Healthy Ball State Now
\
An Honors Thesis (HONRS 499)
by
Christine Furtner
Thesis Advisor
BemYork
Signed
Ball State University
Muncie, Indiana
July 2013
Expected Date of Graduation
May 2013
L
Abstract
The goal of this thesis is to analyze existing data in order to determine the most important community
health needs of the undergraduate university student. Through secondary research into university life, a
picture of the needs of the college population was achieved. The areas of need were then categorized into
broader, more generalized categories, which were ranked based on the immediacy, preventability, threat,
and ability to intervene for each category.
RUNNING HEAD : HEALTHY BALL STATE NOW Healthy Ball State Now: An Honors Thesis April 30, 2013 Christine Furtner Ball State University 2
HEALTHY BALL STATE NOW
Introduction
Community health, or public health, is a poorly understood concept in the general
population. Simply put, public health is the process of preventing disease from occurring,
prolonging life, and promoting health. This promotion can occur through an ordered effort
performed by the entire population in the context of a community, or by a government's or
private company's efforts. Community health encompasses everything from smoking laws to
education reform, and from an exercise campaign to mental health promotion (Nies and
McEwan, 2011).
Generally, when people think of community health, they think of it in the context of a
country, a state, or a city. People do not think of the university setting as an arena of community
health that needs addressing, but it is. The community health needs of young adults in the
United States are crucially important, and the college environment provides a great medium for
communicating and achieving many public health goals in this population. Further, by
intervening in the population of college students, individuals can be set up for healthy lifestyles
during the course of their lives, thereby reducing the need for community health interventions in
the future.
Ball State University is one such college community in which public health interventions
can be realized. With the help of the officials, professors, and campus leaders at Ball State
University, undergraduate students can begin to lead healthier lifestyles and improve their well­
being. This task cannot begin to be realized until more research is completed into the public
health needs of university students as a whole. From there, a picture of where the community is
in terms of needs of the collegian can be determined, and a trajectory determined .
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The goal of this thesis is to analyze existing data in order to determine the most important
community health needs of the undergraduate university student. Through secondary research
into university life, a picture of the needs of the college population was achieved. The areas of
need were then categorized into broader, more generalized categories, which were ranked based
on the immediacy, preventability, threat, and ability to intervene for each category.
Demographics ofBall State University
In order to research the public health needs of the undergraduate students, one first needs
to examine the make-up of the population. There are 16, 652 total undergraduate students at Ball
State University. Approximately 57% of that population is female (N=9494) and the remaining
43% is male (N=7158). Almost 90% are Indiana residents (89.7%; N=14935) (Office of
Director of Systems Technology, "Enrollment by Gender and Residency", 2012). The age of the
population is divided into three cohorts. 33.8% of the population is between the ages of 17 and
19 (N=5637), 60.8% of the popUlation is between ages 20 and 25 (N=10126), and 5.2% is over
age 25 (N=866). The remaining 23 students are of unknown age (Office of Director of Systems
Technology, "Enrollment by Age", 2012).
Ball State University has identified several ethnic and race groups in the student
population. The vast majority of students are Caucasian (N=13936), but the remaining 11.9% of
the population identify with a minority group. 1,061 (6.4%) are African-American, 142 (0.8%)
are Asian American, 487 (2.9%) are Hispanic, 22 (0.1%) are Native American, and 15 (0.1%)
are Pacific Islander. A further 260 (1.5%) undergraduates identify as belonging to more than one
group. Ball State also has a very active international student population, and 374 (2.2%) students
are nonresident aliens. 355 (2.1%) students are listed as unknown (Office of Director of Systems
Technology, "Enrollment by Race" 2012)
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Rationale ofthe Prioritization of Objectives
Four major public health objectives have been isolated in research for university students.
They are further broken down into relevant subcategories that are specifically important for
college students. The priorities are mental health, injury and violence, communicable diseases,
and healthy bodies.
The top priority is mental health. Mental health was selected as the highest priority,
because the stressors of college can cause significant impairment in the functioning of students.
Further, problems in this category can lead to problems in the other areas. For example,
depression can lead to inactivity, and substance use can lead to injury. The subtopics covered in
this section are stress, depression and suicide, eating disorders, and substance abuse.
The second priority is given to the objective of injury and violence prevention. It is given
a high priority listing because injury is often caused by a particular individual, so the problem
can be treated directly at the source. Further, education and resources make the injury very
avoidable. The subtopics covered under injury and violence prevention are drunken driving,
intimate partner violence, and sexual assault.
The third priority addressed is communicable diseases. The problem of communicable
diseases is very significant on a college campus, where there are many individuals residing and
spending time in close quarters. It is given a lower priority because it is difficult for many
diseases to be stopped because of the herd effect. Subtopics covered include commonly spread
diseases and sexually transmitted diseases.
The final priority is healthy bodies. It is listed in the top four priorities as a healthy body
is important for maintaining a full life. It is listed as the lowest of the four because most
universities have spent significant resources on this issue already, and it would be even more
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HEALTHY BALL STATE NOW
costly to effectively control the health of individuals. Subtopics included in this section are
nutrition, inactivity, smoking, and alcohol use.
Objective 1: Mental Health
The collegiate years serve as a starting point for many mental health concerns. Anx.iety
can severely increase in college students as they adjust to university life. When a student has
inadequate social, personal, and academic support, they may fail to cope with the new
challenges. This inability to cope with change may act as a catalyst, thus spurring on mental
health concerns (Brandy, 2011).
In recent years, there has been a surge in research investigating mental health in young
adulthood, particularly among college age students. This is due to an increase in students
desiring access to mental health services. In the past twenty years, reported rates of depression
have doubled and suicidal students have tripled (Bullis and Zimmerman, n.d.).
A study also
found that 90% of counseling centers on university campuses have noticed an increase in both
number and severity of students seeking mental health services (Franklin, 2009). Further, studies
have shown that as many as 12-18% of college students have a diagnosable mental illness (Lee
et.al, 2009).
Stress
Stress is a universal human experience, but it is felt particularly by young college
students. As stated earlier, many factors contribute to the stress of college, including a new level
of self-sufficiency, difficult classes, financial insecurities, added responsibilities, and being away
from home. Non-traditional college students also have stressors of adding to current levels of
responsibility and managing their family during schooling (BSU Counseling Center, 2013).
HEALTHY BALL STATE NOW
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Stress in college students is on the rise. According to a recent study done by the Higher
Education Research Institute (HERJ), the percentage of freshmen who perceived high levels of
stress is at an all time high. The study also found that women reported feeling overwhelmed
significantly more frequently than men did, with a ratio of more than 2 :1 (pryor et.al, 2012) .
AJthough stress is at an all time high, stress tolerance is at an all time low. Bland and colleagues
(2012) found that several stress-management strategies that millennial college students employ
are avoidance of tasks, such as use of social media, eating, shopping, using substances, and
tidying up. Though students use these techniques to decrease stress, the study shows that these
mechanisms lower one's ability to tolerate stress (Bland et.al, 2012).
Stress at the university level is associated with poor outcomes in many areas. Stress can
have a significant effect on health. An inability to cope with stress over time can lead to anxiety,
depression, anorexia, and other mental disorders. If specific body systems are not able to
maintain the stress response over a prolonged period of stress, one might have negative outcomes
in terms of physical health. The body will become more prone to infections, experience insulin
resistance and subsequent diabetes, or may develop hypertension, asthma, or blood clots
(Varcolis and Halter, 2010).
Perhaps one of the best-perceived signs of stress is sleep disturbances. According to the
American College Health Association (ACHA), only 4% of all college students reported waking
up feeling very rested every day of the week, and most (58.4%) of students report feeling well­
rested less than half of the days in the week. 42.1% of students also reported that daytime
sleepiness was a medium, big, or very big problem for them (ACHA, 2011) .
Depression and Suicide
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The most visible mental health concern among the population of college students is
depression. Major Depressive Disorder is characterized by clinically significant distress and
impairment of important areas of functioning such as social and occupational functioning
(Varcolis and Halter, 2010). According to the ACHA (2011), 18.2% ofal! college students have
been diagnosed with depression. As it is such a predominant mental health concern, universities
tend to focus most of their mental health resources on it. In 2011,54.2% of college students
reported receiving information on depression and/or anxiety from their university (ACHA,
2011). Ball State also has invested a lot of time and money in addressing the needs of depressed
students. It is easy to access information, resources, and techniques for working through
depression and depressive episodes.
Even though depression is the focal point of mental health concerns on campuses across
the nation, the problem is still under-addressed. Though about 20% of students on university
campuses have been diagnosed with depression by a licensed professional, 31. 8% of students
self-reported that in the past year they were so depressed that "it was difficult to function"
(ACHA, 2011). This discrepancy indicates that 13.6% of students may have undiagnosed or
untreated depression . Furthermore, 3.1 % of students report taking prescription antidepressant
medications that were not prescribed to them (ACHA, 2011). People who self treat do not have
medical supervision and are not receiving counseling from professionals who can identify
suicidality or potential for violence that may be side effects of these medications.
The ACHA (2011) has also found that 18.9% of college students have seriously
considered suicide at some point, indicating that at least 3% of all suicidal students have never
been diagnosed with MDD. Another 6.7% of students have attempted suicide at some point in
their lives. These statistics on MDD and suicidal tendencies are reflected by a lack of knowledge
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and a desire for more information by university students. 48 .5% of students report a desire to
receive more information on depression, and 35.3% would like more information on suicide
prevention.
Eating Disorders
According to Erikson's theory of development, individuals participating in the traditional
college begin experiencing an internal conflict of intimacy versus isolation, which means that
their primary concern is investing in relationships, and in particular finding a romantic partner.
Though this conflict can cause many concerns for the health of college individuals, one that is
most visible is eating disorders. The leading theory of eating disorders is biological in nature
and proposes that inside of a sex there is competition for attractiveness that will lead individuals
of the sex to eat more or less in order to optimize their appeal (Abed et.al. 2011). Furthermore,
social pressures to maintain fitness in certain groups such as athletes and sorority women, a high
level of stress and anxiety, and ready availability offood pose further risks for disordered eating
in college students. Thus the rate of college students with an eating disorder many be as high as
5.3% (ACHA, 2011)
Though the incidence of eating disorders is low at only two to four percent of the general
population, it has recently become a priority in adolescent mental health (Miller, 2006).
However, this trend is not reflected at the university level, even though men and women entering
college are at the age of highest risk for developing an eating disorder. The ACHA (2011) found
that 38% of students reported receiving materials about preventing and identifying signs of
eating disorders (ACHA, 2011). Further, as many as 35-45% of women report that they believe
that they are "fat" and/or would like to lose weight, and that number is on the rise, constituting a
significant and increasing risk to the university student (Miller, 2006).
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Like in many mental health concerns, the primary individuals who can affect those with
eating disorders are those that surround them. Hoffman et.a!. (2011) found that though the
majority of students feel that they can help friends with eating disorders, a large portion lacked
the confidence to approach their friends about the issue.
Substance Abuse
Drug use is a significant problem on college campuses, as it is in the general population.
Many experts tie drug use to a mental health deficiency, and the American Psychiatric
Association is currently classifying it as a mental disorder. And as is true for many other mental
disorders, the highest risk populations are young adults. The largest population of drug users in
the United States are those between ages 18 and 20. 23 .8% of people this age report use of illicit
drugs in the past month (NIDA, 2012). Though the rate of illicit drug use has stagnated in recent
years, the rate of prescription drug abuse has increased. As many as 15.5% of people between
the ages of 15 and 25 report that they abused or misused pharmaceuticals in the past month
(National Survey on Drug Use and Health, 2013).
Fortunately, the college environment can act as a protective buffer for drug abuse, as
many young adults who are high risk populations do not attend college. However, drug abuse is
still a significant problem on college campuses. In terms of illicit drug abuse, 35 .7% of students
report having used marijuana at some point, 5% have used cocaine, 5.6% have used
hallucinogens, and another 5.6% have used ecstasy. In tenns of pharmaceutical abuse, in the
past 12 months, 7.9% of students reported using prescription pain killers not prescribed to them,
4.2% reported using sedatives not prescribed to them, and 8.5% reported using stimulants not
prescribed to them (ACHA, 2011).
Objective 2: Injury and Violence Prevention
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Injury prevention has become a major issue on college campuses. Though most injuries
are unavoidable, many students fail to take basic precautions for their safety. The ACHA (2011)
found that 22.6% of students fail to always wear seatbelts in a car. Further, only 20% of students
always wear a helmet when riding a bicycle. The survey also found that 61. 9% of students did
not receive any information on injury prevention from their college (ACHA, 2011 .
On college campuses across the United States, violence is on the rise. In the period from
2000 through 2004, the number of crimes perpetrated by college-age students increased by 77%
(Noonan and Vavra, 2007). In the past year, 7.1% of students report getting into a fight and
4.4% report being assaulted (ACHA, 2011). Further, the severity of violence on college
campuses has been increasing drastically. Two-thirds of all the campus attacks that occurred in
the past 113 years, such as the Virginia Tech massacre, happened after the year 1990 (Drysdale
et.al, 2010).
Drunk Driving
Crimes are just one of the many ways that injury and violence constitute a significant
problem on college campuses. Driving under the influence of alcohol or other substances
remains a significant problem. In 2010, the rate of fatalities for impaired driving was highest in
the 21-24 year old age range, which is college-aged (NHTSA, 2012). However, 3.36 million
college students over seven years self-report driving while intoxicated, which averages to
480,000 students annually (College Drinking, 2013)
Fortunately, the overall rate of impaired driving is on the decline. In 2002, 14.2% of the
popUlation aged 12 or over self reported driving while impaired in the past year, compared to
11.4% in 2010 (SAMHSA, 2011). The problem is not eradicated from college campuses,
HEALTHY BALL STATE NOW
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however. According to the ACHA (2011),13.7% of college students admit that in the past 30
days they drove after consuming alcohol.
Intimate Partner Violence
Intimate partner violence (IPV) is any type of violence (physical, sexual, or emotional)
perpetrated by an individual who has a physically or emotionally intimate relationship with
another person. IPV is a problem because it is one of the most prevalent and often least visible
forms of violence in the United States. Predicting the incidence ofIPV is very difficult, because
reporting is dependent upon the victim of the violence. Experts estimate that just more than one
third of all women (35.6%) are victims of IPV in the form of rape, physical violence, or stalking
at some point during their life, and more than a quarter of all men (28.5%) have been a victim in
the same forms during their life. It is also estimated that 1 in 10 women will be raped by a
partner at sometime in their life. (Black et.al, 2011).
College students are at high risk for experiencing or perpetrating IPV because IPV is
more commonly perpetrated in dating relationships. Further, the college environment makes it
easy for people to obtain personal information about intended victims of stalking (Melander,
2010). Just under half (47.1 %) of all female victims ofIPV will first experience IPV between
the ages of 18 and 24, and 38.6% of male victims will first experience IPV during those years
(Black et.al, 2011). The overall rate ofIPV during the college years is also difficult to predict
because ofunderreporting. It is estimated that as many as 47% of all college students will
experience IPV (Melander, 2010).
IPV can have a lasting impact on all victims. 72.2% of all female victims ofIPV have a
lasting fearfulness, 62 .3% report being concerned for their safety, and 62.6% acquire post­
traumatic stress disorder symptoms. Further, a history of IPV leaves a victim at higher risk for
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many physiological complaints, such as sleep disturbances, asthma, irritable bowel syndrome, frequent headaches, chronic pain, and activity limitations (Black et.aJ, 2011) Sexual Assault To a lesser degree sexual assault is a problem on college campuses. Though most cases
of unwanted touching and rape are performed in the context of a relationship, there are
approximately 208,000 cases of sexual assault by non-partners annuaJly (RAINN, n.d.). Five
percent of adults of both sexes report being victims of non-rape assaults during their adult life.
13% of women and 6% of men report experiencing unwanted sexual coercion at some point as
well (CDC, " Sexual Violence", 2012)
On college campuses, the rate of sexual assault is higher than in the rest of the adult
population. This disparity is related to the fact that drugs and alcohol playa major role in many
assault situations, and alcohol is readily available on col\ege campuses. Nearly one in five
(19%) of all college females report being victims of sexual assault or harassment during their
college career (CDC, 2012). Further, 6.5% of all college students report being victims of sexual
assault in the past year (ACHA, 2011)
Objective 3: Communicable Diseases
Communicable disease is any disease that is spreadable and transmissible from person to
person by direct or indirect contact. The diseases are easily spread due to the nature of the
college campus. Closed quarters in dOllnitories, a large population in the dining halls, and
clustered classrooms make contact with infections unavoidable. Unhealthy selections in
cafeterias, a decrease in access to drinking water supply, and pressure to stay up late all lead to a
decreased immune system (Boston Children's Hospital, 2013). Sexually transmitted diseases are
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also very common in the college population due to a lack of education and several other factors
in the college population (Gore, 2012)
Common Diseases
Many diseases such as the cold, influenza, and mononucleosis abound on college
campuses. Because of the environment created on college campuses, the rate of infections in the
college environment is higher than that of the general population of the same age range.
11.4%
of students were treated for strep throat in the past year, 18.5% were treated for a sinus infection,
2.2% were treated for mononucleosis, 6.7% were treated for bronchitis, and 7.5 were treated for
an ear infection (ACHA, 2011).
Though closed quarters and poor immune support play the most significant roles in the
prevention of communicable diseases, there are other factors that affect the infection rates in
college campuses. The first is education. According to the ACHA (2011), 40% of college
students say they have not received materials on preventing the cold, flu, or sore throat. Another
42% of college students would like to receive information from the university about preventing
those diseases. Another important factor is vaccinations. Over half (52.8%) of students have
never received a vaccination for the flu (ACHA, 2011).
Pandemics can be a significant problem on college campuses. In 2009 during the H1N1
pandemic, the majority of infections in the United States occurred on college campuses. The
number of infected college students doubled within the week of August 29th through September
4th, which was one of the weeks that fall classes started at many college campuses. The infection
peaked with a maximum attack rate of29 per 10,000 weekly (ACHA, 2010). Most universities
have protocols to be followed in the event of future pandemics or heavy infection seasons.
Sexually Transmitted Infections
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Diseases that are spread through sexual intercourse or sexual contact are very prevalent
on college campuses across the United States. Approximately 25% of all university students
have been diagnosed with a sexually transmitted disease (SID) (Gore, 2012). Further, almost
halfofthe 19 million new cases ofSTDs in the United States annually occur in the 15- through
24-year-old age range (Cordova et.al, 2011)
Part of the disease rates can be attributed to physiological factors, such as cervical ectopy
(Cordova et.al, 2011); however, the rates can also be attributed to education. A lack of
understanding in the transmission of STDs, a belief that no symptoms means that one is cured, a
bel ief that birth control pi lis do not prevent infection, and failure to use appropriate barrier
protection during all sexual encounters are all prevalent problems on college campuses (Gore,
2012). 40.6% of students have not received education from their col\ege or university on SID
prevention, and another 40.7% would like such material from the university (ACHA, 2011).
A special area of consideration in terms of STDs is the gay, lesbian, bisexual, and
transgender (GLBT) community. Men who have sex with men (MSM) and women who have
sex with women (WSW) have separate risk factors and disease incidence rates than those in the
heterosexual population. In MSM populations, a higher number of sexual partners and a lack of
barrier use has attributed to higher lifetime risk for STDs. In recent years, the number of men in
the MSM category who' also have relations with females is increasing, which has led to an
increase in the incidence of SIDs in both the MSM and heterosexual communities (Cordova
et.al, 2011). Contrary to common belief, those in the WSW population are at risk for acquiring
STDs through exchange of cervicovaginal fluid and direct mucosal contact. This susceptibility
can cause risk due to more sexual partners and asymptomy even when the disease is active.
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HEALTHY BALL STATE NOW
Common diseases for WSW include bacterial vaginosis, trichomoniasis, genital herpes,
papilloma virus, and
mv (Marrazzo et.al, 2005).
Objective 4: Healthy bodies
The dreaded freshman 15 is one of the many issues that plague students entering college,
but diet is not the only problem that threatens the physical health of college students. Improper
diet, lack of exercise, smokjng, and binge drinking constitute important problems for the
university to address. Failure to reverse any of these behaviors can cause significant health
problems later on in life. Heart disease is linked with obesity and smoking. Lung disease is
linked to smoking and inactivity. Liver and other metabolic disorders are linked to drinking and
obesity (Sommers et.al, 2012). By addressing the individual risk factors, a person can effectively
decrease his or her risk for problems down the road.
Diet and Nutrition
Across the board, Americans have problems with maintaining a healthy diet. As the
calorie counts and amount of processing foods go through increases, so do American's waist
measurements. In 2010, 35.7% of the adults in the United States were obese. The college age
population was not too far behind with an obesity rate of32.6% (Ogden et.al, 2012). It is a1so
not hard to believe that almost 40% (39.2%) of all college students are dieting to lose weight
(ACHA, 2011)
Proper nutrition is critically important in college students, because it is the time that
young adults will develop eating habits that will stick with them for the rest of their lives. Many
students choose to eat in the cafeterias or in social situations, and the types of food that are easily
available in these situations are generally too high in fats or carbohydrates and are significantly
lacking in micronutrients, or vitamins and minerals. When it comes to failure to choose healthy
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options, many students also cite lack of time for healthy meals, inability to pay for healthy
options, a dislike for healthy foods, and no desire to change their habits (Troncoso et. al, 2011).
A lack of education can also be attributed to the problem. Researchers have found that
college students look at the nutrition information of a product when they are doing so for health
reasons, to lose weight, but they fail to read them in order to calculate a balanced diet and when
they do not know how (Raspberry et.al, 2007). 41.2% of students also report that they have not
received material on how to eat healthily from their university, and that 60.9% are still interested
in material on eating well (ACHA, 2011).
Exercise
Exercise is very important for the human body. The Department of Health and Human
Services recommends getting at least 2.5 hours of moderate aerobic activity, or five 30 minute
sessions, weekly, in addition to two sessions of weight trainjng weekly (CDC, 2011). Most
Americans fall very short of this goal, and college students are no exception. With heavy class
loads, extracurricular activities, and social engagements, many students feel that they have no
time or energy left for exercise (Ebben and Brudzynski, 2008). Further, as time in college goes
on, students work out less, perhaps due to burnout with exercise routines, more commitments to
things other than their workout routine, or an increase in overall course difficulty or demand.
Sturues have shown that students with higher class standing and increased age work out less than
their younger, freshman counterparts (Mazerat et. al, 2011)
Studies have shown over and over that there are multiple benefits to exercise. Regular
physical activity not only helps maintain weight and reduce risk of disease, but it also can elevate
mood, increase energy by boosting metabolism, and improve focus (Mayo Clinic, n.d .). It can
also decrease stress levels, reverse some of the effects of depression, and increase body image.
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Finally, by creating new connections between a person's brain cells, exercise can improve
learning in college students (Kotz and Haupt, n.d.).
Even with all of the benefits of exercise, the number one reason that college students do
not work out is a lack of motivation; they do not want to work out. Part of the reason that
students do not want to work out may be related to the technological age that students live in.
With all the data and entertainment available at their fingertips, it is no surprise that college
students lack motivation to leave their laptops and hit the gym. Studies have shown that
spending more time on the computer is positively correlated with decreased activity levels
(Fotheringham et.al, 2000).
Smoking and Alcohol Use
Though eating right and working out are critically important for college students,
smoking cessation and alcohol moderation are also important topics when it comes to student
health. Smoking is a risk factor for heart disease, lung disease, and many types of cancers
(Sommers et.al, 2012). Even though smoking is known to cause such problems, smoking is still
a very prevalent issue on college campuses, with more than 20% of people between the ages of
18 and 24 being smokers (CDC, "Adult Cigarette Smoking", 2012).
Social smoking is a recent phenomenon in which a person primarily smokes in certain
situations and with certain people. They do not smoke due to a physiologic need for nicotine,
but rather to pass time with enjoyable company. Approximately two thirds of all college student
smokers are social smokers. These individuals typically do not label themselves as smokers, but
the health consequences are still the same for them as with a non-social smoker. Further, though
non-social smokers understand their risks and often express a desire to quit, the social smokers
do not understand their risks and do not feel that they need to quit (Waters et.al, 2006).
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HEALTIN BALL STATE NOW
After tobacco, alcohol is the most commonly abused drug on college campuses. 14.7% of
students reported using alcohol 10 or more of the past 30 days, and 4.7% reported drinking more
than 10 drinks the last time they socialized (ACHA, 2011 . Further, 31 % of all college students
meet the criteria for alcohol abuse, and another 6% meet the criteria for alcohol dependence
(College Drinking, 2013) .
Significance for the University
Though most college students are well adjusted and do not experience more than one or
two of the problems individually, they still pose a significant predicament to the university as a
whole. High costs can be incurred by the university due to these public health concerns.
Further, the costs to intervene once problems occur are significantly higher than that of the cost
to prevent them from occurring in the first place. Studies have shown that poor adjustment to
college life resulting in these problems can cause poor academic performance, decreased student
retention, and lack of safety on campus.
Academic Performance
It should come as no surprise that student health concerns can have a significant impact
on grades. Stress and anxiety caused significant disruption to college students, with nearly 30%
saying that stress affected their performance and over 20% of students saying anxiety affected
their performance in one or more classes. 21 .2% said that sleep disturbances had an impact on
their academic performance. 18% said that common infections, such as the cold, influenza, and
sore throats affected their grades. Almost 5% of all college students say that drinking aJcohol
had an impact on their course performance (ACHA, 2011).
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Another 12.4% cited depression as a source of academic problems (ACHA, 2011).
Depression is associated with a GPA lower than the university average. The severity of
depressive symptoms is positively correlated to decreased grades (Deroma, 2009) .
Grades represent a significant point in terms of costs for the university. A student who
fails a course due to a community health concern may be forced to take an extra semester before
graduating, especially in rigidly structured programs. Taking an extra semester before
graduation incurs significant costs for taxpayers and institutions for these students to complete
their requirements (ICHE, 2012) . Ball State' s four year graduation rate is only at 44%, meaning
that over half of the students at Ball State fail to complete their degree within four years (BSU
OlE, 2012).
Further, there is a significant cost to the student. In the past 10 years tuition rates have
doubled, and inflation for tuition and fees have increased 100 times more than the rate of growth
for household income. The average student in Indiana has to borrow $27,000 to fund a degree,
or an average of $6,750 annually (ICHE, 2012)
Retention Rates
The rate of college students dropping out can be attributed to a number of things, but the
concerns outlined here are among the most important and most preventable reasons. The
primary reason for "dropping out" of school is a lack of self-efficacy, which is a measurement of
how a person views his or her own ability to complete tasks and accomplish goals. Low self­
efficacy is positively correlated with leaving the university setting. Self efficacy is determined
by a number of factors, including social support, difficulty of task or goal, and success of others.
If a task is difficult, a student does not have the support of friends or family, and others around
HEALTHY BALL STATE NOW
20
them fail or are too successful, they experience high levels of stress. This stress can become too
overwhelming, leading students to drop out (DeWitz et.al, 2009).
Self-efficacy is not the only reason students choose to leave the university. Depression
can cause feelings of avolition, or a lack of desire to do anything, and therefore have less feelings
of commitment to academic obligations. Students who experience these symptoms are 3.7 times
more likely to drop out of college than those that do not (Mud ric, 2012). The number one drug
that predicts high risk for dropping out is alcohol use (Wickline, 2012). Intimate partner
violence can also predict college drop outs when the perpetrator was an acquaintance or attended
the same college (UoL, n.d.)
Though grades constitute a significant problem for the university, retention rates are even
more significant. When a student drops out, the first thing that the university losses annually is
the tuition and fees that student would have spent at that university. This cost at Ball State totals
to more than $9,000 per student per every year that they would have spent at Ball State (BSU
Bursar, 2012) With 20% of all students leaving the university within the flfSt year, and then
another 10% of the original number leaving within their second, this cost adds up quickly for the
university (BSU OlE, 2012).
It also costs the government a significant amount in taxes. Indiana loses approximately
16.6 million dollars every year in federal and state taxes due to college student drop outs
(Schneider and Yin, 2011). This loss costs the university funding, and it costs the taxpayers
whose income went to benefitting these students.
Student Safety
Safety is a very important concern for college students and the university . For some of
these areas, the threats are very clear. Violence can cause injury to students, suicide attempts can
21
HEALTHY BALL STATE NOW
result in death, and intoxicated people can threaten others. However, some of these threats are
less clear. Stressed students are more likely to feel unsafe on campus. Improper eating habits can
result in physiological problems that can place students in danger of heart disease and diabetes
(Sommers et. ai, 2012).
Students generally report feeling very safe on campus during the daytime. At night,
however, only 37.7% of students report that they feel very safe. The areas immediately
surrounding campus pose a perceived threat to student safety as well. Only 58% of all college
students report feeling very safe in the areas surrounding campus during the daytime, and that
number drops to 21.9% at nighttime (ACHA, 2011). A lack of safety in the areas surrounding
campus is significant because many students live in these areas.
Important Interventions
Counseling services have been shown to significantly impact the college experience,
especially in the first year of college. During the first year, students have the most adjusting to
accomplish as they acclimate to the independence, distance from home, and acclimating to the
college environment. The freshman population has the highest ratio of students who have
feelings of worthlessness, loneliness, sleep and appetite disturbances, and suicidal thoughts
compared to any other class. Identification of high risk students and intervention through regular
counseling is essential to preventing anxiety and depression in this population. Further, students
in the high risk population who attended counseling demonstrated increase in their GPA and
fewer students in the group left the university (Lee et.al, 2009).
Education is also a crucial intervention needed at Ball State. As demonstrated
previously, students do not feel that they have adequate education on most of the topics covered
in the objectives. Education is considered the key to preventing problems. If students are
HEALTHY BALL STATE NOW
22
properly taught how to identify problems in themselves and in others, students will feel more
empowered to make a change. Passive programming through bulletin boards and table tents may
prove to be effective tools, as well as having speakers in dormitories and classrooms.
Interventions to improve the health status of students are also vital to the well-being of
students. Offering healthier meal options, calorie counts, and increasing the prices on junk food
can improve the dietary habits of students who eat in the cafeterias. Creating events that promote
exercise or encouraging students to audit a physical education course can increase the activity
level of college students. Smoking cessation accountability groups can help those who want to
quit, and creating a smoke-free campus that has clear consequences for violators can motivate
smokers to quit and clear the air for non-smokers.
Conclusion
Community health is considered to be both a science and an art. It is a science because it
requires an extensive knowledge base of the community, its needs, and what to do . With the
objectives presented, one can gather the necessary information needed to create and impact a
change in the health status of the undergraduate collegian. By examining the data that is
available, further interventions and outcomes can be selected by those with the ability to
intervene to promote the health and well-being of undergraduate students in the population.
The art portion is a consideration of the skills, dedication, and passion that those who
wish to achieve an objective place in the project. However, it cannot be done by one person.
Community health is always achieved through an "organized, community, effort" (Nies and
McEwan, 2011). It needs to be completed by partnering with students, faculty, and university
officials. By addressing these issues with the knowledge provided here, and through
collaboration across the university, public health at Ball State University can be achieved.
23
HEALTHY BALL STATE NOW
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