Making Health Happen on Campus: A Review of a Required General Education Health Course

{ Making Health Happen on Campus: A Review of a Required General Education Health Course Craig M. Becker, Hans Johnson, Karen Vail-Smith, Cathy Maahs-Fladung, Debra Tavasso, Barry Elmore, and Charla Blumell Revisions of general education curricula have been ongoing as universities strive to meet the general education goal of helping students succeed (Glynn, Aultman, & Owens, 2005). The importance of health status with regard to the future health potential of college students and the impact the college years have on their health has been highlighted in the American College Health Association Healthy Campus 2010 document (2004). Research has demonstrated the relationship between student health and academic performance (Pritchard & Wilson, 2003). Findings highlight the negative effects that substance abuse, emotional issues, and risky sexual behaviors have on academic performance (Marlatt & Witkiewitz, 2002; Pritchard & Wilson, 2003; Riley, Durbin, & D Ariano, 2005; Von Ah, Ebert, Ngamvitroj, Parj, & Kang, 2004). With this understanding, the required status of a personal health course in a college general education curriculum should be self-evident, yet its required status continues to be an issue of contention. This article reviews the need for a college-level personal health course, explains why colleges provide an effective place to teach a general education health course, and provides the evaluation results of a personal health course delivered to four thousand students per year. JGE: THE JOURNAL OF GENERAL EDUCATION, Vol. 57, No. 2, 2008 Copyright 2008 The Pennsylvania State University, University Park, PA.

Health Status Seventy-one percent of deaths in the ten- to twenty-four-year-old age group result from automobile crashes, unintentional injuries, homicide, or suicide (Eaton & Centers for Disease Control and Prevention, 2006). Results from the 2005 Youth Risk Behavior Surveillance System indicate that 9.9 percent of high school students had driven a motor vehicle while drinking alcohol. This number more than doubles in college, and researchers estimate that the percentage of college students who drove a motor vehicle under the influence of alcohol increased from 26.5 percent in 1998 to 31.4 percent in 2001 (Hingson, Heeren, Winter, & Wechsler, 2005). College years are the time when many begin to form lifestyle behavior patterns that strongly influence adult behaviors (Pearman & Valois, 1997). Reports also indicate college to be a time when students explore and experiment with high-risk sexual behaviors (Brener & Gowda, 2001; Clemmens, Engler, & Chinn, 2004). The 1995 National College Risk Behavior Survey conducted by the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) indicated that only 29.6 percent of the 62.4 percent of college students having sexual intercourse used a condom during their last sexual encounter. This study also reported that 16.6 percent of college students had drunk alcohol or used drugs at their last sexual encounter, a handicapping factor in a student s ability to make healthy sexual choices (CDC, 1997). These behaviors may explain why almost half of the approximately 19 million new STD infections in the United States each year occur in fifteen to twenty-four year olds. The overrepresentation of college-age students is dramatic because this age group makes up only 25 percent of sexually active individuals (Weinstock, Berman, & Cates, 2004). The fact that many high schools do not provide comprehensive sexual education is another contributing factor to sexual health issues in college (Starkman & Rajani, 2002). In other words, many students come to college without adequate knowledge to make healthier choices regarding sexual health. Additional findings document college students engagement in other risk behaviors. For instance, 34.5 percent of college students had five or more drinks of alcohol on at least one occasion. Additionally, more than one-third (35.1 percent) of college students were in a car with a driver who had been drinking alcohol, and 30.5 percent of the respondents reported they had been drinking when boating or swimming (CDC, 1997). With our increased understanding of health issues and increased public awareness, one would think health behaviors would have improved. But even though we know that condoms are protective, the American College Health 68 Becker et al.

Association assessment indicates that fewer students used condoms for protection in 2005 than did in 2000 (17 versus 22 percent). Additionally, with regard to mental health, more students in 2005 reported feeling depressed, hopeless, or sad, and with regard to lifestyle, more were concerned about their weight than reported in 2000 (American College Health Association, 2005). These negative health behavior trends indicate a need to address health issues and behaviors with the college population. Although findings suggest that college students are moving in the wrong direction with regard to health, all issues described are preventable if students make healthier choices. Education is our best strategy to empower college students to improve their health behaviors and decision-making skills (CDC, 1997; Marlatt & Witkiewitz, 2002; Wechsler, Kelley, Weitzman, San Giovanni, & Seibring, 2000). Overview of a Personal Health Course At a large southeastern university, a basic personal health class is a two-hour requirement in the forty-two-hour Liberal Arts Foundation Curriculum. The goal of this health course is to enable university students to gain the knowledge and skills necessary to make responsible, informed decisions regarding their health and well-being. The course, Health in Modern Society, is taught by the Department of Health Education and Promotion and is one of the largest general education personal health courses in the United States. Course Organization Each academic year over one hundred sections (fifty per semester) of this course are taught to 3,500 4,000 students. Most sections are composed of less than thirty-five students. The yearly course enrollment requires careful management. To coordinate these efforts, a departmental committee of faculty members organizes and updates the course offerings. The committee advises the course coordinator and collaborates in decision making about course offerings, policies, and procedures. Members participate in text selection and in developing and revising the student workbook. The committee also coordinates monthly continuing education workshops for all instructors. To ensure that the best information available is presented, many partnerships between the course and groups on campus and community organizations were created. Partners include the counseling center, student health center, local health care centers, campus peer health groups, police, crisis centers, nutritional service groups, and local and on-campus recreation centers. Making Health Happen on Campus 69

Teaching Methods This innovative two-credit-hour general education course helps students learn by using active learning techniques to involve students with the information that affects their lives (Becker & Glascoff, 2005) as it fosters personal responsibility and lifelong learning. The course covers areas directly related to the wellbeing of college populations: lifestyle, mental health, and sexual health. Course content is delivered through lectures, discussions, and self-assessments. Reflection exercises are used to encourage students to critically think about how their current behaviors affect their present and future health. The course responds to the diverse needs of students by offering sections for nontraditional students and honors students. The course also teaches to about three hundred off-campus and on-campus distance-education students each year. To meet the challenge of multiple sections using many different instructors, procedures are used to standardize course content and its delivery. Strategies include the use of a regularly updated library of PowerPoint presentations on all topics in the class, Web-based lessons for online or face-to-face class enhancement, and original education media. Original media include Booze Truths, a campus-designed video that highlights the risks of alcohol use; a series of fourteen short videos used as Lecture Launchers for Health ; and a series of twelve interview videos that highlight students thoughts about health topics. Instructors also strive to meet student needs by integrating cutting-edge technology. The PowerPoint Lesson Library includes a rich multimedia learning experience with Multipurpose Integrated-Media Modules (MIMMs), internally created technology that is used for both in-class and online instruction. MIMMs allow videos and PowerPoint presentations to play simultaneously as an instructional voice-over is heard. In addition, all MIMMs include an annotated script with additional factual information and discussion questions. Utilizing continuous quality-improvement ideas, coordinating faculty develop new methods and procedures to deliver content. For instance, in 2004, the course added a service-learning component to some of its sections. The effectiveness of service learning has been well documented (Reed, Christian Jernstedt, Hawley, Reber, & DuBois, 2005; Sipe, 2001; Strage, 2004), and a reflection paper about their service-learning experience is required of students because it helps them gain a better understanding of the material as they enhance their civic responsibility. Course Evaluation For the past several years, efforts have been made to determine the effectiveness of this course with regard to lifestyle, mental health, and sexual health 70 Becker et al.

TABLE 1 Average Scores on Knowledge Test by Area Group Paired Sample Area N Mean N Mean Total Pretest 932 15.37 154 16.02 Total Posttest 595 17.42 154 18.51* Pre Mental Health 913 4.03 149 4.12 Post Mental Health 595 4.59 149 4.96* Pre Lifestyle 930 6.85 101 6.85 Post Lifestyle 595 6.88 101 7.36* Pre Sexual Health 894 5.08 149 5.41 Post Sexual Health 595 5.96 149 6.22* *p <.000 knowledge and physical and emotional health behaviors. Knowledge changes were evaluated using a pre/post knowledge test that was developed over several semesters. The thirty-question knowledge test, using questions that demonstrated reliability and discrimination, queried the class s focus areas. Data collected from those who completed both the pre- and posttest were significant (p <.000) for lifestyle, mental health, and sexual health scores (Table 1). Overall, knowledge test mean scores for lifestyle, mental health, and sexual health improved. In the spring 2005 class, after Institutional Review Board approval was received for this evaluation, the knowledge test along with a behavior scale, the Salutogenic Wellness Promotion Scale (SWPS), were made available to students online as pre/post evaluation measures. Students anonymously completed the online evaluation. Students provided a participant-generated passphrase so that pre- and posttest responses could be matched. The SWPS, a multidimensional scale that measures health- promoting actions across dimensions, previously demonstrated good reliability and validity with college populations (Becker, Dolbier, Durham, Glascoff, & Adams, 2008). The SWPS was used to determine if students enrolled in this class altered their health-promoting behaviors. To match course content, only emotional and physical areas were noted. The physical construct measures physical movement in sport or lifestyle and nutrition from food intake. The emotional construct measures the ability to effectively manage emotions. Student-reported data collected from the SWPS indicate that students engaged in the same or more physical and emotional health-promoting behaviors after the course than before the course (Table 2). Making Health Happen on Campus 71

TABLE 2 Average Group Salutogenic Wellness Promotion Scale Scores by Area Pre Post Area N Mean N Mean Physical 968 3.0708 635 3.1633 Emotional 968 3.1546 635 3.1922 Discussion and Recommendations Requiring college students to take a general education course about health guarantees that they are exposed to helpful information about health and related knowledge, behaviors, and skills. Results suggest that it has been effective to deliver health information to college students in a way that strives to meet their needs. Most importantly, students enrolled in this course reversed the negative trend regarding the health behaviors of college students. Not only did students from this class have a statistically significant increase in knowledge, but overall, emotional, and physical health behaviors trended healthier. Students also self-reported that the personal health course was a valuable general education course that should be required for graduation. Data collected about the course described in this article suggest that a personal health course should be a general education requirement. This course evaluation measured immediate changes; evaluations of health courses in the future should attempt to gather longitudinal data about graduating students and compare them with other working adults who did not complete a health course in college. In addition, constraints should be used to assure matching of pre- and posttest respondents. Future studies may also want to include more student notification if testing is done online. Some students did not learn about this opportunity in class and were only notified by e-mail. A required general education personal health course has had positive benefits for college students current health and well-being and their future health potential. Such a course also supports national objectives outlined in Healthy People publications. Most health issues are faced as one ages; arming students with information about health behaviors in college in a required general education course provides them with the ability and knowledge to make wise personal health choices. It is our contention that these findings provide strong evidence that more universities should make a concerted effort to develop and require a general education health course that provides education, skill enhancement, and information about relevant student health issues. 72 Becker et al.

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