The Present of Wellness
Bob Mosier
PROFESSIONALLY SPEAKING
Hettler's NOTE:
Bob Mosier's article was the ACUHO "Article of the Year" for the Talking Stick Publication in
1994
Health
and Wellness Trends
As students enter our colleges and universities, they bring an optimism
for change, experimentation, and learning about themselves, their immediate
environment, and the larger human community.
These attributes provide students with both opportunities for enhancing
positive wellness lifestyle choices, as well as engaging in negative risk-taking
behaviors. The university setting
with its rich human and programmatic resources offers a unique opportunity for
students to make wellness decisions in a number of critical areas affecting
their lives. As students move
through a series of life transitions in a new university culture, they will
develop life-long patterns that will facilitate or hinder their personal
wellness.
Wellness can be defined, as an integrated approach to making healthy
choices that will maximize the potential of the individual.
Wellness developed under the catalytic innovation of individuals such as
Dunn (1961), Travis (1981), Ardell (1977), and Hettler (1980).
These leaders have conceptualized the wellness ideas that many campuses
presently utilize. In particular, Hettler (1980) has developed a six dimensional
model that is widely followed. It
consists of behavioral definitions for the following dimensions:
social, physical, spiritual, intellectual, emotional, and
career/occupational. Some programs
have modified Hettler’s model to include other dimensions, such as
environmental.
In addition, other factors have contributed to the rise of the wellness
movement: reports such as the
LaLonde report on Canadian health (1974), Healthy People (1979), and Ten
Leading Causes of Death in the United States (1975); the cost crisis in
health care costs; movements, such as holistic health, medical self-care, and
physical fitness; research, such as the Framingham studies and the Surgeon
General’s Report on Smoking and Health; responses by business and industry to
promote healthy employees; and professional organizations and associations, such
as YMCA’s/YWCA’s and the Society for Prospective Medicine.
College students face a number of challenges and opportunities as they
attempt to sort through their life choices.
Several major studies have examined the major challenges facing college
students with respect to the physical and mental health. Guyton, et al., (1989)
presented a summary of some of the major challenges and health risks facing
college students. The primary risks
to students’ health were seen as representing five major areas.
The greatest risk was seen to be in the area of sexual health concerns.
Sexually transmitted diseases and unwanted pregnancy are major risks in
this area.
“Although social acceptability of sexual intimacy is increasing,
students becoming sexually active face complex issues such as low
self-esteem, peer pressure, underdeveloped communication skills,
superficial relationships, and loneliness.”
(Guyton, et al., 1989,
pp 9-10)
The second greatest risk to students’ health was identified as
substance abuse, including abuse of alcohol, drugs, tobacco, and food.
The risk was seen as much greater when combined with peer pressure to
abuse substances, academic pressure to achieve, risk taking, and a lack of
health stress management skills.
The third greatest risk to students’ health was perceived to be mental
health concerns, such as fear of failure, low self-esteem, lack of social
support, and superficial relationships. Contributing
to these risks were underdeveloped skills in coping and communicating, serious
emotional concerns, and family problems.
The fourth area of risk involved unhealthy relationships to food,
manifested in eating disorders such as anorexia, bulimia, and obesity.
These seemed to be linked to low self-esteem, depression, lack of
relationship skills, intense fear of failure, and overwhelming pressure to
achieve.
The fifth area of risk involved violence, accidents
and injuries, as well as other related areas.
Delene and Brogowicz (1990) provided information from a survey of health
care concerns of 1,050 students at 3 institutions.
They found the major health concerns of students to be body image, AIDS,
weight control, physical fitness, and cancer.
They also examined the students’ knowledge about health care.
They concluded that: 1)
college students do not appear to be well informed about health care issues, and
2) they tend to be more concerned about body image, physical fitness, and
personal attractiveness then preventing serious illness. With a belief in their own immortality, they tend to not
focus on more serious prevention issues.
Examining mental health needs of students at Columbia, Bertocci, Hirsch,
Sommer, and Williams (1992) reported on the major concerns of students at their
university. The largest concern of students was related to academic
success and school-related issues. These
concerns were amplified in students who had low levels of self-esteem and
assertiveness, those worried about their physical health, abuse of alcohol, and
weight control or eating problems. The second major area of concern focused on
love relationships. These concerns
centered on maintaining a love relationship, ability to communicate to a
partner, and managing school and relationships. In addition, other concerns related to serious psychological
problems: suicidal/homicidal,
thoughts, depression, sadness, mood changes, anxieties, and panic attacks.
Priorities to Address Students’
Health and Wellness Concerns
The U.S. Public Health Service, in their report on Healthy People
2000: National Health Promotion and
Disease Prevention Objectives (1990), listed the leading causes of death for
youth age 15 to 24; 1) injuries; 2) homicide; 3) suicide; 4) cancer; 5) heart
disease; 6) congenital anomalies; 7) HIV infection; 8) pneumonia/influenza; 9)
stroke; and 10) chronic lung disease. The
first three relate to injuries and violence, while the last seven are influenced
by emerging lifestyles. Most of
these causes of death in adolescents and young adults can be modified by more
positive behavior choices.
In order to more effectively deal with the major health hazards facing
adolescents the U.S. Public Health Service in this same report on Healthy
People 2000 (1990), established the following priority areas of health
promotion:
1) physical activity and fitness; 2) nutrition; 3) tobacco; 4) alcohol
and other drugs; 5) family planning; 6) mental health and mental disorders; 7)
violent and abusive behaviors, and 8) educational and community-based programs.
These priority areas are congruent with the previously reported areas of health
concerns of college students. Making
positive changes in individual lifestyles and personal choices can have a
powerful impact on students’ personal wellness.
The present health risks and wellness issues facing college students (HIV
infection, sexually transmitted diseases, alcohol and drug abuse, loneliness,
suicide, low self-esteem, eating disorders, etc.) are fairly complex problems
needing innovative, broadly based, integrated programs and services.
Healthy living needs to be taught, encouraged, and valued.
Guyton, et al., (1989) have a number of recommendations with respect to a
more unified, broad-based, comprehensive institution-wide system of strategies
to effectively deal the students’ wellness concerns.
First, they feel that the academic classroom needs to be used to improve
knowledge about health and lifestyle choices.
Second, university-wide committees and/or task forces linking academic
programs, athletic programs, food service, residence halls and social
organizations need to be developed. Third,
therapeutic support to students for dealing with substance abuse, eating
disorders, sexual concerns, and psychological problems need to be provided.
Fourth, underlying developmental issues such as stress, low self-esteem, and
depression need to be researched. Fifth, wellness and health information needs to be provided
during student staff and student leader training and new student orientation.
Sixth, programs need to be designed to strengthen self-esteem,
self-responsibility, and self-care. Seventh,
minority student leadership needs to be fostered in these programs. Eighth,
emphasis needs to be placed on social issues surrounding the use of alcohol and
drugs. Ninth, no-smoking policies need to be instituted on campus.
Tenth, educational efforts related to eating disorders need to be supported. And
eleventh, affirmative action guidelines and policies need to be supported.
With these general strategies in mind, residence hall staff and students
can play a major role in wellness education.
Residential environments can provide a major arena in which professional
and student staff, student leaders, and students can work together to educate
and support healthy wellness lifestyle choices.
The commitment from the head of Student Affairs, the housing director,
and other key members of the university community is critical to the program’s
success. Allen (1993) indicates
that the following concepts can be used by organizations to support the
development of healthy lifestyles: modeling;
training; rewards and recognition; communication; orientation; relationships and
interaction; resource allocation and commitment; confrontation; and rituals,
myths, and symbols. All of these
elements can be important components of a successful residentially based
wellness program.
Krivoski and Warner (1986) recommend an integrated approach to
implementing wellness programs in student housing.
The recruitment and selection of professional and student staff can be an
opportunity to attract individuals to the program with a commitment to a
wellness lifestyle. Staff training
can provide an on-going structured approach to increase the knowledge of staff
in wellness areas, as well as increase the skill levels in the delivery of
wellness programs. Positive role
modeling by staff can play a major part in the success of this program.
The use of peer educators, such as lifestyle assistants, can be very
helpful. Programs with lifestyle
assistants include schools such as the University of Wisconsin—Stevens Point
(Whiting, 1992), Bryn Mawr College (Bell and Shillingford, 19912), and the
University of Massachusetts (Edelstein and Gonyer, 1993).
Programming can offer a wealth of opportunities to provide wellness
education on campus. A number of schools have utilized Hettler’s wellness
model to address lifestyles and health concerns. In addition to the University
of Wisconsin—Stevens Point, schools such as Phoenix College, Slippery Rock
University, California State Polytechnic University, the University of
Wisconsin—Whitewater, and James Madison University have used Hettler’s
wellness model.
Another strategy is to focus on wellness as a major emphasis in one hall
or to have several floors in a hall become “wellness houses.” A number of
schools, including the University of Wisconsin—Stevens Point, have adapted
this strategy.
Finally, it is helpful to have an evaluation process that provides
feedback on the effectiveness of programmatic strategies.
The goals and objectives of the program need to be periodically evaluated
to ensure that the expected benefits of the program are occurring.
Programs in health promotion and wellness are part of the select mission
status at Stevens Point. The
Division of Student Development/University Relations, the School of Health
Promotion and Physical Education (HPERA) and the athletic department are
partners in providing wellness opportunities for students and staff.
Wellness courses offered through HPERA include ‘Stress Management,”
“The Healthy American,” “Aerobic Dance,” “Personal Wellness for
Preprofessionals,” “Promoting and Marketing Health Promotion/Wellness,”
and “Health Related Fitness
Assessment.” In addition, HPERA
coordinates the Employee Wellness Program for faculty and staff.
The National Wellness Institute, affiliated with UWSP, plans and
implements the National Wellness Conference each summer and provides workshops,
conferences, and consultation to business and higher education institutions
across the country.
Students are introduced to the wellness model during presentations at
summer orientation. In addition,
many students choose to take the Lifestyle Assessment Questionnaire (LAQ), which
provides responses to a personal wellness inventory, a computerized list of
wellness resources on campus, and a risk of death section. The responses to the LAQ are presented to students through
interpretive sessions in the Healthy American Class and through the Student
Health Center. The LAQ provides
valuable information that is used to develop wellness programs across the campus
community.
Many of the wellness program activities are offered through the Student
Health Service where the wellness coordinator is located.
The wellness coordinator directs lifestyle assistants (LAs) or peer
educators in various dimensions of wellness. The LAs – undergraduate and
graduate interns representing disciplines such as health promotion/wellness,
psychology, physical education, human development and nutritional science,
sociology, and biology – are trained in a number of competencies, including
the operation of the Fun, Information, and Testing (F.I.T.) Stop (a portable
fitness testing unit); interpretation of the LAQ’ development of four
different wellness programs to be delivered in the person’s major area of
expertise; the ability to determine training heart rate; and knowledge about the
causes of stress and techniques to relieve stress.
LAs offer programs on topics such as Stop Smoking Clinics, relaxation,
nutrition, depression, enhancing relationships, and FIT Stop testing to
students, faculty, and staff.
The wellness coordinator works with University Food Service and the Human
Development and Nutritional Science Department to educate students about
nutritional choices. Through a
media campaign and numerous menu changes, the students’ nutritional choices
have been expanded to include many wellness options.
Medical self-care is emphasized both in the Health Center and through
courses on general self-care and self-care for diabetics.
A cold clinic in the Health Center offers students an opportunity to
assess their own upper-respiratory infections.
In addition, videotapes, pamphlets, and other types of information are
available in the Health Center waiting room.
Students can also use eight interactive computer software programs to
assess various levels of wellness.
Campus Activities is integrally involved in the promotion and development
of wellness activities and programs. Working
closely with University Housing, the educational impact on student groups and
organizations has been very positive. The
University Counseling Center coordinates the mental health network on campus.
The Counseling Center provides a valuable outreach and consultation
service to students dealing with complex concerns.
Residence Life Involvement. The
Office of University Housing has a strong role in the wellness program.
Residence hall directors coordinate wellness programming in the six
dimensions, provide training to resident assistants on the wellness model,
coordinate programs done by the Las in the hall, and participate in many other
activities. The RA candidate course
and the RA training class both provide knowledge about major wellness themes.
Programs are offered across the wellness dimensions, including
presentations on study skills, sexual assault, alcohol education, goal setting,
test anxiety, racial awareness, stress management, STDs, intramurals, values
clarification, personality types, motivation, eating disorders, alternative
lifestyles, faculty lecture series, relationships, date rape, nutrition,
exercise, and time management.
One of the halls has been designated as a Wellness Hall, with active
wellness programming and a fitness center available to residents.
The wellness council, made up of students, provides major input into the
hall’s programs.
Wellness programming in the intellectual area is focused on by peer
educators on hall staffs called Academic Resource Coordinators (ARCs). The ARCs plan programs and provide a non-credit course
primarily for new first year students on academic skills in the halls.
This program offers strong support for the successful transition of
students into the university.
Campus Activities, the
Counseling Center, the Office of Rights and Responsibilities and the Alcohol
Education Coordinator, and University Housing carry out coordinated programs.
As an example, the Alcohol Education Coordinator has developed several
very fine programs available for residents. The “Hot
SHOTS” program utilizes a group of peer educators to offer a wide
variety of programs about dealing with alcohol abuse.
The “LIVE” program is a 3 hour alcohol education class, focusing on
decision-making and the physiological impact on alcohol on the body. The “SOAR” program offers assertiveness training and a
five-step refusal skills training as an educational response to policy
violations related to alcohol abuse. skills training as an educational response
to policy violations related to alcohol abuse.
In summary, the residential environment provides a unique setting to
educate students about life-long choices and behaviors. While many challenges exist with respect to assisting
residents in making healthy choices, the positive impact on individuals can be
very gratifying for all those involved in this education process.
Submitted by
Robert E. Mosier
University of Wisconsin—Stevens Point
References
Allen, J. R. (1993). Organizational support plays integral role in shaping
healthy lifestyles. Wellness
Management, 9, (3), 6-7.
Ardell, D. (1977).
High level wellness: An
alternative to doctors, drugs and
disease. Emmaus, Pa.: Rodale Press.
Bell, C. and Shillingford, J.P. (1992). Evolution of the Bryn Mawr College
wellness program. Wellness
Management, 8, (4), 9-12.
Bertocci, D., Hirsch, E., Sommer, W., and Williams, A. (1992). Student
mental health needs: Survey results and implications for service. Journal
of American College Health, 41, 3-10.
DeArmond, M.M., Bridwell, M.W., Cox, J.A., McCutcheon, M.,
Beauregard, R.A., Charles, K. E., and Heffern, M.R. (1991). College
health toward the year 2000. Journal of American College Health, 39,
249-253.
Delene, L.M. and Brogowicz, A. A. (1990). Student health care needs,
attitudes, and behavior: Marketing implications for college health
centers. Journal of
American College Health, 38, 157-164.
Dunn, H. (1961). High-level
wellness, Arlington, VA: R.W.
Betty Co.
Edelstein, M.E., and Gonyer, P. (1993). Planning for the future of peer
education. Journal of
American College Health, 41, 255-257.
Guyton, R., Corbin, S., Zimmer, C., O’Donnell, M., Chervin, D. D., Sloane,
B. C., Chamberlain, M.D. (1989). College students and national health
objectives for the year 2000: A
summary report. Journal of
American
College Health, 38 (1), 9-14.
Hettler, B. (1980). Wellness promotion on a university campus. Family and
Community Health, 3 (1), 77-9
Krivoski, J.F. and Warner, M.J. (1986). Implementing strategies for high-
Level wellness programs in student housing. In F. Leafgren (Ed.),
Developing campus recreation and wellness programs (pp.53-66). San
Francisco: Jossey-Bass.
LaLonde, M. (1874). A new perspective on the health of Canadians: A
Working document. Ottawa:
Ministry of Health and Welfare.
Travis, J.T. and Ryan, S.R. (1981). Wellness workbook. Berkeley: Ten
Speed Press.
U.S. Department of Health, Education, and Welfare (1979). Healthy people.
Washington, D.C.: U.S.
Government Printing Office.
U.S. Department of Health and Human Services (1990).
Healthy people
2000: National health promotion and disease prevention objectives.
Washington D.C.: U.S.
Government Printing Office.
U.S. Department of Health, Education, and Welfare. (1975). Ten leading
Causes of death in the United States. Atlanta, GA: Public Health
Service Center for Disease Control.
Whiting, S.M. (1992). Peer education on campus. Wellness Management, 8,
(4), p. 3.