College students' physical activity: application of an ecological perspective.
Physical activity is the cornerstone of a healthy lifestyle and is cited as a key strategy for reducing the risk of chronic conditions and diseases including hypertension, coronary heart disease, diabetes, cancer, and obesity (Chobanian et al., 2003; Farrell et al., 1998; Lee & Paffenbarger, 1998; Paffenbarger & Lee, 1997; Sesso, Paffenbarger, & Lee, 1998). Unfortunately, more than 60% of American adults do not engage in regular physical activity and about 25% of American adults do not engage in any type of physical activity beyond the requirements of daily life (USDHHS, 1996).
A significant percentage of college students do not get adequate physical activity. Makrides et al. (1998) reported that fewer than half of university students participated in exercise three or more times per week. Haberman and Luffey (1998) found that only 39% of students exercised three or more times per week. Suminski, Petos, Utter and Zhang (2002) also studied physical activity patterns of a diverse group of college students and found that 47% of the sample did not engage in vigorous physical activity and 17% were physically inactive. The National College Health Risk Behavior Survey (NCHRBS) reported that 42% of college students participated in vigorous activity at least three times a week, while an additional 20% participated in moderate activity (CDC, 1997). Although some research exists that examines physical activity among college students, there is still a need for more research in this area. There is a particular need to examine in more detail the environmental and institutional factors that impact physical activity behaviors.
In the study and practice of health promotion and behavior change, the focus has traditionally been placed on individual-level factors that influence behaviors. Health behavior interventions have also largely focused on modifying individual factors such as perceptions, attitudes, knowledge and beliefs. While this focus has resulted in many positive outcomes in terms of healthier behaviors, it has limitations. By focusing solely on the individual, the broader context in which humans live is ignored. Potential points of intervention to create positive lasting behavior change are then overlooked. Ecological models to explain and influence human behavior have been developed to examine the relationships between humans and their environment.
Ecology is "the branch of biology that deals with the relations between living organisms and their environment" (Webster's New World Dictionary of American English, 1991, p. 429). In studying human behavior, ecological models include not only the human being, but also the environment in which the human exists. Ecological models in health behavior are valuable because they can help shed light on the multitude of complex factors that influence and are influenced by behaviors.
Ecological models examine the interactions among intrapersonal, sociocultural, policy, and physical-environmental factors. From this perspective, individual-level behavior must be examined in the context in which it occurs. Knowledge, while a precursor, is not in itself typically sufficient to create health-enhancing behaviors (Alters & Schiff, 2003). Therefore, understanding the multiple influences on behavior is critical to identifying potential areas for intervention.
Bandura (1997) described a reciprocal relationship between the individual, the behavior, and the environment in his social cognitive theory. In Bandura's view, each of these components impacts the other. Individuals engage in behaviors, which can affect their environment. The environment also impacts the individual and the behaviors in which an individual chooses to engage.
Green, Kreuter, Deeds, and Partridge (1980) in their Precede/Proceed Model, described an ecological relationship that included multiple factors in the process of planning health promotion programs. They identified several layers of influences including epidemiological, social/environmental, and policy and administrative elements. This model made an important contribution because it assists program planners with understanding the context in which behaviors occur.
Sallis, Bauman, and Pratt (1998) proposed a model for researchers to collaborate with a variety of community agencies to develop policy and environmental interventions for the purpose of increasing physical activity. The model identifies several components that should be incorporated into ecological approaches including creating coalitions among public health, the medical community, and city planners and officials. The authors also pinpointed specific types of policies that should be in place to promote physical activity.
The southeastern region of the US leads the country in many chronic diseases and harmful health behaviors including smoking and obesity. Many students attending colleges and universities in this region come from this background. As emerging leaders, these students will likely be in positions of influence and could potentially impact future health-related policy. For this reason, it is particularly critical to create campus/community environments that support and encourage health-enhancing behaviors among students that they will take with them when they leave campus.
For the current study, an ecological perspective was selected to provide insight regarding the context in which students at a large, public university in the Southeast exist and make choices about behaviors. The goal was to determine the level of physical activity engaged in by this population of students and then use an ecological perspective to explain the findings by identifying factors within the university environment that facilitate or constrain physical activity among students as they interact with the environment. The purposes of this study were to: (1) determine the level and type of physical activity engaged in by a cohort of college students; (2) identify environmental and institutional factors that facilitate or constrain physical activity; and (3) recommend changes in environmental and institutional factors to support physical activity.
A random sample of students was drawn by the University Registrar's office and provided to the investigators. The total population of 18-to-24 year-old undergraduates was 16,070. This sample yielded 1,100 18-to-24 year-old undergraduate students who were registered for the spring 1999 semester. A descriptive, cross-sectional survey was sent to these randomly-chosen students. Approximately one week after the initial survey mailing, reminder postcards were sent to request participation. After two weeks, those who had not returned completed surveys were mailed another survey packet and a request to participate in the study. From the 1,100 mailed surveys, 531 were returned completed, yielding a 48% response rate. While not a diverse sample, it is reflective of the demographics of the student population on campus (Table 1).
Approval from the Institutional Review Board was received. Potential respondents were mailed a questionnaire with a cover letter explaining the purpose of the study, the importance of participating, and that their responses were anonymous. The students were encouraged to respond and return the questionnaire in an enclosed, addressed, stamped envelope.
The quantitative portion of this study included a cross-sectional survey of undergraduate students' physical activity and other health behaviors. The qualitative part of the study focused on elements of the environment and institutional policies that impact students' physical activity. This included campus design, opportunity for physical activity, and campus emphasis on health and physical activity through education and information.
The survey data were first analyzed descriptively by determining frequency distributions. Relationships between categorical and ordinal variables (e.g., the category of living arrangement and frequency of strengthening exercises) were ascertained using one-way analysis of variance with post-hoc comparisons based on Fisher's least significant difference procedure. For the special case of a categorical variable with only two levels (e.g., Greek status or marital status), a two-sample t-test was used. Data analyses were performed using SAS for Windows, version 8.2 (SAS Institute, 1999-2001); p-values less than .05 were deemed statistically significant throughout.
Behavior survey. The instrument, an adaptation of the Centers for Disease Control and Prevention National College Health Risk Behavior Survey (NCHRBS) (CDC, 1997), was comprised of 83 items requesting information about a variety of health behaviors including self-reported weekly physical activities, dietary habits, and demographic information. For specific questions used on the survey refer to CDC (1997). For the purpose of this paper, only the physical activity data are presented; other data are not published at this time.
Self-reported physical activity was assessed as vigorous or moderate, in addition to stretching and strengthening. Vigorous activity was defined as activity engaged in for 20 minutes or more that "made you sweat or breathe hard." Moderate activity was defined as "walking or bicycling for at least 30 minutes at a time." These items were the exact questions as they appeared on the NCHRBS.
Environmental factors. Details concerning the environment were documented using a modification of the Pedestrian and Bicycle Audit, developed by the National Center for Bicycling and Walking (Wilkinson, Eddy, MacFadden, & Burgess, 2002). This audit was designed to assess conditions in a community that impact walking and biking. The researchers observed automobile traffic volume and speed, the presence of bicycle lanes, crosswalks, traffic signals, whether the environment appeared to be safe for pedestrian and bicycle traffic, the ease with which pedestrians and bicyclists could maneuver across the campus, and availability of facilities for physical activity.
Institutional policies. Institutional policies were examined by conducting interviews with key informants on campus. The Director of Campus Recreation and the undergraduate advisor for Kinesiology and Health Promotion were interviewed regarding policies and curriculum requirements related to physical activity. The Director of Campus Recreation was queried regarding usage data for facilities and types of programming available to students for recreation and physical activity. The Undergraduate Advisor was questioned about the curriculum requirements for physical activity across the wide variety of academic programs on the campus.
Students were surveyed regarding their participation in physical activity and their responses were compared to the results of the NCHRBS. In this cohort of students, 39% participated in vigorous physical activity, compared to 42% of the NCHRBS sample. Participation rates for stretching and exercises to strengthen were similar to the national sample (see Table 1). The two samples differed in the area of moderate activity: 41% of the students said they participated in moderate activity in contrast to 20% in the national sample. The difference in moderate activity levels between students in the current study and those in the NCHRBS may be due to the nature of the campus on which the current study took place, which is spread out and requires substantial walking. Walking is included in the moderate category. While it could be argued that walking for transportation is not considered to be "intentional exercise" research has demonstrated that this type of physical activity positively impacts health (Wilkinson et al., 2002). Furthermore, the NCHRBS defines walking as moderate physical activity (CDC, 1997).
Figure 1 displays the percentage of students who reported participating in the various categories of physical activity and the number of days they participated. It can be seen in this figure that in each level and type of physical activity (vigorous, moderate, stretching, or strengthening) at least one third of the respondents did not participate at all. The category with the largest number of non-participants was strengthening.
[FIGURE 1 OMITTED]
Demographic characteristics were examined to determine if they were related to participation in exercise. Comparisons were made in frequency of exercise among students in four different types of living arrangements. The groups differed on the frequency of participation in vigorous activity ([F.sub.3,525] = 2.8, p = .04) and on frequency of strengthening exercises ([F.sub.3,524] = 3.2, p = .02). Post-hoc analyses indicated that those living with friends or roommates participated in vigorous activity and in strengthening exercises significantly more often than those who lived alone (p = .02 for vigorous activity and p = .01 for strengthening). In addition, those living with roommates did strengthening exercises more frequently than those living with a boyfriend, girlfriend or spouse (p = .03). Frequency and type of exercise was also associated with the location of the students' housing (on campus, off-campus or with parents/other). In particular, housing location was related to engagement in moderate activity at least 30 minutes ([F.sub.2,525] = 6.5, p = .002). Post-hoc analyses indicated that those who lived on campus participated in this type of exercise more frequently than either off-campus dwellers (p = .007) or those who lived with their parents (p = .01). Married students participated less frequently in vigorous activity ([t.sub.527] = 2.0, p = .04) and in strengthening exercise ([t.sub.526] = 2.1, p = .04), compared with their unmarried counterparts. Fraternity and sorority members participated in moderate activity for at least 30 minutes more often than non-members ([t.sub.526] = 2.4, p = .02).
The University campus is located in the center of a city of approximately 260,000 people. The campus is designed for motor traffic rather than foot or bicycle. This design is exemplified in a variety of ways (Table 3). Drivers in the area do not slow down or stop for pedestrians in crosswalks and pedestrians and cyclists are often seen hurrying across streets to avoid cars driving at fast speeds. There are few bike lanes, and the central buildings on the campus are located such that those on bicycles must park them a fair distance from the buildings. Bicycles are not permitted on many of the sidewalks on campus. The campus is surrounded by busy thoroughfares, which are difficult and dangerous for pedestrians and cyclists to use due to high traffic volume. Main thoroughfares go through the center of campus as well, resulting in many students crossing the street in the middle of the block rather than at crosswalks.
Furthermore, there are few facilities on the outskirts of the campus that provide groceries and other basic needs. Therefore, campus residents are forced to rely on motor transportation to meet basic needs that cannot be met on campus. Many students on campus travel home on weekends, and thus bring cars to the campus and park them there during the week. Since only 37% of students live on campus and use of cars is convenient, the result is heavy reliance on cars rather than on walking or biking. One of the few activity-promoting features of campus is that it encompasses a large area; thus students on campus are often forced to walk some distance to classes.
Recreational facilities. At the time of this survey, the University did not have a true recreational facility. The University was behind other benchmark institutions in terms of these facilities. Almost all recreational facilities were shared between campus recreation and academic programs or athletics, thus limiting access. The result was inadequate student recreational facilities with overcrowded conditions and lack of opportunity for students, faculty, and staff to engage in physical activity (Table 3).
Health education services and academic requirements. The Health Education Program of the University Health Service (student health) employed a registered dietitian who had a master's degree in Health Education and was a Certified Athletic Trainer. Her time was divided between nutrition counseling for student athletes, clinical services for students with eating disorders or dietary concerns, and providing nutritional and physical activity education and information to the student population. Since the undergraduate student population at this institution was approximately 17,000, one health educator could not reach even a fraction of students in need of services. Educational programming, pamphlets, and bulletin board information were provided to those who requested it.
There is no general university academic requirement for health education and/or physical education in the academic program. This course work is required by only by a few disciplines (i.e., Kinesiology, Health Promotion, Elementary Education) as part of the major.
Policies. Through our discussions with key personnel in campus recreation, general university advising, and student services, we concluded that there is a lack of coordinated effort to encourage physical activity. The Department of Campus Recreation does send literature to general advising and orientation sessions to make new students aware of opportunities to engage in recreation on campus. At the time of this survey, recreational facilities and opportunities were provided to students free of charge. Other than that, few efforts appear to be in place to encourage students to engage in physical activity (Table 3).
A limitation in this study was that the researchers have no information about the non-responders. It is known that people tend to over-report exercise (USDHHS, 1996). Further, with self-reported health-related data, there is the potential that those who choose to respond to surveys regarding health behavior may be engaging in the desired behavior with greater prevalence than those who choose not to respond (Isaac & Michael, 1995). Thus, the data presented here likely represent the highest level of activity possible and students may actually be exercising less then reported.
In this sample, certain demographic characteristics were associated with higher levels of activity (living with friends or roommates; living on-campus; being an undergraduate; being single; being a member of a fraternity or sorority). With the exception of class standing and marital status, the higher levels of activity related to the other demographic characteristics demonstrate that living environment is associated with physical activity levels. Research has demonstrated that people who live in areas with greater access to goods and services within walking distance are more likely to engage in higher levels of daily activity since they can walk or bike to those services rather than having to rely on automobiles for transport (Ewing, Schmid, Killingsworth, Zlot, & Raudenbush, 2003). Students who live on campus and with others may be more likely to walk or bike for transportation than those who live alone and/or off campus.
Students at this university engaged in physical activity at about the same rate as nationally, except they participated in moderate activities at a higher rate than the national sample. As we alluded to above, this is probably due to the nature of the campus, which covers a fairly wide geographical area and thus students often walk between classes. Since this campus feature may inadvertently cause students to exercise more, one wonders what other campus features could be enhanced or barriers reduced to promote physical activity. We have several recommendations based on our data. In terms of campus design, more bicycle lanes need to be provided, and stop signs should be placed at crosswalks. Stop signs would force drivers to stop and at the same time would encourage people to ride bikes and walk because they would feel safer in doing so. Main thoroughfares going through the middle of campus should be dosed and traffic re-routed around the outskirts of campus to provide a safer walking and biking environment. Social-ecological theory related to physical activity and urban planning has identified two types of human environments: car-oriented and pedestrian-oriented (King, Stokols, Talen, Brassington, & Killingsworth, 2002). Car-oriented environments are designed to facilitate the movement of cars while pedestrian-oriented environments are structured to support the movement of people. From this perspective, the campus in the current study would be considered to be a car-oriented environment because it is most supportive of movement of cars rather than people. This orientation should be changed if the desire is to facilitate rather than constrain physical activity.
Adequate recreational facilities are necessary to promote physical activity. At the time this study was conducted, facilities were inadequate to meet the needs of the student population. Since that time, a new 87,000 square foot facility has been built. The authors are in the process of evaluating how this facility impacts physical activity levels on campus. Nonetheless, the recommendation for adequate recreational facilities is relevant for most college campuses.
Relative to curriculum, although many institutions no longer have a general university requirement for physical education classes, this issue should be revisited if administrators wish to demonstrate a commitment to promoting healthy lifestyles for students.
Much more could be done on campus to promote student engagement in physical activity. A coordinated effort is needed among campus recreation, student affairs, student health, and academic units to implement individual, environmental, and institutional factors that promote physical activity and to eliminate barriers to physical activity.
This study just "skims the surface" in its use of the ecological perspective. It has been suggested that health promotion researchers begin to "fashion a transdisciplinary perspective that encompasses thought and expertise from all levels of analysis" (King et al., 2002, p. 11). Stokols (1996) observed that in health promotion programming we tend to focus on individual-level interventions and ignore the environmental factors that exert profound influences on individuals' behavior. This study was an attempt to bridge the divide between an individual-level and environmental-level focus. While the current study makes a contribution to understanding the physical activity levels of a specific cohort of college students, perhaps more importantly it demonstrates an approach that can be extrapolated to a broader population. The ecological perspective can be applied to analyses of many health behaviors among communities. To impact physical activity at the population level, it is critical to take a broader view of the many factors influencing it. The ecological perspective provides a framework by which to identify multiple areas for potential intervention, the ultimate outcome being communities that encourage and support healthy choices among their residents.
Responsibility I--Assessing Individual and Community Needs For Health Education
Competency B--Distinguish between behaviors that foster and those that hinder well-being.
Sub-Competencies: 1) Investigate physical, social, emotional and intellectual factors influencing health behaviors.
2) Identify behaviors that tend to promote or compromise health.
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This project was supported by The University of Kentucky Health Service and The Prevention Research Center at the University of Kentucky.
Ruth R. Staten, PhD, ARNP and Mary Kay Rayens, PhD are affiliated with the College of Nursing at the University of Kentucky. Kim Miller, PhD, CHES and Melody Powers Noland, PhD, CHES are affiliated with the Department of Kinesiology and Health Promotion in the College of Education at the University of Kentucky. Address all correspondence to Dr. Kim Miller, KHP Department, 217 Seaton Building, University of Kentucky, Lexington, KY 40506-0219; PHONE: 859-257-4091; FAX: 859-323-1090; E-MAIL: email@example.com.
Table 1. Demographic Characteristics of the Sample (N=531) and University Population Variable Sample % University % Gender (Female) 63% 52% Age (<21) 53% 74% Race Caucasian 88% 82% African-American 3% 5% Asian 4% 2% Hispanic 2% 1% Other 3% 10% Living where On-campus 31% 31% Off-campus 54% 69% Parents/other housing 15% NA * Student status (Full-time) 91% 82% Class standing Lower division (Fr & Soph) 46% 48% Upper division (Jrs & Seniors) 41% 50% Uncertain 13% 2% Marital status Never married 94% NA * Married 5% NA * Separated/divorced 1% NA * Intercollegiate athletics (Yes) 5% NA * Fraternity/Sorority (Yes) 16% 15% * These data were not available from the institution at the time of this paper Table 2. Physical Activity Participation Rates for Sample vs. NCHRBS (1997) Level or Type of Physical Activity Sample NCHRBS Level Vigorous 39% 42% Moderate 41% 20% Type Stretching 39% 36% Strength 35% 33% Table 3. Summary of Results of Environmental and Institutional Analysis Environmental Factors (Wilkenson et al, 2002) * Campus designed for motor traffic rather than pedestrian traffic * Limited access for bicycles * Limited availability of goods within walking distance * Minimal crosswalks and traffic signals to assist pedestrians and bicyclists with crossing the street * Drivers often do not yield to pedestrians and bicyclists * Minimal benches and other places for people to sit and rest Institutional Factors * Insufficient recreational facilities * Minimal health education services * No general university academic requirement for physical activity * Lack of coordinated effort to encourage physical activity
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|Author:||Rayens, Mary Kay|
|Publication:||American Journal of Health Studies|
|Date:||Jan 1, 2005|
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