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Building Healthy Academic Communities Journal The official journal of the National Consortium for Building Healthy Academic Communities designed to promote comprehensive, evidence-based practices on faculty & staff wellness, student wellness, academic medical centers, and wellness innovation.


Table of

Content Page 01– 04 Board of Directors Editorial Advisory Board President’s Message

Page 05 – 06 Editorial: New Year’s Resolutions

Page 07 – 16 Ready to Move: A Unique University Worksite Wellness Initiative

Page 17 – 22 Evaluation of Dog Walking Programs to Promote Student Nurse Health

Page 23 – 33 Perceived Barriers to Meditation Among College Students: The Role of Personality Traits

Page 34 – 43 Online Dating and the Risk of Sexual Assault to College Students

Page 44 – 55 Expressive Writing: A Self-Care Intervention for First Year Undergraduates

Page 56 – 66 Examining Student Wellness for the Development of Campus-Based Wellness Programs


Building Healthy Academic Communities Journal Vol. 3, No. 1, 2019

BUILDING HEALTHY ACADEMIC COMMUNITIES (BHAC) Board of Directors

President: Megan Amaya, PhD, CHES, is an assistant professor of clinical practice and director of health promotion and wellness at The Ohio State University. She is past-president of the Society of Public Health Educators Ohio Chapter, and former steering team member for the central region Healthy Ohio Business Council. Megan is a certified health education specialist. She has been instrumental in the launching of our National Consortium for Building Healthy Academic Communities. She coordinated the 2013 National BHAC Summit and the Ohio BHAC Summit in 2014. Megan was also a member of the planning committee for the 2015 and 2017 National Summits. President-elect: Bernadette Melnyk, PhD, RN, FAANP, FNAP, FAAN, is vice president for health promotion, university chief wellness officer, and dean of the College of Nursing at The Ohio State University. She also is a professor of pediatrics and psychiatry in the College of Medicine. She is an internationally recognized expert in evidence-based practice, health and wellness, mental health, and intervention research, and is a frequent keynote speaker at national and international conferences on these topics. Her scholarship record includes over 19 million dollars of sponsored funding from federal agencies as principal investigator and over 280 publications, including four books. She served a four-year term on the 16-member United States Preventive Services Task Force and currently serves as a member of the National Quality Forum’s (NQF) Behavioral Health Standing Committee and the National Institutes of Health’s National Advisory Council for Nursing Research. She serves as editor in chief of the journal Worldviews in Evidence-based Nursing, and is a board member of the National Guideline Clearinghouse and National Quality Measures Clearinghouse. In addition, she is an elected member of the Institute of Medicine, elected fellow of the National Academy of Medicine, the American Academy of Nursing, the National Academies of Practice and the American Association of Nurse Practitioners. Secretary: Mary Johnson, DNP, APRN, FNP-BC, CWP. After completing a bachelor of science degree in Molecular Biology at Meredith College, Johnson obtained an accelerated bachelor of science degree in Nursing, a master of science in Nursing as a family nurse practitioner, and a doctorate of nursing practice at Duke University. In 2015 she returned to Meredith to serve as the director of Health Services. At Meredith, she serves as co-chair of the campus' Wellness Advisory Committee and member of the Safety and Health Committee, Orientation Committee, and various campus task forces related to student wellness. She also serves as an advisor for the campus’ peer educators and a preceptor for both UNC, Duke, and Meredith students in nursing and public health. After transferring some Healthy Campus 2020 principles to Meredith during her initial program assessment, Mary obtained her certified wellness practitioner designation with the National Wellness Institute and continues to use this knowledge to influence both in her practice and campus education. Advisory Board Chair: Lindsey W. Nanney, M.S, PAPHS, GFS serves as the Physical Activity and Wellness Coordinator at the University of North Carolina Wilmington. The program, a graduation requirement for all undergraduate students, focuses on whole person well-being and sustainable engagement in physical activity. Approximately 3200 undergraduate students go through the program each academic year. Lindsey previously served as the Lifetime Physical Activity and Fitness Program Coordinator at East Carolina University. 1


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Treasurer: Brenda Seals is an associate professor and chair of the Department of Public Health at The College of New Jersey. She teaches Research Methods, Grant Writing and oversees Capstone Projects for the BS and MPH programs. She serves as a co-investigator on many community-based participatory approach projects including a Patient Centered Outcomes Research Institute (PCORI) study of hepatitis among Asian Americans living from Delaware to New York City. She is also co-investigator of a CDC REACH grant geared to improve diets among Chinese, Vietnamese, Korean and Filipino Community Based Organizations serving meals to community members. Another component of the REACH grant works with Asian supermarkets to promote healthier foods and improve store offerings of lower salt, higher fiber and better oil products. Brenda has worked with Native American and African American populations for studies of HIV, cancer, violence and injury and mental health. Research & EBP Chair: Mario R. Ortiz, RN, PhD, PHCNS-BC, FNP-C, FNAP, is dean and professor of nursing at Binghamton University's Decker School of Nursing, director of the school's Kresge Center for Nursing Research, Executive Director of Community Practices, and serves on the Healthy Campus Initiative Board of Directors. He has a proven record of success in developing healthcare education programs that meet community healthcare and service gaps with a focus on wellness, has established and nurtured critical partnerships with healthcare providers and organizations to provide healthcare to the underserved, and has a rich portfolio of community, faculty, and staff development. He has garnered millions of dollars in endowments and grants to support community-based health and wellness efforts. Ortiz earned a PhD in nursing from Loyola University Chicago and is a nationally certified community/public health nurse specialist and family nurse practitioner. Membership Chair: Stacy Connell is the first senior director for Health Initiatives at the Georgia Institute of Technology. She leads the newly established Health Initiatives department which focuses on providing upstream, innovative, and relevant health and well-being programs, services, and initiatives that lead to thriving and fulfilled students and employees. Prior to Georgia Tech, Stacy served at North Carolina State University as the Associate Director of University Recreation and created university-wide wellness initiatives for students and employees in addition to leading club sports, intramural sports, fitness, outdoor adventures and challenge course programs. Stacy also worked as the assistant director for Fitness & Wellness at the University of Georgia and Texas Christian University.

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Building Healthy Academic Communities (BHAC) Journal Meredith Wallace Kazer PhD, APRN, FAAN Editor-in-Chief Fairfield University Fairfield, CT EDITORIAL ADVISORY BOARD Megan Amaya, PhD, CHES Ohio State University Columbus, OH

Columbus, OH Cathy Kropff, M.S. CWWS Virginia Polytechnic Institute and State University Blacksburg, VA

Susan Bartos, PhD, RN, CCRN Fairfield University Fairfield, CT

Ivelisse Lazzarini, OTD, OTR/L Monmouth University West Long Branch, NJ

Diane M. Burgermeister PhD, PMHCNS-BC Madonna University Livonia, MI

Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN The Ohio State University Columbus, OH

Jill A. Bush, PhD, FACSM, CSCS*D The College of New Jersey Ewing, NJ

Kathy Murphy, RN, BA, DipN, RNT, MSc, PhD National University of Ireland Galway, Ireland

Jenifer Chilton, PhD, RN The University of Texas at Tyler Tyler, TX

Michele C. Murray, PhD Seattle University Seattle, WA

Joy Doll, OTD, OTR/L Creighton University Omaha, NE Johann M. Fiore-Conte Binghamton University Binghamton, NY

Leslie Neal-Boylan, PhD, RN, APRN, FAAN Massachusetts General Hospital Institute of Health Professions Boston, MA

Christine S. Gipson PhD, RN, CNE The University of Texas at Tyler Tyler, TX

Meghan Potthoff, PhD, CPNP-AC, APRN-NP Creighton University Omaha, NE

Patrick Kelley, MD, DrPH Fairfield University Fairfield, CT

Jeffery L Ramirez PhD, PMH-NP, ARNP Gonzaga University Spokane, WA

Judith Kimchi-Woods, PhD, RN, MBA, CPNP, CPHQ Chamberlain College of Nursing

Christie Shelton, PhD, RN, CNE, NEA-BC Jacksonville State University Jacksonville, AL 3


President’s Message

Dear Colleagues, A lot has happened in BHAC over the past six months, since our last journal edition. In particular, the 4th National BHAC Summit, as well as our webinar series, Member Portal, National Wellness Challenge, and so much more. With the terrific team effort led by the executive director, Kat Marriot, and our marketing director, Keira McGlone, along with the Board of Directors, Advisory board, and additional efforts, the Consortium continues to bring to life many of the goals and objectives from our strategic plan. The Summit, which takes a yeoman’s amount of work, was a huge success, and we look forward to the next one in 2021 at the University of North Carolina, Wilmington. So many wonderful best practices and strategies to improve student, faculty, and staff health and wellness were shared, as well as innovative and novel ideas that can be expanded upon to further the literature base - which brings me to our fifth edition of the BHAC Journal, the one you are reading now. As practitioners, we are passionate about the work we do. This is all the more reason why we need to continue to share our efforts with the broader field of academic health and wellness and health promotion as a whole. You, as the expert and the reader, can help translate research into practice. It is critical for us to all to continue to learn from each other, identifying where more work needs to be done and celebrating the efforts that are producing positive results. I hope the articles benefit your campus wellness efforts. In addition, please consider contributing to the BHAC Journal. We need more solutions to the issues facing our college campuses. The journal is an important way for us to share our programs, outcomes and key topics with each other. In the words of Helen Keller, “Alone we can do so little; together we can do so much.” Megan Amaya, PhD, CHES Director of Health Promotion & Wellness, The Ohio State University Assistant Professor of Clinical Nursing President, National Consortium for Building Healthy Academic Communities


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Editorial New Year’s Resolutions Meredith Wallace Kazer, PhD, APRN-BC, FAAN Editor-in-Chief With the coming of each New Year, I begin to ponder a resolution. I like to think of this as pattern of selfreflection – identifying something that’s not quite working and devising a plan to fix it. The resolution process has become so traditional that my friends and families begin to ask me about it around Thanksgiving time. With a few exceptions, I’m pretty good at sticking to these resolutions and working them into my personal and professional lives, although some could be perceived as less ambitious than others. For example, one of my most infamous resolutions was to wear more hats, which I continue religiously. A few years ago, I gave up road rage. I floated the idea of holding more grudges, but at the urging of both family and friends who would undoubtedly suffer from such a resolution, I decided to go to the gym twice a week – a resolution that was notably better for my personal and relational health. Through my leadership role at the University, I leveraged this resolution to facilitate a steeply discounted gym membership for faculty and staff that continues today. As 2018 came to a close, the idea for my new year’s resolution presented itself in a series of media stories about the plastic recycling problem we are facing in our nation. By popular reports more than 300 tons of plastic are produced globally each year and only about ten percent is recycled. China - where the U.S. had previously shipped most of our recyclables – has recently placed restrictions on accepting most U.S. plastics which has reduced the market for recyclables among waste-management companies (Semuals, 2019). Most of the plastics now end up in the landfills where they will sit for hundreds of years, or in waterways where they will be consumed by fish and wildlife. What can be done to resolve this issue? According to Dr. Trevor Zink from the University of Loyola Marymount, “The answer is all about consumption. As Dr. Zink puts it, recycling can never make up for consumption. The real environmental value can be achieved through simply reducing our consumption. (Sudakow, 2018)” So for 2019, I decided to give up plastics – at least to greatest extent possible. This is no easy task. I conducted substantial research to determine what plastics I buy and ultimately dispose of which I could substitute with more environmentally friendly-packaged products or do without. I used a top down approach beginning with a shampoo bar, bamboo toothbrush and Eco-dent floss. I make my own toothpaste with baking soda and coconut oil (a combination of which may oddly also be used for deodorant). I never buy single-use plastic water bottles, soda, etc. or Styrofoam coffee cups and use refillable water bottles and cups instead. I keep recyclable bags in the car and use them for not only groceries, but everything - clothes, beauty supplies, and medications. I bought reusable straws and distributed them to my family. I buy fresh from the bakery or produce department instead of prepackaged items in a plastic and choose cardboard containers for milk and juice, cleaning products, dish and laundry detergent, buying in bulk whenever possible. We compost produce and paper waste even going so far as to sift through the trash before we ship it to the dump to see what can be composted or reused. As I write this editorial, I’m pleased to report that the resolution has gone well. But as many will point out, my personal no-plastics pledge won’t make much of a difference in the health of our nation. As faculty, staff and students within academic communities, we all have the opportunity and responsibility to care for our earth. If photos of © 2019 Kazer. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International

License (https://creativecommons.org/licenses/by-nc-nd/4.0/)


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plastic-filled beaches and bird bellies aren’t enough to spur action, the toxins consumed by wildlife have entered the food chain (Andrews, 2012) and are posing a threat to human health. Let’s work with our sustainability committees (or create one if it doesn’t already exist) to address the use of plastics on our campuses. Campus communities can make a substantial impact on plastic usage nationally and it is time to take action! As I stated in one of my earlier editorials, the majority of the world’s leaders pass through our academic doors. My University hands them a recyclable water bottle, but there is more to be done. Let’s join together to forge a path toward less plastic consumption and healthier academic communities for our faculty, staff, and students while they are on our campuses and motivate members of our communities to create such environments wherever they go. REFERENCES Andrews, G. (2012). Plastics in the ocean affecting human health. Geology and Human Health Topical Resources. Retrieved April 8, 2019 from https://serc.carleton.edu/NAGTWorkshops/health/case_studies/plastics.html Semuels, A. (2019). Is this the end of recycling? The Atlantic. Retrieved March 31, 2019 from (https://www.theatlantic.com/technology/archive/2019/03/china-has-stopped-accepting-ourtrash/584131/). Sudakow, J. (2018). Should we stop recycling? The answer might surprise you. Inc. Retrieved March 31, 2019 from https://www.inc.com/james-sudakow/the-biggest-misconceptions-about-recycling-real-businessopportunities-in-circular-economy.html).

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Ready to Move: A Unique University Worksite Wellness Initiative Mariah Deinhart, MPH, CHES Carol Kennedy-Armbruster, PhD, FACSM, C-EP School of Public Health/Department of Kinesiology Indiana University - Bloomington ABSTRACT Background: Ready to Move (RTM), a university worksite wellness program, was implemented to get employees moving more and sitting less by combining student health coaching and activity trackers (AT’s). Aim: This article provides program specifics and survey data outcomes to facilitate ideas for university faculty, staff and student collaboration. The intent of the article is to provide an example of how academic classes can contribute to employee worksite wellness programming within a university. Methods: Twelve cohorts (2015 - 2017) comprised of 295 university employees received Fitbit Flex ATs and health coaching from students enrolled in a physical activity (PA) behavioral interventions class during a 10-week program. The employees met with their student coach eight times to learn how to use their AT and set movement goals. Employee’s completed self-reported surveys on average PA days and PA confidence pre/post program. Results: Findings revealed RTM significantly impacted employees average number of PA days and their confidence in ability to sustain PA. Employee qualitative comments revealed RTM instilled the importance of utilizing ATs combined with student engagement made the experience enjoyable and effective. Conclusion: RTM’s combination improved employee movement outcomes and provided additional programming ideas for the employee wellness program at a large Midwestern university. Submitted 8 October 2018: accepted 2 March 2019 Keywords: university worksite, activity trackers, physical activity, confidence The 2018 Office of Disease Prevention and Health Promotion’s (ODPHP) physical activity scientific report concluded that physical activity bouts of any length of time contribute to the health benefits associated with the accumulated volume of physical activity. This 2018 scientific recommendation is different from the 2008 ODPHP recommendation that stated that physical activity occur in 10-minute continuous bouts. The 2018 ODPHP scientific report points to the need to shift the focus to encouraging physical activity throughout the day. This change may be critical in reducing the anxiety many non-movers experience when considering their initial steps to moving more. In order for these initial steps to take place, a distinction between exercise and physical activity is essential. Exercise is often associated with activities performed in a gym setting whereas physical activity is any bodily movement produced by skeletal muscles requiring energy expenditure (World Health Organization, 2018). This bodily movement can include household chores, playing, working, and countless recreational activities. By turning the focus to physical © 2019 Deinhart & Kennedy-Armbruster. This article is published under a Creative Commons Attribution-NonCommercialNoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/)


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activity, non-movers may find movement activities they not only enjoy but also can maintain. Getting the non-moving population to enjoy movement may prove to have the greatest impact on our nation’s health over time. Walking is an activity many people find enjoyable and can obtain health benefits from (Sullivan & Lachman, 2017). The American Heart Association (AHA, 2014) states that walking 30 minutes a day can improve blood pressure, reduce the risk for coronary heart disease and stroke, boost mental wellbeing, support a healthy weight, as well as reduce the risk of osteoporosis, type II diabetes, and breast and colon cancer. Consequently, simply walking more throughout the day can “count” towards improving health and well-being. Technology applications, including wearable devices and smartphones, have helped reinforce the concept that cumulative steps per day is important and relevant to health outcomes. These devices reinforce the concept that any movement “counts” towards improving health and wellbeing. The ACSM Worldwide Survey of Fitness Trends (Thompson, 2018) named wearable technology in the top five trends for the past three years. Forbes (Marr, 2016) suggests this trend will continue to grow. Activity trackers monitor daily activity and track the user’s movement while incorporating goal setting, feedback, social support, and rewards into the device’s compatible smartphone applications. Segar (2017), a behavioral sustainability scientist, points out how wearable technology and their smartphone applications have allowed the anti-gym and non-mover population to find their own, comfortable form of movement. Individuals who dislike traditional exercise or are uncomfortable in a gym setting are prime users for wearable technology due to its ability to provide personalized, immediate, digital proof of how much movement they are accumulating. Meeting the daily moderate to vigorous physical activity (MVPA) guidelines requires 7,000-8,000 steps/day for adults (Tudor-Locke et al., 2011). Segar suggests that continual feedback is essential in successfully pursuing and achieving goals. Wearable devices show the accumulated step count directly on the device’s screen. This accumulated step count in addition to the device's movement reminders help combat sedentarism, identified as a major risk factor for all-cause mortality and particularly heart disease (Benatti & Ried-Larsen, 2015). Users can view how many steps they received compared to the previous day, week, month, or year. Segar argues that although these devices are valuable tools for reaching goals, they are only tools. In order to sustain motivation, it must come from within oneself. Despite wearable technology’s strengths of including goal setting, feedback, rewards, and social support, Sullivan & Lachman (2017) mention some critical behavior change strategies missing from these devices. Action planning is a strategy that includes “if, then” plans. This motivates individuals to plan how, when, and where to achieve goals. Through action planning, individuals can identify previous barriers preventing goal achievement. By addressing barriers, it is possible to overcome obstacles. Wearable devices do not contain action planning and barrier identification strategies crucial for physical activity long-term goal attainment. Inactive individuals need specific strategies in order to sustain daily movement practices. Wearable devices incorporate behavior change information, yet more behavioral strategies and human coaching may help sustain change. Health and fitness professionals’ effort to change sedentary lifestyles and sustain movement have been largely unsuccessful. With an approximate 80% exercise program dropout rate, it’s been suggested that health and fitness professionals struggle to properly motivate clients (Gidlow, Johnston, Crone, & James, 2005; Abbott, 2014). Wolever et al. (2013) defined health coaching as a client-centered process that includes client-determined goals, integrates learning and self-discovery, provides education, and encourages health behavior accountability. Enhancing communication skills like providing feedback, emotional support, and expressing empathy coupled with training in behavior change techniques and health behavior models are most relevant in preparing health coaches (Wolever et 8


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al., 2013). Sforzo, Moore, and Scholtz (2015) proposes that health coaching creates sustainable behavior change by helping clients become more responsible, mindful, resilient, self-compassionate, and more fully engaged in leading a healthy lifestyle. This develops a client’s motivation and confidence. According to Sforzo et al. (2015) health coaches take off their “expert” hat, foster possibilities, ask effective questions and help clients elicit their agenda. If these questions and possibilities are client-centered, the coach can be a facilitator of change, and a partner in the process (Sforzo et al., 2015). Rutjes, Willemsen, Kersten-van Dijk, De Ruyter, and Ijsselsteijn (2017) compiled data from semi-structured interviews with health coaches who had an average of 10 years of experience. Each health coach expressed the importance of a tailored approach with clients. The more specific and tailored advice, the more likely the client is to adhere. Based on the daily lives of each client, health coaches work to elicit change over time. Coaches encourage a systematic change process with the client “driving the bus.” Each client will have their own path with distinct successes and setbacks. METHODS Survey data were collected from 295 university employees enrolled in a 10-week PA program called Ready to Move (RTM) offered through the University employee wellness program in collaboration with the School of Public Health (SPH) Department of Kinesiology’s academic class. This total number of employees consisted of 12 cohorts spanning from Fall of 2015 to Spring of 2017. Total students involved in delivering the program was 218. The university employees received a FitBit Flex activity tracker as well as individual health coaching from the students enrolled in the Department of Kinesiology’s physical activity (PA) behavioral interventions class. The Fitbit Flex® was chosen by the university wellness program directors because of cost and ease of use (Kiessling & Kennedy-Armbruster, 2016). The university wellness program recruited the employees for this project through marketing and an organized sign up process. The employees, paired with a student coach, were required to meet together eight times throughout the semester outside of classroom. A coaching/tracking combination was encouraged through academic content taught in the classroom. During these meetings, the employees learned how to use their AT’s and set movement goals. Because the student coach was enrolled in an academic class, meeting with and coaching their assigned employee was attributed to a grade. Employees were made aware that a student’s grade was dependent upon their participation in this program. This outside of class experience allowed students to practice their coaching skills on real people striving to change and helped hold employees accountable in meeting with their student coach. Pre/post program selfreported surveys on average PA days and PA confidence were administered to employee’s. Student health coaches were educated on behavior change techniques, motivational interviewing strategies and the coach versus expert approach. In addition to educating their clients on how to use ATs, the students applied the classroom material by coaching their clients through behavior change utilizing specific, measurable, attainable, realistic, time-bound (SMART) goal setting and motivational interviewing techniques practiced in class. The students focused on what the client was interested in whether it was exercise (ACSM guidelines), Physical Activity (ODPHP, 2018) or reducing sedentary time during the workday. This Human Movement Paradigm (Figure 1; Armbruster, Evans, & Laughlin, 2019; Kennedy-Armbruster, Evans, & Reed, 2019) was presented throughout the class as an idea for what to discuss with clients in terms of physical activity options paying particular attention to physical activity during the workday.

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Michelle Segar discusses the importance of clients wanting to participate in movement and transforming “I should” statements to “I want” (Segar, 2015). She explains the detrimental effects of movement feeling like a chore. When the RTM clients were asked, “What movement activities do you enjoy?” the most common answer was walking (Figure 2). This was an important realization as the student health coaches encouraged activities employees wanted to do. There was limited gym-talk as the focus was on work and home-based movement. Workstation movements to perform at a desk, strategies to move throughout the workday, and building at-home movement routines were encouraged throughout the program.

Figure 1. Human Movement Paradigm

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Figure 2. Word cloud created from the survey question “What movement activities do you enjoy?” RESULTS Pre and post RTM program surveys were completed by employees to measure behavioral outcomes and evaluate the program’s impact. Results from 12 cohorts comprising 295 employees found both a statistically significant (p < .001) increase in the number of days clients participated in physical activity (Figure 3) as well as their confidence in ability to sustain physical activity (Figure 4). Question Utilized: In the average workweek, how many days do you get 30 minutes or more (for at least 10 minutes at a time) of light to moderate physical activity? Examples include walking, pushing a lawn mower, or slow cycling.

Figure 3. Pre/post comparison representing a significant increase in PA days The number of days clients participated in physical activity significantly increased with a mean difference of 1.087. 11


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Question Utilized: My confidence level in my ability to reach and sustain regular physical activity/movement:

Figure 4. RTM pre/post survey confidence scale. Post program average in confidence was 8.06. There was a significant increase pre to post program with a mean difference of 0.927. Overall, significant increases in client’s average days of PA and confidence in ability to sustain PA were found with this 10-week RTM program combining activity trackers and student health coaching. QUALITATIVE RESULTS Table 1

Client Comments on ATs “The tracker makes me accountable and makes me want to do more” “The tracker made me aware of how little I was moving during the day. I was often surprised the first couple of weeks to find out how much, or really how little, I walked between the time I arrived at work and the time I left. After recognizing this lack of movement, the fitness tracker gave me specific, easily measurable goals to work toward. It was easy to see at a glance how much activity I’d gotten so far that day, and I frequently made adjustments partway through the day to get more steps. I’ve gotten better at estimating steps now, so that even on days I forget to wear my Fitbit, I can still keep track of generally where I’m at with my steps.” “The tracker provided more accountability and a specific goal to reach. The goal of working out every day is vague and wasn’t motivating all the time. The tracker provided specific goals and also feedback when those goals were met.”

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Table 2

Explanations From Clients who Answered yes to, “Has This Program Changed Your Views on Physical Activity?” “I no longer see movement as ‘all or nothing.’ Every little bit can make an impact” “My coach helped me to think about exercise not only as something that happens at the gym, but instead should incorporate movement throughout my day, including many activities I enjoy and could do more while having fun and feeling good.” “I generally tend to think of ‘exercise’ as something difficult and time-consuming; this program has helped me to see how to fit short bursts of activity into my normal life.” “I have always exercised, but it has been more point in time. This program is about moving more throughout day. Maybe a good parallel is small meals over the course of the day instead of one big meal.” DISCUSSION The results point to the idea that ATs combined with student health coaching accountability can play a role in increasing movement awareness and providing movement motivation in a university environment. Which factor plays a greater role in the outcomes could not be determined. Sforzo et al. (2015) suggests when the responsibility of goal setting shifts to the client, the client becomes empowered to make sustainable behavior change. The technique used in this program is different from an “exercise prescription” that has followed more of a medical model of intervening in lifestyle change. Bloomfield (2017) believes there is a need to translate science into practice. The authors did their best to repeat the intervention for several years before reporting outcome data to help strengthen data outcome reliability. Others like Rutjes et al. (2017) suggested through their work that there are clear benefits to the combination of wearables and health coaching which was also found in the RTM program outcomes. The number one takeaway from the RTM program was to MAKE time to MOVE throughout the day (Fig. 5).

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Figure 5. Word cloud created from the survey question “What is the number one take-a-way from your participation in the Ready to Move program?” CONCLUSION Taking the coach approach, finding movement activities that participants enjoy, making goal setting the participant’s responsibility, in combination with utilizing wearable devices for immediate and objective feedback may help increase physical activity and decrease time spent in sedentary behavior. The 2018 Physical Activity Guidelines Scientific Report is relatively new, but this RTM program outcomes reflected their recommendation of the need to replace sedentary behavior with light-intensity physical activity as well as reduce time spent in sedentary behavior. Program ideas that foster and encourage these strategies may help increase the physical activity of sedentary participants in an academic worksite community. The program’s success has worked to create additional movement programs incorporating faculty, students, and employees utilizing the wellness program. Faculty looking for enhanced teaching methods, students wanting hands-on learning, and employees working towards better health in a university setting was enough to make an impact for all at this large Midwestern university. More specific analysis related to which aspect of the program had the highest impact (i.e., tracker, coaching, student accountability) is needed in order to have a better understanding. However, overall it was an effective program for enhancing days of physical activity, confidence and community engaged experiences between students and university employees.

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REFERENCES Abbott, A. A. (2014). Philosophy & Standards Part II. ACSM's Health & Fitness Journal, 18(1), 34-38. https://doi.org/10.1249/FIT.0000000000000010 American Heart Association. (2014). American Heart Association recommendations for physical activity in adults. Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-HeartAssociation-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.WsEFcdPwY0o Armbruster, C.K., Evans, E., & Laughlin, C. (2019). Fitness and Wellness: A Way of Life, Human Kinetics Publisher, Champaign, IL. Benatti, F. B., & Ried-Larsen, M. (2015). The effects of breaking up prolonged sitting time: a review of experimental studies. Medicine & Science in Sports & Exercise, 47(10), 2053-2061. https://doi.org/10.1249/MSS.0000000000000654 Bloomfield, S. (2017). Translating Clinical Science to Clinical/Real World Applications: Relevance to Exercise Science. ACSM Translational Journal, 2(22), 146-147. Gidlow, C., Johnston, L. H., Crone, D., & James, D. (2005). Attendance of exercise referral schemes in the UK: A systematic review. Health Education Journal, 64(2), 168-186. https://doi.org/10.1177/001789690506400208 Kennedy-Armbruster, C.A., Evans, E., & Reed, R. (2019). Exercise prescription for the apparently healthy. ACSM Clinical Exercise Physiology, 1st Edition, Ch. 4., Wolters Kluwer Publishers. Kiessling, B., & Kennedy-Armbruster, C. (2016). Move More, Sit Less, And Be Well. ACSMâ&#x20AC;&#x2122;s Health & Fitness Journal, 20(6), 26-31. Marr, B. (2016). 15 noteworthy facts about wearables in 2016. Retrieved from https://www.forbes.com/sites/bernardmarr/2016/03/18/15-mind-boggling-facts-about-wearables-in2016/#450785182732 Office of Disease Prevention and Health Promotion (2008). Physical activity guidelines for Americans. Retrieved from https://health.gov/paguidelines/guidelines/. Office of Disease Prevention and Health Promotion. (2018). The 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Retrieved from https://health.gov/paguidelines/second-edition/report.aspx Rutjes, H., Willemsen, M. C., Kersten-van Dijk, E. T., de Ruyter, B. E. R., & IJsselsteijn, W. A. (2017). Better together: opportunities for technology in health coaching from the coach's perspective. E-Coaching for Health and Wellbeing (eCHW-2017), pp. 1-14. Segar, M. L. (2017). Activity Tracking and Motivation Science: Allies to Keep People Moving for a Lifetime. ACSM's Health & Fitness Journal, 21(4), 8-17. Segar, M. (2015). No sweat: how the simple science of motivation can bring you a lifetime of fitness. AMACOM Div American Mgmt Assn.

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Sforzo, G. A., Moore, M., & Scholtz, M. (2015). Delivering change that lasts: health and wellness coaching competencies for exercise professionals. ACSM's Health & Fitness Journal, 19(2), 20-26. Sullivan, A. N., & Lachman, M. E. (2017). Behavior change with fitness technology in sedentary adults: a review of the evidence for increasing physical activity. Frontiers in public health, 4, 289. https://doi.org/10.3389/fpubh.2016.00289 Thompson, W. R. (2018). Worldwide survey of fitness trends for 2018. ACSMs Health Fit J, 21(6), 10-19. https://doi.org/10.1249/FIT.0000000000000341 Tudor-Locke, C., Craig, C., Brown, W., Clemes, S., De Cocker, K., Giles-Corti, B., Hatano, Y., Inoue, S., Matsudo, S., Mutrie, N., Oppert, JM., Rowe, D., Schmidt, M., Schofield, G., Spence, J., Teixeira, P., Tully, M., & Blair, S. (2011). How many steps/day are enough for adults? International Journal of Behavioral Nutrition and Physical Activity, 8(79), 1. https://doi.org/10.1186/1479-5868-8-79 Wolever, R. Q., Simmons, L. A., Sforzo, G. A., Dill, D., Kaye, M., Bechard, E. M., & Yang, N. (2013). A systematic review of the literature on health and wellness coaching: defining a key behavioral intervention in healthcare. Global Advances in Health and Medicine, 2(4), 38-57. https://doi.org/10.7453/gahmj.2013.042 World Health Organization. (2018). Physical activity. Retrieved from http://www.who.int/mediacentre/factsheets/fs385/en/.

Please address correspondence to: Mariah Deinhart Department of Kinesiology Indiana University â&#x20AC;&#x201C; Bloomington Bloomington, IN 47405 Tel: 641-420-2087 mariahdeinhart@gmail.com Author Note The authors would like to thank Patty Hollingsworth, Director of Healthy IU, Samantha Schaefer, Healthy IU Manager, IUB, IUE, IUS and Julie Newsom, Healthy IU Communication Specialist for their support, assistance, and belief in the importance of combining academic and service opportunities for the benefit of both students, faculty and staff. Without their support and assistance, the RTM program would not have flourished like it did at Indiana University.

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Evaluation of Dog Walking Programs to Promote Student Nurse Health Morgan Yordy, DNP, ACNS-BC, RN-BC Auburn University School of Nursing Emily Graff, DVM, PhD, Dipl. ACVP Auburn University College of Veterinary Medicine ABSTRACT Aim: To provide a brief review of health concerns associated with a sedentary lifestyle and summarize some of the benefits of walking, with specific focus on the value of dog-walking programs as a means to improve health and wellness for the student nurse. Methods: A professor within the School of Nursing and Doctor of Veterinary Medicine collaborated to review research on the benefits of dog walking and interventions utilizing dogs to increase and sustain physical activity in their owners and those that enjoy the companionship a dog can provide. Results: Dog walking is an intervention to increase activity among student nurses due to companionship and the sense of obligation dogs provide. Research suggests that dog owners are more physically active with subsequent health benefits for both owners and dogs. Animal assisted therapy programs within the university setting can link students with dogs to improve physical activity. Conclusion: Dog walking has benefits to both people and dogs. Nursing faculty can develop physical activity programs within their institution that incorporate walking a dog to enhance physical activity among student nurses. Further research is needed to empirically evaluate effectiveness of dog walking in the student nurse population. Submitted 20 September 2018: accepted 25 January 2019 Keywords: obesity, dog-walking, nursing students Unhealthy lifestyles and obesity are common problems among Americans and combined with a sedentary lifestyle have a negative impact on morbidity and mortality (Ignatavicious & Workman, 2016; Ogden, Carroll, Kit, & Flegal, 2014). However, this problem is not unique to the general population, and is reflected in the nursing profession. In a survey of over 2,100 female nurses conducted by the University of Marylandâ&#x20AC;&#x2122;s School of Nursing, over 55% were overweight or obese, citing stress as a factor (Han, Trinkoff, Storr, & Geiger-Brown, 2011). Student nurses are also subject to the negative impact of inadequate physical activity. While nursing students are exposed to the benefits of health promotion in their curriculum, many do not apply health promoting activities to their own life (Bryer, Cherkis, & Raman, 2013). The modern nurse is a critical member of the healthcare team; however, current curricular demands put nursing students at risk for an unhealthy lifestyle (Bryer et al., 2013; Griffin, 2017) that may follow them throughout their career. There is a critical need to carefully evaluate and develop new means to increase and sustain lifestyle changes that promote adequate physical activity for nursing students in hopes that these lifestyle changes will continue after graduation. This paper provides a brief review of the literature regarding Š 2019 Yordy & Graff. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/)


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current health concerns associated with a sedentary lifestyle and summarizes some of the benefits of walking, with specific focus on the value of dog-walking programs integrated into a university as a means to improve health and wellness for nursing students. An additional goal is to outline a role for faculty to develop programs aimed at increasing dog walking on campus and thus improving health. HEALTH RISKS ASSOCIATED WITH A SEDENTARY LIFESTYLE According to the Centers for Disease Control and Prevention (2015), adults ranging from 18 years of age to those over 65, need a minimum of 150 minutes of moderate-intense aerobic activity every week. However, in the United States, there are low numbers of adults that actually meet these recommendations and, therefore, are at risk for health disparities that lead to increased morbidity and mortality (Centers for Disease Control and Prevention, 2015; Richards, 2016). Specifically, inactivity or a sedentary lifestyle has been correlated to increased obesity, cardiovascular disease, cancer, and mental illness (Hiles, Lamers, Milaneschi, & Penninx, 2017; Knight, 2012). In contrast, low to moderate physical activity is recommended for the management and or treatment of numerous diseases including non-alcoholic fatty liver disease (Van der Windt, Sud, Zhang, Tsung, & Huang, 2017), diabetes mellitus (Hamasaki, 2016), renal disease (Zelle et al., 2017), Alzheimerâ&#x20AC;&#x2122;s disease (Buchman et al., 2012; Cass, 2017), chronic obstructive pulmonary disease (COPD) (Lahham, McDonald, & Holland, 2016), and a variety of autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, and inflammatory bowel disease (Sharif et al., 2018). Taken together, these studies support the notion that increased physical activity is crucial in the prevention, and management of many diseases. SPECIFIC CONCERNS FOR NURSES AND NURSING STUDENTS Nursing is the largest group of healthcare workers, with 3.6 million nurses in the United States (Yoder, 2017). Unfortunately, beginning early in their careers, some nurses do not meet the suggested weekly activity guidelines. The 2016 National College Health Assessment II found only 20% of nursing students were meeting the recommended physical activity guidelines (American College Health Association, 2018). A survey conducted by Gillen (2014) reported significant numbers of nursing students are overweight, with many not engaging in any form of physical activity. It is clear that these findings are more than just a recent trend, as over 50% of nurses are estimated to be overweight or obese (Speroni, Williams, Seibert, Gibbons, & Earley, 2013). While there are only a handful of studies that have been conducted there is evidence to suggest that the habits and lifestyles nurses develop as students are being carried over into their careers (Wills & Kelly, 2017; McSharry & Timmins, 2016). Thus, obesity is one of the most common health concerns among nurses along with, arthritis, chronic pain, irritable bowel syndrome, and mental health problems such as anxiety and depression (Letvak, 2012). Nursing students are susceptible to high levels of stress, citing long clinical hours, demanding curriculum, altered routines from undergraduate students in other programs of study, heightened liability, and feelings of failure (Bryer et al., 2013; Chunta, 2017; Griffin, 2017). When students transition into the workplace, work related stress can exacerbate other health issues, including obesity, hypertension and burn-out. Approximately 62% of nurses report they had considered leaving the profession, citing stress as a factor (Wright, 2014; Yoder, 2017). As a result, nurses may have increased risk for a subset of diseases associated with stress and decreased physical activity. Physical inactivity and unhealthy lifestyles are linked to decreased health, dependence on medications and caffeine to function, injuries 18


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relating to overexertion, burn-out, and public distrust of health teaching (Chunta, 2017; Crane & Ward, 2016; Hicks et al., 2008; Ruff & Hoffman, 2016; Speroni et al., 2013; Wills & Kelly, 2017) . Self-care, that includes increased physical activity, is a health priority for the nurse and, therefore, a health priority for nursing students. It is important to develop programs to promote self-care while in nursing school so the healthy-lifestyle and physical activity can translate to the workplace after graduation. BENEFITS OF WALKING Physical inactivity is a modifiable risk factor (Bopp, Child, & Campbell, 2014; Eijsvogels & Thompson, 2015; Vitztum, 2013) and walking, as a form of aerobic exercise to improve fitness and maintain a healthy weight, can be used to counter act a sedentary lifestyle and promote self-care (Garcia et al., 2015; Hanson & Jones, 2015). There is abundant evidence that individuals who achieve the recommended amount of exercise in the form of brisk walking had positive health outcomes. For patients with nonalcoholic fatty liver disease, 150 min/week of brisk walking significantly reduce intrahepatic triglyceride content (Van der Windt et al., 2017). In a study that evaluated newly diagnosed breast cancer patients, increased physical activity defined as brisk walking, reduced mortality up to 44% compared to non-participants (Ammitzboll et al., 2016). Walking also improves mental health owing to the release of serotonin, a neurotransmitter which has been shown to enhance the feeling of well-being (Abbasi, 2016). Walking is a low-impact form of physical exercise (Vitztum, 2013) that is accessible and inexpensive (Schneider et al., 2015). These are important factors for students who often have limited time and resources. Increasing steps can reduce mortality rates (Tufts University, 2016) and even short bouts of exercise due to time constraints have beneficial health effects (Eijsvogels & Thompson, 2015). In addition, walking with a companion provides a positive relationship and a sense of accountability that helps reinforce and sustain the lifestyle. Incorporating exercise into a weekly routine and developing positive relationships are useful mechanisms for alleviating stress and improving health (Wright, 2014). Ideal companions for walking are close friends and family members who can provide accountability and support. They do not necessarily need to be human. IMPACT OF DOGS AND DOG OWNERSHIP ON WALKING Almost half of the US population owns a dog (Burns, 2013), and several studies provide data supporting dog walking as a method to increase activity (Richards, McDonough, Edwards, Lyle, & Troped, 2013a; Richards, McDonough, Edwards, Lyle, & Troped, 2013b; Schneider et al., 2015), with dog ownership cited as a primary reason for increased activity in study participants. An important explanation for these findings is when an individual walks a dog, they have a positive interaction that provides a sense of responsibility and companionship. Participants are more apt to walk when they are not alone. A dog walking survey, DAWGS (the Dogs And WalkinG Survey) was completed by 429 individuals and findings from this study demonstrated that dog companionship, self-efficacy, and social support correlate with dog walking (Richardset al., 2013a). Walking is not only beneficial to people, but has health benefits for dogs as well (Chandler et al., 2017). Like people, dogs suffer from disease processes, such as obesity, irritable bowel disease, and osteoarthritis that are ameliorated by regular low impact exercise, such as walking (Frye, Shmalberg, & Wakshlag, 2016; Huang & Lien, 2017; Vitger et al., 2017; Vitger, Stallknecht, Nielsen, & Bjornvad, 2016; Warren et al., 2011). In addition, dog walking provides social stimulation and interaction with people and other dogs that may improve the dogâ&#x20AC;&#x2122;s 19


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psychological health and reduce undesired behavioral problems such as aggression to people (Shin & Shin, 2017; Westgarth, Christian, & Christley, 2015). Given the health and social benefits of dog walking for dogs and people, there is clear evidence that dog walking is a mutually beneficial experience and because of these factors, dog walking may be an ideal activity to focus and develop programs aimed at increasing physical activity and wellness. SUMMARY OF CURRENT DOG WALKING PROGRAMS A study conducted by Rhodes, Murray, Temple, Tuokko, and Higgins (2012) focused on the health benefits to the dogs as an incentive to dog walking. Fifty-eight participants self-reported dog walking times and pedometer readings when walking. The intervention group had an increase in dog walking due to the sense of obligation to the dog. However, the study was limited as an overall increase in walking was associated with participation in the study (Rhodes et al., 2012). While this information makes interpretation of the study results difficult, it does support the notion that walking increases with a positive sense of obligation and responsibility, particularly when the owner observes health benefits in their dog. Richards, Ogata, and Ting (2015) piloted a randomized controlled trial relating dogs, physical activity, and walking (Dogs PAW) to a person’s behavior and the social and physical environment. Communication is important in creating and sustaining successful dog walking programs. Richards et al concluded motivating factors such as easy to access and readable guidelines in the form of email communication that provide credible data on dog walking and health benefits is a crucial factor to increase dog walking (Richards et al., 2015). Dog walking elicits feelings of affection and enjoyment. A walk-along study was conducted on participants who self-reported walking their dog three times a week. The walk-along interview occurred during the participant’s time for walking their dog. The interview concluded walking dogs elicits memories and captured emotions from the human-animal interaction (Cameron, Smith, Tumitily, & Treharne, 2014). A survey of 391 participants using the DAWGS self-report instrument conducted by Richards et al. (2013a) uncovered self-efficacy and social support from friend and dog were motivation factors to increase walking. These findings are consistent with the results of Richards et al. (2013b) that demonstrate when dog owners who do not currently walk their dogs on a regular basis are emailed motivational factors to increase walking, walking increased. Dog ownership is related to walking frequency. In a large Women’s Health Initiative observational study of post-menopausal women (Garcia et al., 2015), dog owners and non-dog owners completed a self-reported questionnaire. Dog owners were more likely to walk and less likely to be sedentary if the participant owned a dog. In addition, if the participant lived alone, those owning a dog increased walking frequency (Garcia et al., 2015). Young adult dog owners spent more time walking at a moderate to vigorous level, with longer time frames (Richards, 2016). Including a dog in a walking program has shown to increase commitment and adherence to a walking program (Schneider et al., 2015; Vitztum, 2013). Dog walking, as part of dog ownership, is an important intervention to increase physical activity for adults (Cameron et al., 2014; Christian et al., 2013; Schneider et al., 2015). PROPOSED INTERVENTION PROGRAMS AND THE ROLE OF THE FACULTY Faculty are instrumental in developing health initiatives for their students that are engaging and sustainable. Importance lies in not only the specific health issues afflicting the current nursing population, but those modifiable 20


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conditions nursing students can focus on during their program of study to promote and sustain health. One critical aspect to any initiative program for students is the role of the faculty. Faculty need to be a positive role model for the student nurse (Wills & Kelly, 2017) and encourage students to dedicate themselves to self-care (Crane & Ward, 2016). The Health Promotion Model developed by Nola Pender (2011) focuses on the eight beliefs to health promotion. Recognizing the important variables associated with health promotion, the nursing faculty can guide student programs to build on current health knowledge to promote and sustain health behaviors. Giving people advice such as â&#x20AC;&#x153;walk or increase physical activityâ&#x20AC;? does not seem to work, or if it does work, only for a short period of time (Hanson & Jones, 2015). A recent survey noted that while students are less likely than professionals to adopt healthy lifestyles, it is an important time to establish physical activity so that is was more likely to become a habit in their professional role (Wills & Kelly, 2017). The goal is to incorporate motivational factors to increase long-term commitment to increased physical activity. Providing social support to encourage walking behaviors is linked to positive outcomes (Bopp et al., 2014; Crane & Ward, 2016; Richards et al., 2013a). Motivation also increases activity. Walking has shown to be very beneficial to the dog and individuals are motivated when cues to promote dog walking are utilized (Richards, 2016; Richards et al., 2013a; Richards et al., 2013b; Schneider et al., 2015). The mentorship role of faculty is critically important as students can confide in faculty (Reeve, Shumaker, Yearwood, Crowell, & Riley, 2013). Students can use physical activity as a coping method and faculty should recognize mental health needs of students and encourage coping methods (Chernomas & Shapiro, 2013). Therapy dogs in an academic setting provide support (Young, 2012) and contact with dogs has been shown to reduce the negative effects of stress (Delgado, Toukonen, & Wheeler, 2018). Dog walking is a proven intervention to increase physical activity and in turn, promote health (see Table 1).

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Table 1 Review of Dog Walking Programs Author, Title, Purpose Journal and Year Garcia et al Examine a crosssectional Relationships association between dog between dog ownership and ownership and physical activity in postmenopausal postmenopausal women women. Preventative Medicine, 2015 Rhodes et al

Viability of dog walking for Pilot study of a dog physical activity walking targeting canine randomized exercise intervention: Effects of a focus on canine exercise. Preventative Medicine, 2012

Design/Sample

Discussion, Recommendations and Limitations

Logistic regression models to evaluate dog ownership and physical activity.

Discussion: Dog owners were less sedentary, more likely to reach recommended walking guidelines, and more likely to stroll rather than walk fast as compared to non-dog-walkers.

36,984 - dog owners

Recommendations: Health promotion initiatives should focus on the benefits of regular dog walking for dog-owners and non-dog owners.

115, 645 - non-dog owners

Limitations: ▪ Dog ownership does equate to dog walking ▪ Did not account for effects of duration of dog ownership, or breed related difference (size of dog) on dog walking ▪ Limited generalization of sample; only postmenopausal women Randomized control trial Discussion: Increased walking was noted in both participant groups. Questionnaire and pedometer readings at Baseline, 6 weeks, and 12 weeks post intervention 58 participants- 30 allocated to the intervention and 28 to the control group

Recommendation: Provide dog owners a sense of responsibility to the dog in order to increase dog walking Limitations: ▪ Potential bias associated with recruitment of volunteer participants ▪ Small sample size ▪ Information on health was not collected or evaluated ▪ Did not collect data on dog breed related effects

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Richards Does Dog walking predict physical activity participation: Results from a national survey American Journal of Health Promotion, 2016

Richards et al Psychosocial and environmental factors associated with dog-walking International Journal of Health Promotion and Education, 2013

Identify common characteristics of dog owners who walk their dogs, including frequency, duration and overall physical activity

Cross-sectional study

Determine if overall physical activity affected is by psychosocial and environmental factors with dogwalking

Multiple logistic regression and structural equation modeling used to exam data from a survey (DAWGS)

4,010 participants who participated in the 2005 ConsumerStyles mailpanel survey Chi-square tests and analysis of variance to examine characteristics and frequency/duration. Analysis of covariance used to determine physical activity

Discussion: While dog walking increases activity among dog owners, many study participants failed to meet recommended guidelines. The age and sex of the owner effect frequency and duration of walks. There was no link between minutes of walking and obligation to the dog. Recommendations: Physical activity interventions should target dog owners and promoting this activity is a good strategy to increase physical activity. Limitations: ▪ Longitudinal studies are needed to determine effects/correlations of BMI on walking. ▪ Wording of the questionnaire could be confusing and limited; no multi-select option ▪ Reliant on recall from self-reports Discussion: Dog health is a motivating factor for walking. In addition, walking trails or grassy areas and dog companionship are factors associated with increased dog walking minutes. Recommendations: Develop programs aimed at self-efficacy; social support, companionship, environment to increase weekly dog walking minutes.

391 dog-owners Limitations: ▪ Sample lacking generalization; primarily white, female, and well-educated ▪ Reliant on recall from self-reports

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Richards et al Dogs, Physical Activity, and Walking (Dogs PAW): Acceptability and feasibility of a pilot physical activity intervention. Health Promotion Practice, 2015 Schneider et al

Describe a social cognitive theory intervention to increase dog walking among dog owners and evaluate the feasibility and acceptability of the intervention

Determine if encouraging dog An online social walking increases network to increase physical activity walking in dog in dog owners owners: A randomized trial. Medicine & Science in Sports & Exercise, 2014

Randomized control trial Discussion: Motivating cues placed in easy to read and access e-mails as well as the credibility of the information were motivating factors to increase walking in the Descriptive statistics intervention group. 49 participants divided into the intervention or control group

Recommendations: Using emails focusing on obligation to the dog, social support, and self-efficacy to encourage dog walking. Limitations: ▪ Small sample size ▪ Reliant on recall from self-reports ▪ Data limited to immediate post-intervention—long-term follow-up needed

Cluster-randomized control trial

Discussion: Smaller social platforms used to increase physical activity are feasible and promote positive outcomes of dog walking

102 sedentary dogowners

Recommendations: Social networking or other platforms can be used to develop dog-walking groups Limitations: ▪ Limited generalization; mostly white, female, and well educated ▪ Reliant on recall from self-reports

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Faculty driven health promotion interventions include setting up exercise programs targeting dog walking, providing motivational cues, using creative methods to retain participants, and working with communities to implement change. A large population of dog owners lives within the United States, therefore a logical first intervention is to target students who are already dog owners to â&#x20AC;&#x153;get walking.â&#x20AC;? In a survey of 4,010 participants, 44% were dog owners and of those, less than half reported walking their dog on a regular basis (Richards, 2016). Studies have shown the benefits to dog walking include commitment and adherence to walking programs (Vitztum, 2013), increased physical activity (Schneider et al., 2015) and the feelings of enjoyment (Cameron et al., 2014). A goal for faculty to target nursing students who own dogs to encourage walking for their health and the health of their dog. The next intervention to increase activity is the development of dog walking groups among nursing students within the institution. Walking groups tend to engage participants and provide a sense of companionship (Hanson & Jones, 2015). Social networking sites, such as Meetup, utilized by Schneider et al. are an excellent mechanism to form and develop dog walking groups with the intent to increase activity. While managing schedules was a challenge, overall the study participants increased their steps, and their perceived positive outcomes of dog walking (Schneider et al., 2015). Nursing faculty could work with the organizationsâ&#x20AC;&#x2122; intranet, email, and other social media sites to arrange walking groups inside the organization. In addition, set up times within the school of nursing that faculty and students could walk dogs together, thus forming a mentorship. Finally, it is critical to target students who may not have ready access to their dogs as walking partners. A recent survey that evaluated the effects of animal assisted therapy (AAT) programs on nursing students and the older patients discovered that there is a large percentage of students who own dogs, but do not have access to regular interaction with their dogs, as ~56% of students said they left their dog in their hometown with their parents (Yordy, Pope, & Wang, 2018). This means there is likely an unrecognized loss of emotional support for these students who are separated from canine companions while at school, which in turn may be affecting their mental and emotional health. The same University where the survey was conducted has an AAT program within the school of nursing for outreach and service, which incorporates three dogs that are in need of enrichment and could benefit greatly from walking programs. By merging student health initiatives with AAT programs, faculty could promote walking initiatives for students and therapy dogs with mutual benefits. There is also potential to expand programs through collaboration between nursing and veterinary colleges. There are over 900 canine visitation programs at colleges and universities across America (Herzog, 2015). These programs assist in stress and anxiety reduction in students. Faculty could work with handlers to incorporate walking as a form of therapy that is mutually beneficial for both student and dogs. Further research is needed to investigate the role of dog walking for students who love dogs but cannot have one on campus as well as therapy dog use for exercise not just emotional support. It also would be interesting to investigate the impact on health benefits with the idea that AAT programs are not just for emotional therapy, but for exercise as well. CONCLUSION There are many negative implications to a sedentary lifestyle that can be counteracted through low impact exercise, such as walking. Walking regularly has valuable health benefits and dog walking in particular, has cumulative benefits to nurses, nursing students, and their canine companions. While there are many opportunities to improve 16


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health, dog walking taps into a subgroup of individuals and allows them to develop a program that is sustainable for their lifestyle and is understudied. Nursing faculty play an important role in student health and the adoption of healthier lifestyles. In order to promote health, one role for faculty could be to influence health promotion by developing evidence-based health initiatives such as dog walking programs that are sustainable and attainable within the school of nursing. This includes incorporating student dog walking initiatives with AAT programs. Further research is needed to empirically evaluate effectiveness of dog walking on student and canine health, with a goal to improve and better develop programs for the future.

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REFERENCES Abbasi, J. (2016). As walking movement grows, neighborhood walkability gains attention. JAMA, 316(4), 382-383. https://doi.org/10.1001/jama.2016.7755 American College Health Association. (2018). American College Health Association-National College Health Assessment II: Reference group executive summary fall 2017. Retrieved from https://www.acha.org/documents/ncha/NCHAII_FALL_2017_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf. Ammitzboll, G., Sogaard, K., Karlsen, R. V., Tjonneland, A., Johansen, C., Frederiksen, K., & Bidstrup, P. (2016). Physical activity and survival in breast cancer. European Journal of Cancer, 66, 67-74. https://doi.org/10.1016/j.ejca.2016.07.010 Bopp, M., Child, S., & Campbell, M. (2014). Factors associated with active commuting to work among women. Women and Health, 54(3), 212-231. https://doi.org/10.1080/03630242.2014.883663 Bryer, J., Cherkis, F., & Raman, J. (2013). Health-promotion behaviors of undergraduate nursing students: A survey analysis. Nursing Education Perspectives, 34(6), 410-415. https://doi.org/10.5480/11-614 Buchman, A. S., Boyle, P. A., Yu, L., Shah, R. C., Wilson, R. S., & Bennett, D. A. (2012). Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology, 78(17), 1323-1329. https://doi.org/10.1212/WNL.0b013e3182535d35 Burns, K. (2013). AVMA report details pet ownership, veterinary care. Journal of the American Veterinary Medical Association, 242(3), 280-285. https://doi.org/10.2460/javma.242.3.280 Cameron, C., Smith, C., Tumitily, S., & Treharne, G. (2014). The feasibility and acceptability of using mobile methods for capturing and analyzing data about dog-walking and human health. New Zealand Journal of Physiotherapy, 42(3), 163-169. Cass, S. P. (2017). Alzheimer's Disease and exercise: A literature review. Current Sports Medical Reports, 16(1), 19-22. https://doi.org/10.1249/jsr.0000000000000332 Centers for Disease Control and Prevention.(2015). How much physical activity do older adults need? Retrieved from https://www.cdc.gov/physicalactivity/basics/older_adults/index.htm Chandler, M., Cunningham, S., Lund, E. M., Khanna, C., Naramore, R., Patel, A., & Day, M. J. (2017). Obesity and associated comorbidities in people and companion animals: A one health perspective. Journal of Comparative Pathology, 156(4), 296-309. https://doi.org/10.1016/j.jcpa.2017.03.006 Chernomas, W.M. & Shapiro, C. (2013). Stress, Depression, and Anxiety among undergraduate nursing students. International Journal of Nursing Education Scholarship, 10(1), 255-266. https://doi.org/10.1515/ijnes-2012-0032 Christian, H., Westgarth, C., Bauman, A., Richards, E. A., Rhodes, R., & Evenson, K. (2013). Dog ownership and physical activity: A review of the evidence. Journal of Physical Activity & Health, 10(5), 750-759. https://doi.org/10.1123/jpah.10.5.750 Chunta, K. S. (2017). Faculty role in promoting nursing student health. American Nurse Today, 12(7), 1. Retrieved from https://www.americannursetoday.com/ 18


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Crane, P. J., & Ward, S. F. (2016). Self-healing and self-care for nurses. Association of periOperative Registered Nurses Journal, 104(5), 386-400. https://doi.org/10.1016/j.aorn.2016.09.007 Delgado, C., Toukonen, M., & Wheeler, C. (2018). Effect of Canine Play Interventions as a Stress Reduction Strategy in College Students. Nurse Educator, 43(3), 149-153. https://doi.org/10.1097/NNE.0000000000000451 Eijsvogels, T. M., & Thompson, P. D. (2015). Exercise is medicine: At any dose? Journal of the American Medical Association, 314(18), 1915-1916. https://doi.org/10.1001/jama.2015.10858 Frye, C. W., Shmalberg, J. W., & Wakshlag, J. J. (2016). Obesity, exercise and orthopedic disease. Veterinary Clinics of North America. Small Animal Practice, 46(5), 831-841. https://doi.org/10.1016/j.cvsm.2016.04.006 Garcia, D. O., Wertheim, B. C., Manson, J. E., Chlebowski, R. T., Volpe, S. L., Howard, B. V., . . . Thomson, C. A. (2015). Relationships between dog ownership and physical activity in postmenopausal women. Preventive Medicine, 70, 33-38. https://doi.org/10.1016/j.ypmed.2014.10.030 Gillen, S. (2014). Unhealthy lifestyles adversely affect nurses' ability to deliver quality care. Nursing Standard, 28(29), 12. https://doi.org/10.7748/ns2014.03.28.29.12.s14 Griffin, A. (2017). Wellness and thriving in a student registered nurse anesthetist population. American Association of Nurse Anesthetists Journal, 85(5), 325-330. Retrieved from https://www.aana.com/publications/aana-journal Hamasaki, H. (2016). Daily physical activity and type 2 diabetes: A review. World Journal of Diabetes, 7(12), 243-251. https://doi.org/10.4239/wjd.v7.i12.243 Han, K., Trinkoff, A. M., Storr, C. L., & Geiger-Brown, J. (2011). Job stress and work schedules in relation to nurse obesity. Journal of Nursing Administration, 41(11), 488-495. https://doi.org/10.1097/NNA.0b013e3182346fff Hanson, S., & Jones, A. (2015). Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. British Journal of Sports Medicine, 49(11), 710-715. https://doi.org/10.1136/bjsports-2014094157 Herzog, H. (2015). Stress relief in seven minutes, doggie style: Do programs using dogs to relieve anxiety in university students really work? Animals and Us. Retrieved from https://www.psychologytoday.com/us/blog/animals-and-us/201511/stress-relief-in-seven-minutes-doggiestyle Hicks, M., McDermott, L. L., Rouhana, N., Schmidt, M., Seymour, M. W., & Sullivan, T. (2008). Nurses' body size and public confidence in ability to provide health education. Journal of Nursing Scholarship, 40(4), 349-354. https://doi.org/10.1111/j.1547-5069.2008.00249.x Hiles, S. A., Lamers, F., Milaneschi, Y., & Penninx, B. W. J. H. (2017). Sit, step, sweat: Longitudinal associations between physical activity patterns, anxiety and depression. Psychological Medicine, 47(8), 1466-1477. https://doi.org/10.1017/S0033291716003548 Huang, H. P., & Lien, Y. H. (2017). Effects of a structured exercise programme in sedentary dogs with chronic diarrhoea. Veterinary Record, 180(9), 224. https://doi.org/10.1136/vr.103902

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Ignatavicious, D., & Workman, M. (2016). Medical-Surgical Nursing: Patient Centered Collaborative Care (8th ed.): Elsevier: St. Louis, Missouri. Knight, J. A. (2012). Physical inactivity: Associated diseases and disorders. Annals of Clinical Laboratory Science, 42(3), 320-337. Retrieved from www.annclinlabsci.org/ Lahham, A., McDonald, C. F., & Holland, A. E. (2016). Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD: A systematic review and meta-analysis of randomized controlled trials. International Journal of Chronic Obstructive Pulmonary Disease, 11, 3121-3136. https://doi.org/10.2147/copd.s121263 Letvak, S. (2012). Managing nurses with health concerns. Nursing Management, 43(3), 7-10. https://doi.org/10.1097/01.NUMA.0000412225.50350.bd McSharry, P. & Timmins, F. (2016). An evaluation of the effectiveness of a dedicated health and well being course on nursing studentsâ&#x20AC;&#x2122; health. Nurse Education Today, 44, 26-32. https://doi.org/10.1016/j.nedt.2016.05.004 Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814. https://doi.org/10.1001/jama.2014.732 Pender, N.J. (2011). Heath promotion model manual. Retrieved from: [https://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350/HEALTH_PROMOTION_MANUAL _Rev_5-2011.pdf. Reeve, K. L., Shumaker, C.J., Yearwood, E.L., Crowell, N.A., & Riley, J.B. (2013). Perceived stress and social support in undergraduate nursing studentsâ&#x20AC;&#x2122; educational experiences. Nurse Education Today, 33, 419-424. https://doi.org/10.1016/j.nedt.2012.11.009 Rhodes, R. E., Murray, H., Temple, V. A., Tuokko, H., & Higgins, J. W. (2012). Pilot study of a dog walking randomized intervention: Effects of a focus on canine exercise. Preventive Medicine, 54. https://doi.org/10.1016/j.ypmed.2012.02.014 Richards, E. A. (2016). Does dog walking predict physical activity participation: Results from a national survey. American Journal of Health Promotion, 30(5), 323-330. https://doi.org/10.1177/0890117116646335 Richards, E. A., McDonough, M. H., Edwards, N. E., Lyle, R. M., & Troped, P. J. (2013a). Development and psychometric testing of the Dogs and WalkinG Survey (DAWGS). Research Quarterly for Exercise and Sport, 84(4), 492-502. https://doi.org/10.1080/02701367.2013.839935 Richards, E. A., McDonough, M. H., Edwards, N. E., Lyle, R. M., & Troped, P. J. (2013b). Psychosocial and environmental factors associated with dog-walking. International Journal of Health Promotion and Education, 51(4), 198-211. https://doi.org/10.1080/14635240.2013.802546 Richards, E. A., Ogata, N., & Ting, J. (2015). Dogs, physical activity, and walking (dogs PAW): Acceptability and feasibility of a pilot physical activity intervention. Health Promotion Practice, 16(3), 362-370. https://doi.org/10.1177/1524839914553300 Ruff, A., & Hoffman, J. (2016). Self-care for the nurse entrepreneur: Finding time and balance. American Holistic Nurses Association Beginnings, 36(5), 8-9, 24-25. Retrieved from https://www.ahna.org/Home/Publications 20


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Schneider, K. L., Murphy, D., Ferrara, C., Oleski, J., Panza, E., Savage, C., . . . Lemon, S. C. (2015). An online social network to increase walking in dog owners: A randomized trial. Medicine and Science in Sports and Exercise, 47(3), 631-639. https://doi.org/10.1249/mss.0000000000000441 Sharif, K., Watad, A., Bragazzi, N. L., Lichtbroun, M., Amital, H., & Shoenfeld, Y. (2018). Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmunity Reviews, 17(1), 53-72. https://doi.org/10.1016/j.autrev.2017.11.010 Shin, Y. J., & Shin, N. S. (2017). Relationship between sociability toward humans and physiological stress in dogs. Journal of Veterinary Medical Science, 79(7), 1278-1283. https://doi.org/10.1292/jvms.16-0403 Speroni, K. G., Williams, D. A., Seibert, D. J., Gibbons, M. G., & Earley, C. (2013). Helping nurses care for self, family, and patients through the nurses living fit intervention. Nursing Administration Quarterly, 37(4), 286-294. https://doi.org/10.1097/NAQ.0b013e3182a2f97f Tufts University. (2016). New evidence for body and brain benefits of walking. Health and Nutrition Letter. Retrieved from https://www.nutritionletter.tufts.edu/issues/12_3/current-articles/New-Evidence-for-Body-andBrain-Benefits-of-Walking_1902-1.html van der Windt, D. J., Sud, V., Zhang, H., Tsung, A., & Huang, H. (2017). The effects of physical exercise on fatty liver disease. Gene Expression, 18(2), 89-101. https://doi.org/10.3727/105221617x15124844266408 Vitger, A. D., Stallknecht, B. M., Miles, J. E., Hansen, S. L., Vegge, A., & Bjornvad, C. R. (2017). Immunometabolic parameters in overweight dogs during weight loss with or without an exercise program. Domestic Animal Endocrinology, 59, 58-66. https://doi.org/10.1016/j.domaniend.2016.10.007 Vitger, A. D., Stallknecht, B. M., Nielsen, D. H., & Bjornvad, C. R. (2016). Integration of a physical training program in a weight loss plan for overweight pet dogs. Journal of the American Veterinary Medical Assocation, 248(2), 174-182. https://doi.org/10.2460/javma.248.2.174 Vitztum, C. (2013). Human-animal interaction: A concept analysis. International Journal of Nursing Knowledge, 24(1), 3036. https://doi.org/10.1111/j.2047-3095.2012.01219.x Warren, B. S., Wakshlag, J. J., Maley, M., Farrell, T. J., Struble, A. M., Panasevich, M. R., & Wells, M. T. (2011). Use of pedometers to measure the relationship of dog walking to body condition score in obese and non-obese dogs. British Journal of Nutrition, 106(S1), S85-S89. https://doi.org/10.1017/S0007114511001814 Westgarth, C., Christian, H. E., & Christley, R. M. (2015). Factors associated with daily walking of dogs. BMC Veterinary Research, 11(1), 116. https://doi.org/10.1186/s12917-015-0434-5 Wills, J., & Kelly, M. (2017). What works to encourage student nurses to adopt healthier lifestyles? Findings from an intervention study. Nurse Education Today, 48, 180-184. https://doi.org/10.1016/j.nedt.2016.10.011 Wright, K. (2014). Alleviating stress in the workplace: Advice for nurses. Nursing Standard, 28(20), 37-42. https://doi.org/10.7748/ns2014.01.28.20.37.e8391 Yoder, L. (2017). Nursing: The balance of mind, body, and spirit. MEDSURG Nursing, 26, 75. Retrieved from www.medsurgnursing.net/

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Yordy, B. M., Pope, W. S., & Wang, C.-H. (2018). Canine outreach promoting engagement: The effect of meaningful activities on studentsâ&#x20AC;&#x2122; attitudes toward cognitively impaired older adults. Nurse Educator. Advance online publication. https://doi.org/10.1097/nne.0000000000000549 Young, J. (2012). Pet Therapy: Dogs de-stress students. Journal of Christian Nursing, 29(4), 217. https://doi.org/10.1097/CNJ.0b013e31826701a7 Zelle, D. M., Klaassen, G., van Adrichem, E., Bakker, S. J., Corpeleijn, E., & Navis, G. (2017). Physical inactivity: A risk factor and target for intervention in renal care. Nature Reviews Nephrology, 13(3), 152-168. https://doi.org/10.1038/nrneph.2016.187

Author Correspondence may be addressed to: Morgan Yordy, DNP-ACNS-BC, RN-BC Auburn University School of Nursing 710 South Donahue Drive Auburn, AL 36849 BMY0004@auburn.edu

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Perceived Barriers to Meditation Among College Students: The Role of Personality Traits Samantha Whitford, MSW Keith Warren, Ph.D. The Ohio State University College of Social Work ABSTRACT Background: Meditation is likely to be a useful intervention for anxiety and depression, and is increasingly common as a clinical intervention and informal practice among university students. However, meditation dropout rates are high, and it is likely that perceived barriers to meditation play a role. While neuroticism is known to predict dropout, there has been no study relating personality traits to these barriers. Aim: To better understand the barriers to meditation practice that university students experience. Methods: We used online survey data to analyze the relationship between personality traits, whether students practice meditation, time spent on academic and other work, and university students’ perception of barriers to meditation. Results: We found a nonlinear relationship between neuroticism and perceived barriers; the number of perceived barriers increased with increased neuroticism but eventually flattened out. Participants who meditate perceive more barriers than those who do not. We found no relationship between time spent in other activities and perception of barriers. Conclusions: Those students who would benefit most from meditation may have the most trouble continuing. Clinicians applying meditation as an intervention in a university setting should be ready to work with students on barriers to practice. Submitted 4 January 2019: accepted 28 February 2019 Keywords: meditation, barriers to meditation, neuroticism, mindfulness, university students Meditation includes a wide variety of techniques for bringing attention to the breath, cognition, the body, a repeated word, or one’s own stream of consciousness, with the goal of altering cognition and emotion (Dahl, Lutz, & Davidson, 2015). Studies indicate that meditation can help reduce a person’s depressive symptoms and relapse into depression (Cavanagh, Strauss, Forder, & Jones, 2014; Eisendrath, Chartier, & McLane, 2010; Peit , 2011; Kenny & Williams, 2005; Klainin-Yobas, Cho, & Creedy, 2011; Manicavasgar, Parker, & Perich, 2010). Meditation is known to reduce stress and anxiety (Cavanagh et al., 2014; Sharma & Rush 2014; Vollestad, Nielsen, & Nielsen; 2011), and there is evidence that meditation improves hypochondria, which involves both stress and anxiety regarding health (Suraway, McMannus, Muse, & Williams, 2014). Meditation is also known to help insomnia (Winbush, Gross, & Kreitzer, 2007). There is also evidence that meditation may improve attention and memory (Sharma, 2015). Anxiety and depression are the two most common mental health issues reported by college students (Center for Collegiate Mental Health, 2017) and so it is not surprising that meditation has seen increasing application with this © 2019 Whitford & Warren. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/)


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population. In a meta-analysis of 25 studies of mindfulness meditation given to college students as treatment for anxiety, Bamber and Morpeth (2018) found a moderate to large effect size in most studies. There is exploratory evidence that mindfulness meditation improves the general sense of well-being of college students (Crowley & Munk, 2016). While meditation appears to benefit individuals with affective disorders, program compliance and retention are problematic. In a study of mindfulness-based self-help interventions, Cavanagh, Strauss, Forder, and Jones (2014) found that on average, across studies, 73% of participants completed meditation interventions, but that attrition rates could be as high as 52%. In a meta-analysis of mindfulness based treatments of anxiety disorders, Vollestad, Nielsen, and Nielsen (2012) found attrition rates in individual studies as high as 45%. In a study of loving-kindness meditation (LKM), Frederickson, Cohn et al. (2008) reported a rate of attrition due to noncompliance of 28%. In a study of LKM as a treatment for back pain, Carson, et al. (2005) reported an attrition rate of 42%. It is worth noting that nearly all intervention studies are short term, and that in the case of meditation, a skill that is intended to be practiced for years, any attrition figure is likely to be underestimated. In an attempt to understand one possible source of program noncompliance, Berghoff, Wheeless, Ritzert, Wooley, and Forsyth (2017) assigned students to either ten minutes or twenty minutes of mindfulness meditation per day for two weeks. They found no statistically significant difference in compliance between the two groups. As they noted, however, programs such as Mindfulness Based Stress Reduction (MBSR) often involve considerably longer daily periods of practice, so it is possible that differences in compliance would appear if a third group were assigned to longer periods of meditation. Further, the time frame of the experiment was shortâ&#x20AC;&#x201D;it is possible that differences in adherence would have appeared after a month or two. Neuroticism is a personality trait that is known to be correlated with the presence of mood disorders such as anxiety and depression (Paulus, Vanwoerden, Norton, & Sharp, 2016; Newby et al., 2017), for which meditation is frequently used as a clinical treatment (Cavanagh et al., 2014; Eisendrath et al., 2010; Peit, 2011; Kenny & Williams, 2005; Klainin-Yobas et al., 2011; Manicavasgar e al., 2010). It has long been noted that neuroticism predicts compliance in studies of meditation. Delmonte (1980) found that neuroticism was negatively correlated with frequency of meditation practice. In a later, prospective study, Delmonte (1988) found that neuroticism predicted short-term compliance with a meditation schedule. More recently, Dobkin, Irving and Amar (2012) cite a number of studies suggesting that individuals with more volatile personalities may be at increased risk of attrition in studies of mindfulness based interventions, which typically occurs in the early stages. Thus, while there is evidence that long term practice of meditation can reduce neuroticism (Crescentini & Capurso, 2015; Leung & Singhal, 2004; Van Den Hurk et al., 2011), neuroticism appears to incline subjects toward lower levels of compliance in the early stages. In the absence of longitudinal studies, it is also possible that the common finding of lower levels of neuroticism in senior meditators partly represents a tendency of more neurotic meditators to drop out. Why would someone who is high in neuroticism be less likely to comply with a meditation protocol, the long term effect of which would be to lower neuroticism? One possibility is that individuals who are higher in neuroticism perceive more barriers to meditation. Using a sample of 150 family caregivers of cancer patients, Williams, Van Ness, Dixon and McCorkle (2011) found that neuroticism was positively correlated with perceived barriers to meditation. No one has at this point replicated this finding with university students. Given the increased use of meditation in the clinical treatment of students, such a replication is justified. 24


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METHODS This study was approved by a University Institutional Review Board prior to any data collection. All participants were currently enrolled in university level course work. A convenience sample of participants was recruited from a Midwestern university with a total enrollment of 59,482 through a series of emails sent from the university’s Office of Student Life and College of Social Work. The emails were circulated to students at both graduate and undergraduate levels. Participants who consented to be part of the study were directed to a Qualtrics page where they could take the electronic survey. A five dollar Amazon gift card was given as an incentive for taking the survey. Personality type was measured using the Big Five Inventory (BFI; John, Donahue & Kentle, 1991). The BFI is a 44-item scale measuring extraversion, agreeableness, conscientiousness, neuroticism, and openness. Cronbach’s alpha reliability of the BFI subscales ranges from α = .75 to .90, with a mean of over .80 and test-retest reliability over three months ranging from r = .18 - .90. The BFI has also shown convergent validity with peer ratings of personality and other measures of Big Five personality traits (John & Srivastava, 1999). Median test-retest reliability of the BFI has varied from r = .66 - .78 in different studies of university students (Gnambs, 2016). Participants’ perceptions of barriers to meditation were measured using the 17-question Determinants of Meditation Practice Inventory (DMPI; Williams et al., 2011). The DMPI has a Cronbach’s alpha of α = .87 and a test-retest intraclass correlation coefficient of r = .86 (CI = .82-.90). In addition to these two instruments, respondents were asked whether they meditated at all, if so the type of meditation they practiced, the highest degree they had completed, the number of hours they spent on work and school per week and their gender. Analysis proceeded in two stages. In the first stage, a local regression curve was fit to a scatterplot of neuroticism as a predictor of barriers to meditation as a check for nonlinearity in the relationship. Local regression (LOESS) fits a weighted least squares regression function to a scatterplot within a moving window. It therefore allows the detection of nonlinear structure in scatterplots (Cleveland, 1979). For instance, if participants’ perception of barriers to meditation rose rapidly at low levels of neuroticism but then flattened out, LOESS would produce a plot that showed this. The LOESS curve was fit using SAS Studio 3.5 (SAS Institute 2016), using a locally linear fit and a smoothing parameter of .6. Following this visual analysis, a Generalized Additive Model (GAM) was fit to the dataset. GAM allows regression using a scatterplot smoother, yielding a model using multiple predictors that is robust to departures from regression linearity assumptions (Hastie & Tibshirani, 1986). The GAM was fit using the R package gam (Hastie, 2018). Alpha was set at .05, but probabilities are also reported. RESULTS Eighty-four percent of participants were female, while sixteen percent were male. Seventy percent of participants reported they had completed some college, with 15% having an associate degree, 10% a bachelor’s degree, and 5% a master’s degree. A plurality of participants, 37%, reported that they spent 11 - 20 hours per week completing school work and extracurricular activities, with 33% reporting 21 - 30 hours, 12% 31 - 40 hours, 10% 40 hours or more, and 8% 0 - 10 hours. Forty-three percent of respondents worked 0 - 10 hours at paid employment, 27% worked 11 - 20 hours, 13% worked 21 - 30 hours, 7% worked 31 - 40 hours, and 10% worked 40 or more hours. Sixty nine percent of respondents reported practicing meditation while 31% reported not practicing. Of those who practiced meditation, 82% reported practicing mindfulness meditation, 12% concentration meditation, 33% physical meditation such as

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T’ai chi or yoga, and 16% some other form of meditation. Thus, a considerable percentage of those who did meditate practiced more than one form of meditation. In this administration, Cronbach’s alpha was α = .830 for the DMPI, α = .827 for the BFI neuroticism subscale, α = .883 for the BFI extraversion subscale, α = .726 for the BFI agreeableness subscale, α = .787 for the BFI conscientiousness subscale and α = .775 for the BFI openness to experience subscale. Descriptive statistics for these variables can be found in Table 1. Table 1 Descriptive Statistics for Determinants of Meditation Practice Inventory and Big Five Inventory Subscales Variable Determinants of Meditation Practice Inventory Big Five Inventory Extraversion Big Five Inventory Agreeableness Big Five Inventory Conscientiousness Big Five Inventory Neuroticism Big Five Inventory Openness

Minimum 16.00 10.00 23.00 15.00 13.00 18.00

Maximum 64.00 40.00 45.00 43.00 39.00 47.00

Mean 39.1839 25.6471 34.4048 31.1412 26.6471 37.3095

Std. Deviation 9.51196 7.31715 5.19527 6.00823 6.00735 5.95156

Figure 1 shows the LOESS curve fit of the BFI neuroticism subscale as a predictor of perceived barriers to meditation as measured by the DMPI. The relationship is nonlinear. Estimated DMPI score shows a gradual exponential increase from 32 at a BFI neuroticism score of 16 to a peak of 45 at a BFI neuroticism score of 33, after which the relationship flattens out.

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Figure 1. LOESS regression curve of neuroticism as a predictor of barriers to meditation, degree = 1, smoothing parameter = .6, 95% CI. GAM MODEL Ninety-three participants began the survey. Six of those provided no data on either the DMPI or the BFI. Missing data on individual questions meant that an additional eight participants were excluded from the final GAM analysis due to listwise deletion of cases (Allison, 2001). The results of that analysis can be found in Table 2.

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Table 2 Results of the Generalized Additive Model, Using the Determinants of Meditation Practice Inventory as the Dependent Variable Variable Sum Sq. F Value P Value Neuroticism Extraversion Agreeableness Conscientiousness Openness Practice Meditation Gender Hours At School Hours At Work

1333.4 46.9 29.9 16.0 22.7 1284.9 148.7 245.8 37.8

20.7325 0.7289 0.4650 0.2492 0.3531 19.9782 2.3117 3.8216 0.5870

>0.001 0.39618 0.49759 0.61920 0.55432 >0.001 0.13298 0.05465 0.44619

Among the Big Five personality traits, Neuroticism was a statistically significant predictor of DMPI (Sum Sq. = 1333.4, F value = 20.735, p value < .001), but this was not true of Extraversion, Agreeableness, Conscientiousness or Openness. Whether people practiced meditation was a statistically significant predictor of DMPI (Sum Sq. = 1284.9, F value = 19.978, p value < .001). Gender was not statistically significant, nor were hours spent at either school or work. Following this initial model, nonsignificant variables were removed from the model sequentially in order to test for relationships that may have been suppressed due to collinearity. In particular, it seemed possible that hours spent at school might be a statistically significant predictor of DMPI if hours spent at work were removed from the model. But this was not the case. Elimination of hours spent at work led to no significant change in the parameter values associated with hours spent at school. Successive backward elimination of all variables other than neuroticism and the practice of meditation failed to yield any changes in statistical significance. DISCUSSION The analysis in this study found that both neuroticism and whether a student meditates predicted studentsâ&#x20AC;&#x2122; perception of barriers to meditation (Sum Sq. = 1333.4, F = 20.735, p < .001 and Sum Sq. = 1284.9, F = 19.978, p < .001, respectively). Neuroticism had a nonlinear relationship to that perception, first rising and then flattening out. No other personality traits were correlated with perceived barriers to meditation. However, the scores on conscientiousness and openness to experience were high, as might be expected for a sample of university students, and there may not have been enough variability in these variables to establish a relationship. Gender did not correlate with perceived barriers to meditation. Neither hours at school nor hours at work correlated with perceived barriers. This study is clearly exploratory, consisting of a small convenience survey of university students. Since it is correlated with mood disorders, neuroticism is both an important variable itself, one of the Big Five personality traits (John & Srivastava, 1999) and a valuable proxy measure for the presence of anxiety and depression. It seems likely that a personality trait such as neuroticism precedes an individualâ&#x20AC;&#x2122;s perception of barriers to meditation, and it seems 28


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unlikely that perceived barriers to meditation would impel students to meditate. This reasoning suggests that the independent variables of statistical significance temporally precede the dependent variable. The finding that neuroticism predicts perceived barriers to meditation offers an explanation for previous evidence that neuroticism predicts noncompliance with meditation (Delmonte, 1980; Delmonte, 1988; Dobkin et al., 2012). Since neuroticism has frequently been found to correlate with the presence of mood disorders (Paulus et al., 2016; Newby et al., 2017), the most common reason for referral to university counseling services (Center for Collegiate Mental Health, 2017), this raises an obvious difficulty with meditation as a treatment for these conditions. Those clients who need the intervention most are likely to perceive more barriers to doing it. It may seem paradoxical that those students who practiced meditation would perceive more barriers to the practice, but commentary on this point goes back for at least 1,500 years. Both classic meditation manuals such as the Visuddhimagga (Buddhaghosa, 2003) and contemporary meditation manuals such as Mindfulness: A Practical Guide to Awakening (Goldstein, 2016) emphasize what Buddhist scriptures discuss as hindrances to meditation, such as restlessness or doubting the benefits of practice. A number of DMPI items, such as being unable to stop thoughts or not thinking that meditation can help one, directly echo these hindrances. In many cases, an individual is unlikely to notice these until he or she has begun practice, just as someone who does not exercise regularly is unlikely to understand the full difficulty involved. University counselors who are using meditation as an intervention should be prepared to discuss barriers to meditation with their clients, and potentially to measure them with the DMPI. They should also monitor clients who are working on meditative interventions, both as part of the process of discussing barriers and to make sure that clients are actually meditating. While many meditative interventions are delivered in psychoeducational formats, it should be possible to take some time each week to discuss progress and barriers. Finally, alternative interventions such as cognitive behavioral therapy should be made available. Researchers who are analyzing the relationship between neuroticism and barriers to meditation should be aware that linear models may underestimate the strength and statistical likelihood of this relationship. Moreover, studies of the relationship between neuroticism and barriers to meditation in clinical populations may fail to detect it, since the relationship is essentially flat at the high levels of neuroticism that are likely to characterize individuals in psychotherapy, particularly for mood disorders. CONCLUSION The use of meditation as a clinical intervention, particularly mindfulness meditation, has grown dramatically in the last two decades (Van Dam et al., 2018). Process research that looks at barriers to practice, reasons for attrition, teaching styles and possible negative effects, has grown more slowly. We hope that this article will encourage university counselors to look a bit more closely at the processes that students who practice meditation go through and the challenges they face.

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REFERENCES Allison, P. D. (2001). Missing Data. Newbury Park, Ca: Sage Publications. Bamber, M. D., & Morpeth, E. (2018). The effects of mindfulness meditation on college student anxiety: A metaanalysis. Mindfulness. https://doi.org/10.1007/s12671-018-0965-5 Berghoff, C. R., Wheeless, L. E., Ritzert, T. R., Wooley, C. M. & Forsyth, J. P. (2017). Mindfulness meditation adherence in a college sample: Comparison of a 10-min versus 20-min 2 week daily practice. Mindfulness, 8, 1513-1521. https://doi.org/10.1007/s12671-017-0717-y Buddhaghosa, B. (trans. Nanamoli; 2003). The Path of Purification: Visuddhimagga. Onalaska, Washington: Pariyatti Publishing. Carson, J. W., Keefe, F. J., Lynch, T. R., Carson, K. M., Veeraindar, G., Fras, A. M., & Thorp, S. R. (2005). LovingKindness Meditation for Chronic Low Back Pain. Journal of Holistic Nursing, 23(3), 287-304. https://doi.org/10.1177/0898010105277651 Cavanagh, K., Strauss, C., Forder, L., & Jones, F. (2014). Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of mindfulness and acceptance-based self-help intervention. Clinical Psychology Review, 34, 118-129. https://doi.org/10.1016/j.cpr.2014.01.001 Center for Collegiate Mental Health (2017). Annual Report. Available at: https://sites.psu.edu/ccmh/files/2018/02/2017_CCMH_Report-1r4m88x.pdf Cleveland, W. S. (1979), â&#x20AC;&#x153;Robust Locally Weighted Regression and Smoothing Scatterplots.â&#x20AC;? Journal of the American Statistical Association, 74(368), 829-836. https://doi.org/10.1080/01621459.1979.10481038 Crescentini, C., & Capurso, V. (2015). Mindfulness meditation and explicit and implicit indicators of personality and self-concept changes. Frontiers in Psychology, 6, 44. https://doi.org/10.3389/fpsyg.2015.00044 Crowley, C., & Munk, D. (2016). An examination of the impact of a college level meditation course on college student well being. College Student Journal, 51(1), 91-98. Dahl, C. J., Lutz, A., & Davidson, R. J. (2015). Reconstructing and deconstructing the self: Cognitive mechanisms in meditation practice. Trends in Cognitive Sciences, 19(9), 515-523. https://doi.org/10.1016/j.tics.2015.07.001 DelMonte, M. M. (1980). Personality characteristics and regularity of meditation. Psychological Reports, 46, 703-712. https://doi.org/10.2466/pr0.1980.46.3.703 DelMonte, M. M. (1988). Personality correlates of meditation frequency and dropout in an outpatient population. Journal of Behavioral Medicine, 11(6), 593-597. https://doi.org/10.1007/bf00844908 Dobkin, P. L., Irving, J. A., & Amar, S. (2012). For whom may participation in a mindfulness-based stress reduction program be contraindicated? Mindfulness, 3, 44-50. https://doi.org/10.1007/s12671-011-0079-9 Eisendrath, S., Chartier, M., & McLane, M. (2011). Adapting Mindfulness-Based Cognitive Therapy for TreatmentResistant Depression. Cognitive and Behaviour Practice, 18:362-370. https://doi.org/10.1016/j.cbpra.2010.05.004 30


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Frederickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J. & Finkel, S. M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential resources. Journal of Personality and Social Psychology, 95(5), 1045- 1062. https://doi.org/10.1037/a0013262 Gnambs, T. (2016). Sociodemographic effects on the test-retest reliability of the Big Five Inventory. European Journal of Psychological Assessment, 32(4), 307-311. https://doi.org/10.1027/1015-5759/a000259 Goldstein, J. (2016). Mindfulness: A practical guide to awakening. Louisville, Colorado: Sounds True. Hastie, T. (2018). R package gam: Generalized Additive Models. Retreived from: https://cran.rproject.org/web/packages/gam/gam.pdf Hastie, T., & Tibshirani, R. (1986). Generalized Additive Models. Statistical Science, 1(3), 297-310. https://doi.org/10.1214/ss/1177013604 John, O. P., Donahue, E. M., & Kentle, R. L. (1991). The Big Five Inventory--Versions 4a and 54. Berkeley, CA: University of California, Berkeley, Institute of Personality and Social Research. https://doi.org/10.1037/t07550-000 John, O. P., & Srivastava, S. (1999). The Big Five trait taxonomy: History, measurement, and theoretical perspectives. In L. A. Pervin, & O. P. John (Eds.), Handbook of Personality: Theory and Research (pp. 102–138). New York: Guilford Press. Kenny, M.A., & Williams, J.M.G. (2005). Treatment-resistant depressed patients show a good response to mindfulness-based cognitive therapy. Behaviour Research and Therapy, 45,617-625 https://doi.org/10.1016/j.brat.2006.04.008 Klainin-Yobas, P., Cho, M., & Creedy, D. (2011). Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: A meta-analysis. International Journal of Nursing Studies, 49:109-121. https://doi.org/10.1016/j.ijnurstu.2011.08.014 Leung, Y., & Singhal, A. (2004). An examination of the relationship between qigong meditation and personality. Social Behavior and Personality: An International Journal, 32(4), 313-320. https://doi.org/10.2224/sbp.2004.32.4.313 Manicavasgar, V., Parker, G., & Perich, T. (2011). Mindfulness-based cognitive therapy vs. cognitive behavior therapy as a treatment for non-melancholic depression. Journal of Affective Disorders, 130:138-144. https://doi.org/10.1016/j.jad.2010.09.027 Newby, J., Pitura, V. A., Penney, A. M., Klein, R. G., Flett, G. L., & Hewitt, P. L. (2017). Neuroticism and perfectionism as predictors of social anxiety. Personality and Individual Differences, 106, 263–267. https://doi.org/10.1016/j.paid.2016.10.057 Paulus, D. J., Vanwoerden, S., Norton, P. J., & Sharp, C. (2016). From neuroticism to anxiety: Examining unique contributions of three transdiagnostic vulnerability factors. Personality and Individual Differences, 94, 38–43. https://doi.org/10.1016/j.paid.2016.01.012 Piet, J., Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for preventions of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Science Review, 31,10321040. https://doi.org/10.1016/j.cpr.2011.05.002 31


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SAS Institute Inc. 2016. SAS® Studio 3.5. Cary, NC: SAS Institute Inc. Sharma, M., & Rush, E. (2014). Mindfulness-based stress reduction as a stress management intervention for healthy individuals: A systematic review. Journal of Evidence-Based Complementary and Alternative Medicine, 19(4), 271-286. https://doi.org/10.1177%2F2156587214543143 Sharma, H. (2015). Meditation: Process and effects. An International Quarterly Journal of Research in Ayurveda, 36(3), 233–237. https://doi.org/10.4103/0974-8520.182756 Surawy, C., McManus, F., Muse, K., Mark, J., & Williams, G. (2015). Mindfulness-based cognitive therapy (MBCT) for health anxiety (Hypochondriasis): Rationale, implementation and case illustration. Mindfulness, 6:382-392. https://doi.org/10.1007/s12671-013-0271-1 Van Dam, N. T., Van Vugt, M. K., Vago, D. R., Shmalzl, L., Saron, C. D., Olendzki, A. …Meyer, D. E. (2018). Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspectives on Psychological Science, 13(1), 36-31. https://doi.org/10.1177/1745691617709589 van den Hurk, P. A. M., Wingens, T., Giommi, F., Barendregt, H. P., Speckens, A. E. M., & Van Schie, H. T. (2011). On the relationship between the practice of mindfulness meditation and personality: an exploratory analysis of the mediating role of mindfulness skills. Mindfulness, 2, 194–200. https://doi.org/10.1007/s12671-011-0060-7 Vollestad, J, Nielsen, M., & Nielsen, G. (2012). Mindfulness- and acceptance – based interventions for anxiety disorders: A systematic review and meta-analysis. The British Journal of Clinical Psychology, 51, 239-260. https://doi.org/10.1111/j.2044-8260.2011.02024.x Williams, A., Dixon, J., Van Ness, P., & McCorkle, R. (2011). Determinants of meditation practice inventory: Development, content validation, and initial psychometric testing. Alternative Therapies in Health and Medicine, 17(5), 16-23. Winbush, N., Gross, C., & Kreitzer, M. (2007). The effects of mindfulness-based stress reduction on sleep disturbance: A systematic review. EXPLORE, 3(6), 585-59. https://doi.org/10.1016/j.explore.2007.08.003

Author correspondence may be addressed to: Keith Warren, Ph.D. The Ohio State University College of Social Work Stillman Hall, 213 1947 College Rd. Columbus, OH 43210 warren.193@osu.edu

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Acknowledgements The authors would like to acknowledge financial support from The Ohio State University College of Social Work and valuable consultation with Lauren Goodridge of the SAS Institute.

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Online Dating and the Risk of Sexual Assault to College Students Meredith Jean Scannell Center for Clinical Investigation Brigham and Women’s Hospital ABSTRACT Background: Advances in technology have created different platforms, such as online dating, where college students can meet other people. One serious risk factor of using online dating is the risk of sexual assault. Many sexual predators will use online dating as a method to connect with potential victims who are often vulnerable and trusting. Aim: This paper discusses the risk of sexual assault among college students who use online dating sites. Faculty can be pivotal in educating students on the dangers of online dating and sexual assault. In addition, faculty members are in a position to recognize signs students may be exhibiting after a sexual assault, offer advice, and provide linkage to necessary services. Results: Risk factors of sexual assault are explored in depth, including predatory tactics and the vulnerability specific to college students. Provided are key safety tips for online dating as well as recommendations regarding resources and reporting to law enforcement. Conclusions: Online dating is popular among college students. Educating students in safety factors will enable them to consider the potential dangers and risk of sexual assault. In addition, higher education institutions must consider the needs of students and provide links to resources, support systems and reporting mechanisms. Submitted 13 January 2019: accepted 1 April 2019 Keywords: Campus sexual assault, online dating, apps, sexual violence, technology Sexual assault is a serious public health issue. It is defined as “any type of sexual contact or behavior that occurs without the explicit consent of the recipient,” including acts such as forced sexual intercourse, forcible sodomy, child molestation, incest, fondling, and attempted rape (United States Department of Justice, 2016). In a national study, 19.3% of women and 1.7% of men have been raped during their lifetimes, and 43.9% of women and 23.4% of men have experienced other forms of sexual violence including unwanted sexual contact and sexual coercion in their lifetimes (Breiding et al., 2014). The latest National Bureau of Justice Statistics’ National Crime Victimization Survey reported 431,840 cases of sexual assault in 2015 (Truman & Morgan, 2016). Rates of sexual assault rage from 6.0% to 44.2% of college students (Fedina, Holmes, & Backes, 2018). More vulnerable to sexual assaults are first-year and second-year students as well as female students who are disproportionately affected compared to their male college student counterparts (Fedina et al., 2018; Sinozich & Langton, 2014). Over the years, the use of technology and social media has become a standard activity among young adults. Unfortunately, there has been a growing trend of sexual violence seen with the use of technology, often called technology-facilitated sexual violence (TFSV) (Henry & Powell, 2018). TFSV includes both in-person and virtual © 2019 Scannell. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International

License (https://creativecommons.org/licenses/by-nc-nd/4.0/)


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sexual acts including, stalking, sexual harassment, dating abuse, pornography, sexual exploitation, and sexual assault (Henry & Powell, 2018). The prevalence of TFVS is largely unknown, however, there has been an alarming increase in national surveillance data in England with a six fold increase over five years of sexual assaults related to online dating, with 25% of these victims between the ages of 15 and 19 years of age (National Crime Agency [NCA], 2016). Research has found female college students are at a risk for TFSV, with 34% of female college students experiencing cyberstalking, 28% receiving unwanted text and voice messages, and 21% receiving unwanted sexual images (DeKeseredy et al., 2019). In another study, females who experience forms of technology-facilitated stalking and received unwanted messages were more likely to report also a sexual assault (DeKeseredy et al., 2019). ONLINE DATING College students are vulnerable to sexual assault due to their unique circumstances and frequent use of online dating sites. It has been found that more than 50% of college students use online dating (Beauchamp et al., 2017; Newett, Churchill, & Robards, 2018). Reasons college students use dating sites and apps vary from entertainment purposes to seeking new friendships, casual dating or sex, to seeking long-term committed relationships (Beauchamp et al., 2017; Cobb & Kohno, 2017). Online dating allows for an increased possibility of finding someone with similar interests more readily than traditional dating or in situations when traditional dating is not an option (Vandeweerd, Myers, Coulter, Yalcin, & Corvin, 2016). The vast majority of college students will also try to make face-to-face connection, with 83.7% of students will meet someone face-to-face after connecting with them online (Beauchamp et al., 2017). One vulnerability that places college students at risk for TFSV is the amount of personal information that they share on dating sites. When individuals join a dating site, they create a profile disclosing their personal information. Some dating sites ask users a series of questions to gather more personal information, which may not have been initially disclosed when creating the profile. Some questions are standard, such as favorite food or music, while others are more personal such as one's religious or political views, and yet others are very private questions, which can include one's sexual preferences or substance use histories (Cobb & Kohno, 2017). Some dating sites allow the users to enhance their profiles by linking different social and non-dating online networks, which may allow for additional personal information or photos to be shared between sites (Albury, Burgess, Light, Race, & Wilken, 2017). Connections may happen which allows access to their more personal information, especially if other social media platforms are linked, with additional personal details, and information about their friends and family made available (Murphy, 2018; Albury et al., 2017). Other online sites and apps have a geolocation, allowing users who are connected to each other to be notified if they are within a certain proximity of each other (Murphy, 2018). The use of online dating services is an easy method for sexual predators to find potential victims (Powell & Henry, 2018). There is no method of determining whether individuals are dangerous or have a criminal history based on their app profile (Abramson, 2014; NCA, 2016). It has been found that 47% of assailants who used online dating sites to connect with their victims, also had a previous criminal conviction (NCA, 2016). Sexual predators can create an anonymous profile and engage with potential victims under false pretenses (Goldsborough, 2017). Research has shown certain characteristics, such as looks, pictures, interests, and place of living can be perceived as being trustworthy (Jin & Martin, 2015). Some perpetrators will try to make their profiles more desirable and falsify their appearance, age, or employment in efforts to appear to be a better dating candidate to attract others (Abramson, 2014; Vandeweerd et al., 016). Over time, online relationships develop with emotional attachment and trust, thereby 35


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increasing vulnerability. This vulnerability and trust then is used against the individual who may be easily lured into a position where sexual assault or other TFSV can occur (NCA, 2016). Often, the perpetrator will persuade the victim to meet with in a few days of the initial contact in a secluded area, such as one of the individuals house, which has been found to be where 72% of online dating sexual assaults occur (NCA, 2016). One of the most significant factors associated with sexual assault among college student is alcohol consumption (Lorenz & Ullman, 2016). The pharmacological effects of alcohol have been shown to reduce the perception and judgement of sexual aggression, can render someone incapacitated, impair one’s ability to fend off a perpetrator, impact one’s ability to make good judgements; the person is more likely to engage in risker behaviors as well (Fedina et al., 2018; Lorenz & Ullman, 2016). Getting together for drinks is a common scenario for meeting someone in person after an online connection is made. However, this can place a person in a difficult situation when meeting someone whose intentions are not for just drinks and will take advantage of the situation, especially if alcohol is involved, which can result in a sexual assault (Powell & Henry, 2018). Meeting in an environment where alcohol is readily available and a social norm can increase one’s vulnerability for a sexual assault. One area that has been identified in contributing to risk of sexual assault with online dating is the differences of the expectations between the two individuals (NCA, 2016). Women are more likely to join a dating site seeking friendships and relationships and men more like to join seeking sexual partners casual “hookups” (Newett et al., 2018). Hookups are causal encounters between two individuals that involve varying degrees of sexual activities, from kissing each other to having intercourse. Misinterpretation and different expectations also occur when a profile indicates that they are looking for a serious relationship but are really looking for casual sex, thereby misleading the other individual (Vandeweerd et al., 2016). With many dating apps, simple conversations can quickly escalate into a sexual nature. These conversations can create an unequal balance for the actual desire for sexual activity when meeting in person for the first time. Sexual messages via texting have been found to increase the risk for sexual assault (Dir, Riley, Cyders, & Smith, 2018). The NCA (2016), found 52% of victims reported sexual conversations with the assailant prior to their first meeting. Another factor is the culture of hooking up. For some people, online dating is a method of meeting someone and facilitating a hookup. While the activities involved in a hookup can vary, it always entails some sort of sexual act. Even in cases where both parties were interested in hooking up, studies have found 75% of campus sexual assaults occurred in the context of a hookup(Flack et al., 2016). Because of this, some students using a dating site for hooking up may be increasing their risk of sexual assault. DISCUSSION College students have many unique circumstances which increase their vulnerability to sexual assault. The use of online dating apps is popular among many college students. The risk of using online dating and sexual assault is often not addressed in preventive efforts (Dills, Fowler & Payne, 2016). For some college students, navigating a new school system, city, and state is a daunting task. If there is a student who had difficulty making friends or joining organizations, online dating is an easy way to meet new people and try to mitigate the loneliness of not having friends or being in a new city. Predators will often look for lonely people and prey on their needs to make connections and exploit them. On the other hand, some students may have some experience with online dating in high school and can draw upon learned self-protective measures. However, some students may come from small communities or backgrounds in 36


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which being a potential victim of violence is not a reality in their community, but is a risk in the college community. leaving some students more vulnerable to predators. Education is a necessary preventative component in addressing this problem. The majority of students will have a mandatory educational training on sexual assault (Amar, Strout, Simpson, Cardiello, & Beckford, 2014). It has been identified that the training should occur for all students on a yearly basis and to use social marketing campaigns to increase awareness (Amar et al., 2014). The CDC recommends campuses incorporate principles of prevention to provide educational trainings in various ways, such as in-person and with sexual violence information presented at different times so that messages about sexual violence and available resources will reach students multiple times (Dills et al., 2016). Information on online dating and TFSV should be included in educational trainings and include what is helpful for students, such as the scope of the problem, gender dynamics, ways to resist sexual violence, the need for reporting, and on and off campus resources (Amar et al., 2014). Other recommended training include teaching skills kills to prevent dating violence, promoting healthy sexuality, and empowering and engaging students to promote social norms that protect against violence (Dills et al., 2016). With online dating, the perception of knowing someone is higher after sharing personal information and photos. Some people do not fully consider the dangers of online dating, which can lower the threshold of suspicious behavior and place them at risk for an assault (Beauchamp et al., 2017). In addition, even if there are safety concerns, college students will continue to meet up with individuals they have connected with from online dating, even if they perceive some safety concerns (Beauchamp et al., 2017). This creates a false sense of security and individuals may take risks they normally would not with typical strangers such as meeting them in a secluded area or in their homes (NCA, 2016). Forensic nurses are in a key position to educate patients and the public on the risks of online dating and sexual assault (see Table 1. Safety Tips to Consider with Online Dating). Table 1 Safety Tips to Consider with Online Dating •

Be wary of dates that occur in isolated areas, such as an individual home.

Avoid dates who do not use pictures in their profiles, or refuse to send pictures or details of themselves over the app and will only do so outside of the app.

Avoid or limit personal details on dating sites, as the individual is then aware of your address, telephone number and other personal information.

Do not be pressured into meeting an individual especially in a location which can isolate you.

Avoid being pressured into changing the location of the date, especially if the date started in a public place and the individual is insisting you change to a secluded location.

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Meet a person from a dating app in a public place, where it is easy to leave such as a café or shopping center.

Inform someone else, such a friend or relative, that you are meeting someone for the first time and share that person’s profile so they are aware of who you are meeting.

If the meeting is going poorly or making you feel uncomfortable, make a quick excuse to leave. Do not linger and allow for an opportunity for the date to continue.

If an individual doesn't want to meet in person after a period of time of correspondence, stop the online relationship.

When sharing personal information, limit the amount of information so that it cannot be searched on the internet; only give a first name or nick name when meeting a date for the first time.

Avoid linking social meeting accounts where your personal information and close contact information can be shared or easily accessed.

Avoid drinking alcohol or limit alcohol intake on your date.

Avoid going to a place of residence on the first few dates.

Turn off the geolocation service on your profile so that you cannot be tracked.

Sources: National Crime Agency. (2016). Emerging new threat in online dating, initial trends in internet dating-initiated serious sexual assaults. Retrieved from https://www.west-info.eu/files/file3.pdf Office of the Esafety Commissioner. (2016). Dating apps and websites. Retrieved from https://www.esafety.gov.au/women/being-social/online-dating/dating-apps-and-websites

The federal civil law, Title IX of the Education Amendments Act of 1972, requires higher educational institutions to address sexual violence (DeMatteo, Galloway, Arnold, & Patel, 2015). The law requires employees within the higher educational institution to respond appropriately to reports of sexual violence and to train employees in how to respond appropriately to reports of sexual violence (DeMatteo, Galloway, Arnold, & Patel, 2015). The United States Task 38


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Force to Protect Students from Sexual Assault issued recommendations to address sexual violence on campus as a priority, includes services for victims (The White House, 2017). Despite the legal mandate, campus response and polices in addressing sexual assault varies across institutions. One study found only 70% of colleges had information on whom to contact after a sexual assault is reported (Sabina & Ho, 2014). In addition, even when there is a response, some students have a negative experience after reporting an assault which can cause a secondary victimization and negatively impact the recovery process (Orchowski, & Gidycz 2015). These system issues create a culture where students don’t want to report a sexual assault. Khan, Hirsch, Wambold, and Mellins (2018) found only 8 out 89 incidents of sexual assault were officially reported. Training efforts for sexual assault prevention need to be targeted to faculty and include information on the need to use a trauma-informed approach when responding to students after an assault. A trauma-informed approach allows for an understanding of the impact of trauma has on the acute and recovery phase, allowing for a culture of safety empowerment and healing (Miller, 2018). Future research must explore reasons students do and do not report the sexual assault so that interventions and prevention efforts can be targeted to what is working as well as exploring areas to develop different ways in which students can report as sexual assault (Khan et al., 2018). Unfortunately, many victims of sexual assault do not seek healthcare services such as a medical forensic exam after a sexual assault (Khan et al., 2018). Many individuals will not seek out or talk about their dating experiences even when services are available (Beauchamp et al., 2017). Beauchamp et al. (2017) found 87.27% of college students will not discuss their dating experiences. One reason for not wanting to discuss or report a sexual assault is a protective factor, which if the assaulted person does not label the act as a sexual assault, then they can believe that nothing harmful occurred (Khan et al., 2018). Some college students do not report the assault due to fear of the perpetrator and that they may be assaulted again or face retaliation (Schwarz, Gibson, & Lewis-Arévalo, 2017). The use of alcohol has also been associated with a lack of reporting from students who believe that they will be blamed for the assault due to consuming too much alcohol or may be blamed because they should not have been drinking alcohol to begin with (Schwarz, Gibson, & Lewis-Arévalo, 2017). Services should be advertised and promoted on their confidential and blame free nature, as these are often reasons students do not seek services. Another reason for not reporting a sexual assault is related to the assaulted individuals’ perceptions of risks and benefits; the risk to social life and academics often outweighed the benefits of reporting, and the added stress of reporting the assault was not desirable (Khan et al., 2018). Reporting an assault may result in the complaint going through the campus judicial process. The campus judication process is one method in which students can file a complaint; it is an official campus process where the complaint is heard and judgements and outcomes are made. There is no nationally standardized process in how a campus judication process occurs. Cases of sexual assault can take place on campus which is heard at the judication board. Members of the judication board can consist of faculty, students, administrators, and staff (Amar et al., 2014). The process is often difficult, and essential information needed such as how to file a complaint, what the process consists of, whom can be present as well as what the burden of proof is and possible outcomes of the complaint may not be available (Sabina & Ho, 2014). In addition, outcomes in cases where a perpetrator is found guilty of a sexual assault may only result community service or a fine (Amar et al., 2014). A need for institutions to have clear information on the judicial process is necessary so that an informed choice for the student can be made if they want to proceed. In addition, the culture of the college must consider the secondary victimization of students when reporting a sexual assault and use a trauma informed approach when creating policies that address sexual violence. 39


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To date, little is known of the prevalence and associations with online dating and sexual assault in the United States. Countries such as the United Kingdom have been monitoring sexual assaults related to online dating and have seen a significant increase in the number of assaults (NCA, 2016). Collecting data on online dating related assaults allows researchers to define trends, identify who is most at risk, and share what safety measures can be taken (NCA, 2016). Many official forms and mandatory forms in documenting sexual assaults do not reflect the advances in technology and may need to be updated to obtain an accurate description of the prevalence of the problem (Commonwealth of Massachusetts, 2016). Knowing how prevalent the problem is essential in addressing priority areas. The issue may be a serious concern that needs to be addressed. In the United Kingdom, data have shown a sharp increase in online dating related sexual assaults which allows prevention efforts to address this as a growing concern (NCA, 2016). If local communities or health centers are not collecting this data, another avenue may be for colleges and university to include this area when there is a report of a sexual assault. Another consideration in collecting data is categorizing the assailant. For some individuals, the assailant may not be viewed as a stranger as the online relationship may have occurred for a length of time (NCA, 2016). A new category of how the assailant is categorized should be considered, as the individual may believe they know the person as an acquaintance, perhaps as the result of trusting a false profile as the individuals is a stranger and not someone really known to the individual. Even if national data is not collected in this manner, having local sites or state sites collecting this information can allow for an awareness of how prevalent the problem has become. CONCLUSION Online dating is a popular activity in which many young people engage. For some, meeting someone new is an exciting time, especially if you are looking for a relationship. However, online dating doesnâ&#x20AC;&#x2122;t come without risk. Knowing possible risk factors and areas of vulnerability will allow young adults to make informed choices that improve their safety. As employees in higher educational institutions, we are obligated to address these concerns. Addressing these concerns requires an understanding of how prevalent the problem is, educating students on prevention methods that are consistent with the technology they are using, and implementing resources that are sensitive to the unique circumstances that college students face.

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REFERENCES Abramson, G. (2014). Weaving a tangled web. Journal of Applied Learning Technology, 4(4), 36-38. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12678303 Albury, K., Burgess, J., Light, B., Race, K., & Wilken, R. (2017). Data cultures of mobile dating and hook-up apps: Emerging issues for critical social science research. Big Data & Society, 4(2), https://doi.org/10.1177/2053951717720950 Amar, A. F., Strout, T. D., Simpson, S., Cardiello, M., & Beckford, S. (2014). Administratorsâ&#x20AC;&#x2122; perceptions of college campus protocols, response, and student prevention efforts for sexual assault. Violence and Victims, 29(4), 579-593. https://doi.org/10.1891/0886-6708.VV-D-12-00154 Beauchamp, A. M., Cotton, H. R., LeClere, A. T., Reynolds, E. K., Riordan, S. J., & Sullivan, K. E. (2017). Super likes and right swipes: How undergraduate women experience dating apps. Journal of the Student Personnel Association at Indiana University, 1-16. Breiding, M. J., Smith, S. G., Basile, K. C., Walters, M. L., Chen, J., & Merrick, M. T. (2014). Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization--national intimate partner and sexual violence survey, United States, 2011. Morbidity and Mortality Weekly Report.Surveillance Summaries (Washington, D.C.: 2002), 63(8), 1-18. Cobb, C., & Kohno, T. (2017). How public is my private life?: Privacy in online dating. Paper presented at the Proceedings of the 26th International Conference on World Wide Web, 1231-1240. https://doi.org/10.1145/3038912.3052592 Commonwealth of Massachusetts. (2016). Provider sexual crime report. Retrieved from http://www.mass.gov/eopss/law-enforce-and-cj/law-enforce/sexual-dom-viol/provider-sexual-crimereport.html DeMatteo, D., Galloway, M., Arnold, S., & Patel, U. (2015). Sexual assault on college campuses: A 50-state survey of criminal sexual assault statutes and their relevance to campus sexual assault. Psychology, Public Policy, and Law, 21(3), 227. https://doi.org/10.1037/law0000055 DeKeseredy, W. S., Schwartz, M. D., Harris, B., Woodlock, D., Nolan, J., & Hall-Sanchez, A. (2019). TechnologyFacilitated Stalking and Unwanted Sexual Messages/Images in a College Campus Community: The Role of Negative Peer Support. SAGE Open, 9(1). https://doi.org/10.1177/2158244019828231 Dills, J., Fowler, D., & Payne, G. (2016). Sexual violence on campus: Strategies for prevention. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/pdf/campussvprevention.pdf Dir, A. L., Riley, E. N., Cyders, M. A., & Smith, G. T. (2018). Problematic alcohol use and sexting as risk factors for sexual assault among college women. Journal of American College Health,1-8. https://doi.org/10.1080/07448481.2018.1432622 Fedina, L., Holmes, J. L., & Backes, B. L. (2018). Campus sexual assault: A systematic review of prevalence research from 2000 to 2015. Trauma, Violence, & Abuse, 19(1), 76-93. https://doi.org/10.1177/1524838016631129

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Flack, Jr., W. F., Hansen, B. E., Hopper, A. B., Bryant, L. A., Lang, K. W., Massa, A. A., & Whalen, J. E. (2016). Some types of hookups may be riskier than others for campus sexual assault. Psychological Trauma: Theory, Research, Practice, and Policy, 8(4), 413. https://doi.org/10.1037/tra0000090 Goldsborough, R. (2017). Don't be a lonely heart victim. Teacher Librarian, 45(2), 62-63. Henry, N., & Powell, A. (2018). Technology-facilitated sexual violence: A literature review of empirical research. Trauma, Violence, & Abuse, 19(2), 195-208. https://doi.org/10.1177/1524838016650189 Jin, S., & Martin, C. (2015). “A match made… online?” the effects of user-generated online dater profile types (freespirited versus uptight) on other users' perception of trustworthiness, interpersonal attraction, and personality. Cyberpsychology, Behavior, and Social Networking, 18(6), 320-327. https://doi.org/10.1089/cyber.2014.0564 Khan, S. R., Hirsch, J. S., Wambold, A., & Mellins, C. A. (2018). 'I didn't want to be 'that girl'': The social risks of labeling, telling, and reporting sexual assault. Sociological Science, 5, 432-460. https://doi.org/10.15195/v5.a19 Lorenz, K., & Ullman, S. E. (2016). Alcohol and sexual assault victimization: Research findings and future directions. Aggression and Violent Behavior, 31, 82-94. https://doi.org/10.1016/j.avb.2016.08.001 Miller, D. (2018) Trauma-informed care: Treating the whole person. Fast Facts About Forensic Nursing (pp. 39-47). New York, NY: Springer Publishing. https://doi.org/10.1891/9780826138675.0005 Murphy, A. (2018). Dating dangerously: Risks lurking within mobile dating apps. Catholic University Journal of Law and Technology, 26(1), 7. National Crime Agency (NCA; 2016). Emerging new threat in online dating, initial trends in internet dating-initiated serious sexual assaults. Retrieved from https://www.west-info.eu/files/file3.pdf. Newett, L., Churchill, B., & Robards, B. (2018). Forming connections in the digital era: Tinder, a new tool in young Australian intimate life. Journal of Sociology, 54(3), 346-361. https://doi.org/10.1177/1440783317728584 Office of the Esafety Commissioner. (2016). Dating apps and websites. Retrieved from https://www.esafety.gov.au/women/being-social/online-dating/dating-apps-and-websites. Orchowski, L. M., & Gidycz, C. A. (2015). Psychological consequences associated with positive and negative responses to disclosure of sexual assault among college women: A prospective study. Violence Against Women, 21(7), 803-823. https://doi.org/10.1177/1077801215584068 Powell, A., & Henry, N. (2018). Policing technology-facilitated sexual violence against adult victims: Police and service sector perspectives. Policing and Society, 28(3), 291-307. https://doi.org/10.1080/10439463.2016.1154964 Sabina, C., & Ho, L. Y. (2014). Campus and college victim responses to sexual assault and dating violence: Disclosure, service utilization, and service provision. Trauma, Violence, & Abuse, 15(3), 201-226. https://doi.org/10.1177/1524838014521322 Schwarz, J., Gibson, S., & Lewis-Arévalo, C. (2017). Sexual assault on college campuses: Substance use, victim status awareness, and barriers to reporting. Building Healthy Academic Communities Journal, 1(2), 45-60. https://doi.org/10.18061/bhac.v1i2.5520 42


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Sinozich, S., & Langton, L. (2014). Rape and sexual assault victimization among college-age females, 1995-2013. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Truman, J.L., & Morgan, R.E. (2016). Criminal victimization, 2015. ( No. NCJ 250180). Washington D.C.: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Retrieved from https://www.bjs.gov/content/pub/pdf/cv15.pdf United States Department of Justice. (2016). Sexual assault. Retrieved from https://www.justice.gov/ovw/sexualassault Vandeweerd, C., Myers, J., Coulter, M., Yalcin, A., & Corvin, J. (2016). Positives and negatives of online dating according to women 50+. Journal of Women & Aging, 28(3), 259-270. https://doi.org/10.1080/08952841.2015.1137435 The White House (2017). The White House Task Force to Protect Students from Sexual Assault. Washington D.C.: Retrieved from https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Documents/1.4.17.VAW%20Event.Guid e%20for%20College%20Presidents.PDF

Author correspondence may be addressed to: Meredith Jean Scannell Center for Clinical Investigation Brigham and Womenâ&#x20AC;&#x2122;s Hospital Boston, MA 02115 mjscannell@bwh.harvard.edu

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Expressive Writing: A Self-Care Intervention for First Year Undergraduates Monica Kennison, EdD, RN Berea College Connie Lamb, PhD, RN Berea College Judy Ponder, DNP, RN Baptist Health Richmond Lisa Turner, PhD, RN, PHCNS-BC Berea College Aryn C. Karpinski, PhD Kent State University Laura C. Dzurec, PhD, PMHCNS-BC, ANEF, FAAN Boston College Connell School of Nursing laura.dzurec@bc.edu ABSTRACT Background: As incoming students grapple with stress and traumatic experiences at alarming rates, faculty and institutions are increasingly promoting resilience and self-care activities. Expressive writing (EW) may be an underutilized self-care practice for addressing students’ stressful or traumatic experiences. Aim: This pilot study aimed to describe the effects of an expressive writing (EW) intervention on participants’ mental and physical health and stress levels. Methods: The study design was mixed methods. The convenience sample of 32 undergraduate participants were assigned, every other one, to either an EW intervention group who wrote about a stressful or traumatic experience (n = 18), or a neutral writing (NW) group (n = 14) who wrote about trivial topics. Data regarding sample characteristics, cortisol level, quality of life, and impact of the EW intervention were collected via a demographic survey, the SF-36v2® Health Survey (Maruish, 2011), salivary sampling and exit survey, respectively. Results: Comparison of SF-36v2® pre- to post-test demonstrated higher gains in mental health in the experimental group, relative to the control group. Fourteen (44% of total group) reported that they would recommend EW to a friend to help with stressful or traumatic experiences. Conclusions: EW may support first year undergraduates’ self-care related to addressing past or current stressful or traumatic situations. Submitted 12 March 2019: accepted 24 April 2019 Keywords: college populations, self-care methods/groups, stress © 2019 Kennison, Lamb, Ponder, Turner, Karpinski, & Dzurec. This article is published under a Creative Commons AttributionNonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/)


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Writing helps to heal (Pennebaker & Smyth, 2016). For the past thirty years, expressive writing (EW) has been studied among both healthy and ill populations. Despite its potential utility for assisting college students to deal with stressful or traumatic experiences, it may be underutilized as a self-care technique incorporated in campus resilience and wellness programs often part of the onboarding process for incoming college students. The prevalence of psychological disorders is greater among university students than among their community counterparts (Hussain, Guppy, Robertson, & Temple, 2013). In a large sample of college freshmen, 81.8% reported experiencing at least one potentially traumatic event (PTE) and 8.7% reported experiencing four or more PTEs prior to entering college (Overstreet, Berenz, Kendler, Dick, & Amstadter, 2017). Moreover, a history of interpersonal PTE (e.g., physical assault, sexual assault, unwanted sexual situation) was associated with trauma related distress, anxiety and depressive symptoms, and increased alcohol use (Overstreet et al., 2017). The stress of transitioning to college, added to students’ personal traumatic event exposure, may amplify student vulnerability. First year undergraduates, in particular, express concerns about the stigma, privacy, and anonymity in seeking counseling (Hussain et al., 2013). The purpose of this pilot study was to describe the utility of an EW intervention addressing stressful or traumatic experiences as a therapeutic self-care practice for first-year undergraduates. BACKGROUND EW has repeatedly improved health outcomes, minimized psychological and physical symptoms, and promoted overall well-being (Boals, 2012). In EW, individuals are asked to write about traumatic, stressful, or emotional life events for 15 – 20 minutes each day, on 3 – 4 consecutive days (Pennebaker & Beall, 1986). Over time, the ”bottling-up” of feelings and related lack of disclosure about personal and traumatic experiences places individuals at risk for major and minor illnesses. EW –exposition, free writing, or journaling, for example— can facilitate emotional disclosure and improved health outcomes that may not otherwise occur (Pennebaker & Smyth, 2016). A significant body of literature links EW to improved emotional and physical health outcomes for healthy college students (Alparone, Pagliaro, & Ilaria 2015) including: fewer health center visits (Pennebaker & Beall, 1986), less depression severity (Booker & Dunsmore, 2017), improved self-esteem (Mum, 2014), less self-criticism (Troop, Chilcot, Hutchings, & Varnaite, 2012), less sleep difficulty (Arigo & Smyth, 2011) and decreased intrusive thoughts (Boals, 2012). Among Chinese undergraduates, EW improved psychological, social, and physical health (Yang, Tang, Duan, & Zhang, 2015). Moreover, a recent meta-analysis of twenty-one independent studies of EW among youths aged ten to eighteen years (Travagin, Margola, & Revenson, 2015) found an overall positive, yet small, mean effect size (d = 0.127) and significant d-effect sizes ranging from 0.107 to 0.246 in the domains of emotional distress, problem behavior, social adjustment, and school participation. Given the salience of stress in the lives of many college students, the ways that students cope with stress may be a critical factor in determining who is adversely affected and may serve as a target for interventions to increase resilience and prevent mental health disorders (Coiro, Bettis, & Compass, 2017). More than 19,000 undergraduates from 40 institutions participated in the 2018 American College Health Association (ACHA) - National College Health Assessment Survey II (ACHA-NCHA-II). Over 50% of respondents reported experiencing three or more “traumatic

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or very difficult to handle” situations (e.g., social or intimate relationships, family problems) in the 12 months preceding their participation. The impetus for the study reported here, as a part of a larger wellness initiative, came from an investigator review of trended data from ACHA-NCHA-II annual surveys. Those data indicated that first year undergraduates attending a rural, liberal arts college in the south fared significantly worse than did the normative group of undergraduates in reported stress levels and other physical and psychological health outcomes. Five-year average data indicated that 24% of first-year students at the involved institution came from at-risk or distressed Appalachian counties (College Fact Book, 2016-2017). To better serve students’ health and wellness needs, institution administrators embarked on an extensive campus-wide wellness initiative targeting first year students at onboarding. Study investigators sought to determine whether an EW intervention would mitigate stress and improve quality of life for incoming undergraduates during their transition to college. Quality of life was defined as the subjective assessment of health and well-being encompassing physical, mental, emotional, and social domains of life (Healthy People 2020, 2010). Stress was defined as an “individual’s reaction to any change that requires an adjustment or response, which can be physical, mental, or emotional” (Townsend & Morgan, 2018, p. 2). This study focused on first-year undergraduates’ physical and mental components of quality of life as measured by the SF-36v2® survey (Maruish, 2011) and levels of stress, as measured by salivary cortisol. RESEARCH QUESTIONS Three questions guided this study: (1) What are the effects of an EW intervention on the quality of life and stress level of first-year undergraduates as measured by the SF-36v2® survey (Maruish, 2011) and salivary cortisol; (2) What stressful or traumatic experiences are described by first-year undergraduates during an EW intervention?; and (3) How does an EW intervention impact self-care of first-year undergraduates’ dealing with stressful or traumatic experiences? METHODS Design The mixed methods design was used to improve understanding and utility (Bazeley, 2108) of the EW. The study incorporated an experimental, two-group, pretest-posttest control group design to determine the effect of an EW intervention on student stress and quality of life. The two-groups were an EW (experimental) and NW (control) group. Qualitative data and descriptive statistics were obtained from an investigator-developed exit survey. Following institutional review board approval two weeks prior to study initiation in fall 2016, the investigators displayed flyers advertising the study throughout campus. All first-year undergraduates over the age of 18 and attending the participating academic institution were eligible to participate in the study. The target sample comprised 419 full-time enrollees.

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Participant Recruitment A week after the flyers were displayed, an announcement explaining the study with an invitation to participate was sent via email listserv to all first-year students. A second email announcement was sent one week after the first. Additionally, faculty members teaching first-year required courses allowed researchers to explain the study and solicit participants face-to-face prior to class. The flyer, email announcement, and face-to-face meetings listed the date and place where interested participants would meet to begin the study. A total of 39 undergraduates (9%) responded to the recruitment efforts by arriving at the pre-determined location. The study was explained, questions were answered, and written consent was obtained. Expressive Writing Intervention The EW intervention consisted of four, 20-minute writing sessions conducted on each of four consecutive days. Participants were each given a notebook and pen to handwrite. Writing prompts given to participants in the EW and neutral writing (NW) control groups came from the works of Pennebaker (Pennebaker & Beall, 1986; Pennebaker & Smyth, 2016). Those in the EW experimental group were given a sealed envelope with the same typed prompt each day to write continuously about their deepest thoughts and feelings related to a single or multiple stressful or traumatic experience. Participants in the NW control group were given a similar sealed envelope with a typed prompt to write about a different non-emotional topic each day (e.g., a nature scene, walking directions). The writing was neither read nor kept by the researchers. Instruments Instruments used in the study were: demographic survey, salivary cortisol analysis, SF-36v2® survey (Maruish, 2011), and an exit survey. Participants completed a demographic form to ascertain data on age, gender, race and academic area of interest. Participants’ salivary cortisol was used to measure their stress levels and to support evaluation of the effectiveness of the EW intervention (Sanada, et al., 2016). Quality of life (QOL) was measured with the SF-36v2® survey (Maruish, 2011), a short-form Likert scale health survey. The SF-36v2® survey consists of 36 items with eight scales aggregated into summary measures of physical and mental health. The Physical Component Summary (PCS) score is derived from four aggregated subscales: Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP) and General Health (GH). The Mental Component Summary (MCS) score is derived from four aggregated subscales of Vitality (VT), Social Functioning (SF), RoleEmotional (RE) and Mental Health (MH). Higher scores on the two summary measures, that is, physical and mental health, indicate better quality of life. The SF-36v2® survey is standardized using means and standard deviations from the 1998 and 2009 U.S. general population. The t-score based scores in the U.S. general population instrument have a mean of 50 and standard deviation of ten as does the SF-36v2®. Normative data from the 1998 and 2009 general U.S. adult population sample are used to compare test subjects. (QualityMetric Health Outcomes Scoring Software 5.0 Users’ Guide, 2016; Maruish, 2011). The SF-36v2® survey has been widely used as a reliable and well-validated tool to measure quality of life and, in particular, to evaluate the effects of interventions (DeBerrard & Masters, 2014).

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The investigator-developed exit survey consisted of 11 items on a Likert scale. Survey items asked participants to describe their thoughts and feelings related to the EW intervention. The exit survey also included four open-ended questions asking participants to share the general topic of their writing and how the EW impacted them personally. Procedure To ensure investigator consistency in data collection and administration of the EW intervention, investigators wrote step-by-step guidelines (e.g., preprinted prompts for the EW [experimental] and NW [control] writing groups) that investigators used for data collection. On day one of the study, investigators met students in a designated private area. Enrollees signed a consent form, provided a saliva sample and completed the demographic tool and SF-36v2ÂŽ health survey (Maruish, 2011). To protect confidentiality, data were numerically coded. Investigators collected saliva specimens using the passive drool collection approach (Granger, Johnson, Szanton, & Out, 2012). Following saliva collection procedures, investigators alternated assigning each participant to either the experimental (EW) or neutral writing (NW) control group. Investigators handed enrollees a journal, pen, and sealed plain envelope with either the EW or NW prompt. Once writing began, enrollees were timed for 20 minutes; after 20 minutes elapsed, enrollees were asked to finish their writing, notified they were free to leave with the journal, and reminded to return the following three days at the same time and place. On the following three consecutive days, the procedure was repeated. On day four, the last writing session, all enrollees were verbally reminded to return in three weeks for the posttest and second saliva sample. Those who completed the study were thanked and given a movie ticket for participation. Because this research was conducted as part of a larger first-year health promotion initiative, researchers deemed one year an appropriate time frame for the exit survey evaluating the effectiveness of the EW intervention. Thus, at one year, participants were emailed, via Qualtrics, an exit survey with closed- and open-ended questions about the EW intervention. RESULTS Data analysis followed Bazeleyâ&#x20AC;&#x2122;s (2018) guidelines for how to conduct triangulation in mixed methods design, including: Creating a list of shared concepts, assessing convergence of thematic data, assessing completeness and developing a unified description. Investigators analyzed demographic data descriptively using frequency and percentage statistics (See Table 1). Of the 39 study enrollees, a sample of 32, predominantly females (26 or 81.3%), ranging in age from 18 to 48 (median age 19 years), completed the study. While all 18 of those in the EW group finished the study, seven (1 male and 6 females) assigned to the control group did not complete, a finding similar to those of other EW studies (Lancaster, Klein, & Heifner, 2015).

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Table 1 Descriptive Statistics of Total Sample N (%)______________________________________ Race African American/Black 3 (9.4) Asian 2 (6.3) Bi-/Multi-Racial 6 (18.8) Caucasian/White 18 (56.3) Hispanic/Latino 3 (9.4) Academic Area of Interest* BIO/BUS/PSYCH/CFS 12 (37.5) NUR/CS/MUS 6 (18.8) Undecided/Varying 14 (43.8) Stress Management Strategies Exercise (43.8) Music (18.8) Television (6.3) Writing (6.3) Napping (6.3) _________________________________________________________________________ *BIO = Biology, BUS = Business Administration, PSYCH = Psychology, CFS = Child & Family Studies, NUR = Nursing, CS = Computer Science, MUS = Music. The investigators used three separate Split-Plot Analyses of Variance (ANOVAs) to analyze the effects of the EW and NW intervention on the dependent variables of quality of life physical health (i.e., SF-36v2ÂŽ Physical Component Summary [PCS] scores), quality of life mental health (i.e., SF-36v2ÂŽ Mental Component Summary [MCS] scores), and salivary cortisol levels across two-time periods (i.e., pre-intervention and three-week post-intervention). Salivary Cortisol Levels Salivary cortisol was normalized using standard competitive ELISA test, and results were reported in ng/ml. The normal range of salivary cortisol of the total sample was 0 - 2 ng/ml, and wide variability was evident at both pre- and posttest. Of the 32 salivary samples, 6 (19%) were outliers and were eliminated from comparison testing, leaving 26 (81%) used for group comparison. Mean cortisol level of the experimental (EW) group showed a decreasing trend from pre- to posttest, whereas the control (NW) group mean cortisol level remained relatively unchanged from preto posttest (Figure 1).

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Figure 1. Estimated marginal means of cortisol at pre-posttest. Physical Component Summary Score of SF-36v2® (Maruish, 2011) At pre- and post-time points, the total sample, experimental, and control group scores demonstrated means above the national norm of 50.00 in physical health on the SF-36v2® survey (Maruish, 2011). The PCS score showed little change from pre- to posttest in either group. Mental Component Summary Score of SF-36v2® (Maruish, 2011) At pre- and posttest, the total sample, EW experimental, and NW control groups’ scores were below the national norm on the MCS scale consistent with ACHA-NCHA-II survey results showing mental health outcomes below national norms for this population of incoming undergraduates. Table 2 shows that from pre- to posttest, the mean MCS scores of the EW experimental group increased from 35.93 to 43.35 compared to NW control group showing a trend toward improved mental health. Conversely, mean MCS scores of the NW control group remained relatively unchanged (43.03 to 41.92) suggesting the NW had no effect on control groups’ mental health. Further analysis using three separate Split-Plot Analyses of Variance (ANOVAs) to determine between and in group effects of the EW intervention at pre- and posttest on the main variables of: Cortisol level, PCS and MCS did not yield statistical differences across two-time periods (i.e., pre-intervention and three-week post-intervention). 50


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Table 2 Descriptive Statistics of Physical and Mental QOL Stress of Groups at Pre-Posttest _______________________Experimental Control____________ N = 18 N = 14 Time 1 Time 2 Time 1 Time 2 M (SD) Range M (SD) Range M (SD) Range M (SD) Range Variable______________________________________________________________________ PCS 55.10 (5.29) 19.69 54.71 (4.62) 15.37 55.47 (5.61) 20.65 56.67 (5.12) 20.38 MCS 35.93 (16.22) 48.77 43.35(11.79) 43.38 43.03 (8.98) 31.22 41.92 (14.46) 50.17 ______________________________________________________________________________ PCS = Physical Health Component Summary Score; MCS = Mental Health Component Summary Score Exit Survey Analysis Fourteen of the 32 participants (44%) provided narrative responses to the open-ended prompts on the exit survey (e.g., describe the topic of your writing, describe the impact of the EW on you personally). Descriptive statistics were used to analyze the Likert scale responses and open-ended narratives on the exit survey. In response to the item, “Writing about my deepest thoughts and feelings related to a stressful or traumatic event was helpful,” 71% of respondents answered affirmatively. Eighty-six percent of respondents agreed or strongly agreed to the statement, “My time as a participant was enjoyable.” Similarly, 77% answered affirmatively to the statement, “I would tell a friend to take part in a study where one writes about his/her stressful or traumatic.” Narrative responses were analyzed using the process of repeated literal, interpretive and reflective readings (Mason, 2018) and thematic analysis (Nowell, Norris, White, & Moules, 2017). An outside peer reviewer with expertise in qualitative analysis of narrative data verified the findings. When asked to describe the topic of their writings, respondents described death of a family member and hometo-college transition. “I wrote about my relationship with my late grandmother, the events leading to her death, and the aftermath of her passing. She was a tremendous presence in my life as a child, and I lost her when I was 16. I also lived with her in the two weeks leading up to her passing, which was my first time witnessing death with my own eyes. I also wrote about all the secrets that came out after she died, and how it made me feel to know them all now that I couldn’t ask her about them anymore. Transitioning from home to college was expressed differently by different respondents. One commented, “I wrote about how scared I was as an international student in America. I was quite young and have never been left home before so I felt like I did not fit into the new culture I found myself in.” A second respondent differentiated between college and home life, “I mostly just talked about my life back home and [how] peaceful it was compared to my life now at … college.” When asked about how the EW intervention impacted them, one respondent commented, 51


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“It was strange, writing about trauma did help me unearth these feelings to confront them, but it also put me in a fog to have them remembered inside me and replayed in my head. Although I must definitely say it’s therapeutic to simply get it off your chest. Writing it is almost like telling someone about it.” A second respondent expressed a similar comment on the therapeutic value of EW, “Writing is very helpful to me… The structure of the environment gave me a way to dive into difficult stuff and then not get stuck there, but come back out again and go on with my over-scheduled day.” DISCUSSION Results of this pilot study demonstrated a trend among intervention group participants toward lower cortisol levels and higher mean MCS scores from pre- to 3-week posttest when compared to the control group. However, the posttest higher mean MCS scores and lower salivary cortisol did not reach statistical significance, and that was surprising. In future studies the researchers may want to schedule an initial posttest measure of cortisol and the SF36v2® (Maruish, 2011) closer to the intervention and consider adding exclusion criteria for medications and health problems known to alter cortisol. The PCS score showed little change from pre- to posttest in either group. This was not surprising given all participants worked at least ten hours per week in addition to maintaining a full-time academic course load. The findings of this mixed methods study meld into a cohesive picture that first-year undergraduates may find EW therapeutic as a self-care intervention to address stressful or traumatic experiences. An EW intervention may be a helpful complement to a multimodal wellness initiative. Further research is indicated to link EW to quality of life and stress. This is particularly germane for schools that find their incoming students fare worse than national norms of quality of life health indicators or maladaptive coping (DeBarard & Masters, 2014). LIMITATIONS The small sample size at one geographic location and use of a convenience sample limit generalizability of study findings. There were no exclusion criteria regarding participants’ excessive physical activity, caffeine ingestion, and current use of antibiotics, recent infection, or certain health problems that might affect salivary cortisol levels (Pritchard, Stanton, Lord, Petocz, & Pepping, 2017). Any of those factors may have influenced results. The researchers did not screen for participants’ concurrent engagement in other self-care activities (e.g., mindfulness, stress reduction) that may have impacted results. CONCLUSION First year undergraduates represent a vulnerable population with significant physical and mental health problems. EW proffers the privacy and simplicity that some first year undergraduates find therapeutic and would recommend to a friend to help manage stressful or traumatic experiences. Faculty and staff engaging in resilience and healthy work environment initiatives may want to further investigate EW as a complement to other self-care interventions to help students manage their current or past stressful or traumatic experiences. 52


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REFERENCES American College Health Association. American College Health Association-National College Health Assessment II: Undergraduate Student Executive Summary Fall 2018. Silver Spring, MD: American College Health Association; 2018. Retrieved from https://www.acha.org/documents/ncha/NCHAII_Fall_2018_Undergraduate_Reference_Group_Executive_Summary.pdf Alparone, F. R., Pagliaro, S., & Rizzo, I. (2015). The words to tell their own pain: Linguistic Markers of cognitive reappraisal in mediating benefits of expressive writing. Journal of Social and Clinical Psychology, 34(6), 495-507. https://doi.org/10.1521/jscp.2015.34.6.495 Arigo, D., & Smyth, J. M. (2011). The benefits of expressive writing on sleep difficulty and appearance concerns for college women. Psychology & Health, 27(2), 210-226. https://doi.org/10.1080/08870446.2011.558196 Bazeley, P. (2018). Integrating analyses in mixed methods research. Los Angeles: Sage. https://doi.org/10.4135/9781526417190 Berea College. Fact Book 2016-2017. Retrieved from https://www.berea.edu/ira/wpcontent/uploads/sites/27/2017/04/FactBook2016-2017.pdf Boals, A. (2012). The use of meaning making in expressive writing: When meaning is beneficial. Journal of Social and Clinical Psychology, 31(4), 393-409. https://doi.org/10.1521/jscp.2012.31.4.393 Booker, J. A., & Dunsmore, J. C. (2017). Expressive writing and well-being during the transition to college: Comparison of emotion-disclosing and gratitude-focused writing. Journal of Social and Clinical Psychology, 37(7), 580-606. https://doi.org/10.1521/jscp.2017.36.7.580 Coiro, M. J., Bettis, A. H., & Compass, B. E. (2017). College students coping with interpersonal stress: Examining a control-based model of coping. Journal of American College Health, 65(3), 177-186. https://doi.org/10.1080/07448481.2016.1266641 DeBerrard, M. S., & Masters, K. S. (2014). Psychosocial correlates of the Short-Form-36 Multidimensional Health Survey in university students. Psychology, 5, 941-949. https://doi.org/10.4236/psych.2014.58104 Granger, D. A., Johnson, S. B., Szanton, S. L., Out, D., & Shumann, L. L. (2012). Incorporating salivary biomarkers into nursing research: An overview and review of best practices. Biological Research in Nursing, 14(4), 347-356. https://doi.org/10.1177/1099800412443892 Healthy People 2020. (2010). Foundation health measure report. Health-related quality of life and well-being. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Health-Related-Quality-of-Lifeand-Well-Being Hussain, R., Guppy, M., Robertson, S., & Temple, E. (2013). Physical and mental health perspectives of first year undergraduate rural university students. BMC Public Health,13, 848. https://doi.org/10.1186/1471-2458-13848 Lancaster, S. L., Klein, K. P., & Heifner, A. (2015). The validity of self-reported growth after Expressive writing. Traumatology, 21(4), 293-298. https://doi.org/10.1037/trm0000052

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Maruish, M. E. (Ed.). (2011). User’s manual for the SF-36v2 Health Survey (3rd ed.). Lincoln, RI: QualityMetric Incorporated. Mason, J. (2018). Qualitative research. (3rd ed.). Los Angeles: Sage. Mum, L. (2014). Increasing self-compassion and positive body esteem: An expressive writing intervention. Dissertation Abstracts International: Sciences and Engineering, 75(2-B)(E). Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1). https://doi.org/10.1177/1609406917733847 Overstreet, C., Berenz, E. C., Kendler, K. S., Dick, D. M.., & Amstadter, A. B. (2017). Predictors and mental health outcomes of potentially traumatic event exposure. Psychiatry Research, 247, 296-304. https://doi.org/10.1016/j.psychres.2016.10.047 Pennebaker, J.W. & Beall, S.K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274-281. https://doi.org/10.1037/0021-843X.95.3.274 Pennebaker, J. W., & Smyth, J. M. (2016). Opening up by writing it down: How expressive writing improves health and eases emotional pain. (3rd ed.). New York: Guilford Press. Pritchard, B. T., Stanton, W., Lord, R., Petocz, P., & Pepping, G-J. (2017). Factors affecting measurement of salivary cortisol and secretory immunoglobulin A in field studies of athletes. Frontiers in Endocrinology, 8, 168. https://doi.org/10.3389/fendo.2017.00168 QualityMetric health outcomes scoring software 5.0 users’ guide. (2016). Lincoln, R.I.: QualityMetric. Ramler, T. R., Tennison, L. R., Lynch, J. & Murphy, P. (2016). Mindfulness and the college transition: The efficacy of an adapted mindfulness-based stress reduction intervention in fostering adjustment among first-year students. Mindfulness, 7(1), 179-188. https://doi.org/10.1007/s12671-015-0398-3 Sanada, K., Montero-Marin, J., Diez, M.A., Salas-Valero, M., Perez-Yus, M.C., Morillo, H.,… Garcia-Camayo, J. (2016). Effects of mindfulness-based interventions on salivary cortisol in healthy adults: A Meta-analytic review. Frontiers in Physiology, 19, 471. https://doi.org/10.3389/fphys.2016.00471 Townsend, M. C., & Morgan, K. (2018). Psychiatric mental health nursing (9th ed.). Philadelphia: Davis. Travagin, G., Margola, D., & Revenson, T. A. (2015). How effective are expressive writing interventions for adolescents? A meta-analytic review. Clinical Psychological Review, 36, 42-55. https://doi.org/10.1016/j.cpr.2015.01.003 Troop, N. A., Chilcot, J., Hutchings, L., & Varnaite, G. (2012). Expressive writing, self-criticism, and selfreassurance. Psychology and psychotherapy: Theory, research and practice, 86, 374386. https://doi.org/10.1111/j.2044-8341.2012.02065.x Yang, Z., Tang, X., Duan, W., & Zhang, Y. (2015). Expressive writing promotes self-reported physical, social and psychological health among Chinese undergraduate International Journal of Psychology, 50(2), 128-134. https://doi.org/10.1002/ijop.12081 54


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Author correspondence may be addressed to: Monica Kennison, EdD, RN Berea College CPO 2190 Berea, KY 40404 kennisonm@berea.edu Acknowledgements The authors wish to acknowledge Dr. Patricia Clark of Georgia State University for suggestions on data analysis and Berea College colleagues who offered invaluable expertise: Dr. Matthew Saderholm for testing the salivary samples and Ms. Jill Gurtatowski and Dr. Maggie Robillard for help planning and implementing the EW intervention.

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Examining Student Wellness for the Development of Campus-Based Wellness Programs Alexia F. Franzidis, PhD Steven M. Zinder, PhD School of Health and Human Services University of North Carolina Wilmington ABSTRACT Background: Despite the many campus-based wellness programs and services offered through entities such as student services, many U.S. students lack the strategies, skills, or support systems to manage stress or change pre-existing behaviors, resulting in unhealthy behaviors and poor overall wellness. Since patterns developed during this time can form a solid foundation for future health behaviors, there is a need to develop and design wellness programs that stimulate positive health-behavior change. Aim: The purpose of this study was to assess student wellness of college students at a four-year public university to inform campus-based health programs, events, and services. Methods: An anonymous, single-structured survey was administered at an on-campus event (N = 225). The instrument covered six dimensions of wellness: physical wellness, social wellness, intellectual wellness, emotional wellness, spiritual wellness, and environmental wellness. Results: Significant differences for gender were found in the dimensions of social wellness, emotional wellness, and physical wellness. Females reported higher levels of social and emotional wellness, while males reported higher levels of physical wellness. Differences in age for emotional wellness, and year of study for physical wellness were also found. Conclusions: Findings provide insight to direct interventions and programs that would enhance students’ wellness knowledge and behaviors. Submitted 2 October 2018: accepted 28 February 2019 Keywords: college student wellness, student well-being, health behaviors College provides an ideal environment to shape students’ health behaviors (Coxey, 2018; Dubois, 2006). Students are away from home, surrounded by different individuals, lifestyles, and support groups (Harmon, Forthofer, Bantum, & Nigg, 2016), and they are responsible for their own health and well-being, potentially for the first time (Ridner, Newton, Staten, Crawford, & Hall, 2016). Since patterns developed during this time can form a solid foundation for people’s future health behaviors (Ridner et al., 2016), many colleges and universities require students to take a wellness course during their degree programs. Such programs are shown to increase students’ knowledge on lifetime wellness topics and stimulate positive healthbehavior change (Lockwood & Wohl, 2012; McCormick & Lockwood, 2006). In addition to these courses, most institutions offer a variety of campus-based health programs through counseling centers, health centers, and related entities such as student services. These units offer frequent events tailored to specific subpopulations (e.g., year of © 2019 Franzidis & Zinder. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0

International License (https://creativecommons.org/licenses/by-nc-nd/4.0/)


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study, gender, sexual orientation), on a particular health topic (e.g., smoking, vaping, drinking). The programs are designed to improve students’ physical and mental health (Slavin, Schindler, & Chibnall, 2014), promote psychosocial and stress management techniques (Conley, Travers, & Bryant, 2013), decrease depression and anxiety (Dvořáková et al., 2017), and develop positive health behaviors to enhance students’ quality of life (Baldwin, Towler, Oliver, & Datta, 2017). For example, participation in a mindfulness-based program has been shown to increase first-year college students’ life satisfaction, and decrease their depression and anxiety (Dvořáková et al., 2017). While college can be a time to adopt positive health behaviors, it can also be a time for students to develop negative habits that may affect their well-being and contribute to chronic diseases later in life (Lederer & Oswalt, 2017). Students report high levels of alcohol and tobacco use (Mallett et al., 2013; Ridner et al., 2016), poor diet (Hudd et al., 2000; LaFountaine, Neisen, & Parsonse, 2006), infrequent physical activity (LaFountaine et al., 2006), increased stress (Hudd et al., 2000), and insufficient sleep (Beauchemin, Gibbs, & Granello, 2018; Ridner et al., 2016). This has resulted in an increase in emotional and behavioral health problems, such as depression, anxiety, and psychological distress (Brunner, Wallace, Reymann, Sellers, & McCabe, 2014; Downs, Alderman, Schneiber, & Swerdlow, 2016). A recent study showed that first-year college students experienced a steep decline in their psychological and social well-being within the first six months of their arrival to campus (Conley, Kirsch, Dickson, & Bryant, 2014). These problems may be attributed to the additional challenges students face, such as increased tuition costs, academic demands, time pressures, and stress from living away from home (Mowbray et al., 2006). Despite the many campus-based wellness programs and services offered, many U.S. students lack the strategies, skills, or support systems to manage stress or change pre-existing behaviors (Beauchemin et al., 2018; Wharf Higgins, Lauzon, Yew, Bratseth, & McLeod, 2010), resulting in unhealthy behaviors and poor overall wellness (Dubois, 2006). There is a need to continue to develop and design programs that increase students’ wellness knowledge and behaviors (Nesbitt, 2012). Higher education, due to its insulated environment, can provide layers of support not found or readily available in the general community (Downs et al., 2016; Lederer & Oswalt, 2017). There is renewed interest for interventions, research, programs, and policies to assist this population with enhancing their health and wellness skillset (Lederer & Oswalt, 2017). Such programs would help students cultivate healthy behaviors, learn how to address the challenges they face while in higher education (Christianson et al., 2018), and develop healthy skills to prevent chronic diseases later in life (Lederer & Oswalt, 2017; Ridner et al., 2016). Some researchers believe it is the duty of higher education institutions to improve the health of this segment of the population, and is integral to their mission (Lederer & Oswalt, 2017). For campus-based health and wellness programs to be truly effective, they should incorporate all dimensions of wellness into their programing. Wellness, a conjunction of “well-being” and “wholeness,” is an integration of various dimensions (such as physical, spiritual, social, emotional, environmental, occupational, and intellectual), that contribute towards quality of life (Myers, Sweeney, & Witmer, 2000). Educational and interventional campus-based health services and programs should be tailored to the specific needs of their college student population (Mowbray et al., 2006). Programs should be marketed and communicated effectively, highlighting the scheduled programs, and available services and facilities (Christianson et al., 2018), with the aim of “reaching students who do not present themselves” (Grace, 1997, p.248), thus promoting student participation (Dubois, 2006). 57


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Previous researchers have examined wellness differences between traditional and non-traditional students (Myers & Mobley, 2004), year of study (LaFountaine et al., 2006), gender (Baldwin et al., 2017; LaFountaine, 2009; Wharf Higgins et al., 2010; Stock et al., 2001), institution type (Baldwin et al., 2017), and college athletics (Beauchemin, 2014; LaFountaine, 2009). Such studies have yielded mixed results. Significant differences have been reported for gender. Males are consistently noted to be more physically active compared to females (Baldwin et al., 2017; LaFountaine, 2009; Myers & Mobley, 2004), reported higher levels of wellness, specifically those related to physical, emotional, and social wellness than their female counterparts (Myers & Mobley, 2004), and scored higher in their sense of worth and social relationships compared to females (LaFountaine, 2009). These findings contradict other studies that report females are more knowledgeable and better at practicing health prevention behaviors than their male counterparts (Wharf Higgins et al., 2010; Stock et al., 2001), and experience a greater feeling of belonging due to their social relationships (Baldwin et al., 2017). Other variables, besides gender, have also produced equivocal results. One study demonstrated an increase in studentsâ&#x20AC;&#x2122; level of wellness with class standing (Oleckno & Blacconiere, 1990), while others noted a decline in nutrition and stress management during the first year (LaFountaine et al., 2006). Another showed students attending a liberal arts college were more physically active, compared to those attending a research college (Baldwin et al., 2017); however, the researchers note that these findings could be attributed to gender. While these studies provide valuable insight into student wellness, the inconsistency of the findings necessitates a need to examine a broad cross-section of students to identify differences in self-perceived levels of wellness, behaviors, or concerns of college students (Quinn, Ghaziri, Mangano, & Thind, 2018). A further understanding of these differences will allow for tailored programs and concentrated marketing efforts (Anderson, 2015), with the purpose of being relevant to student needs and noticeable to students (Christianson et al., 2018). It has been encouraged by researches to provide additional investigations to contribute, verify, or refute these current findings (Myers & Mobley, 2004). The purpose of this study was to assess the perceived level of wellness of students to guide the development of campus-based health programs and prevention strategies. METHODS Subjects from a four-year, public university with approximately 15,000 students in the United States, were invited to participate in an anonymous, single-structured survey about their perceived levels of wellness. To ensure they were reaching a broad cross section of students, the researchers set up a booth during an on-campus event, and students attending the event were asked to complete the survey. The University Institutional Review Board (IRB) approved all procedures and the data collection instrument used in this study. The subjects were told the purpose of the study and asked their age. Only students 18 years and older were eligible. Participation was voluntary, and no incentive was given. Students that agreed to participate signed the consent form, and were asked to complete the paper survey at an adjoining booth separate from the researchers. The instrument came from the text adopted by the universityâ&#x20AC;&#x2122;s mandatory basic studies academic wellness course (Hopson, Donatelle, & Littrell, 2015). The course is designed to provide knowledge on developing and maintaining personal wellness. At the beginning of the course, students are asked to complete the instrument to assess their current levels of wellness across six dimensions: Physical wellness (e.g., engagement in physical activity, diet, perceptions of body image), social wellness (e.g., meaningful relationships, partaking in social activities), intellectual wellness (e.g., 58


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time management, reflection on perceptions and behaviors), emotional wellness (e.g., self-opinion, ability to express and handle emotions), spiritual wellness (e.g., faith, appreciation of life), and environmental (e.g., waste reduction and recycling, conscious purchasing). Each dimension contained 10 questions, and each item was scored on a Likert Scale (1 = never; 5 = always). At the completion of each section, a total score was calculated for that dimension. After completing all sections, students were asked to analyze and summarize their results. The purpose of the activity was to help students identify areas that necessitate a behavioral change to improve their quality of life. In the present study, the researchers used the identical instrument, with the score calculations and meanings removed. In addition to the survey, the researchers collected demographic information on age, gender, and year of study, to analyze the impact these variables had on student wellness. All data were analyzed using SPSS, version 24.0. RESULTS There were 241 completed student surveys. Of these, 16 participants were 25 years or older. As the researchers were interested in only examining traditional college students 1, these cases were removed, resulting in a final number of 225. The sample consisted of 86 males (38%) and 139 females (62%) between 18 and 24 years of age. Of the sample, 46 students were first-year students, 47 students were sophomores, 69 were juniors, 60 were seniors, and four were considered other (graduate student or those taking longer than four years to complete their degree). Six separate univariate ANOVAs were performed, one for each dimension of wellness, utilizing the subjectsâ&#x20AC;&#x2122; total score in each dimension for analysis (e.g., physical wellness, social wellness, intellectual wellness, emotional wellness, spiritual wellness, and environmental wellness). Post-hoc analysis on significant main effects were computed using multiple one-way ANOVAs to elucidate which survey questions contributed to the differences. Significant differences were found in the dimensions of social wellness (males = 4.03 +/- 0.08; females = 4.39 +/- 0.07; p = .0001), emotional wellness (males = 3.70 +/- 0.09; females = 4.02 +/- 0.08; p = .044), and physical wellness (males = 3.54 +/- 0.09; females = 3.24 +/- 0.08; p = .001) between males and females. Differences in emotional wellness were found based on students age (18 = 4.46 +/- 0.19; 19 = 3.89 +/- 0.11; 20 = 3.97 +/- 0.11; 21 = 3.98 +/- 0.09; 22 = 3.85 +/- 0.14; 23 = 3.41 +/- 0.18; 24 = 3.97 +/- 0.28; p = .007), and differences in physical wellness were found based on students year of study (first-year = 3.21 +/- 0.13; Sophomore = 3.29 +/- 0.16; Junior 3.44 +/- 0.12; Senior = 3.55 +/- 0.09; Other = 2.88 +/- 0.34; p = .042). No significant differences were found in the intellectual, spiritual, or environmental wellness dimensions based on age, gender, or year of study. No significant interactions were found between gender, age, or year of study. Results of the post-hoc analysis on significant main effects of gender and social wellness can be seen in Figure 1. Nine questions were significantly different, with females consistently reporting a higher number (always = 5; often = 4) compared to males. Five questions were significantly different in the emotional wellness dimension based on gender. As illustrated in Figure 2, females consistently reported a higher number (always = 5; often = 4) compared to males. Five questions were significantly different in the main effect of gender and physical wellness. As illustrated in Figure 3, males consistently reported a higher number (always = 5; often = 4) compared to females, except in Question 1.

1

Students aged 25 or greater are classed as non-traditional (Myers and Mobley, 2004; LaFountaine et al., 2006) 59


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Figure 1. Gender - Social Wellness 6 5

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Figure 2. Gender - Emotional Wellness 6 5 4

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E.1. I find it easy to laugh, cry, and show emotions such as love, fear, and anger and I try to express them in positive ways. E.2. I avoid using alcohol or drugs as a means to forget my problems or relieve stress E.3. My friends regard me as a stable, well-adjusted person whom they trust and rely on for support. E.4. When I am angry, I try to resolve issues in non-hurtful ways rather than stewing about them. E.9. I try not to be too critical or judgmental of others. Figure 3. Gender - Physical Wellness 6 5 4

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P1. I listen to my body and make adjustments or seek professional help when something is wrong. P3. I engage in vigorous exercise three to four times per week. P4. I do exercise for muscular strength and endurance at least two times per week. P5. I do stretching and limbering exercised at least five times per week. P7. I feel good about the condition of my body. I have lots of energy and can get through the day without being overly tired. 61


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Results of the post-hoc analysis on significant main effects of age and emotional wellness can be seen in Figure 4. 18 year olds scored higher in Questions E2, E3, and E8 on the dimension of emotional wellness compared to older students (as seen in the legend of the figure). 4.8

Figure 4. Age - Emotional Wellness

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* E2. 18 year olds scored significantly higher than 22 year olds. ** E3. 18 and 20 year olds scored significantly higher than 19 year olds. *** E8. 18 year olds scored significantly higher than 23 year olds. E.2. I avoid using alcohol or drugs as a means to forget my problems or relieve stress. E.3. My friends regard me as a stable, well-adjusted person whom they trust and rely on for support. E.8. I feel good about myself and believe others like me for who I am. CONCLUSIONS The purpose of this study was to assess student wellness to inform campus-based health programs, events, and services. The findings revealed differences between gender and social wellness, gender and emotional wellness, and gender and physical wellness. Females scored higher in almost all questions related to social wellness (i.e., nine out of ten questions). Compared to males, female students reported having strong relationships (S4), people to talk to about private feelings (S5), engage in selfless social activities (S9, S10), and feel positive about their relationships and interactions with others (S1, S2, S3, S6, S8). Additionally, female students also scored higher than males in half of the questions related to emotional wellness. Females found it easier to express their emotions, positive or negative, in a health manner (E1, E4), see themselves as stable and non-judgmental (E3, E9), and were less likely to use alcohol or drugs to relieve problems or stress (E2). The results suggest male students have fewer social support systems and meaningful relationships, indicating they have fewer people to talk with when they are stressed and are more likely to 62


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use drugs or alcohol to relieve problems or stress. These findings align with studies that report females enjoy health benefits from their social relationships, and are better at practicing emotional and social prevention behavior strategies than their male counterpart (Baldwin et al., 2017; Wharf Higgins et al., 2010; Stock et al., 2001). The present study showed males were more active than females, engaging in more aerobic activity, strength and endurance exercises (P3, P4, P5), and had more energy due to their physical condition (P7). These findings are consistent with previous studies that also report males to be more physically active (Baldwin et al., 2017; LaFountaine, 2009; Myers & Mobley, 2004). The only question on which females scored higher was listening to their body and seeking advice if something went wrong (P1). This may be due to the questionâ&#x20AC;&#x2122;s close alignment with social or emotional wellness (i.e., interacting with others, following through with feelings). Differences in age for emotional wellness, and year of study for physical wellness were also shown. A closer analysis of the questions showed that students have a higher level of self-esteem (E8), consider themselves more reliable (E3), and avoid using alcohol or drugs to relieve stress or problems (E8) when they are younger (18 years old), than when they are older (22 or 23 years old). These findings suggest that as students age throughout their schooling, their wellness behaviors decline. This is consistent with those that report a decline in student physiological health and well-being after commencing college (Conley et al., 2014). These findings highlight the need for specific programs targeting the distinctive needs of males and females, and students of various ages, and can be used to inform and influence campus-based health and wellness programs and marketing efforts. Programs should be developed for males to enhance their social and emotional wellness. For example, sessions that offer strategies or mechanisms to increase or build social support networks, methods for students to share items of stress, or suggestions on healthy alternatives for relieving stress. Additionally, initiatives that encourage females to increase their physical activity levels should be introduced. While this study was conducted at a mid-size university in the United States, the findings are still of value in particular to the campus where the study was conducted, and to other universities of a similar size and type. It adds to the body of knowledge on student wellness, and the debate on factors that impact student wellness. Due to the important role that campus-based health programs can play in studentsâ&#x20AC;&#x2122; lives, and the increase in reported health related concerns, the authors recommended other colleges conduct a general wellness assessment to design and market programs to specific sub-populations and their needs.

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REFERENCES Anderson, D. S. (Ed.). (2015). Wellness issues for higher education: A guide for studentaffairs and higher education professionals. New York: Routledge. Baldwin, D. R., Towler, K., Oliver, M. D., & Datta, S. (2017). An examination of college student wellness: A research and liberal arts perspective. Health Psychology Open, 4 (2), 1 - 9. https://doi.org/10.1177%2F2055102917719563 Beauchemin, J. (2014). College student-athlete wellness: An integrative outreach model. College Student Journal, 48(2), 268-280. Beauchemin, J., Gibbs, T., & Granello, P. (2018). Wellness promotion courses in university settings: A review of the outcome research. Building Healthy Academic Communities Journal, 2(1), 36-49. https://www.doi.org/10.18061/bhac.v2i1.6344 Brunner, J. L., Wallace, D. L., Reymann, L. S., Sellers, J. J., & McCabe, A. G. (2014). College counseling today: Contemporary students and how counseling centers meet their needs. Journal of College Student Psychotherapy, 28(4), 257-324. https://doi.org/10.1080/87568225.2014.948770 Christianson, J., Kattelmann, K., Moret, L., Riggsbee, K., Vilaro, M., Olfert, M. D., … & Colby, S. (2018). College Campus Wellness Programs: Identifying and Addressing the Health Needs of College Students. Journal of Nutrition Education and Behavior, 50(7), S110. https://doi.org/10.1016/j.jneb.2018.04.146 Conley, C.S., Kirsch, A.C., Dickson, D.A., & Bryant, F.B. (2014). Negotiating the transition to college: developmental trajectories and gender differences in psychological functioning, cognitive- affective strategies, and social wellbeing. Emerging Adulthood, 2(3),195–210. https://doi.org/10.1177/2167696814521808 Conley, C. S., Travers, L. V., & Bryant, F. B. (2013). Promoting psychosocial adjustment and stress management in first-year college students: The benefits of engagement in a psychosocial wellness seminar. Journal of American College Health, 61(2), 75-86. https://doi.org/10.1080/07448481.2012.754757 Coxey, A. (2018). Students' perspective of healthy living in college. Doctoral dissertation. Eastern Illinois University. Downs, N. S., Alderman, T., Schneiber, K., & Swerdlow, N. R. (2016). Treat and teach our students well: college mental health and collaborative campus communities. Psychiatric Services, 67(9), 957-963. https://doi.org/10.1176/appi.ps.201500465 Dubois, E. (2006). Assessment of health-promoting factors in college students' lifestyles. Doctoral dissertation. Auburn University. Dvořáková, K., Kishida, M., Li, J., Elavsky, S., Broderick, P. C., Agrusti, M. R., & Greenberg, M. T. (2017). Promoting healthy transition to college through mindfulness training with first-year college students: Pilot randomized controlled trial. Journal of American College Health, 65(4), 259-267. https://doi.org/10.1080/07448481.2017.1278605 Grace, T. W. (1997). Health problems of college students. Journal of American College Health,. 45(6), 243-250. https://doi.org/10.1080/07448481.1997.9936894

64


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Harmon, B., Forthofer, M., Bantum, E., & Nigg, C. (2016). Perceived influence and college students' diet and physical activity behaviors: An examination of egocentric social networks. BMC Public Health, 16(473), 1-10. https://doi.org/10.1186/s12889-016-3166-y Hopson, J. L., Donatelle, R. J., & Littrell, T.R. (2015). Get fit stay well! (3ed.) San Francisco: Pearson Education. Hudd, S., Dumlao, J., Erdmann-Sager, D., Murray, D., Phan, E., & Soukas, N. (2000). Stress at college: Effects on health habits, health status and self-esteem. College Student Journal, 34(2), 217 - 227. LaFountaine, J. (2009). Student athlete wellness: gender perspectives. Journal of Coaching Education, 2(2), 24-44. https://doi.org/10.1123/jce.2.2.24 LaFountaine, J., Neisen, M., & Parsons, R. (2006). Wellness factors in first year college students. American Journal of Health Studies, 21(3/4), 214 - 218. Lederer, A. M., & Oswalt, S. B. (2017). The value of college health promotion: a critical population and setting for improving the public’s health. American Journal of Health Education, 48(4), 215-218. https://doi.org/10.1080/19325037.2017.1316692 Lockwood, P., & Wohl, R. (2012). The impact of a 15-week lifetime wellness course on behavior change and selfefficacy in college students. College Student Journal, 46(3), 628-641. Mallett, K.A., Varvil-Weld, L., Borsari, B., Read, J.P., Neighbors, C., & White, H.R. (2013). An update of research examining college student alcohol-related consequences: new perspectives and implications for interventions. Alcoholism: Clinical and Experimental Research, 37(5), 709–716. https://doi.org/10.1111/acer.12031 McCormick, J., & Lockwood, P. (2006). College student perception of wellness concepts. Physical Educator, 63(2), 78 – 103. Mowbray, C. T., Mandiberg, J. M., Stein, C. H., Kopels, S., Curlin, C., Megivern, D., ... & Lett, R. (2006). Campus mental health services: Recommendations for change. American Journal of Orthopsychiatry, 76(2), 226-237. https://doi.org/10.1037/0002-9432.76.2.226 Myers, J., & Mobley, K. (2004). Wellness of undergraduates: Comparisons of traditional and nontraditional students. Journal of College Counseling, 7(1), 40-49. https://doi.org/10.1002/j.2161-1882.2004.tb00258.x Myers, J. E., Sweeney, T. J., & Witmer, M. (2000). The Wheel of Wellness Counseling for Wellness: A holistic model for treatment planning. Journal of Counseling and Development, 78(3), 251-266. https://doi.org/10.1002/j.1556-6676.2000.tb01906.x Nesbitt, M. (2012). Examining the effects of a one-semester health behavior course on college students' perception of wellness. Master’s Thesis. University of Illinois at Urbana-Champaign. http://hdl.handle.net/2142/31222 Oleckno, W. A., & Blacconiere, M. J. (1990). Wellness of college students and differences by gender, race, and class standing. College Student Journal, 24(4), 421-429. Quinn, B., El Ghaziri, M., Mangano, K. M., & Kaur Thind, H. (2018). Toward total student health: A qualitative pilot study. Journal of American College Health, 1-6. https://doi.org/10.1080/07448481.2018.1484365 65


Building Healthy Academic Communities Journal Vol. 3, No.1, 2019

Ridner, S. L., Newton, K. S., Staten, R. R., Crawford, T. N., & Hall, L. A. (2016). Predictors of well-being among college students. Journal of American College Health, 64(2), 116-124. https://doi.org/10.1080/07448481.2015.1085057 Stock, C., Wille, L., & Krämer, A. (2001). Gender-specific health behaviors of German university students predict the interest in campus health promotion. Health promotion international, 16(2), 145-154. https://doi.org/10.1093/heapro/16.2.145 Slavin, S.J., Schindler, D.L., & Chibnall, J.T. (2014). Medical student mental health 3.0: Improving student wellness through curricular changes. Academic Medicine, 89, 573â&#x20AC;&#x201C;577. https://doi.org/10.1097/ACM.0000000000000166 Wharf Higgins, S. J., Lauzon, L. L., Yew, A. C., Bratseth, C. D., & McLeod, N. (2010). Wellness 101: Health education for the university student. Health Education, 110(4), 309-327. https://doi.org/10.1108/09654281011052655

Author correspondence may be addressed to: Alexia F. Franzidis, PhD 601 S College Rd Wilmington, NC 28403 franzidisa@uncw.edu Steven M. Zinder, PhD 601 S College Rd Wilmington, NC 28403 zinders@uncw.edu

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Building Healthy Academic Communities Journal Vol. 3, No.1, 2019  

The official journal of the National Consortium for Building Healthy Academic Communities designed to promote comprehensive, evidence-based...

Building Healthy Academic Communities Journal Vol. 3, No.1, 2019  

The official journal of the National Consortium for Building Healthy Academic Communities designed to promote comprehensive, evidence-based...

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