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

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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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.

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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,

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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(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

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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.

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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

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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).

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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

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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

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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

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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

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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.

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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.

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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

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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.

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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).

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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.

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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

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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.

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Figure 4.1 Male physical activity behaviors. This figure illustrates male subject attitudes on
physical activity.

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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.

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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.

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Figure 4.3 Male nutrition behaviors. This figure illustrates male subject attitudes on nutrition.

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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.

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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

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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.

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Figure 4.5 Male alcohol and other drug behaviors. This figure illustrates male subject
attitudes on alcohol and other drug behaviors.

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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

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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

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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.

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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

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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.

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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

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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

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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

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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.

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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

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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.

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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.

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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

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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.

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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.

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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

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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

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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

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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.

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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

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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

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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.

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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

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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

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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

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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

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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.

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Appendices
Additional Methodology

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Appendix A
Electronic Recruitment Messaging

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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!

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Appendix B
Informed Consent

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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

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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

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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

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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.

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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

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Appendix C
Demographic Data Sheet

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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

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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.

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Appendix D
Initial Interview Protocol

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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?

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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?

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Appendix E
Follow-up Interview Protocol

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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?

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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?

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Appendix F
Completed IRB Forms

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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

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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

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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.

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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.

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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

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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.

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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?

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[N/A_] (14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue
participation at any point in the process and all data is immediately discarded?

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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

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location?
[_] (5.3) Is there a statement as to who will have access to the records?

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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?

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[_] (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)

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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:

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[_] (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?

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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

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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

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Appendix G
Certificate of IRB (CITI) Training

139
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140
COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR
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controlled trial. PLOS One, 10(7), e0132605.
https://doi.org/10.1371/journal.pone.0132605

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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
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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.

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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.
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West Virginia Junior College, Morgantown, WV
• Online Program Coordinator, January 2011-June 2013; Adjunct Instructor, January 2011Present

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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.
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COLLEGE STUDENT PERCEPTIONS OF HEALTH BEHAVIOR
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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

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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

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