Ickes (2016), Larson, Orr, and Warne (2016), as well as across the majority of studies included in the systematic review by Plotnikoff et al (2015). The similarity of these demographic points across the vast majority of the research are important as it indicates uniformity across sample population and is indicative that there is a much smaller incidence of sample bias across the research field. The body of research studying health behavior change in college students is vast, and because of the secondary findings on academic performance metrics in much of the research becomes an essential part of the entire literature review pertinent to the author’s primary dissertation research focus. In the Colby et al. (2017) study, health behaviors measured, including eating, stress and physical activity, were measured by gender, and found that students, 29 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR regardless of gender, that were deemed at-risk in regard to these health behaviors self-reported lower academic success rates. This study involved data analysis in college students across 13 college campuses in the United States. Further studies indicate, however, that poor health behaviors are not isolated to college students with low academic performance. Harrington and Ickes (2016) identified that regardless of qualitative data on body mass index (BMI), college students in all BMI ranges exhibited poor health behaviors. While secondary outcome measurements in that study showed no statistically significant correlation between BMI and academic performance, there was indication that health behavior programming interventions could potentially benefit other areas that affect academic performance, such as in stress management and physical activity participation. Data collection on college student health, as discussed previously by tools such as the NCHA, provided the grounds for further research on health behavior and potential relationship to academic performance on a more focused scale at individual institutions. In the study by Larson, Orr, and Wayne (2016) on an individual, 4-year, postsecondary institution, multiple regression analysis was used to evaluate and determine which health variables were best predictors of grade point average (GPA). Included variables in the study were stressors, health behaviors, substance use, mental health, and physical activity. This research by Larson et al. (2016) found a statistically significant variance in GPA based upon mental health stressors. The relationship between intervention programming designed to alleviate stress and improved GPA was noted in this study. While the NCHA is such a valued tool in the field of college student health behavior, the vast amount of data that it contains allows it to be a tool for additional, expanded research on particular areas of this expansive survey tool. The secondary analysis by Wald, Muenning, O’Connell, and Garber (2014) on NCHA II looked specifically at academic performance 30 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR outcomes. Since the NCHA collects data on so many health behavior data points, often the academic implications may become lost in the vast amount of data findings. The Wald et al. (2014) study concentrated on the potential associations between various health behaviors, including physical activity, strength training, nutritional habits, and sleep in college undergraduate students and academic performance. This was a cross-sectional observational study in 40 U.S. colleges and universities in the fall 2008 term, under the NCHA II survey tool. Identification within the analysis showed that less than half of college students met recommended guidelines for physical activity, less than a third met strength training guidelines, and less than five percent and less than 25 percent met nutritional and sleep guidelines, respectively. This data set was analyzed with the academic performance outcomes of respondents, and showed that those college students who met or exceeded recommended guidelines in these health behavior areas had statistically significant higher academic performance. Beyond the secondary analysis work by Wald et al. (2014), several other studies analyzing or replicating the NCHA on a smaller scale exist. Studies by Upright, Esslinger, and Hays (2014) and Morris-Paxton, Elkonin, and Van Lingen (2017) examined wellness behaviors, wellness programming interventions, and health behaviors at individual institutions to examine an individual university’s statistical analysis as compared to the larger findings of the NCHA. The Upright et al. (2014) study focused on a mid-size public institution in the mid-southern U.S. While the racial demographics were slightly skewed, the majority of the health behavior patterns were similar to the national data collected in the NCHA. A key institutional finding however indicated that stress was the largest health behavior that impacted academic performance, thus leading to discussions on adapting strategies to meet that particular need at the institution. This 31 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR differed slightly from the leading health behavior on poor academic performance nationally. In the Morris-Paxton et al. (2017) study, findings indicated that students who worked to improve wellness behaviors in two or more areas typically had higher academic performance than students who only improved their health in one or no metrics. Critical Reviews of the Literature Further research, including higher level of evidence, critical and systematic reviews, such as that by McFadden (2016) indicate while a need still exists for study supporting health behaviors and the potential relationship with academic performance, this gap is decreasing with a growing body of active research being conducted. Also, McFadden (2016) found that college systems, both within 2-year and 4-year institutions, possess the ideal infrastructure to both gather data regarding health behaviors as well as to implement health behavior programming that foster student health behavior change in effort to improve academic performance. While the study by McFadden (2016) indicated that a need for further experimental research exists particularly as it pertains specifically to college student academic performance outcomes around health behavior interventions, a valid body of research exists that has been systematically reviewed several times for meta-analysis. Critical reviews by the likes of Plotnikoff et al. (2015) and Michael, Merlo, Basch, Wentzel, and Wechsler (2015) provide high level of evidence for inclusion in analyzation of the existing research regarding health and academics. While the Michael et al. (2015) study focused solely on studies exploring potential correlation of student health and academic performance, Plotnikoff et al. (2015) further analyzed studies specific on health behavior interventions and academic performance, including physical activity interventions, nutrition interventions, and other health behaviors. This review also indicated that across the body of research, implications 32 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR for the positive relationship between higher academic performance and positive health behaviors exist. This systematic review and meta-analysis is critical for the development of and in addressing the research problem. In the Michael et al. (2015) study, inclusion criteria measured review articles between 1980 and December 2014 that examined association between health behaviors and academic achievement in college students. 259 unique articles met the inclusion criteria and were evaluated. Findings through the literature review show positive correlation between student health behaviors and academic performance, specifically that physical activity has the most correlational effect to improve academic performance. Across all findings, physical activity is the most studied health behavior in relation to academic performance, and also provides the most consistent results in regard to the impact on academic achievement. While this data point is important, there may be some outcome bias in that physical activity impact on academic outcomes is the most commonly studied intervention in the field. It is also typically the easiest to measure as well as the ease in which experimentation can be designed and implemented. While there is a continuously growing body of research on the measurement of non-physical activity health behavior interventions, physical activity behavior study continues to be the most prominent. In further systematic review, Plotnikoff et al. (2015) also performed a meta-analysis discussing the impact and role of health behavior interventions targeted at students enrolled in post-secondary education institutions. Selection method for inclusion was health-focused intervention studies at post-secondary institutions from 1970-2014, using MEDLINE, PsychINFO, CINAHL, ERIC, and ProQuest databases. All quantitative study designs were eligible for inclusion. 41 total studies met inclusion criteria and were selected for the systematic 33 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR review. Results of the review showed that significant improvement in at least one health outcome was attained in at least 29 out of the 41 studies, with the most improvement in physical activity studies. A major finding of the study showed that interventions spanning a university semester or less generally resulted in greater significance in outcomes assessed as opposed to longer studies. Using both the Michael and Plotnikoff studies as a lens, the evolution of research on health behavior interventions serves as a version in miniature of the national scope of health care issues. Studies on the beginning of the inclusion criteria in the 1970s through the early 1990s often focus on health behavior interventions toward smoking cessation and cancer interventions (Chen, Minton, & Adams, 1989). Studies that appear in the mid-to-late 1990s through the early 2010s focus on dietary, physical activity, and stress behaviors, often in relation to their interaction with obesity (Bravata, Sanders, Huang, Krumholz, Olkin, Gardner, & Bravata, 2003). More recent studies to the present day focus on health behavior interventions around dangerous health behavior such as opioid use (McCabe, Teter, Boyd, Knight, & Wechsler, 2005) . This same evolution occurred on a broad scale in the public health sector. Additionally, this evolution in collection of data is mirrored in the evolution of the NCHA. This evolution is key in understanding the existing research, and formulating the continued experimental intervention research on college student health behavior. This meta-analysis and review is also crucial to addressing the research problem in the dissertation, as it will help to inform the experimental design parameters and possible collection method in the dissertation research. While the study indicated physical activity interventions had the most improvement on academic performance, evidence in the review also showed potential positive relationship between other, non-physical activity health behavior interventions and 34 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR improved academic performance outcomes. These secondary health behavior interventions are a key component of health behavior change for college students and present opportunity for advanced statistical data collection in the dissertation phase to further expand this particular niche in the research field. While the ACHA tool has provided significant data to the field, and avenues for further experimental design and research on various health behaviors, the lack of the ACHA’s own experimental research creates a perceived gap in the regard to efficacy of particular health interventions, including educational programming and controlled-trial interventions. However, the ACHA is the most comprehensive survey tool that provides evidence of college student health behavior statistics that researchers in the field have access to. Even with the lack of experimental design within the ACHA, the wealth of data it collects provides a valuable framework and identifies potential health behavior interventions, as well as predictors for outcomes, that researchers in the field can and should utilize for further experimentation. Health Behavior Interventions and Academic Performance With understanding of the importance of researching health behaviors of college students and findings that indicate relationships to academic performance, specific health behavior interventions and their effect on college student academic performance are the most critical body of research to the dissertation research problem. Specifically, there are four key areas of intervention that make up the field of experimentation: physical activity interventions, nutrition interventions, drugs and alcohol programming interventions and studies, and stress management interventions. These key areas reflect the self-reported areas of health that most affect college students as evidenced by the NCHA (ACHA, 2017). As previously discussed, much of the 35 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR research and the most systematically reviewed part of the field centers on physical activity interventions. However, there is a growing body of high level of evidence research that exists and continues to expand on the other key areas of intervention studies. Physical Activity Interventions on Academic Performance While a vast body of research exists examining physical activity intervention on academic performance in primary and secondary students, focus on college student academic performance and the potential relationship with physical activity is quickly growing at unprecedented levels, with new and expansive research focusing on new trends and shifting lifestyle behaviors, technological advances, and new areas of intervention (Nobrega, Hillman, Dowd, Cirera, & Ribera, 2018; Ferrer & Laughlin, 2017; Lewis, Napolitano, Buman, Williams, & Nigg, 2016). This evolution and growth of the field focusing on physical activity (PA) interventions and their potential relationship with college student academic performance can provide evidence to support college and university initiatives for funding and implementing campus recreation facilities and other health behavior interventions and programming. This body of evidence also provides data for return on investment for colleges and universities that seek to create health behavior programming to bolster retention and academic success. There are many studies in the body of research on PA interventions that support a positive relationship between physical activity levels and improved college student academic performance. Cross-sectional research by Brock, Wallace Carr, and Todd (2015) examined campus recreation usage in relation to academic performance and other health behavior indices in college freshmen students. 179 first year college students participated in a three-part online survey. Twenty-seven percent were male and 86% were Caucasian. Grade point average, body 36 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR mass index, physical activity usage, and TV viewing time were some of the variables measured for outcome. There were positive and impactful findings on GPA and the health indices measured. Of note, the results of the study suggested that students with higher GPAs and more favorable health index behaviors are more likely to partake in campus recreation usage and be more physically active. Todd, Czyszczon, Carr, and Pratt (2009) conducted earlier research in regard to campus recreational usage, upon which the 2015 study built. The purpose of this earlier study was to compare various determinant variables including grade point average, physical activity, nutrition, body mass index, smoking, and utilization of electronic media among user types of campus recreation facilities at a medium-sized public university. The two-part qualitative study included online questionnaire as well as a field-based follow up. Results showed statistically significant correlations among higher campus recreation facility usage and lower BMI, higher overall GPA, higher PA levels, decreased electronic media usage, and better nutritional behaviors. Additional observations recorded higher levels of tobacco usage for non-, low-, and moderate-recreation facility users as opposed to individuals who had high use of campus recreation facilities (Todd et al., 2009). As addressed in the Brock et al. study (2015), campus recreation facilities are the main center of physical activity across the majority of college campuses worldwide. Other studies focusing on PA interventions toward academic performance that have emerged recently has been the study of academic course load, academic stress, and PA levels. Calestine, Bopp, Bopp, and Papalia (2017) examined the relationship of physical activity in regard to both cardiovascular and muscular endurance training and academic outcomes in college students. Their demographic representative sample at a mid-size university replicated similar demographic information to the ACHA demographic data. Unique results in this study found 37 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR that academic success and PA interventions in college students are differentiated in primary and secondary education subjects in relation to both the efficacy of intervention types as well as in the measurement of perceived academic stress in individuals with low levels of PA. The data indicated a statistically significant relationship with lower levels of PA and higher levels of academic stress. This study, particularly in the college student population, can be seen as reflective of the earlier work completed by Pronk and Kottke (2009) in worker populations that showed reduced levels of stress in workers who engaged in higher levels of PA. Again, the study of intervention in the college student population can be seen as an example of more general health population trends, research, and outcomes. Another trend from this study that is replicated throughout the body of research focuses upon the concepts of academic stress, sometimes referred to as study-related fatigue (De Vries, van Hoof, Geurts, & Kompier, 2016). In their study, De Vries et al (2016) completed a two-arm parallel, randomized controlled trial to observe exercise as an intervention on reduction of studyrelated fatigue. Secondary observations included this PA intervention (low intensity running) with potential relationship between cognitive function and academic performance measures. This study was particularly well designed in relation to exclusion criteria to allow for a minimal design bias and well executed experimental design. In review of the study, a statistically significant relationship was found in decreasing academic stress through the PA intervention. However, while no statistically significant relationship to low intensity PA and improved academic performance, some data that reflected a potential relationship with PA positively influencing academic performance. Two-way analysis of variance (ANOVA) of the study data exemplified that the intervention group difference receiving physical activity reduced study related fatigue better than the control group. 38 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Other research exists within the body of evidence that provides strong, statistically significant evidence for PA, particularly moderate-to-vigorous physical activity (MVPA), and its positive impact on college student academic performance. In a highly cited and replicated study, Winter et al. (2007) studied high-impact, vigorous running interventions on learning. The purpose behind this randomized, controlled trial study was to build upon the science that regular PA improves cognitive functions and lowers the risk for age-related cognitive declines. Additionally, the primary focus was to determine whether exercise also has an immediate beneficial effect on cognition. Two types (high impact anaerobic sprint, low impact aerobic running) of PA intervention and variables were tested against a controlled condition, to measure the dependent variables of learning speed as well as immediate and long-term success in acquiring a novel vocabulary. The subject methodology and sampling were completed from male college students studying sport science. Exclusion criteria included bilingualism, any history of neurological, psychiatric or other medical disease, and recent consumption of recreational drugs, and a limited amount of nicotine, caffeine and alcohol intake. Results showed that the MVPA intervention had a positive and statistically significant impact on learning outcomes, specifically in this study, learning speed and cognitive acquisition. Moreover, MVPA interventions using lower intensity PA compared to high impact springs had a greater impact upon academic outcomes. The application of PA interventions to college academic performance has allowed for study of other areas of intellect, including emotional intelligence and cognition. In their work on collegiate sport, academic performance, and emotional intelligence (EI), Dobersek and Arellano (2017) examined student-athlete populations in comparison to non-athletes to measure EI differences as well as exploration into secondary research if evidence exists to support 39 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR participation in collegiate sports impacting or influencing the relationship between emotional intelligence and academic performance as measured by grade point average. This study design collected descriptive, quantitative research using a demographic survey. Out of 203 total participants, surveyed usage of a demographic questionnaire including the Emotional Intelligence Inventory were applied in data collection. Results of this study indicated a positive relationship among empathy, self-confidence, and academic performance in the student-athlete population. Student-athletes demonstrated a higher GPA compared to non-athletes, and typically scored higher on EI than non-athletes, except in the data point for empathy. Since studentathletes typically participate in a maximum of 20 hours of athletic, physical activity per week (Dobersek & Arellano, 2017), a strong correlational relationship among physical activity and academic achievement as well as EI and cognition was found. As in the Winter et al. (2007) study, a secondary branch of the research explores MVPA in the form of musculoskeletal strength training interventions on academic performance. In the research completed by Xiaofen Deng, Castelli, and Ayers (2013), the association between weekly strength training frequency and grade point average (GPA) as well as demographic characteristics of the same among undergraduate students at a large state university in the Southern U.S. was examined. This study consisted of a secondary analysis of the university’s 2008 ACHA data. The study was a retrospective non-experimental, cross-sectional research design. The results of the analysis indicate that there is a statistically significant, positive relationship between the number of strength exercise sessions per week and increased GPA attainment. These results indicate that further examination of the possible causal relationship between strength training and GPA is warranted. The Xiaofen Deng et al. (2013) study encouraged more research by others such as the Cunliff, Aweau, Colacicco, Farnell, and Powers 40 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR (2014) study which found that the more strength-training sessions per week a student engaged in, the higher the self-reported GPA. While there continues to be development in the field exploring aerobic, anaerobic, and blended PA interventions, there is not enough high level of evidence in the review of the literature to one type of PA intervention over another. However, the literature review does indicate that the level of intensity of the PA intervention, particularly that of MVPA in relation to strength training interventions, is more effective than lower intensity activity in affecting improved college student GPA. Nutrition Interventions on Academic Performance As in the population at large, college students face many of the same challenges regarding nutrition and quality of life. College students face difficult health decisions in regard to nutrition, especially students who are living on their own for the first time. These students are often faced with difficult nutrition decisions to make, and many have never had proper nutrition education (ACHA, 2017). This can often lead to the dreaded “freshman 15”, and spur on other dangerous and detrimental nutritional behaviors and consequences (ACHA, 2017). In fact, according to the most recent ACHA data, 33.7 percent of students are overweight or obese (ACHA, 2017). While there exists such a wealth of literature exploring PA interventions and college student academic performance, experimentally designed research exploring how college students’ nutritional behavior and interventions on nutrition may be related to academic success has also been explored. The recent systematic review by Burrows, Whatnall, Patterson, and Hutchesson (2017) indicates that research into nutritional interventions and college student academic performance nearly coincides with the timeline on studies in other health behavior interventions. As early as 1976 with the Blai study on female college students’ eating habits and 41 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR correlation with academic achievement, the history of this particular body of research within the field indicates that there has been an interest in observing non-physical activity interventions and academic achievement in college students for over 40 years. Nutrition interventions, as with PA interventions, have historically looked at academic success measures in primary and secondary school students, however, as in the PA intervention niche within the field, an emergence and applicability for research on the potential nutrition intervention relationship with college student academic performance has emerged in recent decades. The Burrows et al. (2017) systematic review reported on measures of dietary intake and academic performance, with commentary on the association between these variables. In analysis of the studies selected for inclusion, results mainly focused on intake of fruits and vegetables and studies on breakfast consumption. Standard GPA was the most common measure of academic performance. 71% of the included studies showed significant positive associations between diet and academic achievement, primarily regular meal consumption, meeting national recommendations for healthy foods intake, and regular breakfast consumption. Much of the research included in this review, as well as the extracted data analysis, support the clinical research within general populations that have identified certain nutrients that modify brain function, increase cognition, and have been proven to do so across the lifespan (Wurtman, 1982). This is important in that, as in PA interventions, many of the results of these studies are statistically significant and can be generalized to larger populations, providing higher level of evidence for relationship between these interventions and positive academic performance. Additional nutrition related intervention studies continue to promote the potential positive relationship to academic performance. In the 2013 study by Deliens, Clarys, De Bourdeaudhuij, and Deforche, a study of diet and weight behaviors among first year college students in a 42 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR quantitative cohort study was conducted. . Data was collected via an online health behavior questionnaire. Both GPA and course completion were utilized as measurement for academic performance. Sample population had an average age of 18.7 years of age, 67% of which were female. Significant results in this study showed that students who performed poorly based on GPA and those that did not finish course exams had higher increases in waist circumference, made poorer nutritional choices, engaged in less PA, consumed more soda, and also consumed more alcohol. Research, such as that by Valladares, Duran, Matheus, Duran-Aguero, Obregon, and Ramirez-Tagle (2016) indicates that, on a study measuring eating factors of cognitive restriction, uncontrolled eating, and emotional eating, female participants scored significantly higher in emotional eating than male participants. Additionally, statistically significant findings showed that female participants with higher GPAs were better at limiting their own food intake and had lower uncontrolled eating behavior than females with lower academic performance. Possible relationships among emotional health, academic performance, and eating and nutritional habits may exist (Valladares et al., 2016). Regarding nutritional behavior interventions, it is quite common within the literature base to see both empirical and experimental research segmented by gender. There are significant differences in the science regarding nutrition when comparing men and women, and the research focusing on college students in this particular area of intervention reflects concentrated, segmented studies between the sexes. This is also evident in the more general body of research, and the foundations and evidence for such is also found by segmentation in the NCHA. This is important as intervention techniques and success vary between men and women. This differentiation also helps to support data legitimacy and assists in removing potential data bias. 43 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Observance of this demographical difference can be seen in such studies as the aforementioned Valladares et al. (2016) study as well as in the study by Kuhlman, Ludy, Morgan, and Leone (2014). The Kuhlman et al. study (2014) focused, like much of the research, on female college students in regard to health-related weight variables and academic success. This prospective cohort study found that students with higher GPAs were associated with lower BMI index, lower body fat percentages, had lower alcohol consumption rates, and lower instances of behavioral difficulties. Data was assessed from anthropometric measurement and validated questionnaires. Throughout this review, these health-behaviors and their relationship to academic performance by gender are consistent, however, the lack of experimental design studies focusing on male-only students presents a challenge in generalizability. Nonetheless, Ruthig, Marrone, Hladkyj, and Robinson-Epp (2011) examined longitudinal studies inclusive of male populations. They observed the significant differences in how male and female college students’ nutritional behavior affects academic performance outcomes. This study further identified the need for targeted, gender-specific interventions in relation to nutritional behaviors and potential application to academic success. Another study including male subjects by Bureau, Razon, Saville, Tokac, and Judge (2017) provided data that supports a positive relationship between nutrition-related behaviors and academic performance. This study is unique in that it focuses on the Dualistic Model of Passion (harmonious and obsessive) on health behaviors and intervention to academic performance. Regression analysis used in this study found that students, regardless of gender, with obsessive passion behaviors for disordered eating and other disordered health behaviors generally engage in poor nutritional and other health behaviors, and thus experience greater negative outcomes academically than students who are harmoniously passionate about their 44 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR academics (Bureau et al., 2017). This study results were indicative for both male and female subjects. With healthy weight management being such an important tool in regard to overall physical and mental health, interventions that are created and differentiated by gender is supported through nationally recognized and generalizable research by the likes of Tsai, Nan, Xiao, and Ma (2015). Their study using data from the National Health and Nutrition Examination Survey shows that, at lower Body Mass Indices (BMIs) men are more likely than women to lose and maintain weight loss, increase exercise, and eat less fat, whereas women are more likely to join weight loss programs, take prescription diet pills, and follow special diets (Tsai et al, 2015). Interestingly, at higher BMIs, both men and women responded the same to weight perception, weight dissatisfaction, and attempted weight loss. As with the lack of maleonly intervention research in college students, this study re-emphasized that there is a need for further research on male-specific intervention studies in the general population as well. These data further suggest the need for gender-differentiated weight loss interventions and programming for college students, as well as a justification for further exploration of malespecific intervention effectiveness on nutrition and eating behaviors. Drugs and Alcohol Studies on Academic Performance Outside of nutrition and physical activity, health behaviors that have the greatest negative effect on college student academic performance arise from drug and alcohol use and abuse. The National Center on Addiction and Substance Abuse (2015) and the U.S. Department of Education (2008) report that government spending on substance abuse education in grant funding to colleges and universities totals over $7 million since 1999. This figure does not include the 45 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR individual institutions’ discretionary budget spending on substance use and abuse awareness. With drug and alcohol use extremely common across college campuses, studies on the effect of substance use on academic performance is essential in the creation of educational programming on the dangers of substance use and abuse. ACHA data (2017) indicates that actual use of all tobacco and nicotine products is less than 18%. Tobacco cessation programming across college campuses has been particularly effective in reducing tobacco consumption by over 3% from 2015 (ACHA, 2017). In that same time frame, alcohol use is up from 59.5% to 66.7%, and marijuana usage is up from 15% to 20%. This last statistic appears to indicate a reflection among college students, as seen in the general population, in the acceptance of marijuana usage as more U.S. states decriminalize marijuana usage for both medicinal and recreational usage. Another area of concern is the usage of prescription drugs, particularly stimulants that are not prescribed, up to 12.5% from 10.7% in 2015 (ACHA, 2017). The literature within the field further examines intervention effectiveness and the perceived academic consequences of misuse and abuse of these substances within college student populations. The empirical research base can be focused in three main areas: alcohol, marijuana, and stimulant use and abuse intervention research. A growing area that, as reflected within general health behavior, will soon be of interest to researchers focusing on college students, is opioid use and abuse and its effects on academic performance. In addressing these areas, there are several studies which provide insight to programming interventions to alleviate substance abuse effects on academic performance. In a longitudinal cohort study, Arria, Caldeira, Bugbee, Vincent, and O’Grady (2015) found statistically significant evidence that marijuana use frequency predicted skipping class, which then predicted GPA as well as time to graduation. Marijuana use 46 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR contributed indirectly to lower GPA, longer time to graduation, and more frequently skipping classes. While no significant direct paths were observed, negative effects on all measured outcomes of marijuana use indicated negative relationship with academic performance. In a systematic review of the literature conducted by Blavos, Glassman, Sheu, Thompson, DeNardo, and Diehr (2017) 70 studies that met the inclusion criteria of date range and publication in peer reviewed journals were included in the review. Overall results of the systematic review noted that most studies were lacking in scientific rigor, lacked large sample sizes, and other flaws in the research designs and methodology. However, even with these issues of scientific design, relational characteristics between marijuana use and negative academic performance were evidenced. Another longitudinal study by Meda et al. (2017) showed statistically significant relationship between high levels of alcohol/low levels of marijuana use and lowered GPA in comparison to sober peer groups. Additional findings show that students who use both substances in moderate-to-high levels have significantly lower GPAs by comparison. In the longitudinal aspect of this study, students who reduced use over time had significantly higher GPA compared to individuals who remained constant in their moderate-to-high use of the substances in the 2 year study period (Meda et al., 2017). In relation to alcohol use, Piazza-Gardner, Barry, and Merrianos’ 2016 cohort study of ACHA data utilized one- way analysis of variance and logistic regression analyses. Results of this study indicated that students with low GPA consumed a higher number of alcoholic drinks than those students with higher GPA. Additionally, higher GPA students were less likely to engage in episodic or binge drinking than those with lower GPAs. The data also showed that the number of drinks consumed within a seven day period was the strongest predictor of academic 47 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR achievement. The research results confirm previous research which deduces that academic achievement is reduced as a result of alcohol consumption. Relative to review on stimulant usage, Ponnet, Wouters, Walrave, Heiman and Van Hal (2015) found significant positive relationship among attitude, perceived control, and use of stimulants for academic performance purposes. Additional findings showed that procrastination tendencies in students led to more frequent stimulant use for academic performance. Students with high levels of academic psychological distress were more likely to use stimulants in effort to boost academic performance. In the growing area of stimulant research in college students and the adult population at large, the emerging expert is Martha Farah. Her work at the University of Pennsylvania has been leading the way in further study of the actual and perceived motivational and cognitive advantages of enhancement stimulant usage. In the Illieva and Farah (2013) study in college-aged adult populations, participants self-reported that stimulant usage was enhancing of both motivation related and cognition-related functions. However, enhancement users of stimulants found that the pills enhanced motivation, and indeed reported that the pills enhanced motivation significantly more than cognitive ability. This indicates that there is perhaps more danger in college students taking non-prescription or misusing prescription stimulants for perceived academic performance, when there may be not statistically significant evidence to support real cognitive benefit to academic performance. Lastly, use of opioids as analgesics by college students and their potential relationship to academic performance will certainly become more prevalent as the opioid epidemic in the U.S. progresses. Arria, O’Grady, Caldeira, Vincent, and Wish (2008), in a stratified, random sample survey of first-year college students initially found that non-medical users of opioid analgesics had significantly lower GPAs as compared with nonusers. These students also tended to skip 48 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR more classes, and spend less time studying. A significant result of this study indicated that nonmedical users of prescription opioids pose a high-risk population for academic problems in university settings. As evidenced through these studies, there is significant negative correlation between substance abuse, use, and misuse and academic performance and, among all health behaviors, may be the behavior that needs the most support across college campuses in promoting academic success and positive retention. While there is a lack of truly randomized experimental studies on drug and alcohol use by college students and their outcome on academic performance, this gap is justifiable in that there are major ethical concerns regarding actual experimentation of interventions or randomized trials studying drug or alcohol use in college students. As a primary ethical consideration in research is to limit the exposure to harm for test subjects, it is understandable that there is a lack of research in this particular circumstance. Additionally, the legal status of both cannabis to all populations, and the considerations of legal drinking age, are obstacles that also limit the nature of research around these substances and college students. Stress Management Interventions on Academic Performance As indicated by the ACHA data regarding college students, stressors related to academics are one of the largest issues that students attribute to poor academic performance. Proven research in the generalized population shows that stress management interventions can be greatly effective improving subjective, cognitive, and emotional health (Eriksen, Ihlebaek, Mikkelsen, Gronningsaeter, Sandal, & Ursin, 2002). Since there is such a large percentage of students that attribute stress to poor academic performance, it is not surprising that colleges and universities spend significant time and monetary resources combatting academic-related stress. The literature 49 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR shows that of particular interest, veteran service members as college students have been a focus of stress management and academic performance measurements. Much of this may be attributed to the particular circumstances many returning service members cope with post-deployment or active duty, including post-traumatic stress disorder (PTSD). In a 2014 study by Bryan, Bryan, Hinkson, Bichrest, and Ahern, a study of 422 student service members (both active duty and veteran) were observed. Results of the study showed a significant relationship that symptoms of depression were associated with lower GPA, however, PTSD symptoms were not significantly related to lower GPA. Additional findings of this study showed that severity of depression symptoms was also indicative of poor academic performance in task timeliness, exam failures, and negative class attendance behaviors. Lastly, the results imply that participants with greater levels of emotional distress were more inclined to poor academic performance. While not unique to veteran service member college students, as most college students report higher levels of emotional distress, these results can be applied to interventions in that regard. Examining stress-management interventions more closely on non-veteran college students, Conley, Travers, and Bryan (2013) used a randomized sample assignment to examine the effectiveness of a wellness seminar focusing on psychosocial issues aimed at first-year college students. Results showed significant group effects for perceived improvements in positive well-being and reduction of negative distress, as well as perceived greater improvement in psychosocial adjustment and stress management by conclusion of the intervention. Other alternative stress management interventions which show promise toward academic performance are interventions like yoga and tai chi. In Kauts and Sharma (2009), a study to determine the effects of yoga on academic performance in relation to perceived student stress among precollege students was completed. This study was a quasi-experimental cohort design. Results of 50 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR the study show statistically significant evidence that students in the yoga intervention performed better overall in the academic performance tests as opposed to the control group. Additionally, students in the low stress group performed better than those in high-stress group, both in the control and intervention groups, indicating that stress also affects student academic performance. Lastly, students in the yoga intervention in both low and high stress groups reported better management of anxiety and improvement in concentration and stress management (Kauts & Sharma, 2009). Studying the effectiveness of tai chi interventions, Zheng et al. (2015) conducted an experimental, randomized controlled trial study focused on recruited college students (n=206) who were then randomly allocated to a control group or a tai chi exercise intervention group. While no statistically significant evidence on academic performance was found, anecdotal evidence of improved stress management has been observed. Conclusion The wealth and depth of the existing literature concerning college student health behaviors and academic performance outcomes has grown since the earliest studies over 50 years ago. Development of such tools as the ACHA’s NCHA to compile quantitative data about the health behaviors of college students has contributed immensely to this growth. Additionally, college student health, as a microcosm of the general population’s health, has provided a unique space for researchers to design and test intervention efficacy to replicate relationships between health behaviors and executive cognitive functions as well. Beyond that, the particular research area of the relationship between health behaviors and college student academic performance has helped to extend and advance similar studies in primary and secondary school test subjects to help further explore and understand the nature of the relationship between health and learning 51 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR throughout the lifespan. This field has diversified to look at multiple health behavior interventions as ways to increase cognition, academic performance, and other outcomes. This research is important as it helps colleges and universities justify the continued expenditure of time, staffing, and monetary resources for health programming and health interventions, toward student retention outcomes. This research and its positive findings also help colleges and universities to actualize real return on investment of these resources. There can be no doubt that the main body of research focuses on and justifies that physical activity interventions have significant impact on academic performance, more so than other health behavior interventions. Research into the efficacy of other health behavior interventions, such as nutritional, stress management, and drug and alcohol interventions, while less studied than physical activity, also show positive relational aspects to academic performance outcomes as well. Within physical activity intervention, strong correlation between moderate and vigorous physical activity (MVPA) and improved academic performance is evident. While the modalities of MVPA efficacy are less clear, when comparing cardiovascular versus muscular training exercise, strong relational data indicates that MVPA can have a positive effect on college student academic performance. Further, evidence on MVPA and recreational facility usage across college campuses shows helps to reinforce the need for recreational programming at all university levels. In nutrition interventions, the research indicates a clear relationship among positive indicators of healthy nutrition, body weight, and other measures including improved academic performance metrics. This line of research provides colleges and universities with sound, evidence-based research to support continued funding of nutrition education, nutrition interventions, and other investments in healthy weight management programming across 52 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR campuses, to the end that these initiatives help to support retention and student success. The research also strongly suggests positive relationships between poor academic performance and detrimental health behaviors regarding alcohol and drug use, abuse, and misuse. The overwhelming evidence in this particular area of health behavior study suggests that colleges and universities can make the most impact in improving retention, academic success, and other academic related outcomes by creating strong educational programming and interventions surrounding drug and alcohol abuse prevention. Of particular interest in this regard is the study of current trends in drugs and alcohol use among college students, such as with opioid and nonprescription stimulant use, and how new evidence will emerge on these behaviors. Lastly, stress management interventions show insignificant, yet potentially positive relationships between decreased student stressors and positive academic performance metrics. The ACHA data supports the notion that the majority of college students suffer from one or more stressors and these stressors affect academic performance. This data helps to justify college and university spending on student mental health programming and interventions. Further evidence-based research is needed, however, to better understand the relationship between stress, academic performance, and interventions that could possibly reveal further relationships between the two. While the review of the literature supports positive relationships between health behaviors and college student academic performance generally, there are still areas that can be addressed within the field to enhance what practitioners, scholars, and researchers understand about this relationship. Further research based on gender-specific interventions for female, and especially, male college students is needed to better understand what health behavior factors affect them the most. This evidence will also help to better understand how interventions targeted to gender-specific demographics work in relation to academic performance outcomes. 53 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Supplementary research exploring modalities of physical activity intervention on academic performance measures is warranted to help better determine what type of exercise is best for cognition and student success. This type of research can have far reaching implications across the development and understanding of how physical activity affects cognition and learning across the lifespan. Gaps in the long-term understanding of how drugs like cannabis affect academic performance measures and long-term learning and brain function also exists. Closing this gap will help to provide evidence not only toward college students health outcomes, but also in the body of research at large on cannabis. Other drug interventions and behaviors, such as binge drinking, use of opioids and stimulants, and newer drug concepts such as psychedelic microdosing offer a relatively unexplored avenue for further development. Further intervention research on other aspects of health data as evidenced in the ACHA such as sexual health, violence and domestic abuse, and sleep behaviors in college students may also help to identify possible relationship with academic performance. Finally, the focus on this area of the field of research has potential to shift dramatically as new health issues arise. Examples include the impact of smart devices and screen time, new health afflictions, and adaptive technology for health and wellness. Researchers in this field must be prepared with evidence-based research to address these changes and to create programming and interventions based on this evidence. Regardless of how the field changes, the future direction of how the research field is vast and affords much diversity in developing new interventions as well as niches to study as it relates to health behaviors and academic performance. 54 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR CHAPTER III METHODOLOGY The purpose of this chapter is to introduce the research methodology for this qualitative grounded theory study regarding the perceptions of college student health behaviors on academic performance. The primary problem examined within this study is exploring how and why student health behavior perceptions may impact academic performance. Study of this problem is essential due to the amount of resources invested in college student recruitment, retention, and success programming as well as the investment on health programming for student outcomes, and to determine if can be effective in student health behavior change. The main purpose of this dissertation research is to explore college student perceptions of how health behaviors impact academic performance, specifically those behaviors as derived or impacted from institutional programming. Additionally, this research will explore student perceptions on the efficacy of a university’s health education programming, and the student perceptions of factors that shape the behaviors of, or create barriers to, student health decisions and wellness. Lastly, examining the role that SCT plays in the health behavior patterns of college students including social determinants present will be examined. The methodology for the dissertation research was created based on certain factors and circumstances, as well as best practices in qualitative research, specifically the ability to conduct a grounded theory based design by implementing a two-part interview protocol and ensuring that aspects of the qualitative study utilized techniques that help lend to credibility. This approach allowed for a more complete understanding of college students’ experiences in relation to their health behaviors and provided an opportunity to develop theory from the data in order to understand what factors influence health behaviors. Included in this review of the methodology 55 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR is the research design and subjects of the study. Additional subsections will include the process for collection and analysis of the qualitative data. This study used a grounded theory approach. Grounded theory design attempts to identify phenomenological data through either existing or new theoretical models (Bandura, 1986). In identifying the perceptions of college student health behaviors, the author rationalized that grounded theory design would be best to examine behavioral research questions. Qualitative research is primarily focused on producing data and insight that is not arrived at through means of quantification or other statistical operations (Strauss & Corbin, 1998). The focus in this study was to gain a sense of what factors and health behaviors are most important to the research participants. Research Design The completed study used a qualitative inductive grounded theory approach. Typically, grounded theory research designs provide a way to “ground” a research theory within rationale observation and allows for the discovery of emerging patterns in data with the generation of theories from that data. Grounded theory is often used in examining behaviors, and the perception of subjects and their actions. Grounded theory design is particularly well suited for behavioral research in that it provides ecological validity with representation of real-world observation (Strauss & Corbin, 1998). There are a few areas of concern for grounded theory design as well, such as eliminating preconceptions in the collection and analysis phases of the data. While there are other qualitative design types to consider, given the nature of the research in this situation, a grounded theory design was best to observe behavior, and the crux of this research involved observing student behaviors as they relate to health. Thus, the grounded theory approach was the best design for this study (Strauss & Corbin, 1998). 56 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Behaviors such as physical activity levels, eating habits, drug and alcohol use behaviors, and stress management techniques were explored using a two-part interview process. Additional demographic information was obtained and measured through a demographic information collection form. Additionally, the perceptions of the benefits, strengths, and weaknesses of current health educational programming offered was examined, as well as the students’ perceptions of how their health affects their academic performance and the university’s overall health education programming. Setting For this dissertation study, the California University of Pennsylvania campus was employed to complete the research. The university, founded in 1852, is a member of the Pennsylvania State System of Higher Education, and is classified as a Doctoral/Professional University under the Carnegie Classification. The university is located in Washington County, Pennsylvania, approximately 35 miles from Pittsburgh. In utilizing this setting, the researcher had access to the undergraduate student body to recruit participants. Additionally, by utilizing the university as the setting for the study, the researcher was able to use a private conference room to conduct the individual interview protocols with participants. The same room was used for all participants for both interview protocols. The setting for this was in the university’s alumni office, first floor conference room. This provided a private yet inviting space for the study participants to share their insights over the protocols with the author, and to reduce participant stress. Participants While the setting used was California University of Pennsylvania, the 2017-2018 Integrated Postsecondary Education Data Systems (IPEDS) data (California University of 57 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Pennsylvania, 2018) gives a dynamic view of the proposed, potential study participant characteristics. Out of 7,788 total undergraduate and graduate students, 56.4 percent are female, and 24.3 percent are non-White minorities. 76.06 percent of students are between ages 18-29. 25.6 percent of the student population is pursuing a 100% online program of study. As the University does not currently utilize a tool to obtain health behavior data, current student health behaviors are unknown for the campus at large. Ideally for this study, approximately eight to 20 students were ideal to be selected for study in order to achieve data saturation for purposes of validity (Yin, 2016). The actual study yielded nine participants, eight of whom completed the study to conclusion (n=8). Demographic characteristics for the sample include: 50 percent were male (n=4), while 50 percent were female (n=4). Two participants (n=2) were non-White minorities, or 25 percent of participants. All participants (n=8) were between the ages of 18-29. The average age of participants was 20.75 years. Overall, the participants’ demographic characteristics were parallel to the University’s IPEDS data. This helps contribute to the soundness of the study and the sample size in proportion to the University at large. Participants were recruited from electronic invitation (Appendix C1) via campus email accounts as well as in person at a recruitment table at the campus student hub, the Natali Student Union, using purposeful sampling. Students were instructed to respond through their university email to the primary researcher. Selection was to be the first 20 students that meet the inclusion criteria of having attended the university for at least one full academic year, either living on the campus or as a commuter student, currently enrolled at least part-time as an undergraduate student, and consented to participate in the study on a volunteer basis. Nine participants responded and met the criteria, however, only eight (n=8) completed the study in its entirety. The ninth participant withdrew from the study due to academic stress. The concept of academic 58 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR stress, or stress due to academic issues, was found to be evident among all the participants and became a major tenet of the grounded theory as will be discussed in future chapters. The exclusion criteria prohibited any student who attends 100% online courses, graduate students, and any current or former student-athlete participating or who has participated in any of the sponsored NCAA athletic teams, as student athletes have significant advantages in health education and resources compared to the average college student. The use of a purposeful sampling strategy that was consistent with typical cases helped to illustrate the perceptions of a normal college student (Yin, 2016). Thus, this sample of the general undergraduate college student population was utilized for this study. Consent was provided in a pre-interview protocol meeting, and the completed consent forms were obtained at the time of the first interview. Participation of the sample was free of any coercion or undue influence from the researcher. Informed consent was provided electronically and in writing to participants at the time of the initial interview (Appendix C2). Data Collection The initial semi-structured interview was conducted within two weeks of the informational/consent meeting and was conducted in a one-to-one format following the initial interview protocol described in Appendix C4. First, the consent was obtained, followed by the demographic data sheet (Appendix C3), which was used to obtain the demographic information in the initial semi-structured interview. The demographic information sheet was completed by each subject. Once the demographic information sheet was obtained, the semi-structured interview protocol was conducted. The demographic information sheet was corroborated through member checking during the second interview for purposes of accuracy and consistency. The 59 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR semi-structured interview protocol was conducted in a well-lit, warm, and inviting conference room on the university campus. The interview protocol was audio-recorded for accuracy and then manually transcribed by the researcher for data analysis. Once the initial interview was conducted, the secondary or follow-up interview protocol was scheduled for approximately 8-10 weeks in the future. All interviews were completed before finals week of the Spring 2019 semester. The purpose for the 8-10 week interval was to assess any changes in perceptions of health behaviors and university health behavior programming. This secondary interview utilized a similar interview protocol (Appendix C5) as the initial interview with additional questions regarding perceptions of behavior change. The secondary, follow-up interview was conducted in the same manner as the initial interview, in the same setting, and the interviews were manually transcribed by the researcher. In addition to transcriptions, the field notes from both interview protocols were utilized to help triangulate the data for soundness, consistency, and saturation. Data Analysis For this grounded theory design, narrative data was analyzed mainly through the three phases of coding; through the display of themes and relationships present within the data; and presenting theoretical rationale for the observed behaviors within the data and determining soundness of the data. In using Social Cognitive Theory (SCT) as a theoretical framework for viewing the research problem, the analysis of the codified data helped in determining if SCT is applicable to student health behavior change, or if an alternative theory exists to best describe the phenomena of college student health behavior change. Throughout the existing literature of qualitative research in applied exercise science, grounded theory designs are typical for 60 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR identifying motivation in health behavior change and in determining perceptions (Nehl et al., 2012; Osborn et al., 2016; Petosa et al., 2003). This process and procedure are typical of the grounded theory design (Strauss & Corbin, 1998). Specific aims. The specific aims of the study were to assess college student perceptions of individualized health behaviors and habits, and the perceptions of college students on how these behaviors affect individual academic performance. Secondary aims of the study included interpreting student perceptions on the effectiveness and quality of university health programming education, and interpretation and analysis of the perceived factors that cause or contribute to individual college student behavior change. Through the grounded theory design approach, compiling data, disassembling data through coding, and reassembling the data through the analysis process (Yin, 2016) to display themes and a theoretical framework for the phenomena helped contribute to effective presentation of the data. The demographic information data was utilized for data synthesis and presentation and display of data variances. Qualitative data was collected through two interview protocols, both the initial interview protocol (Appendix C4) and the secondary interview protocol (Appendix C5). These semi-structured, open-ended interview protocols were audio recorded, and the researcher also took field notes during the interviews. The field notes and audio recordings of both interviews were triangulated for purposes of establishing rationality and trustworthiness within the proposed study, which is a commonly accepted tool in establishing qualitative research validity and dependability (Patton, 2001). In the study, the data collected by individual respondents shared very similar characteristics, reaching saturation by the completion of the eighth and final research subject based on recurring themes and no new data insights. 61 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Steps in data evaluation. The demographic data was compiled across all participants and analyzed using means and averages. Of the subjects that completed the study (n=8), 50% of participants were female (n=4). Twenty-five percent of participants (n=2) identified at Black or African American. 87.5% of participants (n=7) live off campus, either with roommates in noncampus housing, or at home with parents and commute. Additional demographic data will be discussed in the study findings. In analysis of the qualitative data, all audio recordings of the interviews were transcribed. A total of nine hours, 34 minutes of audio recordings from the dual interview protocol were manually transcribed by the researcher using an audio playback and voice-to-text program, specifically, the Google Docs Voice Typing tool. The average total interview time per participant was one hour, three minutes (1.05 hours). In addition to the audio recordings, the author utilized handwritten field notes for each interview for each subject, for purposes of triangulation and future coding steps. This data was codified using open coding to identify the phenomena of the behaviors including reasons why students choose to participate in positive health behaviors, the phenomena of the perception of health behaviors and their perceptions toward academic performance, as well as perceptions of how programming to educate on these health behaviors is perceived. Next, themes emerged from this phase of coding which were then utilized across the remaining phases of the coding process. Manual sentiment analysis was performed during all phases of the coding process. Manual sentiment analysis is the process of manually analyzing the transcribed data to identify either positive, neutral, or negative ratings to each interview protocol subsection (Thelwall, Buckley, Paltoglou, Cai, & Kappas, 2010). This analysis helped uncover where subjects are positively influenced, and in what health behavior areas they may need further direction, behavior change, or education on. 62 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR In the axial coding phase, categories and properties to relate the data and phenomena to each other were identified. Particularly in this axial coding phase, identified categories were established to help better explain perceptions of health behavior programming and understanding for why students engage in behavior change, as well as perceptions of health behavior and academic performance. Lastly, after manual axial coding was completed, one of the identified categories was chosen for selective coding and used to relate the other categories and themes, and thus identify the core concepts surrounding perceptions of student health behavior and academic outcomes. This manual selective coding process better established the themes that pertain to student perception of health behaviors and their academic performance (Gowin, Cheney, Gwin, & Wann, 2015). From these manual coding phases, the grounded theory emerged. The manual coding process was important through all phases of coding in helping to correctly identify the themes within the data. Data display and verification. Data is displayed in a number of ways. Primarily, overall themes and categories are presented in a hierarchical chart format. In this format, the interrelation of those themes and categories are visually displayed as well. The use of word clouds has also been utilized to visually depict the frequency and weight of specific terms, ideas, and themes within the data. The researcher utilized these word clouds to depict variances in the data particularly in sentiment analysis and identifying themes. As previously discussed, the researcher used member checking for applicability and fittingness of the demographic data, as well as triangulation between interview transcriptions, audio recordings, and interview field notes to establish internal validity, integrity, and a level of saturation within the data. Lastly, due to the size of the study and the repetitiveness of the outcomes in the interview protocols, the researcher attributed reliability with data saturation, as saturation of data in grounded theory 63 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR approach shows data as empirically confident when categories, themes and descriptions of the categories are saturated (Straus & Corbin, 1998). This allows for the concept of the grounded theory to emerge (O’Reilly & Parker, 2013). As seen in the research findings, saturation was achieved. 64 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR CHAPTER IV RESEARCH FINDINGS Through the research process and analysis of data, several of the research questions examined were able to be addressed, while through the grounded theory research design a new theory on health behaviors and academic performance arose. Within this section of the research findings, the author addresses: the findings of student perceptions on their health behaviors and academic performance; findings of student perceptions on institutional health programming; manual sentiment analysis of student perceptions on four areas of health behaviors; the findings of manual open, axial, and selective coding; and the emergence of the Student Stress Theory on Health and Academic Performance. Integrity of the Data For this dissertation study, the author employed certain measures to identify and verify the veracity of the data and the narrative that emerged from the interview protocols. In terms of credibility of the qualitative data, the author used member checking to confirm all of the collected demographic information. For the narrative data that emerged from the two interview protocols, the author used data triangulation of the interview protocols, field notes from each participant interview, and the verbatim transcripts from each interview. Additionally, the interview protocols were recorded at different time intervals as well to further add a variety of the data source across time. This common methodology in data triangulation is a basic tenet of triangulation in qualitative sociological research since the early 1970s (Denzin, 1970). 65 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR To help establish dependability, the methodology and design of the grounded-theory study conducted in this dissertation in Chapter III has been explained, in detail, to allow for future repetition of the study in other campus or collegiate settings. The author believes that the data narrative is transferable to other college populations based on the demographic makeup of the sample especially when compared to both institutional IPEDS and national IPEDS data. Additionally, based on the emerging narrative from all participant data, the author believes that data saturation has occurred and this also lends to the confirmability of the study, particularly in that participant bias would have been limited. Results RQ1: Student Perceptions of Factors Shaping Health Behaviors and Attitudes As one of the primary research problems of the study, the author sought to identify student perceptions of their existing or changing health behaviors and how that may affect their academic performance. The research findings indicate that there is not much variance by gender or other demographic about the student perceptions of their health behaviors and academic performance. As evidenced by quotes in the research depicted in the data word cloud, there was little variance among motivation and perception of health behaviors between male and female participants. The biggest variance in motivation between male and female participants occurred in the area of nutrition and eating habits, as evidenced by the lack of male response regarding “beach body” or “vacation” as a motivation for engaging in health behaviors. Among all demographics, there were mixed perceptions and motivations about individual health behaviors. This mixed perception was also evident in student health behaviors and academic performance. 66 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Physical activity. Among nearly all participants, physical activity is perceived as anything that is “not being sedentary” or, as evidence by saturation from the participants (n=7), anything that required being active, moving, or constituted as exercise. 62.5% of participants had a consistent, existing physical activity routine. Among the participants, 87.5% indicated that outside motivation, either situational (such as summer time and the “vacation” or “beach” body) or personage (friends, family, others) factors helped to motivate to engage in physical activity. 75% of female respondents indicated situational factors, while none of the male respondents identified a situational factor to motivate change in physical activity. This was the most significant difference between males and females in terms of motivators and perception of physical activity. One other observation as evidenced in the data is the type of physical activity most associated by gender. Male respondents typically mentioned weightlifting, bodybuilding, or more high intensity workouts such as CrossFit, while the female respondents mentioned group exercise classes and cardiovascular training in their definitions of physical activity routines. Barriers to changing or increasing physical activity levels were also observed. Across all participants, 62.5% indicated time as a stressor for a physically active lifestyle. The secondary interview protocol indicated that the remaining 37.5% of participants encountered a time barrier/stressor to their existing routine. The concept of stress as an influencer on student health behaviors began to emerge within this first section of the interview protocol. This concept would present itself as a recurring theme throughout the research process. Another finding in this early stage is that time as a factor or barrier to physical activity, and time as a stress mechanism, is shared among all demographics. Among participants, the effect of social media on information gathering, motivation, and perception of physical activity was also observed. 100% of the participants used some form of 67 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR social media for information, instruction, or general knowledge on physical activity. 87.5% of all respondents used both YouTube and Instagram for instructional and informational assets regarding physical activity. All female respondents also indicated they used Instagram for motivation and inspiration for fitness goals. 25% of respondents, both of whom were male, indicated that they used other sites like bodybuilding.com or reddit for additional information. This statistic reinforces the differentiation in respondents on type of physical activity routine. As is evidenced in the other segments of the research, overall motivation to change or engage in physical activity is mixed. Aspects of SCT exist, particularly in male respondents, however, there are elements of the trans-theoretical model (TTM) in terms of female respondents, specifically in the pre- and contemplation phases (Prochaska & DiClemente, 1983). This multivariable motivation to change is observed throughout the interview protocols and data analysis. Figures 4.1 and 4.2 below visually depict physical activity perceptions of both male and female study participants. 68 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.1 Male physical activity behaviors. This figure illustrates male subject attitudes on physical activity. 69 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.2. Female physical activity behaviors. This figure illustrates female subject attitudes on physical activity. Nutritional habits. The perceptions of student nutritional habits were also explored in the interview protocols. At least 37.5% admitted that they primarily eat fast food, frozen meals, and other pre-cooked items. 50% of respondents indicated that they try to eat “healthy” or “health conscious”. The remaining subject indicated that they eat “good and bad” foods. Three of the four female respondents admitted that nutritional choices were difficult as they are “picky eaters”, while no male respondent indicated that they were too selective in their food habits. 70 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Several interesting factors emerged from the protocol sections on nutrition. Time, as a stressor mechanism, was indicated by 100% of respondents as a barrier to eating well. Specifically, areas of concern were meal preparation time, time in choosing a place and menu, time to cook in terms of health value. One male respondent indicated that “time is the biggest factor in me choosing what to eat”. Another surprising factor or motivator in determining nutritional habits is money. 87.5% of respondents indicated that cost is a big factor in determining eating habits. Three subjects were quoted as “broke college kids” and that “health food costs more”. Specifically, two male respondents and two female respondents indicated that their nutritional behaviors cause stress as they are food insecure. Food insecurity, as defined by the United States Department of Agriculture, is “prolonged, involuntary lack of food” (USDA, 2006). USDA data shows that marginal to very low food security has consequential effects on anxiety, as well as food variety, desirability of diet, disrupted eating patterns and reduced food intake. Subjects were much more aware of nutritional behaviors and their potential impact on academic performance, as discussed below. The additional impact of food security-related stress mechanisms was not evidenced or perceived by the subjects, but in analysis of the data in the grounded theory process, it is evident that it has serious implications and contributions to the Student Stress Theory that emerged in the selective coding process. Figures 4.3 and 4.4 below visually represent perceived nutritional behaviors and attitudes for male and female participants. 71 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.3 Male nutrition behaviors. This figure illustrates male subject attitudes on nutrition. 72 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.4 Male nutrition behaviors. This figure illustrates male subject attitudes on nutrition. Drug and alcohol usage. The conversations within the interview protocol regarding drug and alcohol behaviors were a delicate matter. As noted in the documentation submitted for IRB approval, this section of the interview protocols was possibly the section that could have presented the most risk to subjects. As such, the researcher worded the questions in such a way that subjects did not have to fully disclose their habits or behaviors in this segment, rather, their perceptions of these behaviors among their peers. Evidenced through the protocols, 100% of subjects indicated that marijuana and alcohol are the most commonly used substances on campus. 75% of the subjects identified alcohol as the number one drug of choice on campus. 73 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Additionally, 87.5% had no “stigma” with marijuana. One male respondent was quoted as “not considering it a drug especially in Pennsylvania where you can get it prescribed”. This response reinforces the continuing change in perception of cannabis use across the nation, as evidenced in other studies as recent as 2018 (Blevins, Marsh, Banes, Stephens, Walker, & Roffman, 2018). 100% of respondents indicated that primary drug and alcohol use is of a casual and social nature, as a “way to stay social” on campus. 75% of respondents indicated that their engagement in the “college party scene” is typically influenced by their peer group. Outside of cannabis and alcohol, 3 of 8 respondents had 3rd hand knowledge of other drug usage, including cocaine and benzodiazepines. Another observation from the interview protocols that reflects national trends is the nonprescription use of Adderall as a “study drug”. Five of the eight subjects indicated that they have used, or have peers that have used Adderall as a study aid. This data point is reflected in studies like that of Dr. Martha Farah at the University of Pennsylvania (Ilievea & Farah, 2013). Further observations of the perception of drug and alcohol behaviors on campus show that substances, particularly alcohol and cannabis, are typically used and accepted by peer groups (75%). This also reflects sentiments that the use of alcohol and cannabis, in social situations, is “what you do in college”, as quoted by seven of the eight subjects. Perhaps unsurprising given the demographics of the subjects and the concentrated effort by special interest groups to deter young adults from tobacco use, there is a 100% sentiment among respondents that their peer group is very much against tobacco use. However, while smoking has passed out of vogue, subjects indicated (75%) that there is an increased use of vaporizing and similar devices on campus, and that “nicotine addiction is a real problem” among peers on campus. 87.5% of respondents indicated that they believe nicotine addiction is an issue 74 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR among their peers. Lastly, the perception that there is not a problem with drug or alcohol abuse across campus was prevalent among respondents (62.5%), and rather that the perception is that among peers, drug and alcohol use is moderate. While this is an encouraging finding about responsible use of alcohol and other drugs, 50% of subjects indicated that they also perceive their peer groups to use alcohol and other drugs as a tool for stress relief due to emotional stress triggers as well as academic stress triggers. All respondents indicated that they would likely change their perception of alcohol and other drug usage due to situational factors, including if: they personally or someone close to them was injured or became ill/addicted ( 37.5%), personally had a bad experience with alcohol or other drugs (37.5%), or personally got in trouble with the law (25%). Figures 4.5 and 4.6 below visually represent male and female perceptions on alcohol and other drugs. 75 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.5 Male alcohol and other drug behaviors. This figure illustrates male subject attitudes on alcohol and other drug behaviors. 76 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.6 Female alcohol and other drug behaviors. This figure illustrates female subject attitudes on alcohol and other drug behaviors. Mental health and stress management. Specifically, the research data shows that all subjects identified stress as “anxiety”, and 100% of respondents indicated that stress triggers that cause anxiety are time management, work, and academics. 100% of the respondents also indicated that they are currently stressed. Additional stress triggers that subjects attributed to causing their anxiety and stress were financial related (100%), family stress (37.5%), and feelings of loneliness or depression (25%). In terms of stress management, all subjects responded that they currently utilize various coping mechanisms to deal with stress. 67.5% of respondents indicated their coping mechanisms were self-taught, while the remaining respondents indicated 77 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR that they learned coping mechanisms from parents or peers. Specifically, an even split of respondents indicated that they would be motivated to change coping mechanisms to better manage stress through situational factors of motivation, as well as intrinsic factors of motivation. Subjects are very much aware and perceive that stress is a major factor in other facets of their lives, and that stress is very much a factor in their overall health. Figure 4.7 below visually represents the attitudes and perceptions of both male and female subjects regarding mental health and stress management. Figure 4.7 Male and female mental health and stress management behaviors. This figure illustrates both male and female subject attitudes on mental health and stress management. RQ2: Perceptions of Health Behaviors and Academic Performance Through the research, a mixed perception of the effects of health behaviors on academic performance exist among the subjects. The author originally presumed that students would be less cognizant of the short-term, long-term, and immediate effects of health behaviors on academic performance. However, the responses indicated an understanding or peripheral perception among the subjects of certain aspects of impact that health behaviors can have on 78 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR student academic performance. This varied among the various health behaviors observed, however, even in areas where students did not perceive effects or a limited effect, subjects were very much aware that, theoretically, all facets of health behaviors could affect academic performance in some way. Physical activity. Among all health behaviors, only physical activity was perceived to have neutral, no, or very little impact on academic performance. 50% of participants indicated that they perceived no short-term or long-term effects of PA on academic performance. The other half or respondents indicated a perception that PA can affect academic performance in terms of “mindset, mental and emotional wellness”. These participants indicated that they “feel better mentally and physically, more energy and focus for study” and correlated focus in the gym to the same focus required to study in class. However, no direct impact of physical activity on academic performance was perceived by any of the subjects. 25% of respondents indicated that they thought PA and GPA could be linked long term. One female participant was quoted as “maybe not in short term, but definitely long term health could impact your GPA over the long run”. One other male respondent indicated that his continued commitment to a PA routine “has been helping me feel more focused in class and focus on tasks better”. Nutritional habits. In relation to nutrition and eating habits, there was a wider understanding of both immediate and long-term academic performance impact. 67.5% of the respondents indicated that they perceived nutrition to have both immediate and long term effects on GPA. One male subject indicated the “fuel manifests in outcomes” including mental performance. The concepts of food security, and other nutritional stress triggers that manifest themselves from food security can contribute to academic stress which negatively affects academic performance was observed by three of the eight subjects. 79 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR One male and one female subject also indicated that being hungry during the day can “cause me to lose focus and distract me in class”. One female respondent also indicated that “eating better foods helps me feel better throughout the day, and that helps my academic performance both short and long term”. Subjects also indicated clear classroom performance perceptions based on their food consumption. Six of the eight subjects indicated that they believed healthier diet choices would contribute to better wellness which, as quoted by one of the male respondents of the six, “is critical to performing well in the classroom”. It is evident among these responses that subjects not only perceived that better nutrition could positively impact academic performance, actual physiological responses to the quality of nutrition were experienced and perceived to be a benefit. Drug and alcohol usage. By far, students were most cognizant of the perceived effects of drug and alcohol use upon academic performance. All subjects indicated that they perceived that substance abuse or misuse would have immediate and long-term negative effect on academic performance. One subject admitted first-hand experience and that “having an 8am class when you’re hungover isn’t very much fun”. 87.5% of the subjects responded that they perceive that students could lose focus on class if they focus too much on social life and partying. Specifically, all subjects perceived that alcohol and other drug usage could: affect class attendance (50%); be used as a negative stress coping mechanism (25%); or lead to expulsion or failing out (37.5%). Specifically, 75% of subjects believed that engaging in moderation, or as one female respondent said, “finding your school/party balance” is important to being academically successful while still engaging in socially acceptable alcohol and other drug use. Mental health and stress management. As in the findings of academic impact of alcohol and other drugs, subjects were extremely conscious of the relationship between stress 80 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR and GPA. 100% of subjects identified that stressors or stress triggers affect their academic performance, including: focus in class, prioritization of “major” classes vs. “blowoff” classes, time management, test anxiety, and causing focus distractions. 67.5% of respondents indicated that external stressors, such as family, finances, and other situational factors increase stress, which also affects GPA. Half of the subjects indicated that stress specifically causes focus issues. Student stress continues to be an apparent influence on health behaviors among college students as evidenced from these findings. However, students were also aware that making positive changes in coping with stress can be beneficial academically. 67.5% of subjects indicated that making changes in coping mechanisms helped with GPA improvements. Specifically, better coping techniques have led to better focus on assignments and time management, being less impulsive on projects and assignments, being more engaged in class, and being more focused on task related activities. Because 100% of subjects responded that they experience stress and academic related stress, it is evident that student stress and student mental health may be the most important aspect of college student health and wellness that needs addressed through programming, research, and other investigation in regard to long term student health. Figure 4.8 below represents the visualization of perceptions by both male and female subjects regarding health behaviors and academic impact. 81 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.8 Male and female perception of stress and academic performance. This figure illustrates attitudes of male and female subjects regarding how mental health and stress management affect academic performance. RQ3: Student Perceptions on Institutional Health Programming & Efficacy An additional aim of the study was to examine the perceptions of students on the effectiveness and reach of institutional health programming on the four examined areas of student health behaviors. Subjects were asked a series of questions on each area within the interview protocols regarding their perception of the institution’s health programming. These findings illustrated both the positive and negative aspects of the institution’s current health 82 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR programming, as well as what student subjects perceive to be the biggest areas of opportunity to provide more relevant and effective health programming. Physical activity. Among the subjects, 100% have used or utilized the campus recreational facilities. As has been noted among other findings in regard to the research questions, time as a barrier to utilizing campus recreation resources is an issue for all research subjects interviewed. Four subjects recommended the campus recreation facility adopt a 24 hour structure which is a growing trend in the exercise industry. Half of the respondents indicated that they were dissatisfied with the number of group exercise classes and formal fitness programming by the institution. 37.5% of respondents suggested more informal recreation opportunities would be beneficial to motivating students to engage in PA on campus. 25% of subjects preferred additional studio space for individual workouts to avoid “gym intimidation”, which they identified as a barrier to engaging in a physical activity routine utilizing the campus recreation facilities. 75% of respondents felt that there were many options for PA on campus, but two respondents were quoted as feeling that campus-sponsored PA options were not “advertised” to the student population enough. One additional insight by a male subject was that “there should be more activities available for outside recreation” and that the campus outdoor recreation spaces could be improved upon. A final insight regarding student perceptions of institutional PA programming is that there could be more external (institutional) motivation for students to be physically active. Nutritional habits. In terms of institutional programming for nutrition, subjects were very vocal about their perceptions. 87.5% of subjects exclusively use campus dining facilities, and those same respondents typically opt for fast casual dining options on campus. Again, time (in 87.5% of the respondents) is a factor in choosing what dining option to utilize. Half of the 83 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR subjects indicated that the institution does not offer enough centrally located, fresh, fast casual dining options. More specifically, subjects indicated a lack of vegetarian and vegan-friendly options for fast casual dining. Subjects that used the main dining hall regularly (n=2) indicated that there are more vegetarian and vegan options, however, it is not set up as a fast casual option and time again plays a role as a barrier to student access to these meal options. 100% of subjects also indicated that the hours of operation for most fast casual or preferred dining options were restrictive and affected student meal choices and nutritional behaviors. Drug and alcohol usage. 100% of participants indicated that they had attended university-sponsored programming regarding alcohol and other drugs. This programming was mandatory either through orientation or for student organizations and Greek life. All subjects, via the mandatory training, were aware of campus resources on alcohol and other drugs, addiction services, and other resources. One subject had utilized campus resources in this regard, but only after a disciplinary referral. Several of the research participants indicated that they had observed the presence of the offices that manage alcohol and other drug interventions at student-focused campus events. Six of the subjects felt that the institution primarily focuses on a “reactive” alcohol and other drug strategy in terms of programming, and those four of the six subjects felt that a proactive attitude toward institutional alcohol and other drug programming and intervention may be more effective for their peers who are struggling with issues revolving around substance use, misuse, and abuse. Mental health and stress management. As has been evident throughout the findings of the research, stress and mental health of college students is a significant issue in terms of health and wellness and academic performance. It is surprising to the author to find that only 62.5% of subjects were aware that the institution offered resources that promoted stress management and 84 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR mental health for students. However, the incidence of use of those resources was 60%. This gap indicates that there is a lack of awareness and focus on dedicated student resources for mental health and positive stress management, yet, there is a need for it as a greater percentage of students most likely need to a) be aware of these resources, and b) would want or need to utilize them. All of the subjects indicated that they would prefer better marketed mental health services and programming, particularly in the areas of: time management (n=6), academic stress (n=7), and mental health and depression (n=4). Figure 4.9 below visually represents the perceptions of both male and female subjects on institutional health programming resource efficacy. 85 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.9 Attitudes on institutional health programming. This figure depicts male and female subject attitudes toward institutional health programming. RQ4: Obstacles, Barriers, and Motivators Influencing Perceptions of Health Behaviors and Change The grounded theory design of the study, and the lens to view perceived health behavior change were examined from a Social Cognitive Theory (SCT) interpretation. A secondary research aim was to attempt to identify theory-based reasoning for the perceived and actualized change of health behaviors among college students. As evidenced through the interview narratives of the participants, and actualized through the three-phased coding process, the researcher was unable to specifically endorse SCT as the primary function of change in perception and actual health behaviors. Rather, as explained further in this chapter in the “Manual Coding and Student Stress as Grounded Theory” section, the researcher observed tenets of several change theories within the participants’ narratives. Through the coding process, an alternative theory suggesting that student stress is the primary obstacle or barrier, as well as a motivator for influencing perceptions of health behavior change, and actualized change, emerged. Manual Sentiment Analysis In addition to the data analysis of the findings, manual sentiment analysis was conducted. The purpose of sentiment analysis is to identify and categorize expressed opinions in order to determine attitudes toward a particular attribute as positive, negative, or neutral (Thelwall, Buckley, Paltoglou, Cai & Kappas, 2010). This was completed manually by the researcher, as was the data analysis, utilizing field notes, audio files, and transcription of the audio file 86 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR interviews. The researcher then classified the overall sentiment for each health behavior based on total respondent sentiment. Physical activity. Physical activity was found to have an overall positive sentiment by the subjects. Respondents typically mentioned positive sentiments such as “enjoy working out”, physical activity being “activities I really enjoy”, and that working out “makes me feel good”. One subject indicated that they had positive mental health aspects from PA, saying “I feel better mentally after working out”. This positive sentiment was seen in both male and female subjects equally. This positive sentiment shows that research subjects were generally inclined to enjoy or have positive associations with their physical activity routine. Figure 4.10 below visually represents combined male and female sentiment analysis of physical activity. 87 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.10 Sentiment analysis: physical activity. This figure depicts male and female subject sentiment analysis toward physical activity. Nutritional habits. The sentiment toward nutritional habits was overall negative. Respondents typically “don’t like to cook”, or felt that health food “costs too much”. As was previously discussed, food security played a role in the sentiment analysis of nutrition. One participant was found to say that food insecurity “makes me feel worse about my eating habits”, while another mentioned that they “hate that I can’t afford the food I want”. One of the main differences between male and female participants in this regard is that female respondents typically “felt pressure to crash diet” and had other negative connotations around weight management and dieting. This led to an overall negative sentiment toward nutritional habits. 88 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.11 below visually represents combined male and female sentiment analysis of nutritional habits. Figure 4.11 Sentiment analysis: nutrition. This figure depicts male and female subject sentiment analysis toward nutrition and eating behaviors. Drug and alcohol usage. In analyzing the sentiment toward alcohol and other drugs, both male and female respondents had a neutral sentiment. Most respondents were “indifferent to weed” and felt that the level of alcohol and other drug usage on campus was “no big deal”. This general indifference to substance use was evident throughout all of the subjects, leading to the neutral sentiment among participants. The one exception across all demographics is a negative sentiment toward tobacco use. Six of eight subjects were quoted as saying “I hate 89 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR smoking” in reference to tobacco products. Figure 4.12 below visually represents combined male and female sentiment analysis of drug and alcohol usage. Figure 4.12 Sentiment analysis: alcohol and other drugs. This figure depicts male and female subject sentiment analysis toward alcohol and other drugs. . Mental health and stress management. As has been expressed throughout the data, a negative sentiment toward mental health and stress was evident in the sentiment analysis. Five subjects were quoted as “having anxiety is bad for me”, while six of the subjects said “I am very stressed”. Others expressed feelings of loneliness and sadness, all of which contributed to a negative sentiment toward current mental health and stress perceptions of the research cohort. 90 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.13 below visually represents combined male and female sentiment analysis of mental health and stress management. Figure 4.13 Sentiment analysis: mental health and stress. This figure depicts male and female subject sentiment analysis toward mental health and stress management. Manual Coding and Student Stress as Grounded Theory The manual coding process, while very labor intensive, provided the researcher with a clear view and review of the triangulated qualitative data. This process enabled the researcher to code, re-code, and assemble the data, and provided a hands-on opportunity to analyze and synthesize the data. Through the initial open coding phase, 156 main data points were identified. 91 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Additionally, another 81 sub-main data points were identified within this initial open coding phase. With this data identified the researcher was able to then begin the axial coding phase. Once the axial coding phase was completed, all 237 data points were able to be grouped into seven main themes. During the last phase, selective coding, the author was able to identify Student Stress and Causes as the main theme that emerged, and relate the other themes from axial coding to it. From there, the emergence of the grounded theory, by design, occurred. Open coding. For the open coding process to occur, the researcher intended to identify specific data points that could be used, by health behavior, to begin to flesh out the data. These points were identified after the transcription of the audio interviews in conjunction with the field notes. Most noticeably, “quotables” or short data points directly taken from transcribed interview quotes, as well as tone, intention, and explicated points from the field notes were used to help identify the data points. In all, 237 main data points from the open coding process were identified. 156 of these were what the author deemed “major” data points or main ideas. An additional 81 sub “major” data points, typically explanations or other quotes supporting those main data points, were identified in the open coding process. These main and sub major data points comprised the extractable data points. During the end of the open coding phase, the researcher identified 11 possible “pre-themes” to be used in the axial coding phase. However, there was considerable overlap of some of the 237 data points among these 11 “pre-themes”. Thusly, for consideration of the axial coding phase, a portion of that would be dedicated to streamlining the main themes and classifying the data points accordingly. Axial coding. In the axial coding phase, the researcher first sought to narrow the eleven “pre-themes” identified in the open coding phase for more accurate naming and to better align the data in order for the remainder of the grounded theory process to take place, namely the final 92 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR phase of selective coding. Eventually, the data was codified into seven distinct categories of themes: Motivations to Change, Obstacles and Barriers, Influencers, Factors and Causes of Student Stress, Perception Changers, Learned Perceptions, and Perception of Health Benefits to GPA. While there were instances of data points fitting both or multiple categories, the researcher was able to narrow the data to these seven categories to better streamline the findings of the qualitative aspects of the research. Motivations to Change specifically looked at the data points that indicated intrinsic and external factors that would have or had motivated for behavior change among participants. Obstacles and Barriers categorized any perceived issues that prevented the subjects from engaging in or access to a specific health behavior. Influencers categorized the perceptions of subjects in regard to factors that contributed to motivation, but were not necessarily named as motivators by the subjects. For instance, the author deemed that social media acted more as an influencer to health behaviors, based on subject responses, more so than a motivator to change. This category in and of itself may make for future exploration via additional research regarding the sphere of influence on college student health behaviors. Factors and Causes of Student Stress categorized all of the data points that led to, contributed to, or were perceived to contribute to the concept of stress for subjects, as well as any of the stress triggers identified in the open coding process. Perception Changers categorized any of the data points uncovered through the interview protocols that indicated or suggested reasoning behind subjects changing or altering health behavior or perception of heath behavior from the first protocol to the second protocol. Learned Perceptions categorized the data points observed that explained or contributed to existing perceptions of the subjects across all of the health behaviors examined. Lastly, the Perception of 93 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Health Benefits to GPA category collected all the data points that dealt with student perceptions of health behaviors impacting academic performance. As these finalized categories emerged, the ability to relate them to each other, and to pull out a main category to selectively codify the data was evident. From there, the researcher was able to utilize these categories in the selective coding process. Selective coding. Within the selective coding process, it was evident that the recurring factor that fit into nearly all seven categories was the concept and factors surrounding student stress. As such, Factors and Causes of Student Stress was selected as the main category theme, and then all other categories were related to it. The Influencers category was related as a subcategory of Motivations to Change, as there was significantly shared data, yet enough distinct data to keep Influencers as its own category. It became evident through the selective coding process that student stress, the triggers of student stress, and the effects of student stress occur throughout all of the examined health behaviors, and that this stress may be the biggest factor that influences how college students engage in health behaviors and how their perceptions of and actualized health and wellness are met. Because of these findings, the author posited the Student Stress Theory as emergent from the grounded theory design of the study. Emergence of student stress theory. As the evidence of stress became present among all of the respondents across all of the health behaviors within both interview protocols, and through the categorization in the axial and selective coding processes, the concept of the Student Stress Theory on Health Behaviors emerged. The study conducted was designed to specifically find and determine how college student health behaviors affect academic performance as well as what causes or contributes to health behavior changes among college students. It is evident that through the research, in regards to the first aim of the study, academic stress can impede upon or 94 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR affect other health behavior areas. Student stress can have both a direct and indirect impact upon academic performance as viewed through health behaviors. In regard to the second aim of the study, it became evident that behavior change in college students could not be attributed to one singular theory. There were aspects of Bandura’s original concepts of SCT in some of the subject’s behavior changes, yet there also were tenets of the TTM, Skinner’s learning theories, and even some aspects of reasoned action, particularly in behaviors regarding alcohol and other drugs. However, for the purposes of this grounded theory design, the author observed that stress mechanisms impacted and affected the health behavior changes in the research subjects. Such examples included academic stress impeding upon physical activity routine time, or time as a stress mechanism affecting or changing eating behaviors. With this considered, the author is confident in the establishment and continued examination of the Student Stress Theory on Health Behaviors. Defined, the author posits that college students experience a significant amount of stress from a variety of sources and stress triggers and mechanisms. This affects the perceptions, characteristics, and engagement in individualized college student health and wellness, particularly in health behaviors. Because of these stress mechanisms, health and wellness behavior changes, both intentionally and unintentionally. This finding is aligned with other findings of stress on student performance and stress affecting wellness in other studies examining the role of stress in academic performance of college students and college students wellness (Conlye, Travers, & Bryant, 2012; El-Ghoroury, Galper, Sawaqdeh, & Burfka, 2012; Godbey & Courage, 1994; Sanders & Lushington, 2002). Visual depiction of the emergence of the selective coding hierarchy is seen below in figure 4.14. 95 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Figure 4.14 Visualization of selective coding. This figure represents the major findings and themes in the selective coding process of data analysis. Evaluation of the Findings The finding of what the real perceptions of college students in relation to their health behaviors are, how they emerge, and how they are influenced by the stressors of being in college are the significant discoveries from this dissertation research. The author believes that due to the research design and methodology, as well as the steps taken to ensure a limit in researcher and participant bias. By using member checking on demographic data, data triangulation with the narrative data obtained through the interview protocols, the makeup of the sample size, and a certain degree of data saturation indicate that the dissertation research can be assessed as trustworthy, reliable, and internally valid. Conversely, the lack of a concrete narrative of data explaining the phenomena of how and why college student health behaviors are acquired is 96 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR disappointing toward answering one of the key research questions in this study. However, even with that shortcoming, the opportunity to further specifically study the motivations for how those behaviors are acquired exists, and exploration of that particular niche of the health and wellness field is important to the development of the research body. The overall findings and the emergence of the student stress theory are significant result of the study in that they allow for future further research, as well as for practical use for higher education administration professionals, particularly those in student affairs, student services, and student wellness fields. This study does offer valuable information for evidence-based practitioners in health leadership, as well as evidence-based thinkers in higher education administration, to apply strategies to help with student success, student retention, student recruitment, and student health and wellness outcomes. Summary In summation, a carefully planned, grounded-theory design was executed as a dissertation research project. The conducting of the study was done with certain checks and balances incorporated into the design and in the research functions, particularly in the interview protocols, to ensure a high degree of trustworthiness, reliability, and transferability of the study and the narrative data. The analysis of the narratives that emerged from the interview protocols showed generally positive perceptions of students toward health. Many similarities in student perceptions of their health behavior exist among gender, with some differences between male and female students. Narrative analysis of how health behaviors are acquired by college students was largely inconclusive in terms of an emerging grounded theory, with some elements of different models 97 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR of change observed through the interview process. The study also showed a generally positive sentiment from the participants toward most health behavior areas explored, with the exception of stress. Through the coding phases of the narrative analysis in the grounded theory design, a new theory, Student Stress Theory on Health Behaviors, materialized. This theory posits that college students have many stressors, and these stressors can influence the perceptions of health behaviors, actualized health and wellness engagement, and academic performance in college students. 98 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR CHAPTER V DISCUSSION, SUGGESTIONS FOR FUTURE RESEARCH, AND CONCLUSION The importance of examining college student health behaviors continues to remain important to various constituents in higher education: the students themselves, parents and families, institutional administrators and managers, and higher education policy makers and thought leaders, among others. As has been evidenced through the review of the literature, as well as the conducting of the qualitative study discussed in this dissertation, understanding how health behaviors are shaped, as well as the factors that influence health behavior decisions, behavior change, and the affect that these health behaviors can have on academic performance and mental health aspects of wellness is key to creating services, programming, and solutions that focus on positive stress management toward health behavior outcomes and student success. Further exploration of student stress management and its implications across multi-dimensional wellness is needed to better understand and identify theoretical knowledge and outcomes, as well as to create practical, easily implemented solutions to better serve the health and wellness needs of college students across all institutions. Implications The qualitative grounded theory study conducted and described in this dissertation set about to meet certain research aims, primarily: to assess college student health behaviors and habits, and the perceptions of college students on how these behaviors affect individual academic performance; to interpret student perceptions on the effectiveness and quality of university health programming education; and to interpret and analyze the factors that cause or contribute to 99 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR individual college student behavior change regarding health habits. These aims at the start of the project were quite broad and the author assumed that the study would turn out exact data satisfying these aims definitively. As can often be the case in research, the author’s plan did not exactly work out as planned. Student health behaviors and habits were assessed, while exploration of individuals’ behaviors and their interpretation of the effect on academic performance was also assessed. Student subjects’ interpretation of the institutional effectiveness of its health programming was also examined, and the factors that could cause health behavior change were also examined. However, the findings within the study were not of the expectation of the author. Ideally, the dissertation research would have provided keen insight to the above, and via the grounded theory approach, an entirely new theory on what motivates behavior change in college students would have emerged. That did not happen. But, a much needed qualitative study in applied exercise science was conducted that helps to contribute to the existing literature and provide a roadmap for future areas of research. The author uncovered certain findings that lend credence to a number of existing theories and research. The study identified that college students are somewhat aware of how certain health behaviors could impact academic performance. The author uncovered that student needs in terms of health programming are not always met, even when an institution can tout state of the art facilities. The study also discovered that stress and stress mechanisms affect multiple dimensions of college student health and wellness, and yet the mental health resources available to students may be some of the most underutilized and ill-marketed services to students, yet the most needed. The motivations to change health behaviors among college students is still unresolved, however, the study has shed light that a number of theories or aspects of theories could be 100 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR applied to health behavior change among college students. While the research conducted could not be considered ground breaking by any means, it does contribute to the wealth and breadth of knowledge regarding college students, and their perceptions about health and wellness at a prime point in their human development. Recommendations for Practice and Future Research Because of the findings of this research, there are several areas of suggestions for future research to be conducted. Further research on what motivates or causes health behavior change is most definitely warranted. Since there are so many models of behavior change in existence, a more dedicated and focused area of research to this end would be beneficial in informing exercise science, allied health, higher education, and other evidence-based practitioners of how college students make health-behavioral based changes. This can help further inform institutional programming and education and outreach regarding health and wellness outcomes. In terms of further research in how health behaviors affect academic performance, quantitative, qualitative, and mixed-methods opportunities may exist that can examine the academic impact of health behavior engagement, and that research can focus on specific behaviors in more detail. For instance, mixed-methods research of implementing the quantitative NCHA at an institution combined with qualitative follow up could help to really determine the impact of certain health behaviors on areas such as attendance, test scores, and overall GPA. This exploration in the research could provide better insight for institutional programming in terms of academic success, as well as in terms of creating effective institutional programming. With regard to the emergence of the student stress theory from the grounded research design, further research can be done to examine stressors on individual health behaviors, or overall multi-dimensional college student wellness, and stress mechanisms. This research could 101 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR potentially examine the academic effects of stress, stress-altered behaviors, stress management programming, stress and multi-dimensional wellness in college students, or other areas similarly related. Additional research could be completed examining the extent that the proposed student stress theory affects health and wellness of college students. In all, this completed study has contributed to the body of literature examining college students, their health and wellness, and academic performance. From there, this study can and does serve as a springboard for a myriad of further exploration and research to better understand college students, their health and wellness, and its interaction with academic performance. Conclusion This study examining college student perceptions of their health behavior, the interactions of health behavior and academic performance, health behavior change, and effective institutional health programming has utilized the existing literature base to add new evidence and theoretical knowledge to the field. With this study and the emergence of the Student Stress Theory on Health and Academic Performance, findings on health behavior change among college students, perceptions on institutional health programming, and student perceptions of health behaviors and impact on academics, the author believes that a significant step in furthering the field of college student health and wellness research has been made. By identifying real issues regarding the effect of student stress upon multi-dimensional wellness and theoretical application of how stress affects student wellness, gaps in institutional health programming and student wants and need, and a further exploration of the motivators behind health-related behavior change among college students, this study has been productive in providing future researchers the opportunity to delve into more depth and breadth in 102 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR understanding how the formative and human development related roles that higher education and college play upon the lives, the health, and the multidimensional wellness of college students. The research conducted in this investigation can, and will hopefully, be used to strategically improve the quality of institutional health education programming and outreach, inform campus thought leaders on the importance of effective stress management programs, and identify strategic areas of student multidimensional wellness that can have important impact on improving outcomes, managing student stress, and improving the overall health and wellness of college students at the institution. The gaps left by this research and the new research questions that may arise from it, such as how health behavior changes in college students are motivated, will help to better serve the field of applied exercise science and perhaps stem future multimethod research and further theoretical and practical applications. The author hopes that future research can improve upon the design, replicate the findings, and theoretically help to improve and understand the effects of stress on academics as well as multidimensional wellness of college students. 103 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Appendices Additional Methodology 104 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Appendix A Electronic Recruitment Messaging 105 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Attention Students! Volunteer to take part in important research on college students and their health! Cal U undergraduate students are needed as volunteers to take part in a brief two-part interview about their health behaviors and how it relates to their lifestyle and academic performance. Questions will include student feedback on physical activity, nutrition, drugs and alcohol, and stress. Help be a part of doctoral research that can make health education programming on campus better and more effective! Interested students should be: • Attending Cal U for more than 1 year • Live on campus or commute • Enrolled at least part time as an undergraduate student • Consent to be a volunteer participant Students interested in participating should contact the main researcher, Ryan Barnhart, via email at barnhart_r@calu.edu. Thank you in advance for your interest in helping to complete this research! 106 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Appendix B Informed Consent 107 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR INFORMED CONSENT RELEASE Consent for participation in Interview Research Nature of the Interview, Interview Setting and Use of Data The proposed interview research: College Student Perceptions of Health Behavior, Academic Performance, and Behavior Change is to gain insight into the perceptions of California University of Pennsylvania students regarding their health behaviors including physical activity habits, nutritional habits, attitudes on drug and alcohol use, and stress management coping mechanisms, and how they relate to the individual’s academic performance. The data collected through a demographic data sheet and audio-recorded interviews will be used for qualitative analysis and coding of themes and categories. Recordings will occur in a secured classroom or other similar secure location on campus. The interview will be conducted in a one-to-one format. The interviewer will work with necessary campus staff and public safety to ensure a secure, safe interview setting. Should inadvertent background recording of others occurs, the audio records will be destroyed and discarded, and the interview will be rescheduled after the setting has been secured. This study is approved by the California University of Pennsylvania Institutional Review Board. This approval is effective 2/10/19 and expires 2/9/20. Primary Researcher The Primary Researcher for this project is Ryan Barnhart, MS, a doctoral candidate in the Doctor of Health Science program at California University of Pennsylvania, conducting doctoral dissertation research. Mr. Barnhart can be contacted for any and all questions regarding the project at 724.98.8013 by call or text, 724.938.5883 by call, or by email at barnhart_r@calu.edu. The faculty advisor for this research proposal is Dr. Brian Oddi, oddi@calu.edu. Voluntary Participation Notice 108 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Any and all participation in this proposed study is voluntarily assumed by the student. Participation in this study may be discontinued at any time without penalty. If participant chooses to discontinue, all data will be properly discarded by the primary researcher. Confidentiality and Anonymity Notice All data and collected from the interview process including interview and demographic data will remain confidential and all results reported will be anonymous. Identity will be protected during both the interview and analysis process by the non-use of any identify determining data points throughout the process. Minimal Risk Notification The researchers affirm that minimal risk to the participant is anticipated, defining minimal risk to be a minimal emotional risk given the nature of the interview questions regarding personal health behaviors. The perceived risk of discussing and interviewing students regarding current health practices and academic performance has the potential to pose a minimal risk to subject emotional wellness due to the nature of the interview questions. However, the researcher has carefully crafted the information collection tools to reflect positively on the subjects’ emotional wellness. The benefit of the research stands to provide guidance and insight on how positive health behavior change may be affected in college student populations, as well as providing areas of opportunity for return on investment of institutional resources related to health education programming. All written and electronic data results will be password-encrypted and maintained on the University’s secure servers. The researcher will take steps to keep personally identifiable information confidential by storing identification and research data secure and separate through randomly assigned numeric values. Participation as Consent 109 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR In addition to this form, the participant completing the interview process is an indication of their consent to use the data for further research reports and/or presentation where the individual’s identity will remain anonymous. Data Protection and Data Use All physical data results will be housed under lock and key on the Cal U university property in the primary researcher’s organizational unit, with the primary researcher having sole access. All electronic data results will be password-encrypted and maintained on the University’s secure servers. The audiotaped recordings will be digitally secured through a password-encrypted file on my university one drive account. Once the study is complete, the recordings will be destroyed. The recordings will not be re-used for presentations or other research, however, selected parts of transcripts and quotations from the recordings may be used in presentations related to the dissertation defense. Detailed Informed Consent and Recoding Release for Participation in Interview Research I volunteer to participate in a research project coordinated by Mr. Ryan Barnhart from California University of Pennsylvania. I understand that the project is designed to gather information about student health behaviors on campus. I will be one of approximately 15 people being interviewed for this research. After having read the above, I understand that: 1) My participation in this project is voluntary, and that I may withdraw and discontinue participation at any time without penalty. If I decline to participate or withdraw my participation, no one on my campus will be informed. 2) I understand that most interviewees will find the discussion interesting and thoughtprovoking. If, however, I feel emotionally uncomfortable in any way during the 110 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR interview session, I have the right to decline to answer any question or to end the interview. 3) Participation involves completing a demographic data sheet and being interviewed twice by Mr. Ryan Barnhart, the primary researcher, a doctoral student at California University of Pennsylvania. Each interview will last approximately 30-45 minutes. Notes will be written during the interview. An audio tape of the interview and subsequent dialogue will be made. If I don't want to be audiotaped, I will not be able to participate in the study. By signing this form, I understand and consent to the use and release of the recording for data encoding and accuracy checking, and will not in any way be distributed or used in any further presentation of the research. I understand that the information and recording is for research purposes only and that my name and image will not be used for any other purpose. I relinquish any rights to the recording. 4) I understand that the researcher will not identify me by name in any reports using information obtained from this interview, and that my confidentiality as a participant in this study will remain secure. Subsequent uses of records and data including interview notes and audiotape and demographic data will be subject to standard data use policies which protect the anonymity of individuals and institutions. 5) Faculty and administrators from my campus will neither be present at the interview nor have access to raw notes, audiotapes, or transcripts of this information. This precaution will prevent my individual comments from having any negative repercussions. 6) I have read and understand the explanation provided to me. I have had all my questions answered to my satisfaction, and I voluntarily agree to participate in this study. 7) I have been given a copy of this consent form. 111 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR My Signature My Printed Name For further information, please contact: Ryan Barnhart barnhart_r@calu.edu 724.938.5883 724.984.8013 Date Signature of the Investigator 112 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Appendix C Demographic Data Sheet 113 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Demographic Information Collection Tool (Appendix C3) Participant # ____________________________________________________________ Age in years_________________ Class standing (Eg. FR, SO, JR, SR)___________ To which gender identity do you most identify? _____Female _____Gender Variant/Non-Conforming _____Male _____Not Listed (if not listed, please _____Transgender Female identify:_____________________) _____Transgender Male _____Prefer Not to Answer Ethnic Origin: Please specify your ethnicity: _____Asian/Pacific Islander _____Hispanic or Latino _____Native American or American Indian ______White _____Black or African American ______Other What is your current living situation? Please choose from the following: ______Live in campus housing alone ______Live in campus housing with roommate(s) ______Live off campus alone (apartment, house, etc.) ______Live off campus with roommate(s) ______Live at home with family 114 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Have you previously taken a college-level health and/or wellness course? ______Yes _____No Have you previously attended a campus health/wellness event, such as the health fair? ______ Yes _____No Please list any and all activities involved with on campus. Please include all clubs, organizations, fraternities or sororities, intramurals, etc. that apply. 115 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Appendix D Initial Interview Protocol 116 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Perceptions of Physical Activity Habits 1) How would you define physical activity? 2) Do you have a physical activity routine? If yes, what does it consist of? If no, why do you currently not participate in physical activity? 3) What factors would or have influenced you to make a decision to begin a physical activity routine or be physically active? 4) Have you ever used campus facilities for physical activity? If yes, which facilities and for what? If no, why not? If no, are there any physical/recreational activities you wish were offered that you would participate in? 5) Do you think that your physical activity has an effect on your academic performance? If yes, why? If no, why not? 6) Do you use social media to find information or interact with others regarding physical activity? If yes, which accounts/platforms? If no, why not? Perceptions of Eating Habits 1) How would you describe your eating habits? What do you eat? 2) What factors influence how and what you eat? 3) Have you ever used campus dining facilities? If yes, which dining options do you eat at most often? If no, why not? 4) Do you think that eating habits have an effect on your academic performance? If yes, why? If no, why not? Perceptions of Substance use, abuse, misuse 1) What type of drugs/alcohol do you think are used most often on campus? 117 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR 2) What are the assumptions/beliefs about drug use among your peers? What are the reasons for using/abusing drugs? 3) What are the assumptions/beliefs about alcohol use among you and your friends? 4) What influences college students to smoke cigarettes (i.e., tobacco)? What are the beliefs about smoking on campus within your friend group? 5) Have you ever participated in any university programming that discusses drug/alcohol/substance use? If so, what programs or events? If no, why not? 6) Do you think that substance use has an effect on academic performance? If yes, why? If no, why not? 7) How do you perceive the drinking/drug culture on campus? Do you think it is prevalent, a problem, or no big deal? Why? Perceptions of Stress management 1) In your own words, how would you define stress? 2) Do you or have you ever felt stressed? If so, why? If not, why not? 3) Have you ever used any university resources for mental health or coping with stress? If yes, which resources? If no, why not? 4) What do you do in order to cope with stress? Where did you learn to cope with stress in this manner? 5) Do you think that stress has an effect on your academic performance? If yes, why? If no, why not? 118 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Appendix E Follow-up Interview Protocol 119 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Perceptions of Physical Activity Habits 1) Has your definition of physical activity changed? If yes, why? If no, why not? 2) Have you made any changes to your physical activity routine? If yes, why? If no, why not? 3) If you began a physical activity routine, what factors caused you to do so? 4) Do you feel that changes in your physical activity routine have affected your academic performance? 5) Do you think the physical activity programming available to students is adequate? Why or why not? Perceptions of Eating Habits 1) Do you feel that you have made any changes to what you eat? If yes, why? If no, why not? 2) Have any factors influenced what you eat? If yes, which factors? If no, why not? 3) Do you think that any changes to your eating habits have had an effect on your academic performance? If yes, why? If no, why not? Perceptions of Substance use, abuse, misuse 1) Have you had any changes in perception on the use of alcohol, tobacco, or other drugs by college students on campus? If yes, why? If no, why not? 2) Do you think that your change in perception has affected your academic performance? If yes, why? If no, why not? Perceptions of Stress management 1) Have you changed or started a technique to manage stress? If yes, why? If no, why not? 120 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR 2) Do you think that changes in how you manage stress has had an effect on your academic performance? If yes, why? If no, why not? 121 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Appendix F Completed IRB Forms 122 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Proposal ProposalNumber Number #18-044 DateReceived Received Date 2/1/2019 IRB Review Request Institutional Review Board (IRB) approval is required before beginning any research and/or data collection involving human subjects Submit this form to instreviewboard@calu.edu or Campus Box #109 Project Title: College Student Perceptions of Health Behavior, Academic Performance, and Behavior Change: A Dissertation Researcher/Project Director Phone # Ryan Barnhart 724.984.8013 E-mail Address Faculty Sponsor (if researcher is a student) Department barnhart_r@calu.edu Dr. Brian Oddi Exercise Science and Sport Studies Anticipated Project Dates 1/15/19 to 12/15/19 Sponsoring Agent (if applicable) Project to be Conducted at Project Purpose: California University of Pennsylvania Thesis Research Class Project Keep a copy of this form for your records. Other - Dissertation 123 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Required IRB Training All researchers must complete an approved Human Participants Protection training course. The training requirement can be satisfied by completing the CITI (Collaborative Institutional Training Initiative) online course at http://www.citiprogram.org New users should affiliate with “California University of Pennsylvania” and select the “All Researchers Applying for IRB Approval”course option. A copy of your certification of training must be attached to this IRB Protocol. If you have completed the training within the past 3 years and have already provided documentation to the IRB, please provide the following: Previous Project Title Date of Previous Project IRB Approval 124 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Please attach a typed, detailed summary of your project AND complete items 2 through 6. 1. Provide an overview of your project-proposal describing what you plan to do and how you will go about doing it. Include any hypothesis(ses)or research questions that might be involved and explain how the information you gather will be analyzed. All items in the Review Request Checklist, (see below) must be addressed. 2. Section 46.11 of the Federal Regulations state that research proposals involving human subjects must satisfy certain requirements before the IRB can grant approval. You should describe in detail how the following requirements will be satisfied. Be sure to address each area separately. (text boxes will expand to fit responses) a. How will you insure that any risks to subjects are minimized? If there are potential risks, describe what will be done to minimize these risks. If there are risks, describe why the risks to participants are reasonable in relation to the anticipated benefits. The risks of the study are minimal. The research does not include any testing/protocols that present any harm to the subject. Participation is voluntary and may be discontinued at any time without penalty. Subjects will be interviewed regarding specific health behaviors: physical activity, nutrition, drug and alcohol use, and stress management. The perceived risk of discussing and interviewing students regarding these current health practices and academic performance has the potential to pose a minimal risk to subject emotional wellness due to the nature of the interview questions. However, the researcher has taken steps to carefully craft the demographic data sheet (Appendix C3), initial interview (Appendix C4), and follow up interview (Appendix C5) questions to reflect positively on the subjects’ emotional wellness. The benefit of the research stands to provide guidance and insight on how positive health behavior change may be affected in college student populations, as well as providing areas of opportunity for return on investment of institutional resources related to health education programming. Subject data will be securely housed and only accessible by the researcher and research adviser. Audio recordings and their transcripts, which may be personally identifiable, will be kept and maintained confidentially by assigning a random subject number to de-identify file names and associated subjects, and subject names and subject identification numbers will be kept separately in separate secure, password encrypted files on the researcher’s university one drive. Recordings will occur in a secured classroom or other similar secure location on campus. The interview will be conducted in a one-to-one format. The interviewer will work with necessary campus staff and public safety to ensure a secure, safe interview setting. Should inadvertent background recording of others occurs, the audio records will be destroyed and discarded, and the interview will be rescheduled after the setting has been secured. 125 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR All written and electronic data results will be password-encrypted and maintained on the University’s secure servers. The researcher will take steps to keep personally identifiable information confidential by storing identification and research data secure and separate through randomly assigned numeric values. b. How will you insure that the selection of subjects is equitable? Take into account your purpose(s). Be sure you address research problems involving vulnerable populations such as children, prisoners, pregnant women, mentally disabled persons, and economically or educationally disadvantaged persons. If this is an in-class project describe how you will minimize the possibility that students will feel coerced. To insure that the selection of subjects is equitable, subject selection/participation will be voluntary in nature. Recruitment for inclusion in the research will be open and selection or inclusion is non-discriminatory. All potential subjects will be provided with informed consent regarding the research. In an effort to provide equity in the recruitment and selection of subjects, the research project and call for participants will be announced through the university email and other electronic forms of communication that reaches all students (Appendix C1), as well as in person recruitment at the Natali Student Center. This provides and equal opportunity for students to be informed of the call for subjects and to participate using purposeful sampling. As the selection would be open, randomization would not be completed. c. How will you obtain informed consent from each participant or the subject’s legally authorized representative and ensure that all consent forms are appropriately documented? Be sure to attach a copy of your consent form to the project summary. Consent would be obtained at the time of the initial interview with interested participants by signing the consent form as noted in Appendix C2. Participation of the sample would be free of any coercion or undue influence from the researcher. Informed consent will be provided electronically and in writing to participants at the time of response to the solicitation for subjects during the initial meeting. Please see informed consent release section of the attached project-proposal overview (see Appendix C2). d. Show that the research plan makes provisions to monitor the data collected to insure the safety of all subjects. This includes the privacy of subjects’ responses and provisions for maintaining the security and confidentiality of the data. 126 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR In regard to the safety of all subjects through data collection, all data including audio files, transcription, and physical and digital copies of demographic data will be secured. Physical files will be secured in the researcher’s locked office in Kara Alumni House. Only the researcher and research adviser will have access to the physical data files. Electronic files will be password-secured on the university’s secured internal user drive with only access allowed to the researcher and the research adviser. Both interview and demographic data will contain some confidential personal identifiers such as name and voice. However, demographic indicators such as age, rather than birth, and other demographic factors that are not HIPAA identifiers will be collected, which will also minimize the risk of access to private subject information. Recordings will occur in a secured classroom or other similar secure location on campus. The interview will be conducted in a one-to-one format. The interviewer will work with necessary campus staff and public safety to ensure a secure, safe interview setting. Should inadvertent background recording of others occurs, the audio records will be destroyed and discarded, and the interview will be rescheduled after the setting has been secured. All written and electronic data results will be password-encrypted and maintained on the University’s secure servers. The researcher will take steps to keep personally identifiable information confidential by storing identification and research data secure and separate through randomly assigned numeric values. 3. Check the appropriate box(es) that describe the subjects you plan to target. Adult volunteers Mentally Disabled People CAL University Students Economically Disadvantaged People Other Students Educationally Disadvantaged People Prisoners Fetuses or fetal material Pregnant Women Children Under 18 Physically Handicapped People Neonates 127 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR 4. Is remuneration involved in your project? 5. Is this project part of a grant? Yes or Yes or No No. If yes, Explain here. If yes, provide the following information: Title of the Grant Proposal Name of the Funding Agency Dates of the Project Period 6. Does your project involve the debriefing of those who participated? Yes or No If Yes, explain the debriefing process here. 7. If your project involves a questionnaire orinterview, ensure that it meets the requirements indicated in the Survey/Interview/Questionnaire checklist. 128 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR California University of Pennsylvania Institutional Review Board Survey/Interview/Questionnaire Consent Checklist (v021209) This form MUST accompany all IRB review requests Does your research involve ONLY a survey, interview or questionnaire? YES—Complete this form NO—You MUST complete the “Informed Consent Checklist”—skip the remainder of this form Does your survey/interview/questionnaire cover letter or explanatory statement include: [x_] (1) Statement about the general nature of the survey and how the data will be used? [x_] (2) Statement as to who the primary researcher is, including name, phone, and email address? [_x] (3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information provided? [x_] (4) Statement that participation is voluntary? [x_] (5) Statement that participation may be discontinued at any time without penalty and all data discarded? [x_] (6) Statement that the results are confidential? [x_] (7) Statement that results are anonymous? [_x] (8) Statement as to level of risk anticipated or that minimal risk is anticipated? (NOTE: If more than minimal risk is anticipated, a full consent form is required—and the Informed Consent Checklist must be completed) [x_] (9) Statement that returning the survey is an indication of consent to use the data? [_x] (10) Who to contact regarding the project and how to contact this person? [x_] (11) Statement as to where the results will be housed and how maintained? (unless otherwise approved by the IRB, must be a secure location on University premises) [x_] (12) Is there text equivalent to: “Approved by the California University of Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and expires mm/mm/mm”? (the actual dates will be specified in the approval notice from the IRB)? [N/A_] (13) FOR ELECTRONIC/WEBSITE SURVEYS: Does the text of the cover letter or explanatory statement appear before any data is requested from the participant? 129 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR [N/A_] (14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue participation at any point in the process and all data is immediately discarded? 130 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR California University of Pennsylvania Institutional Review Board Informed Consent Checklist (v021209) This form MUST accompany all IRB review requests Does your research involve ONLY a survey, interview, or questionnaire? YES—DO NOT complete this form. You MUST complete the “Survey/Interview/Questionnaire Consent Checklist” instead. NO—Complete the remainder of this form. 1. Introduction (check each) [_] (1.1) Is there a statement that the study involves research? [_] (1.2) Is there an explanation of the purpose of the research? 2. Is the participant. (check each) [_] (2.1) Given an invitation to participate? [_] (2.2) Told why he/she was selected. [_] (2.3) Told the expected duration of the participation. [_] (2.4) Informed that participation is voluntary? [_] (2.5) Informed that all records are confidential? [_] (2.6) Told that he/she may withdraw from the research at any time without penalty or loss of benefits? [_] (2.7) 18 years of age or older? (if not, see Section #9, Special Considerations below) 3. Procedures (check each). [_] (3.1) Are the procedures identified and explained? [_] (3.2) Are the procedures that are being investigated clearly identified? [_] (3.3) Are treatment conditions identified? 4. Risks and discomforts. (check each) [_] (4.1) Are foreseeable risks or discomforts identified? [_] (4.2) Is the likelihood of any risks or discomforts identified? [_] (4.3) Is there a description of the steps that will be taken to minimize any risks or discomforts? [_] (4.4) Is there an acknowledgement of potentially unforeseeable risks? [_] (4.5) Is the participant informed about what treatment or follow up courses of action are available should there be some physical, emotional, or psychological harm? [_] (4.6) Is there a description of the benefits, if any, to the participant or to others that may be reasonably expected from the research and an estimate of the likelihood of these benefits? [_] (4.7) Is there a disclosure of any appropriate alternative procedures or courses of treatment that might be advantageous to the participant? 5. Records and documentation. (check each) [_] (5.1) Is there a statement describing how records will be kept confidential? [_] (5.2) Is there a statement as to where the records will be kept and that this is a secure 131 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR location? [_] (5.3) Is there a statement as to who will have access to the records? 132 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR 6. For research involving more than minimal risk (check each), [_] (6.1) Is there an explanation and description of any compensation and other medical or counseling treatments that are available if the participants are injured through participation? [_] (6.2) Is there a statement where further information can be obtained regarding the treatments? [_] (6.3) Is there information regarding who to contact in the event of research-related injury? 7. Contacts.(check each) _] (7.1) Is the participant given a list of contacts for answers to questions about the research and the participant’s rights? [_] (7.2) Is the principal researcher identified with name and phone number and email address? [_] (7.3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information provided? 8. General Considerations (check each) [_] (8.1) Is there a statement indicating that the participant is making a decision whether or not to participate, and that his/her signature indicates that he/she has decided to participate having read and discussed the information in the informed consent? [_] (8.2) Are all technical terms fully explained to the participant? [_] (8.3) Is the informed consent written at a level that the participant can understand? [_] (8.4) Is there text equivalent to: “Approved by the California University of Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and expires mm/mm/mm”? (the actual dates will be specified in the approval notice from the IRB) 9. Specific Considerations (check as appropriate) [_] (9.1) If the participant is or may become pregnant is there a statement that the particular treatment or procedure may involve risks, foreseeable or currently unforeseeable, to the participant or to the embryo or fetus? [_] (9.2) Is there a statement specifying the circumstances in which the participation may be terminated by the investigator without the participant’s consent? [_] (9.3) Are any costs to the participant clearly spelled out? [_] (9.4) If the participant desires to withdraw from the research, are procedures for orderly termination spelled out? [_] (9.5) Is there a statement that the Principal Investigator will inform the participant or any significant new findings developed during the research that may affect them and influence their willingness to continue participation? [_] (9.6) Is the participant is less than 18 years of age? If so, a parent or guardian must sign the consent form and assent must be obtained from the child [_] Is the consent form written in such a manner that it is clear that the parent/guardian is giving permission for their child to participate? [_] Is a child assent form being used? [_] Does the assent form (if used) clearly indicate that the child can freely refuse to participate or discontinue participation at any time without penalty or coercion? 133 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR [_] (9.7) Are all consent and assent forms written at a level that the intended participant can understand? (generally, 8th grade level for adults, age-appropriate for children) 134 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR California University of Pennsylvania Institutional Review Board Review Request Checklist (v021209) This form MUST accompany all IRB review requests. Unless otherwise specified, ALL items must be present in your review request. Have you: [_x] (1.0) FOR ALL STUDIES: Completed ALL items on the Review Request Form? Pay particular attention to: [_x] (1.1) Names and email addresses of all investigators [x_] (1.1.1) FOR ALL STUDENTS: use only your CalU email address) [x_] (1.1.2) FOR ALL STUDENTS: Name and email address of your faculty research advisor [x_] (1.2) Project dates (must be in the future—no studies will be approved which have already begun or scheduled to begin before final IRB approval—NO EXCEPTIONS) [x_] (1.3) Answered completely and in detail, the questions in items 2a through 2d? [x_] 2a: NOTE: No studies can have zero risk, the lowest risk is “minimal risk”. If more than minimal risk is involved you MUST: [x_] i. Delineate all anticipated risks in detail; [x_] ii. Explain in detail how these risks will be minimized; [_x] iii. Detail the procedures for dealing with adverse outcomes due to these risks. [_x] iv. Cite peer reviewed references in support of your explanation. [x_] 2b. Complete all items. [_x] 2c. Describe informed consent procedures in detail. [x_] 2d. NOTE: to maintain security and confidentiality of data, all study records must be housed in a secure (locked) location ON UNIVERSITY PREMISES. The actual location (department, office, etc.) must be specified in your explanation and be listed on any consent forms or cover letters. [x_] (1.4) Checked all appropriate boxes in Section 3? If participants under the age of 18 years are to be included (regardless of what the study involves) you MUST: [_] (1.4.1) Obtain informed consent from the parent or guardian—consent forms must be written so that it is clear that the parent/guardian is giving permission for their child to participate. [_] (1.4.2) Document how you will obtain assent from the child—This must be done in an age-appropriate manner. Regardless of whether the parent/guardian has given permission, a child is completely free to refuse to participate, so the investigator must document how the child indicated agreement to participate (“assent”). [_x] (1.5) Included all grant information in section 5? [x_] (1.6) Included ALL signatures? [_] (2.0) FOR STUDIES INVOLVING MORE THAN JUST SURVEYS, INTERVIEWS, OR QUESTIONNAIRES: 135 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR [_] (2.1) Attached a copy of all consent form(s)? [_] (2.2) FOR STUDIES INVOLVING INDIVIDUALS LESS THAN 18 YEARS OF AGE: attached a copy of all assent forms (if such a form is used)? [_] (2.3) Completed and attached a copy of the Consent Form Checklist? (as appropriate—see that checklist for instructions) [_] (3.0) FOR STUDIES INVOLVING ONLY SURVEYS, INTERVIEWS, OR QUESTIONNAIRES: [x_] (3.1) Attached a copy of the cover letter/information sheet? [x_] (3.2) Completed and attached a copy of the Survey/Interview/Questionnaire Consent Checklist? (see that checklist for instructions) [_x] (3.3) Attached a copy of the actual survey, interview, or questionnaire questions in their final form? [_x] (4.0) FOR ALL STUDENTS: Has your faculty research advisor: [x_] (4.1) Thoroughly reviewed and approved your study? [x_] (4.2) Thoroughly reviewed and approved your IRB paperwork? including: [x_] (4.2.1) Review request form, [x_] (4.2.2) All consent forms, (if used) [x_] (4.2.3) All assent forms (if used) [x_] (4.2.4) All Survey/Interview/Questionnaire cover letters (if used) [x_] (4.2.5) All checklists [x_] (4.3) IMPORTANT NOTE: Your advisor’s signature on the review request form indicates that they have thoroughly reviewed your proposal and verified that it meets all IRB and University requirements. [x_] (5.0) Have you retained a copy of all submitted documentation for your records? 136 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Project Director’s Certification Program Involving HUMAN SUBJECTS The proposed investigation involves the use of human subjects and I am submitting the complete application form and project description to the Institutional Review Board for Research Involving Human Subjects. I understand that Institutional Review Board (IRB) approval is required before beginning any research and/or data collection involving human subjects. If the Board grants approval of this application, I agree to: 1. Abide by any conditions or changes in the project required by the Board. 2. Report to the Board any change in the research plan that affects the method of using human subjects before such change is instituted. 3. Report to the Board any problems that arise in connection with the use of human subjects. 4. Seek advice of the Board whenever I believe such advice is necessary or would be helpful. 5. Secure the informed, written consent of all human subjects participating in the project. 6. Cooperate with the Board in its effort to provide a continuing review after investigations have been initiated. I have reviewed the Federal and State regulations concerning the use of human subjects in research and training programs and the guidelines. I agree to abide by the regulations and guidelines aforementioned and will adhere to policies and procedures described in my application. I understand that changes to the research must be approved by the IRB before they are implemented. Professional (Faculty/Staff) Research Project Director’s Signature Student or Class Research Brian T. Oddi Student Researcher’s Signature ACTION OF REVIEW BOARD (IRB use only) Supervising Faculty Member’s Signature 137 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR The Institutional Review Board for Research Involving Human Subjects has reviewed this application to ascertain whether or not the proposed project: 1. 2. 3. 4. 5. provides adequate safeguards of the rights and welfare of human subjects involved in the investigations; uses appropriate methods to obtain informed, written consent; indicates that the potential benefits of the investigation substantially outweigh the risk involved. provides adequate debriefing of human participants. provides adequate follow-up services to participants who may have incurred physical, mental, or emotional harm. Approved[_________________________________] Disapproved Melissa Sovak, PhD. ___________________________________________ Chairperson, Institutional Review Board ___________2.9.19______________ Date 138 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Appendix G Certificate of IRB (CITI) Training 139 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR 140 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR References Angen, M. (2000). Evaluating interpretive inquiry: Reviewing the validity debate and opening the dialogue. Qualitative Health Research, 10(3), 378-395. https://doi.org/10.1177/104973230001000308. American College Health Association. (2018). ACHA-NCHA assessment II: Reference group executive summary, Fall 2018. Retrieved from https://www.acha.org/documents/ncha/NCHA II_Fall_2018_Reference_Group_Executive_Summary.pdf American College Health Association. (2017). National College Health Assessment. Retrieved from: http://www.acha-ncha.org/docs/NCHA II_SPRING_2017_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf Arria, A., Caldeira, K., Bugbee, B., Vincent, K., & O’Grady, K. (2015). The academic consequences of marijuana use during college. Psychology of Addictive Behaviors, 29(3), 564-575. https://doi.org/10.137/adb0000108 Arria, A., O’Grady, K., Caldeira, K., Vincent, K., & Wish, E. (2008). Nonmedical use of prescription stimulants and analgesics: Associations with social and academic behaviors among college students. Journal of Drug Issues, 38(4), 1045-1060. https://doi.org/10.1177.002204260803800406 Baldwin, K., & Haddad, F. (2010). Research in the exercise sciences; Where we are and where do we go from here: Part II. Exercise and Sport Science Review, 38(2), 42-50. https://doi.org/10.1097/jes.0b013e3181d49644 Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall, 24. 141 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Blai, B. (1976). Some biochemical correlates of academic achievement: College women-their eating habits and academic achievement. Scientific Pedagogic Experiments, 13(1), 5-14. https://files.eric.ed.gov/fulltext/ED110117.pdf Blavos, A., Glassman, T., Sheu, J., Thompson, A., DeNardo, F., & Diehr, A. (2017). Marijuana and college students: A critical review of the literature. American Journal of Health Education, 48(3), 167-184. https://doi.org/10.1080/19325037.2017.129878 Blevins, C., Marsh, E., Banes, K., Stephens, R., Walker, D., & Roffman, R. (2018). The implications of cannabis policy changes in Washington on adolescent perception of risk, norms, attitudes, and substance abuse. Substance Abuse: Research and Treatment, 12(1), 1-6. https://doi.org/10.1171/1178221818814491 Bravata, D., Sanders, L., Huang, J., Krumholz, H., Olkin, I., Gardner, C., & Bravata, D. (2003). Efficacy and safety of low-carbohyrdate diets: A systematic review. Journal of the American Medical Association, 289(14). https://doi.org/10.1001/jama.289.14.1837 Brock, M., Wallace Carr, J., & Todd, M. (2015). An examination of campus recreation usage, academic performance, and selected health indices of college freshmen. Recreational Sports Journal, 39(2), 27-36. https://dx.doi.org/10.1123/rsj.2014-0061 Brown, K., Wengreen, H., Vitale, T., Anderson, J. (2011). Increased self-efficacy for vegetable preparation following an online, skill-based intervention and in-class tasting experience as part of a general education college nutrition course. American Journal of Health Promotion, 26(1), 14-20. https://doi.org/10.4278/ajhp.091214-QUAN-389 Bryan, C., Bryan, A., Hinkson, K., Bichrest, M., & Ahern, D. (2014). Depression, posttraumatic stress disorder, and grade point average among student servicemembers and veterans. 142 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Journal of Rehabilitation Research & Development, 51(7), 1035-1045. https://dx.doi.org/10.1682/jrrd.2014.01.0012 Bureau, A,. Razon, S., Saville, B., Tokac, U., & Judge, L. (2017). Passion for academics and problematic health behaviors. International Journal of Exercise Science, 10(3), 417-434. http://www.intjexersci.com Burrows, T., Whatnall, M., Patterson, A., & Hutchesson, M. (2017). Associations between dietary intake and academic achievement in college students: A systematic review. Healthcare, 5(4), https://doi.org/10.3390/healthcare5040060 Calestine, J., Bopp, M., Bopp, C., & Papalia, Z. (2017). College student work habits are related to physical activity and fitness. International Journal of Exercise Science, 10(7), 1009 1017. https://doi.org/10.1513.127 California University of Pennsylvania. (2018). Integrated Postsecondary Education Data System Report. Retrieved from: https://www.calu.edu/inside/faculty-staff/institutional research/_files/IPEDS_Fall_Enrollment_Data%202017-18.pdf Castelli, D., Centeio, E., Hwang, J., Barcelona, J., Glowacki, E.,…Nicksic, H. (2014). The history of physical activity and academic performance research: Informing the future. Monographs of the Society for Research in Child Development, 79(4), 119-148. https://doi.org/10.1111/mono.12133 Center for Disease Control and Prevention. (2017). National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm Center for Disease Control. (2015). The four domains of chronic disease prevention and chronic disease facts sheet. https://www.cdc.gov/chronicdisease/pdf/four-domains-factsheet2015.pdf 143 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Chen, M., Minton, J., & Adams, B. (1989). Changing college students’ lifestyles in favor of cancer prevention: A case study. Journal of Cancer Education, 4(1), 49-54. https://www.tandfonline.com/toc/hjce20/current Colby, S., Wenjun, Z., Sowers, M., Shelnutt, K., Olfert, M., Morrell, J. …Kattelmann, K. (2017). College students’ health behavior clusters: Differences by sex. American Journal of Health Behavior, 41(4), 378-389. http://dx.doi.org/10.5993/AJHB.41.4.2 Conley, C., Travers, L., & Bryant, F. (2013). Promoting psychosocial adjustment and stress management in first-year college students: The benefits of engagement in a psychosocial wellness seminar. Journal of American College Health, 61(2), 75-86. https://doi.org/10.105012/joach.2013.612123 Cosh, S., & Tully, P. (2015). Stressors, coping, and support mechanisms for student athletes combining elite sport and tertiary education: Implications for practice. Sport Psychologist, 29(2), 120-133. http://doi.org/10.1123/tsp.2014-0102 Cunliff, E., Aweau, J., Colacicco, M., Farnell, G., & Powers, M. (2014). Academic performance and physical activity of college students. Medicine and Science in Sports & Exercise, 46(55), 493. https://doi.org/10.1249/01.mss.0000494943.17918.f4 Davis, C., Tomporowski, P., McDowell, J., Austin, B., Miller, P., …Naglieri, J. (2011). Exercise improves executive function and achievement and alters brain activation in overweight children: A randomized, controlled trial. Health Psychology, 30(1), 91-98. https://doi.org/10.1037/a0021766 Deliens, T., Clarys, P., De Bourdeaudhuij, I., & Deforche, B. (2013). Weight, socio demographics, and health behavior related correlates of academic performance in first year university students. Nutrition Journal, 12(162). 144 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR https://doi.org/10.1186/1475-2891-12-162 Department of Health and Human Services. (2008). Physical Activity Guidelines Advisory Committee Report. https://health.gov/paguidelines/report/ Denzin, N. (1970). Sociological methods: A sourcebook. New Brunswick, NJ. Transaction Publishers. de Visser, R. O., Wheeler, Z., Abraham, C., & Smith, J. A. (2013). ‘Drinking is our modern way of bonding’: Young people’s beliefs about interventions to encourage moderate drinking. Psychology & Health, 28(12), 1460-1480. https://doi.org/10.1080/08870446.2013.828293 De Vries, J., van Hooff, M., Geurts, S., & Kompier, M. (2016.) Exercise as an intervention to reduce study-related fatigue among university students: A two-arm parallel randomized controlled trial. PLOS One, 11(3), e0152137. https://doi.org/10.1371/journal.pone.0152137 Dobersek, U., & Arellano, D. (2017). Investigating the relationship between emotional intelligence, involvement in collegiate sport, and academic performance. Sport Journal, 1(2). https://doi.org/10.15439518.20170817 Donnelly, J., Hillman, C., Greene, J., Hansen, D., Gibson, C., Sullivan, D., … Washburn, R. (2017). Physical activity and academic achievement across the curriculum: Results from a 3-year cluster-randomized trial. Preventative Medicine, 99, 140-145. https://doi.org/10.1016/j.ypmed.2017.02.006 Dweck, C., Walton, G., & Cohen, G. (2014). Academic Tenacity: Mindsets and skills that promote long-term learning. Bill and Melinda Gates Foundation Report on Education. Retrieved from: https://eric.ed.gov/?id=ED576649 145 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR El-Ghoroury, N., Galper, D., Sawaqdeh, A., & Burfka, L. (2012). Stress, coping, and barriers to wellness among psychology graduate students. Training and Education in Professional Psychology, 6(2), 122-134. https://doi.org/10.1037/a0028768 Eriksen, H., Ihlebaek, C., Mikkelsen, A., Gronningsaeter, H., Sandal, G., & Ursin, H. (2002). Improving subjective health at the worksite: A randomized controlled trial of stress management training, physical exercise, and an integrated health program. Occupational Medicine, 52(7), 383-391. https://doi.org/10.1093/occmed/52.7.383 Ferrer, M., & Laughlin, D. (2017). Increasing college students’ engagement and physical activity with classroom brain breaks. Journal of Physical Education, Recreation, & Dance, 88(3), 53-56. https://doi.org/10.1080.07303084.2017.1260945 Garnier-Dykstra, L. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Arria, A. M. (2012). Nonmedical use of prescription stimulants during college: Four-year trends in exposure opportunity, use, motives, and sources. Journal Of American College Health, 60(3), 226-234. Godbey, K., & Courage, M. (1994). Stress-management program: Intervention in nursing student performance anxiety. Archives of Psychiatric Nursing, 8(3), 190-199. https://doi.org/10.1016/0883-9417(94)90053-1 Gowin, M., Cheney, M., Gwin, S., Wann, T. (2015). Health and fitness app use in college students: A qualitative study. American Journal of Health Education, 46(4), 223-230. https://doi.org/10.1080/19325037.2015.1044140 Harrington, M., & Ickes, M. (2016). Differences in health behaviors of overweight or obese college students compared to healthy weight students. American Journal of Health Education, 47(1), 32-41. https://doi.org/10.1080/19325037.2015.1111179 146 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Henry, B., Cormier, C., Herbert, E., Naquin, M., & Wood, R. (2018) Health and health care issues among upper-level college students and relationships to age, race, gender, and living arrangements. College Student Jounral, 52(1), 7-20. Hillman, N., Tandberg, D., & Fryar, A. (2015). Evaluating the impacts of “new” performance funding in higher eduation. Educational Evaluation and Policy Analysis, 37(4), 501-519. https://doi.org/10.3102/0162373714560224 Illieva, I., & Farah, M. (2013). Enhancement stimulants: Perceived motivational and cognitive advantages. Frontiers in Neuroscience, 198(7). https://doi.org/10.3389/fnins.2013.00198 Ismail, A. (1967). The effect of a well-organized physical education program on intellectual performance. Research in Physical Education, 1(1), 31-38. https://doi.org/10.1111/j.1749-6632.1977.tb38262.x Johnson, N. (2017). College costs and prices: Some key facts for policymakers. Retrieved from: https://www.luminafoundation.org/files/publications/issue_papers/College_Costs_and_P ices.pdf Kauts, A., & Sharma, N. (2009). Effect of yoga on academic performance in relation to stress. International Journal of Yoga, 2(1), 39-43. https://doi.org/10.4103/0973-6131.53860 Keays, J., & Allison, K. (1995) The effects of regular moderate to vigorous physical activity on student outcomes: A review. Canadian Journal of Public Health, 86(1), 62-65. https://journal.cpha.ca/index.php/cjph Kuhlman, A., Ludy, M., Morgan, A, & Leone, R. (2014). Health-related variables and academic success in female college students. Journal of the Academy of Nutrition and Dietetics, 114(9), a24-a26. https://doi.org/10.1016.j.jand.2014.06.068 147 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Larson, M., Orr, M., & Warne, D. (2016). Using student health data to understand and promote academic success in higher education settings. College Student Journal, 50(4), 590-602. https://doi.org/10-ej1121548 Lechner, K., Garcia, C., Frerich, E., Lust, K., & Eisenberg, M. (2013). College students’ sexual health: Personal responsibility or the responsibility of the college? Journal of American College Health, 61(1), 28-35. Lewis, B., Napolitano, M., Buman, M., Williams, D., & Nigg, C. (2017). Future directions in physical activity intervention research: Expanding our focus to sedentary behaviors, technology, and dissemination. Journal of Behavioral Medicine, 40(3), 112-118. https://doi.org/10.1007/s10865-106-9797-8 Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Newbury Park, CA; Sage Publications. Macdonald, D., Abbott, R., Hunter, L., Hay, P., & McCuaig, L. (2014). Physical activity academic achievement: student and teacher perspectives on the ‘new’ nexus. Physical Education & Sport Pedagogy, 19(4), 436-449. https://doi.org/10.1080/17408989.2013.769510 McCabe, S., Teter, C., Boyd, C., Knight, J., & Wechsler, H. (2005). Nonmedical use of prescription opioids among U.S. college students: Prevalence and correlates from a national survey. Journal of Addictive Behaviors, 30(4), 789-805. https://doi.org/10.1016/j.addbeh.2004.08.024 McFadden, D. (2016). Health and academic success: A look at the challenges of first-generation community college students. Journal of the American Association of Nurse Practitioners, 28(4), 227-232. https://doi.org/10.1002/2327-6924.12345 148 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Mead, T., Scibora, L., Gardner, J., & Dunn, S. (2016). The impact of stability balls, activity breaks, and a sedentary classroom on standardized math scores. Physical Educator, 73(3), 433-449. https://doi:10.18666/TPE-2016-V73-I3-5303 Meda, S., Gueorguieva, R., Pittman, B., Rosen, R., Aslanzadeh, F., Tennen, H, …Pearlson, G. (2017). Longitudinal influence of alcohol and marijuana on academic performance in college students. PLOS One, 12(3), e0172213. https://doi.org/10.137/journal.pone.0177213 Michael, S., Merlo, C., Basch, C., Wentzel, K., & Wechsler, H. (2015). Critical connections: Health and academics. Journal of School Health, 85(11), 740-758. https://doi.org/10.111/josh.12309 Morris-Paxton, A., Elkonin, D., & Van Lingen, J. (2017). Wellness and academic outcomes among disadvantaged students in South Africa: An exploratory study. Health Education Journal, 76(1), 66-76. https://doi.org/10.1177/0017896916650707 Musgrave, K., & Thornbury, M. (1976). Weight control program for university students conducted by nutrition seniors. Journal of the American Diet Association, 68(4), 462466. http://jandonline.org/ National Center for Educations Statistics. (2017). Fast facts. Integrated Postsecondary Education Data System. https://nces.ed.gov/fastfacts/display.asp?id=372 National Center on Addiction and Substance Abuse. (2015). Off to college: Preventing and reducing substance abuse on campus. Retrieved from https://www.centeronaddiction.org/the-buzz-blog/college-preventing-and-reducingsubstance-abuse-campus 149 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Nehl, E., Blanchard, C., Kupperman, J., Sparling, P., Rhodes, R., Torabi, M., & Courneya, K. (2012). Exploring physical activity by ethnicity and gender in college students using social cognitive theory. Journal of Research in Health, Physical Education, Recreation, Sport & Dance, 7(2), 1-17. https://files.eric.ed.gov/fulltext/EJ993564.pdf Nobrega, M., Hillman, C., Dowd, K., Cirera, E., & Ribera, A. (2018). ActivitPAL™ determined sedentary behavior, physical activity and academic achievement in college students. Journal of Sports Sciences, 18(3), https://doi.org/10.1080/02640414.2018.1451212 Oxford Centre for Evidence Based Medicine (2011). Levels of Evidence. Retrieved from http://www.cebm.net/index.aspx?o=1025. O’Reilly, M., & Parker, N. (2013). Unsatisfactory saturation: A critical exploration of the notion of saturated sample sizes in qualitative research. Qualitative Research, 13(2), 190-197. https://doi.org/abs/10.1177/1468794112446106 Osborn, J., Naquin, M., Gillan, W., & Bowers, A. (2016). The impact of weight perception on the health behaviors of college students. American Journal of Health Education, 47(5), 287-298. https://doi.org/10.1080/1932537.2016.1204966 Patton, M. (2001). Qualitative evaluation and research methods. Thousand Oaks, CA: Sage Publications. Petosa, R., Suminski, R., & Hortz, B. (2003). Predicting vigorous physical activity using social cognitive theory. American Journal of Health Behavior, 27(4), 301-310. https://doi.org/10.5993/ajhb.27.4.2 Piazza-Gardner, A., Barry, A., & Merianos, A. (2016). Assessing drinking and academic performance among a nationally representative sample of college students. Journal of Drug Issues, 46(4), 347-353. https://doi.org/10.1511/jods.2016.464 150 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Plotnikoff, R., Costigan, S., Williams, R., Hutchesson, M., Kennedy, S., Robards, S., …Germov, J. (2015). Effectiveness of interventions targeting physical activity, nutrition, and healthy weight for university and college students: a systematic review and meta-analysis. International Journal of Behavioral Nutrition & Physical Activity, 1(21-10). https://doi.org/10.1186/s12966-015-0203-7 Ponnet, K., Wouters, E., Walrave, M., Heiman, W., & Van Hal, G. (2015). Predicting students’ intention to use stimulants for academic performance enhancement. Substance Use & Misuse, 50(3), 275-282. https://doi.org/10.3109/10826084.2014.952446 Prochaska, J., & DiClemente, C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology. 51(3), 390-395. https://doi.org/10.1037/0022-006x.51.3.390 Pronk, N., & Kottke, T. (2009). Physical activity promotion as a strategic corporate priority to improve worker health and business performance. Preventative Medicine. 49(4), 316321. https://doi.org/10.1016/j.ypmed.2009.06.025 Puhan, M., Akl, E., Bryant, D., Xie, F., Apolone, G., & ter Riet, G. (2012). Discussing study limitations in reports of biomedical studies – The need for more transparency. Health and Quality of Life Outcomes, 10(23). https://doi.org/10.1186/1477-7525-10-23 Roemmich, J., Balanteki, K., & Beeler, J. (2014). Park-like campus settings and physical activity. Journal of American College Health, 63(1), 68-72. https://doi.org/10.1080/07448481.2014.960421 Ruthig, J., Marrone, S., Hladykj, S., & Robinson-Epp, N. (2011). Changes in college student health: Implications for academic performance. Journal of College Student Development, 52(3), 307-320. https://doi.org/10.1353/csd.2011.0038 151 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Sanders, A., & Lushington, K. (2002). Effect of perceived stress on student performance in dental school. Journal of Dental Education, 66(1), 75-81. https://doi.org/1066/1/75 Schwarz, S., & Peterson, J. (2010). Adolescent obesity in the United States. Facts for policymakers. National Center for Children in Poverty. http://www.nccp.org/publications/pub_977.html Slavin, S., Schindler, D., & Chibnall, J. (2014). Medical student mental health 3.0: Improving student wellness through curricular changes. Academic Medicine, 89(4), 573-577. https://doi.org/10.1097/acm.0000000000000166 Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory(2nd ed.). Thousand Oaks, CA: Sage. Strawbridge, W. J., Shema, S. J., Cohen, R. C., & Kaplan, G. A. (2001). Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships. Society of Behavioral Medicine, 23(1), 68-74. http://www.sbm.org/ Thelwall, M., Buckley, K., Paltoglou, G., Cai, D., & Kappas, A. (2010). Sentiment strength detection in short informal text. Journal of the American Society of Information Science and Technology, 61(12(, 2544-2558. Retrieved from http://www.scit.wlv.ac.uk/~cm1993/papers/SentiStrengthPreprint.doc Todd, M., Czyszczon, G., Carr, J., & Pratt, C. (2009). Comparison of health and academic indices between campus recreation facility users and nonusers. Recreational Sports Journal, 33(1), 43-53. https://doi.org/10.1123/rsj.2009-0033 Trockel, M. T., Barnes, M. D., & Egget, D. L. (2000). Health-related variables and academic performance among first-year college students: Implications for sleep and other behavior. 152 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Journal of American College Health, 49(2), 125-38. https://www.acha.org/ACHA/Resources/Publications/Journal/ACHA/Resources/JACH.as px Tsai, S., Nan, L., Xiao, L., & Ma, J. (2015). Gender differences in weight-related attitudes and behaviors among overweight and obese adults in the United States. American Journal of Men’s Health, 10(5), 389-398. https://doi.org/10.1177.1557988314567223 Upright, P., Esslinger, T., & Hays, W. (2014). Health issues affecting college student’s academic performance. KAHPERD Journal, 51(2), 30-36 https://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=96975784&site=eho t-live&scope=site U.S. Department of Agriculture (2006). Definitions of food security. Retrieved from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-theus/definitions-of-food-security/ U.S. Department of Education (2008). Alcohol and other drug prevention on college campuses. Retrieved from http://www.alcoholeducationproject.org/DOEModelPrograms2008.pdf Valladares, M., Duran, E., Matheus, A., Duran-Aguero, S., Obregon, A., & Ramirez-Tagle, R. (2016). Association between eating behavior and academic performance in university students. Journal of the American College of Nutrition, 35(8), 699-703. https://doi.org/10.1080/07315724.2016.1157526 Van Rensburg, C. J., Surujlal, J., & Dhurup, M. (2011). Exploring wellness practices and barriers: A qualitative study of university student-athletes. African Journal For Physical, Health Education, Recreation & Dance, 17(2), 248-265. 153 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Wald, A., Muennig, P., O’Connell, K., & Garber, C. (2014). Associations between health lifestyle behaviors and academic performance in U.S. undergraduates: A secondary analysis of the American College Health Association’s National College Health Assessment II. American Journal of Health Promotion, 28(5), 298-305. https://doi.org/10.4278/ajhp.120518-QUAN-265 Weinstorck, J. (2010). A review of exercise as intervention for sedentary hazardous drinking college students: Rationale and issues. Journal of American College Health, 58(6), 539544. https://doi.org/10.1080.07448481003686034 Winter, B., Breitenstein, C., Mooren, F., Voelker, K., Fobker, M., Lechtermann, A., …Knecht, S. (2007). High impact running improves learning. Neurobiology of Learning and Memory, 87, 597-609. https://doi.org/10.1016./j.nlm.2006.11.003 Wurtman, R. (1982). Nutrients that modify brain function. Scientific American, 246(4), 50-59. http://www.jstor.org/stable/24966568?seq=1#page_scan_tab_contents Wrye, B., & Pruitt, C. (2017). Perceptions of binge drinking as problematic among college students. Journal of Alcohol & Drug Education, 61(1), 71-90. Xiaofen Deng, K., Castelli, D., & Ayers, S. (2013). Association of weekly strength exercise frequency and academic performance among students at a large university in the United States. Journal of Strength & Conditioning Research, 27(7), 1988-1993. https:doi.org/10.1519/jsc.0b013e318276bb4c Yin, R. (2016). Qualitative research from start to finish. New York, NY: Gulford Press. Zheng, G., Lan, X., Li, M., Ling, K., Chen, L., … Fang, Q. (2015). Effectiveness of Tai Chi on physical and psychological health of college students: Results of a randomized 154 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR controlled trial. PLOS One, 10(7), e0132605. https://doi.org/10.1371/journal.pone.0132605 155 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Ryan Bruce Barnhart rbbarnhart@gmail.com/barnhart_r@calu.edu 724-984-8013 6 Valley Vue Drive Uniontown, PA 15401 EDUCATION California University of Pennsylvania • Doctoral Candidate, Health Science, expected graduation December 2019 • Master of Science, 2009 California University of Pennsylvania • Bachelor of Science, Summa Cum Laude, 2008 • Student Association, Inc., Board of Directors President • Distinguished Service Award Recipient PROFESSIONAL EXPERIENCE California University of Pennsylvania, California, PA • Executive Director of Alumni Relations, January 2018-Present • • • • • • • • • Oversee and execute all related functions of Office of Alumni Relations, including all print, digital, and social media campaigns. Plan and execute a comprehensive, nationwide event schedule. responsible for engaging and cultivating relationships with alumni and students, encouraging them to deepen their involvement in the life of the University and to increase their financial support, in an effort to foster and maintain their lifelong relationship with the University. Developed and implemented innovative alumni events designed to build new ways of connecting alumni to one another and their alma mater. Met one-on-one with alumni on behalf of the University to discuss and strategize current and future volunteer opportunities. Worked with campus departments on programming to recruit and engage alumni volunteers. Coordinated with Student Affairs to increase student awareness of alumni activities and prepare students for their role as alumni. Tracked and implemented procedures on Alumni Board fundraising to ensure 100% participation in required board philanthropy. Associate Director of Admission, Global Online and Graduate Studies Programs November 2015-January 2018 • Provided guidance and assistance to the Executive Director of Global Online and Graduate studies in all aspects of day to day operations as well as long term strategic planning. • Designed and implemented short-term and long-term strategies to enhance enrollment management operations across all segments of the recruitment funnel. • Directly serve on the enrollment management planning and implementation committee for both Global Online and Graduate Programs as well as campus-wide enrollment management teams. 156 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Responsible for the recruitment, enrollment and new and continuing enrollment goals for the entire division of 9 staff members and 4 graduate assistants. • Continually improved total registration conversions upwards of 10% per year over year segment, and over 30% since beginning of employment. • Served as lead marketing liaison between faculty and departments and director of marketing to include long-term and short-term planning in all facets including budgeting, creative, and planning. • Provided guidance and advisement on transfer admissions, courtesy transfer evaluations and new student enrollment assistance. • Processed decisions on all undergraduate and graduate admissions applications. • Served as university wide lead for readmission campaign, The Finish Line which to date has generated more than 600 new and readmission enrollments contributing to more than $2.5 million in additional tuition revenue. Assistant Director of Marketing and Recruitment Coordination for Global Online and Graduate Studies Programs, June 2013-Present • Responsible for the conversion of prospective students in online and campus graduate program through the recruitment and enrollment management cycle. • Created and executed strategic enrollment management plan to increase student population in online Undergraduate and online and campus graduate programs. • Provided proactive outreach and client services to new and current students enrolled in the Global Online Programs by delivering accurate information and direction primarily via the phone, email, and some face-to-face interaction with students regarding the University's policies and procedures. • Served as a liaison for students throughout their academic career in dealing with all campus offices, the academic program coordinators, the Office of Global Online Programs, and corporate partners/constituents. • Assumed major responsibility in training staff in processes and procedures, as well as changes and updates to those relevant to specialization. • Supervised 6 other assistant directors, 2 clerk typists, 4 Graduate Assistants and 2 work study students in special projects. • Served as GO Representative for travel purposes in the absence of the GO Coordinator or Staff with respect to Conferences, Events, and other recruitment opportunities. • Responsible for working with the Executive Director and GO Coordinators to ensure ALL GO marketing materials are current and up to date including print and digital media. • Coordinated budgetary efforts with program coordinators to align spend on marketing campaigns that provided return on investment through inquiries, applications, and enrollments. • • West Virginia Junior College, Morgantown, WV • Online Program Coordinator, January 2011-June 2013; Adjunct Instructor, January 2011Present 157 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR Recruited and enrolled students into online programs. Developed strategic marketing plan to recruit students through the enrollment management funnel across West Virginia and Ohio panhandle. • Assisted with development and implementation of strategic enrollment management plan, including media purchasing, branding, and negotiation of contracts with vendors. • Assisted in troubleshooting online student problems in academic and technical areas. • Created and directed online orientation for new students. • Maintained open communication with online students to ensure satisfactory academic progress. • Instructed several courses online utilizing the Pearson eCollege platform. • Achieved certification in Pearson eCollege learning platform. • Instructionally designed content for online programs. • Reviewed curriculum for general education and business program online transitions. • Mapped learning outcomes for all general education and business online classes. Director of Admissions, August 2008-August 2010; Assistant Student Services Director, August 2010-January 2011 • Responsibly created and administered academic, personal, and career advising and tutoring programs for a campus of 300+ students. • Planned and implemented various campus wide student activities and programming including the annual Winter Social, Student Appreciation Week, Graduation, and other activities. • Implemented and directed successful student retention program utilizing social media and other forms of communication. • Presented at recruitment events including high school classroom and lunchroom, college fairs, etc. • Performed enrollment interviews with prospective students and liaised with potential students and families regarding the application process • Performed satisfactory academic progress for probationary students to ensure compliance with DOE and ACICS compliance. • Authored and directed the institutional effectiveness study and presented conclusions at yearly conference. • Performed bi-annual review of curriculum for all 5 academic programs. • Instructed and directed the instruction of core classes in the Business Administration program. • Supervised business faculty and delegated roles to various instructors. • Developed the Management Achievement Program (MAP) for business students. • Networked with students to help facilitate job search and employment opportunities. • Created extra-curricular programming for students to aid in their growth and well roundedness. • • • 158 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR • • • • • • • • Created and managed strategic marketing plan to promote campus events, student services, and other important events to current students. Collaborated with campus leaders to implement a strategic retention plan. Implemented strategic wellness plan to engage and educate community members on wellness and fitness and improve health and wellness literacy in the region. Created and implemented strategic enrollment management plans to recruit high school, non-traditional, and continuing education students across West Virginia, SW Pennsylvania, and Ohio panhandle. Planned and implemented direct outreach campaigns to various learner populations in effort to recruit future students through the enrollment funnel. Collaborated with campus leadership to implement a strategic enrollment management plan to increase traditional undergraduate student population in face to face programs. Processed admissions applications, conducted admissions interviews, and made decisions on application files. Fostered relationships with guidance counselors, teachers, and other decisioninfluencers to create new opportunities to recruit, enroll and retain students. RELEVANT KNOWLEDGE, SKILLS AND ABILITIES • Microsoft Office Suite • Elucian Banner • Hobson’s Radius CRM • Sunworks Degree Works • Microsoft Dynamics CRM • Hobson’s Starfish • Cascade Style Sheet and Web Editing and Content development • Transfer evaluation and academic advisement • Conflict resolution • Curriculum and Course Design • Strong interpersonal communication • Critical thinking and problem solving • Pearson’s eCollege Platform • Desire2Learn • Blackboard Ultra PROFESSIONAL DEVELOPMENT ARTEFACTS • January 2012-December 2014-Contributing Author, www.fitday.com • October 2014-New Directions in Online Learning-“Optimizing Communication Flow for Enrollment Management in Online Programs”, Boston, MA • October 2015-New Directions in Online Learning-“Creating and Implementing Effective Enrollment Strategies for Online Programs”, San Diego, CA • May 2016-Pennsylvania Workforce Development Conference-“Degree Attainment in Pennsylvania: A FinishLine Program Aligned to Goal 2025”, Hershey, PA 159 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR • • • • • November 2017-HealthPlex Associates Annual Meeting Keynote-“Physical Activity and Academic Performance”, Pittsburgh, PA January 2018-Contributing Author, Club Solutions Magazine “3 Ways to Make the Most of the Holiday Season” https://clubsolutionsmagazine.com/2018/01/3-ways-makeholiday-season/ January 2019-Adjunct Instructor of Sport Management at California University of Pennsylvania “Sport in Society” July 2019-iModules Sizzler Conference “SPARK! Presenter”, Orlando, FL October 2019-iModules Impact Group “Morning Keynote”, Pittsburgh, PA REFERENCES ARE AVAILABLE UPON REQUEST 160 COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR