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DIETARY INTERVENTIONS AND EDUCATION

Promoting Wellness on College Campuses Identifying and Addressing the Wellness Needs of College Students

Jenna Christianson, BS; Kendra Kattelmann, PhD, RDN, LN; Kristin Riggsbee, PhD; Lauren Moret, PhD; Melissa J. Vilaro, PhD, MPH; Melissa D. Olfert, DrPH, MS, RDN; Anne E.W. Mathews, PhD, RDN; Makenzie Barr, PhD, RDN, LD; Sarah Colby, PhD, RD

The objective of this study was to explore the health-related knowledge, beliefs, and attitudes of college students. An online and in-class course was offered at 4 universities. As part of the course, focus groups consisting of 102 students met virtually for 5 sessions to answer questions aimed at addressing students’ wellness issues. Students indicated that college campuses need to offer more services centered on student health while addressing the barriers to student wellness overall. Students also indicated that universities better met their needs when communicating about various health-related services and facilities that were available to students. Key words: community- based participatory research, emerging adulthood, first-year college students, health education, obesity prevention, stress management, wellness

Author Affiliations: Health and Nutritional Science Department, South Dakota State University, Brookings (Ms Christianson and Dr Kattelmann); Nutrition Department (Ms Riggsbee and Dr Colby) and Educational Psychology and Counseling Department (Dr Moret), University of Tennessee at Knoxville; Food Science and Human Nutrition Department, University of Florida, Gainesville (Drs Vilaro and Mathews); and Division of Animal and Nutritional Sciences (Dr Olfert) and Davis College of Agriculture, Natural Resources, and Design (Dr Barr), West Virginia University, Morgantown.

Jenna Christianson received a grant from the South Dakota State University Honors Grand Challenges Undergraduate Research Mentorship. Funding for the research was provided by the Agriculture and Food Re- search Initiative grant no. 2014-67001-21851 from the USDA National Institute of Food and Agriculture.

The authors have disclosed that they have no signif- icant relationships with, or financial interest in, any commercial companies pertaining to this article.

P ROMOTING a healthy transition intoadulthood during college may be a useful approach to increasing wellness and health for many emerging adults; thus, universities have a unique opportunity to influence stu- dents’ overall wellness.1 The World Health Or- ganization defines and divides wellness into 2 basic concerns for an individual: (1) re- alizing one’s fullest potential and (2) fulfill- ing one’s role expectations.2 Both concerns are dependent on multiple factors including

Correspondence: Kendra Kattelmann, PhD, RDN, LN, Health and Nutritional Science Department, South Dakota State University, Box 2275A, SWG 425, Brook- ings, SD 57006 ([email protected]).

DOI: 10.1097/TIN.0000000000000169

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mailto:[email protected]

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physical, psychological, social, spiritual, and economic characteristics.3-5 Wellness pro- grams on college campuses need to provide support for all of these factors to facilitate life- long wellness characteristics among emerging adults.3-7 A focus on the physical components of wellness programs on college campuses of- ten includes nutrition, physical activity, and stress management.8

Nutrition is one of the key components of wellness, but many college students (83%) lack knowledge regarding nutritional guidelines1 and fall short of the US Dietary Guidelines for fruit and vegetable intake (con- suming only 2 or less servings of fruits and veg- etables per day).9,10 Research has found sup- portive evidence to link adequate student fruit and vegetable intake to an overall increase in both health and quality of life.11 However, even if students are aware of the perceived health benefits of adequate intakes of the fruits, vegetables, and fiber, most (∼84% of males and females aged 19+ years) fall short of meeting fruit, vegetable, and fiber recom- mendations. Protein (53.7% males and 24.6% females), refined grains (71% males and fe- males), and solid fats and added sugars (81% males and 87% females) are overconsumed.12

This overconsumption of the aforementioned foods combined with low fruit, vegetable, and fiber intakes contributes to major health chal- lenges including obesity, cardiovascular dis- ease, high blood pressure, type 2 diabetes, some cancers, and poor bone health.13 How- ever, these specific, negative health outcomes may be preventable with adequate nutrition and physical activity.13

Physical activity is another component of wellness known for benefiting college stu- dents’ overall health.14 However, similar to nutrition recommendations, many (70%) stu- dents fall short of exercising on a daily basis.15

In fact, most college students report exercis- ing less than 3 days during the week, and students older than 20 years report partici- pating in less physical activity than those 19 years and younger.16 In the United States, less than half of all college students are achieving the recommended levels of physical activity (150 minutes of moderate-intensity aerobic

physical activity throughout the week).16,17

Also, with the increased use of cell phones and other mobile technology in the college- aged population, increasingly more college students are engaging in sedentary behav- iors than in physical activity.18 Balancing time to relax, socialize, and complete academic responsibilities is reported as one of the main barriers for students looking to achieve and maintain a healthy weight.18 In addition, a study addressing weight-related behavior change reported that students were looking for greater support from others to find the mo- tivation to exercise.19 This observation sug- gests that college campus wellness programs may have a prominent role in promoting and implementing recommended physical activity habits.20

Another element of wellness is stress man- agement. Besides nutrition, stress is another area of wellness where college students lack knowledge.8 Fifty-two percent of college stu- dents have high levels of stress.8 High stres- sors are negatively correlated to both col- lege students’ body mass index and quality of life.7,11 Students associate these high levels of stress with the instability that occurs while adjusting to living life on one’s own during emerging adulthood.8 Freedom from parental control can sometimes cause increased stres- sors, but it also presents an opportunity for students to explore their own values and identity.8 With the right tools and knowledge, students may be able to avoid unnecessary stresses associated with emerging adulthood. They could use their college years to grow and learn as individuals to embrace a healthy lifestyle during the college experience.8

Wellness habits that students develop in college extend far beyond their years at university.21 Investigations could address how multiple concurrent health behaviors affect student health.8 Understanding the wellness needs and issues of college students will allow more effective development of col- lege campus wellness programs to promote wellness and reduce future health compli- cations for students.6,7,19,22 The objective of this study was to explore the health-related knowledge, beliefs, and attitudes of a group

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of college students engaged in the Get Fruved research project to better understand what approaches college wellness programs should consider when developing wellness promotion interventions. Get Fruved is a social marketing and environmental change intervention (SMEI) that uses community- based participatory research (CBPR) methods to develop and implement an intervention to prevent unwanted weight gain among older adolescents.

METHODS

Research design and recruitment

CBPR is a type of research approach that actively involves the community being stud- ied in the research process.23 Using these par- ticipatory methods, college students were re- cruited and trained as student investigators and became equal partners with faculty re- searchers to identify priorities and develop interventions to promote health on college campuses.

Student researchers (n = 102; 88 women and 14 men) varying in age (freshmen to seniors) were recruited at 4 land-grant uni- versities and divided into the respective fo- cus groups: University of Florida (n = 29; 25 women and 4 men); South Dakota State University (n = 8; 6 women and 2 men); University of Tennessee (n = 35; 31 women and 4 men); and West Virginia University (n = 30; 26 women and 4 men). Recruitment occurred through posters, announcements in classes across campus, table events, and by word of mouth. The recruits were then in- vited to enroll in a hybrid (using both online and in-class activities) class to develop an SMEI for college campuses and become the student researchers for this project. One SMEI hybrid class was offered at each of the 4 intervention universities.

After informed consent was obtained as part of the SMEI class, student researchers participated in 5 class discussions that took place in the classroom and were audio and video recorded. In these discussions, the stu- dent researchers were provided with a list of questions on 5 major discussion topics

(definition of health, changing behavior, so- cial marketing, changes on campus, and tai- loring messages) (see Table 1) and were asked to discuss their thoughts within the focus group. The questions for each class topic were developed and reviewed for content validity24 by a multistate panel of nutrition ed- ucation researchers with experience in ado- lescent and college obesity prevention. The questions were refined and reviewed for face validity25 by graduate and undergraduate col- lege students of various health majors, in- cluding kinesiology, public health, and nu- trition before being posed to the student researchers enrolled in the SMEI class. As a tenant of CBPR,26-33 with all student re- searchers participating in the process, a dif- ferent SMEI student researcher at each univer- sity volunteered each week to facilitate their focus group. Each week the 4 leaders (one from each university) wrote summaries that reflected the discussion in the focus. Each summary was then reviewed with the focus group for feedback and consensus. Student leaders amended the group’s summary to re- flect most accurately the discussions and en- sure inclusion of all student researchers’ per- spectives. Summaries from each focus group were then posted on a shared Web site, allow- ing the SMEI student researchers across all 4 campuses to access the summary documents. There were 20 focus group discussions in to- tal (5 from each university) that occurred with 20 summarizations posted to inform future in- tervention design activities that would take place later in the semester. All procedures for the University of Tennessee, South Dakota State University, and West Virginia University were reviewed and approved by the institu- tional review board at the University of Ten- nessee, and all procedures for the University of Florida were reviewed and approved by the institutional review board at the University of Florida.

Data analysis

Each group summary (n = 20) served as the main data source for analyses, and 1 student researcher (not involved in the SMEI course) conducted a review of the summaries in

128 TOPIC IN CLINICAL NUTRITION/APRIL–JUNE 2019

Table 1. College Student Health Questions Used in Class Discussions

Questions

Discussion 1: Definition of Healthy What do you think it means to be healthy? Why do you think it is important to be healthy? What things make it harder to be healthy? What things make it easier to be healthy? What do you think needs to change to better this campus? Discussion 2: Changing Behavior Does “behavior” or “changing behavior” matter in a social marketing campaign? Does “behavior” or “changing behavior” matter in the environment college students function in? You are a college student, what works when “changing behavior”? How do we work to engage those who have not thought about their environment or

communication through social marketing? What events may really get the attention of your peers? Discussion 3: Social Marketing What did you like about those (social marketing) campaigns? What did you dislike about those (social marketing) campaigns? Discussion 4: Changes on Campus What are some things that need to be changed on your campus to improve student quality of life? What is the first step in making these (life-improving) changes? Besides nutrition, what are some areas of health that we can target? How will you promote health in these (target) areas? What are some strategies that you can use to change behavior at the individual, community, and

policy levels? Discussion 5: Most Important Message and Tailoring What do you think is the most important thing to communicate to college students as part of Fruved? How will you tailor messaging to students?

comparison with recorded videos of focus group discussions to become familiar with the context as well as content. This review pro- cess led to the development of a codebook to be used for thematic analysis of the class summaries.

The same student researcher and 1 fac- ulty researcher independently read each summary and identified themes using the codebook. The codes from the 2 indepen- dent researchers were compared for coding to reach consensus. Discrepancies between codes were adjusted with a third researcher, eliminating any conflicts.

RESULTS

A total of 7 themes emerged from the student researchers’ class discussions. Four major themes defined and described compo-

nents of college student wellness: what it means to be healthy, importance of health, barriers of health, and facilitators of health (see Table 2). Three major themes emerged, with suggestions on what needs to be done on campuses for programing and implement- ing behavior change: alterations that col- lege campus wellness programs need to ad- dress, approaches for college campus well- ness programs to change student behavior, and approaches for college campus wellness programs to grab students’ attention (see Table 3).

What it means to be healthy

The students in the focus groups reported both positive and negative definitions of what it means to be healthy. The students stated that being healthy includes a positive perspective on both physical and mental

Promoting Wellness on College Campuses 129

Table 2. Themes and Respective Quotes From College Student Health Discussion Questions

What It Means to be Healthy Student Quotes

1. Exercising regularly 2. Consuming a variety of nutrients and

healthy foods 3. Limiting time spent sedentary 4. Sleeping an adequate amount of time 5. Practicing self-confidence 6. Having the ability to manage stress and

emotions 7. Having knowledge of wellness issues 8. Reading food labels 9. Being consistent with health behaviors

10. Not abusing substances 11. Challenging to become healthy 12. Challenging to maintain being healthy

“Don’t be sedentary.” “Vary your diet to get a variety of nutrients.” “People that are able to manage their stress are

healthier than those who have poor stress management skills.”

“(Healthy) can have a negative connotation because it can be viewed as too hard.”

Importance of Health

1. Physical benefits 2. Mental benefits 3. Financial benefits 4. Environmental benefits

“Exercising and eating well is not only food for your body but for your mind as well.”

“Your health affects other aspects of your life.” “Being healthy can save money in the long run.” “Helps the environment.”

Barriers of Health

1. Unhealthy foods on campuses (fast food, convenience food, and chocolate)

2. Misinformation from media outputs, advertisements, food marketing campaigns, and peers

3. Stress 4. Time in students’ schedules 5. Knowledge of health topics 6. Finances 7. Lack of healthy food on campuses 8. Lack of sidewalks on campuses 9. Peer pressure

10. Taste 11. Lack of cooking skills 12. Past experiences with unhealthy habits 13. Conflicting priorities

“Misleading advertising claiming unhealthy things are good for you.”

“Stress and being busy with school (makes it harder to be healthy).”

“Very few middle school or high school curriculums require nutrition courses, stress management courses, or other courses teaching overall health and wellness. Because of this, many incoming college students lack adequate knowledge on how to be healthy.”

Facilitators of Health

1. Having healthy friends 2. Having access to gyms 3. Having access to healthy foods 4. Having access to health education 5. Implementing a daily routine 6. Finding physical and mental balance

“Finding peers that are interested in being healthy.”

“Becoming educated on nutrition and health.” “Balance makes life easier.”

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Table 3. Themes and Respective Quotes From Discussion Questions About Changing College Students’ Behaviors

Changes College Campus Wellness Programs Need to Address Student Quotes

1. Increase healthy food options 2. Increase health education 3. Promote truthful marketing 4. Promote health-related student

organizations 5. Increase encouragement through support

systems 6. Increase the number of sidewalks 7. Decrease the cost of healthy foods 8. Decrease the amount of greasy foods served

“The food court needs to be seriously looked at, reviewed, and revised to include healthier foods and to make it so the healthy choice becomes the easy choice.”

“Market foods truthfully.” “Vegetables in dining hall need to be cooked

with less grease.”

Approaches for College Campus Wellness Programs to Change Student Behavior

1. Provide health education on all health topics

2. Provide students with a support system 3. Accommodate students’ schedules

“Having knowledge of nutrition and its benefits can inspire a change.”

“When the people around you make smart choices, it becomes a lot easier to make smart choices yourself.”

“(Offer) healthier options at later times of operation.”

Approaches for College Campus Wellness Programs to Grab College Students’ Attention

1. Host guest speakers 2. Support wellness oriented clubs 3. Play games 4. Offer cooking classes 5. Hold farmers’ markets 6. Offer free events 7. Allow sponsorship 8. Advertise events 9. Utilize technology

10. Offer themed events 11. Keep events convenient for students

“Move farmers’ market to pedestrian walkway.”

“Having local businesses come down with food/coupons/etc.”

“Free food, free anything.” “(Have a) famous person come in.” “Ask for sponsorship from Traders

Joes/Lucky’s.” “Schedule events toward when students would

be more available. Convenience is key.”

health. The characteristics of being physically healthy were reported as exercising regularly, limiting amount of time being sedentary, in- corporating a variety of nutrients and healthy foods into one’s diet, and receiving adequate sleep. The characteristics of being mentally healthy were reported as having the ability to manage stress, practicing self-confidence, being happy with oneself, and being able to properly address other emotions. Not only

was being healthy looked at from a physical and mental standpoint but the students also described being healthy in terms of being holistic. For example, the idea of “balance” was mentioned to explain that multiple areas of health must complement each other and work together to allow a student to reach optimal health. The concept of being knowl- edgeable regarding health was reported as a characteristic of being healthy. The students

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in the focus groups shared that “knowing how to read nutrition labels and make sustainable choices influence one’s ability to be healthy.” However, being healthy was not just discussed in a positive context. The class discussions reported that being healthy can be viewed as being too hard to obtain. Students specifically mentioned that being healthy can even sometimes be considered a “chore.”

Importance of health

The students described the importance of being healthy in the context of physical, men- tal, financial, and environmental benefits. Stu- dents noted that taking care of one’s physical health prevents disease and improves one’s quality of life. The mental importance of being healthy was noted frequently by the students. The students reported the mental benefits as including having higher levels of concen- tration, a healthier body image, improved self-confidence, and an increase in academic performance. The students also pointed out that the importance of being healthy extends beyond one’s own personal benefits. For ex- ample, one can save money and economically benefit society by avoiding potential medical costs due to an unhealthy lifestyle. The stu- dents in this study reported, “A lot of students say it is expensive to eat healthy; however, the medical bills resulting from future doc- tors’ visits will be far more expensive than eating healthy food now.” The benefits of be- ing healthy were even reported as extending as far as improving one’s own community and environment. The students reported that healthy individuals can influence the com- munity for the greater good by helping the environment, stimulating the local economy, and purchasing from local farmers.

Barriers of health

The students listed the barriers of being healthy in terms of either a lack or an excess of certain resources present in one’s daily life. Lack of time, knowledge, finances, healthy food, and sidewalks were listed as the barriers to college students’ health. When discussing lack of knowledge, the students reported col-

lege curricula not offering enough classes in both stress management and nutrition. Also, the participants reported that college students often do not have enough knowledge on gro- cery shopping. Along with a lack of knowl- edge, a lack of having proper finances to sup- port healthy living was noted. In particular, the students expressed the high expense of college meal plans being required by college campuses was a barrier to being healthy. In addition to the expensive meal plan being a barrier to college students’ health, the lack of access to healthy foods on campus made it harder for college students to be healthy. The cost of healthy food items on campus was re- ported by the students as being a barrier to health on campus. In particular, the students noted that “a salad costs (on average) $7.00 versus a bag of chips and soda, which costs (on average) $3.50.”

The excess of unhealthy foods available on campus including fast food restaurants and convenience foods was listed as contribut- ing to an environment that did not support healthful behavior. The students also noted chocolate as a specific unhealthy food when consumed in excess. In addition, an excess of general misinformation from media outputs, advertisements, food marketing campaigns, and peers were listed as negative attributes of college campuses when trying to promote stu- dent health. The last barrier that students re- ported hindering college students’ health per- tains to the excessive amounts of stress that accompanies a college student’s class sched- ule. For example, the students communicated having excess stress related to struggles with scheduling their time between classes, home- work, social events, eating, and working out. The students noted that being healthy was stressful because finding the time to do health- ful activities was viewed as a chore in a stu- dent’s everyday schedule.

Facilitators of health

The facilitators to improving college stu- dents’ wellness involved increasing support through peers who have healthy habits, places to be active, healthy food, and health ed- ucation. The student researchers reported

132 TOPIC IN CLINICAL NUTRITION/APRIL–JUNE 2019

that students should both have a routine and find balance in their life to reach optimal wellness. The student researchers also re- ported that these actions would not only help students reach small, obtainable goals but also help them learn how to satisfy potentially un- healthy cravings in healthier ways.

Changes college campus wellness programs need to address

The students reported multiple changes that college campus wellness programs could make to address the health of college stu- dents on campus. The students reported that campus wellness programs need to increase supports for various healthy components of everyday life while also decreasing the barri- ers that inhibit student health. Specific rec- ommendations with descriptions for college campus wellness programs are summarized as follows:

Healthy food options: Students requested that campuses need to offer healthier food op- tions, ensuring that these options are avail- able later in the evening and on weekends. The students reported a need to increase the number of salad bars located on cam- pus along with the healthy food options offered at various, existing salad bars. One example included the need for healthier salad dressing choices. Convenience stores were also listed as places where college campuses could increase accessibility to healthier food options. In particular, stu- dents expressed a need for more fresh fruits and requested that college campuses offer healthier juices along with adding smooth- ies to menus. Not only did the students suggest increasing the amount of healthy food on campus but also the access to nu- trition information for each item/dish being offered. They proposed the use of a ranking system to inform students of how their food choices rank in nutrition healthfulness. The students recommended that campuses pro- vide better placement for healthier food options than those that are unhealthy to increase visibility and opportunities so

that students would opt for the healthier choices. The students reported that the price of healthy food options needed to be reduced to increase consumption. For ex- ample, the price of fruits was noted for be- ing a high expense on college campuses by the students. The amount of high-fat, fried foods offered on campus was also noted as an item that needed to be decreased to re- duce the consumption of unhealthy fat in students’ diets. In particular, the students wanted colleges to reduce the amount of fats used when cooking vegetable dishes.

Education: The students listed a variety of health topics for which they desired more education. Topics included mental health, sleep, stress, time management, substance abuse prevention (alcohol and drugs), smoking, sexual health (sexually transmit- ted disease prevention), food safety, phys- ical activity, and nutrition. The students specifically reported that campuses should offer healthy food demonstrations along with offering recipe booklets that students could use.

Truthful marketing: Students reported a need for truthful marketing regarding the food products offered on campuses. Fur- thermore, they requested that all messages must be clearly represented to avoid any potential misinterpretations.

Student organizations: The students desired an increase in the number of student orga- nizations focused on health. This was re- ported as a strategy to increase the number of peers learning and sharing about well- ness.

Support systems: The students reported the importance of mental health on overall health. The students specifically identi- fied receiving personal encouragement to be a beneficial tool that could be used to improve students’ quality of life on campus.

Sidewalks: Sidewalks were listed by the student researchers as locations that could be used to increase and provide opportu- nities for students to engage in physical activity

Promoting Wellness on College Campuses 133

Approaches for college campus wellness programs to change student behavior

The students identified not only what changes college campus wellness programs needed to make but also how such changes should be implemented. The recommenda- tions on approaches for college campus well- ness programs to change student behavior are summarized as follows:

Education: The student researchers men- tioned that education on both nutrition and physical activities must be provided for stu- dents to change their behaviors. For ex- ample, students noted that detailed guides (workout and cooking) were identified as a potential tool that universities could pro- vide to students when imparting educa- tion on a particular health topic. In addi- tion, students reported that they need to be taught about the rewards of changing their behaviors before a change is actually made.

Support systems: Students could be encour- aged to make a lifestyle change by having a support system of friends and/or peers who want to see their fellow students succeed at reaching lifestyle goals. In particular, the students in the class discussions reported that changing behavior is easier when stu- dents are motivated by friends and/or peers who value their own health and wellness needs. In addition, the students wanted the support of the student government and fac- ulty. They stated that they were interested in knowing the services provided by din- ing representatives, dietitians, and student organizations focusing on health and well- ness issues.

Scheduling: The participants identified that students must understand the importance of scheduling time to maintain a healthy lifestyle. For example, students must be committed to scheduling “out” the re- quired amount of time to eat each meal throughout the day. Students must also un- derstand how to create health goals that are both small and attainable to encourage lifestyle changes.

Approaches for wellness programs to grab college students’ attention

The student researchers also identified cer- tain aspects of the college environment and events on campuses more likely to grab college students’ attention. The recommen- dations for college campus wellness pro- grams to grab students’ attention are as follows:

Guest speakers: Students reported being drawn to celebrity speakers.

Club events: Students expressed an interest in clubs promoting wellness needs and issues.

Intramural activities: Students shared an in- terest in engaging in “games” through in- tramural sporting events such as kickball, powder puff football, and ultimate Fris- bee. The students wanted to interact with the school’s mascot during these gaming events.

Cooking classes: Students were interested in learning various cooking skills to prepare healthier meals and suggested having more cooking classes on campuses.

Farmers’ markets: Students recommended having farmers’ markets on campus to in- crease access to “fresher produce.”

Cool factor: Students noted the following characteristics of an event for their abil- ity to grab students’ attention: free, con- venient, themed, sponsored, advertised, and high-tech. For example, the students quoted that “schedule events towards when students would be more available. Convenience is key.” Finally, the students reported that universities must specifically tailor to the needs of this target audi- ence to help facilitate healthy lifestyle changes.

In addition, the students suggested that col- lege campuses must show both the benefits of choosing a healthy lifestyle and the conse- quences of engaging in unhealthy behaviors. Sharing such information with students who are uninformed or unaware may enable the use of the college environment as a tool to initiate health changes.

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DISCUSSION

The objective of this study was to explore the health-related knowledge, beliefs, and attitudes of a group of college students to better understand what approaches college wellness programs should consider when developing wellness interventions. In partic- ular, the results from this study focused on the components of college campus wellness programs including nutrition, physical activ- ity, and stress management. The results from this study showed that the focus groups’ atti- tudes, knowledge, and beliefs toward overall health and wellness involve multiple facets of everyday life. Finding balance between all areas of wellness was mentioned by the student researchers in this study. They further confirmed that they want universities to set priorities that address more than 1 area of wellness at a time (nutrition, stress, physical activity, etc). The student researchers also suggested that college campus wellness pro- grams should continue to facilitate providing physical, emotional, and social supports for students and their wellness goals.

The student researchers reported that col- lege campuses should offer more education on both the wellness areas of nutrition and stress. These results from the class discussions are similar to the results reported by LaFoun- taine and colleagues8 in the Wellness Evalua- tion of Lifestyle (WEL). Results from the WEL indicated that college students reported be- ing the least knowledgeable on the wellness areas of stress management and nutrition.8

The student researchers from this project rec- ognized the need for college wellness pro- grams to offer more nutrition and stress ed- ucation in order to address students’ lack of knowledge related to wellness. The stu- dent researchers also recommended that if college campus wellness programs provide wellness information to students, the well- ness information should not be confusing or misleading. For example, misleading adver- tising that claims unhealthy foods are good for students fosters a confusing environment

that hinders students’ abilities to make edu- cated decisions regarding one’s health. These requests suggest the importance of college campus wellness programs providing clear wellness education and helpful resources for students.

In addition to educating students on physical wellness and behavioral change, col- lege wellness programs need to understand how to best approach changing students’ behaviors.8 Similar to the results reported by Walsh and colleagues34 and Plotnikoff and colleagues,6 the students in this study suggested the importance of students having strong support systems when changing behavior. Also, peers play an influential role in affecting students’ decisions. Nelson and team19 reported that during emerging adult- hood, a student’s support system changes from his or her parents to peers. This change in support showcases how peers become the most important source of change in students’ behaviors related to both alcohol and exer- cise while parents remain the most influential over their children’s health beliefs through modeling.35

College campus wellness programs must recognize the physical wellness needs of a peer-focused support system and offer mul- tiple wellness opportunities for students to engage with each other. Further confirming the findings of Plotnikoff and colleagues,6 not only did the students report that they wanted to find support from their peers but also from the campus student governance and faculty. This suggestion indicates that college campus wellness programs can utilize prominent cam- pus figures as support for student behavioral change. The studies referenced earlier, in ad- dition to results from this study, showcase the importance of college campus wellness pro- grams offering students a strong social sup- port system when looking to alter students’ wellness behaviors.8,11,19,35

Students in this study and previous stud- ies reported the need to find additional ways to cope with stress.8,11 In particu- lar, the students reported the need to learn

Promoting Wellness on College Campuses 135

how to handle stress associated with bal- ancing multiple facets of a busy student schedule. These same findings were also reported by Greaney and colleagues18 in a study analyzing college students’ barriers and enablers for healthful weight manage- ment. Greaney and colleagues18 reported that the time constraints involved with the busy schedules of students were noted as being a main barrier for achieving and maintain- ing a healthy weight. Not only have stud- ies noted high stress associated with busy student schedules as a barrier to healthful weight management8,11 but also a study by Kattelmann and colleagues36 aimed at design- ing an online intervention to prevent weight gain in young adults indicated that stress and time management played key roles in affect- ing a student’s overall quality of life and well- ness. These results further suggest that college campus wellness programs must provide re- sources and social support for multiple facets of students’ busy schedules.

The strengths of this study included a stu- dent body from 4 land-grant universities dis- persed geographically throughout the United States working together using a CBPR ap- proach. The CBPR process gathered college students interested in wellness together to develop a health intervention for college stu- dents. The class discussion questions and de- sign were created and refined by a group of nutrition researchers specializing in college obesity prevention in partnership with gradu- ate and undergraduate students attending the same universities.

The limitations of this study relate to the students’ demographics and must be considered. Recruitment used convenience sampling of students interested in wellness, which might not represent the diversity of a college campus’s student body. The study

consisted of a high female to male ratio, limit- ing gender perceptions on wellness needs and issues. The mixed gender focus groups also did not allow for the development of well- ness interventions targeted for each individ- ual gender. Finally, although the universities involved in this research were from different states, the results may not be generalizable to all universities due to geographic differences (South Dakota State University = rural area; University of Tennessee = urban area; West Virginia University = urban area; and Univer- sity of Florida = urban area).

CONCLUSION

Given that overall wellness of college students is influenced by multiple factors within a student’s environment, administra- tors must be aware of the physical wellness needs and issues students want addressed to improve long-range, comprehensive health and wellness on campus. Targets identified for enhancing student wellness included in- creasing healthy food options, education on health topics, truthful marketing, student or- ganizations focusing on wellness, and support systems. Concurrently, decreases are desired in cost of “healthy food options, availability of unhealthy food options, misinformation regarding health, and stress.”37(pS63) The priorities for facilitating behavioral changes focused on communicating health-related services and facilities available to students, providing a support system for students, educating students on health topics, accom- modating students’ schedules, and offering attention-grabbing events. Future studies should evaluate the impact of addressing these wellness needs and issues of college stu- dents on students’ overall physical wellness.

REFERENCES

1. Zuercher JL, Kranz S. College eating 101: factors influ- encing students’ food decisions. Int J Child Adolesc Health. 2012;5(1):3-6.

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