Mental health of university students has been in the forefront of University Affairs discussions (Universities examine their role in students’ mental health; Universities step up mental health issues and in the blog Speculative Diction). It is encouraging that various universities have taken steps to formulate frameworks and strategies to address the problem. The stigma of mental health problems keeps it invisible, and medicalizing mental health could accentuate the stigma.
Alternatively, redirecting our focus to health promotion would shift the emphasis from stigma to new social norms. University attendance would be positioned as a prime setting and moment to invite all students to cultivate and develop better physical, social, mental and spiritual health. Appreciating the value of health in a university culture creates an environment for positive health choices with far-reaching benefits across the student’s lifespan and good news for the health care system.
Three years of teaching a health promotion course in health sciences, largely to addictions counselling students, has given me a unique window into the trials students face when transitioning to university life. One of the course assignments had students reflect upon what they learned in attempting a health behaviour change in a four-week period (Lee, Yanicki, Solowoniuk, Education for Health, 2011)
University marks an important time of change that launches students into the world. Like all transitions, it is a time when new identities, behaviours and roles are tried and adopted. Removed from their accustomed environment, students are free to experiment and may be profoundly influenced by peer group norms and values. If university poses a host of well documented health risks – such as stress, smoking, sleep problems, poor dietary habits, lack of exercise, weight gain, unsafe sex with multiple partners, time and money management, self-esteem, depression, anxiety, alcohol and drug use – it could also propose health-promoting opportunities. Students learn that they have to sink or swim. When they become aware of the shortfalls of the habits, coping mechanisms and beliefs they are using that could determine their success and life course, that’s also when they are open to new alternatives.
Leaving a familiar home environment opens doorways to fresh possibilities. Some students refer to the “geographical cure” when they detach from former peer groups and family associated with poor health practices. For others, university affords a new vantage point from which to critically assess their past behaviours. University courses and assignments also provide a lens for self-reflection, and assimilating new knowledge can lead to new paradigms of self and the world. A whole new lifestyle has to be negotiated and it helps determine a student’s ability to succeed, prosper and remain healthy.
Conversely, geographical relocation can present challenges that compromise student well-being. Social support ranks high in boosting students’ efforts for better health. Weakening ties with family and friends can reduce students’ much needed social support at least initially, increasing their vulnerability to emotional distress. Time constraints related to work and financial pressures restrict students’ ability to develop a new viable support system, another blow to health. Pub nights, parties and drinking are often the chosen ways to spend time among peers. The strong need for belonging and social connection makes students susceptible to negative peer influence and increases the risk of problematic health behaviours. Mealtimes are social events. Cook-ins and eat-ins, healthy delicious meal menus with themes and atmosphere for those in residence, could help improve students’ nutrition and foster conviviality at the same time.
Peers figure centrally in students’ health behavior change. A peer can act as a healthy role model, such as a gym buddy, offering fun and moral support. Roommates can trade recipes, encourage cooking and healthy eating to replace fast and processed food. Students realize that adopting healthy behaviours is better together than alone. Having a peer on one’s side for healthy behaviour holds students more accountable for staying on course. Team sports provide another opportunity for students to meet their social need and get exercise. Group sessions on strategies for time, stress and money management are valued.
Given the social constructionist nature of change, university may well be a major stop in the life course to shift health norms and practices for the better. The Internet and social media are means to stay connected with existing support networks while building new ones. The high premium placed on peer support in striving for health change was reiterated in a student focus group, made possible by the University of Lethbridge teaching development fund. The consensus converged around group process to bolster individual efforts. Reminiscent of the “fellowship” style of 12-step groups that have served many with addictions by drawing on group narratives and support, students want to discuss their struggles and share strategies with one another to sustain change. Some wished that their health behaviour change assignment could have lasted the entire semester, supported by weekly group check-ins and support. Curricular and extra-curricular programs and activities can be vehicles to support “health-as-a-value” which has been found to be one of the strongest predictors of healthy behaviours among college students (Ritt-Olson et al., Journal of Adolescent Health, 2004). Coming to realize how health is an asset that is cumulative over a lifetime was pivotal to many students’ motivation to change.
Adolescence has long been recognized as a critical developmental transition with concomitant health risks, but we are more oblivious to viewing emerging and mature adults going through university transition in this light. Students closely link any deteriorations or improvements of their health behaviours to their transition through university. The quality of guidance and support from faculty and administrators can make all the difference in the trajectory and outcome of a transition. It is time to pay more attention to creative health promoting opportunities on campus.
Financial, academic, social, and time stressors are a reality of university life. Declines in psychological and physical health among freshman undergraduates, law students and medical students are well known. The recent spotlight on students’ mental health is certainly warranted. However, let’s not forget that physical, social, mental and spiritual aspects of health are inextricably connected . Health is a complex multi-dimensional phenomenon, and requires an “integrated health” approach (HRH The Prince of Wales, Journal of the Royal Society of Medicine, 2012). Attainment of health is achieved not only through individual effort and remedial mental health counselling, but is also something to be supported proactively in the culture of one’s environment. Health-promoting universities, a movement in Europe, seek to build sustainable health promoting living, working and learning environments through culture, processes and policies (Tsouros et al., 1998). It is a concept and vision yet to catch fire in Canada.
Dr. Lee is an associate professor in the faculty of health sciences at the University of Lethbridge.