Running Head: STRESS MANAGEMENT AMONG COLLEGE STUDENTS

Stress Management among College Students

Erich Bonilla, BS, MPH(c)

Rochelle Granados, BS, MPH(c)

Juan Landeros, BA, MPH(c)

Dolores Mancha, BS, MPH(c)

Ana Romero, BS, MPH(c)

California State University, San Bernardino

HSCI 612

March 22, 2019

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Table of Contents

Cover page……………………………………………………………………………………..…1

Table of contents……………………………………………………………………...…..……2-3

Abstract………………………………………………………………………………...………....4

Objective……………………………………………………………………..……………4

Methods…………………………………………………………………………………....4

Results……………………………………………………………………………………..4

Conclusion………………………………………………...………………………………4

Background……………………………………...……………………………………………….5

Topic……………………………………………………....………………………………5

Purpose…………………………………………………………………………………….5

Methods……………………………………………………………………………...……...…….5

Data source………………………………………………………………………………...6

Variables…………………………………………………………………………....…..…6

Data analyses……………………………………………………………………………...7

Results…………………………………………………………………………………………….8

Descriptive data…………………………………………………………………………...8

Bivariate…………………………………………………………………………………...8

Survey validation………………………………………………………………………….8

Discussion………………………………………………………………………………………...8

Data interpretation………………………………………………………………………8-9

Limitations………………………………………………………………………………..9

Implications……………………………………………………………………………….9
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References……………………………………………………………………………………….10

Appendix…………………………………………………………………………………11

Figures with legends……………………………………………………………….…11-19

SPSS files………………………………………………………………………………...19

Data dictionary……………………………………………………………………….20-24
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Structured abstract

Objective. The purpose of this study is to measure the knowledge, attitude, and practice

of undergraduate students, at California State University, San Bernardino (CSUSB), regarding

stress management and the resources available on campus post-intervention, to help students

acquire the skills needed to manage stress at the personal and academic level.

Methods. A survey was developed and disseminated to twenty-five colleges students

recruited from the Health Science course (HSCI) 451 at CSUSB. Participants were selected and

took part in an intervention consisting of a public service announcement (PSA), followed by the

pre and post-test survey instruments that were used to assess, attitude, and practice in regards to

stress and stress mitigation. All analyses were conducted in SPSS version 24 and significance

was set at p less than .05.

Results. Prior to the application of the PSA intervention, there were 36% of respondents

that indicated that they were unaware of the on-campus resources that could be used to mitigate

stress. After the intervention and application of the PSA, there was a 36% increase in those that

indicated that they were aware of on-campus resources, indicating that the PSA increased

knowledge.

Conclusion. The results from our research demonstrated that the public service

announcement (PSA) developed was effective in increasing awareness of stress resources among

the college students attending CSUSB.

Keywords: Stress management; Stress campus resources; California State University San

Bernardino; Self-efficacy
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Background

Topic. Living with high levels of stress can affect an individual's overall health. College

students are at a higher risk of becoming overwhelmed with the transition into college. For some

students, college is the beginning of adulthood and independence. The American College Health

Association-National College Health Assessment (2015) reports that about 20 percent of students

experienced six or more stressful life events in the last year. For some college students, stressors

can be continuous and last throughout their entire college experience. This continuous stress can

be harmful to an individual's health. The National Institute of Mental Health (NIMH) states this

constant stress “may contribute to serious health problems, such as heart disease, high blood

pressure, diabetes, and other illnesses, as well as mental disorders like depression or anxiety.”

The impact of stress goes beyond the physical health, for studies have shown the connection

between stress and negative health behaviors (Hintz, Frazier & Meredith, 2015). Implications of

stress include academic impact, change of sleeping patterns, and mental health issues. Thirty

percent of students reported that their stress affects their academic performance. (NIMH, n.d.),

and more women experience academic stress alongside anxiety at higher rates (Misra &

McKean, 2000). College campuses are recognizing the impact of stress on college students and

are working towards developing programs and offering stress-reducing resources on campus to

help students better manage their stress levels.

Purpose statement. Do CSUSB students have knowledge about their stress indicators and how

to cope with stress after learning about campus resources?

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Methods

Data Source. Two data collectors attended the HSCI 455 course where they distributed

an 18-question pre-survey instrument to a total of twenty-five students. Upon the completion of

the pre-survey, the PSA was administered in a group setting. Following the PSA, an eight-

question post-survey was distributed and collected.

Variables. The questions were both opened and closed-ended. The pre-survey consisted

of questions on demographics, knowledge, practice, and attitudes. The post-survey consisted of

more open-ended questions. The post-survey questions were developed to elicit participant

feedback regarding the intervention. The feedback provided more insight into the participant's

feelings and attitudes towards stress and stress management.

Knowledge can be described as the skills or information a person has amassed through

personal experience and education. In an attempt to measure the knowledge of our sample group,

our pre-survey contained four yes/no questions and one open-ended question that allowed the

student to define stress. The post-survey had four yes/no questions relating to knowledge change.

Attitude measures the participants feeling towards behavior and the possible impact on

their health. To obtain a better understanding of the participants attitude the pre-survey contained

four yes or no questions, and the post-survey had three yes or no questions.

Practice is the application of knowledge when conducting and activity. To better

understand the participant’s practice regarding stress management the pre-survey included three

yes or no questions and one multiple choice question that measured exercise. The post-survey

included one multiple choice question that was designed to measure new practices that would be

implemented by the study participant.

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Data analyses

Pre-survey data was entered into SPSS, and the distribution of responses was analyzed. It

was identified that not all participants were aware of the on-campus resources available to them

that could be used to mitigate stress, it was also identified that 20% of participants were unable

to identify types of stress. It was hypothesized that after the application of the PSA intervention

there would be an increase in respondents that identified knowledge of on-campus resources to

mitigate stress, as well as in increase in the participant's ability to identify stressors. The post-

survey was entered into SPSS, and a post-survey question measuring the change in knowledge of

resources was identified, as well as a survey question measuring the change in self-efficacy of

identifying stressors. Responses were analyzed, and it was identified that 100% of participants

indicated knowledge of resources for mitigating stress after the application of the intervention.

These pre and post survey questions were statistically analyzed for significance. A McNamara

test was run which identified an of .004, indicating that the data was significant and that the null

hypothesis could be rejected. Self-efficacy was analyzed, McNamara test was run which

identified a p-value of 1, indicating that in regard to participants ability to identify stressors, our

data had no significance.

Results

Descriptive data. College students are not aware of the stress management resources

offered on campus. Figure 1 demonstrates the academic level of students that participated.

Participants self-identified their academic levels, with 0% identifying as first years, 8%

identifying as second years, 24% identifying as third years, 28% identifying as fourth years, and

40% identifying as four + years. Figure 2 identifies the gender breakdown of respondents, with

76% of respondents self-identifying as female, and 24% of respondents self-identifying as male.

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Figure 3 identifies the age breakdown of participants who were self-categorized into distinct age

groups, with 16% in the 18-20-year age range, 12% in the 21-25-year age range, and 72% in the

26-30 year age range.

Table 1 identifies the participant's ability to identify stressors prior to participation in the

intervention. 20% of individuals indicated a lack of ability to identify stressors, with a majority

self-reporting an ability to identify stressors. Table 2 identifies that there was a 4% increase in

participants that were able to identify stressors. After participation in the intervention, there was

still 16% of participants that indicated an inability to identify stressors. Table 3 is a statistical

comparison of participants abilities to identify stress prior to and after participation in the

intervention. A p-value of 1 indicates that the intervention had no effect on the participant's

ability to identify stressors. Table 4 identified that prior to the application of the intervention,

only 64% of respondents were aware of resources for managing stress. Table 5 indicated that

after participating in the intervention, 100% of respondents indicated that they were aware of on-

campus resources for managing stress. This indicates an increase of 36% among participants.

Table 6 is a statistical analysis of the change in participants knowledge of on-campus resources.

A p value of .004 indicates strong evidence that we should reject the null hypothesis. This

indicates that knowledge of on-campus resources was affected by the PSA intervention.

Bivariate. Many of the participants were able to identify what stress is 80%. A lower

percent of 36% of participants had knowledge of any campus resources to help manage stress,

compared to 64% of participants.

Survey validation. At the point of creation for our instrument, face validity was

established by having Dr. Mshigeni and Elias Rex review the instrument questions and structure.

However, the instrument was not properly validated via a pilot study nor by checking the

correlation between questions to check for reliability, by running a Cronbach's Alpha test.
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Discussion

Data interpretation. After the application of the intervention, it was found that there

was a measurable increase in the participant’s knowledge of on-campus resources that could be

used to mitigate stress. While there was no significant data to show that there was an increase in

participants abilities to identify stressors, it is important to note that both knowledge and self-

efficacy were increased, with participants indicating a change in knowledge of on-campus

resources and a willingness to access those resources in the future.

Limitations. Every study has limitations, our study had multiple limitations. One

limitation was that there was a limited sample size, therefore it can interfere and decrease

statistical power. A small sample size can also increase the risk of error and skew the results.

Another limitation was that the sample that was used was not a true representation of CSUSB

students. The sample that was used was twenty-five Health Science students. It would've been

beneficial to sample multiple students with different, backgrounds and majors to get a better

understanding of CSUSB population. Picking only Health Science students also was selection-

Bias. Overall the process was time-consuming, the participants had to take a pre and post-test,

and watch a two-minute PSA. The participants were not randomly selected, they were selected

by the professor of the participants. Majority of the participants were female. One limitation that

affected our data was that the Survey questions were not designed for pre and post data

collection. This caused multiple problems when entering the data. Lastly, there was a constant

change of instructions, therefore, it caused an abundance of confusion, frustration, and stress.

Implications. More students at CSUSB would benefit from the resources available on

campus if there was more advertisement during welcome week, student orientation, in the

student housing, etc. Also, if there was constantly new ways to advertise from all the student
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services available at the Student Recreation Center, it would reach a large audience. Lastly, a

couple of improvements for the Student Health Center would be to extend the hours of the

student health center and offer none-direct contact to the psychological services.
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References

American College Health Association. (2015) National college health assessment: Spring 2015

Reference group executive summary. Retrieved from:

https://www.acha.org/documents/ncha/NCHA-

II_WEB_SPRING_2015_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf

CSUSB Main Campus. (n.d.). Retrieved February 17, 2018, from https://www.csusb.edu/

Facts and Stats. (n.d.). Retrieved February 17, 2018, from https://www.csusb.edu/about-

csusb/facts-and-stats

Hintz, S., Frazier, P., Meredith, L., & Tracey, Terence J. G. (2015). Evaluating an Online Stress

Management Intervention for College Students. Journal of Counseling Psychology,

62(2), 137-147.

Misra, R., & McKean, M. (2000). College students' academic stress and its relation to their

anxiety, time management, and leisure satisfaction. American Journal of Health Studies,

16, 1.

ReCAPP: Theories & Approaches: Health Belief Model (HBM). (n.d.). Retrieved March 18,

2018, from

http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.theoriesdetail&PageID=13

U.S. Department of Health and Human Services, National Institutes of Health, National Institute

of Mental Health. (2015). 5 things you should know about stress. Retrieved from

https://www.nimh.nih.gov/health/publications/stress/index.shtml
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Appendix

Tables

Table 1 IDTypesofStress

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 20 80.0 80.0 80.0

No 5 20.0 20.0 100.0

Total 25 100.0 100.0

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Table 2 PostPSAIDStress

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 21 84.0 84.0 84.0

No 4 16.0 16.0 100.0

Total 25 100.0 100.0

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Table 3
Test Statisticsa

IDTypesofStress &
PostPSAIDStress

N 25

Exact Sig. (2-tailed) 1.000b

a. McNemar Test

b. Binomial distribution used.

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Table 4 CampusResources

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 16 64.0 64.0 64.0

No 9 36.0 36.0 100.0

Total 25 100.0 100.0

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Table 5 PostPSAInformed

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 25 100.0 100.0 100.0

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Table 6 Test Statisticsa

CampusResources &
PostPSAInformed

N 25

Exact Sig. (2- .004b

tailed)

a. McNemar Test

b. Binomial distribution used.

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Figures with Legends

Figure 1
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Figure 2
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Figure 3

SPSS files

The SPSS version that we used for our project is SPSS 24.

Data dictionary
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Stress Management Questionnaire

October 17, 2018

College Students Age 18 and Older

Juan Landeros

Erich Bonilla

Rochelle Granados

Dolores Mancha

Ana Romero

Contact: Department of Human Health and Human Ecology

Phone: 909-537-5339

Location: Physical Science (PS) 226

Demographics

Q1 Gender: Range 1-4

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What is your gender?
Female=1
Male= 2
Transgender=3
Other=4

Q2 AcademicLevel: Range 1-5

What is your current academic standing level?
First year=1
Second year=2
Third year=3
Fourth year=4
Four + years=5

Q3 Age: Range 1-4

What is your age range?
18-20=1
21-25=2
26-30=3
30+=4

Q4 EnrollmentStatus: Range 1-3

Are you a full time or a part-time student?
Full time=1
Part time=2
Other=3

Q5 Employed: Range 1-2

Are you currently employed?
Yes=1
No=2

Knowledge

Q6 IDTypesofStress: Range 1-2

Are you able to identify different types of stress?
Yes=1
No=2

Q7 DIYStressManagement: Range 1-2

Have you ever heard of Do it yourself (DIY) stress management?
Yes=1
No=2
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Q8 CampusResources: Range 1-2

Do you know of any campus resources to help you manage your stress?
Yes=1
No=2

Q9 StressHealthAwareness: Range 1-2

Are you aware that stress can cause serious health problems such as: eating disorders,
depression, anxiety and many more?
Yes=1
No=2

Q10 StressDefinition: Range 1-6

In your own words, please define what stress means to you?
Physical Health=1
Mental Health=2
Emotional Health=3
Two Themes=4
Three Themes=5
No Themes=6

Q1 PostPSAInformed: Range 1-2

After watching the PSA on Stress management, do you feel more informed about the
resources that are available at CSUSB?
Yes=1
No=2

Q4 PostPSAIDStress: Range 1-2

After watching the PSA, are you able to identify different types of stress?
Yes=1
No=2

Q5 PostPSAPositiveManagement Range 1-2

Does the PSA have positive ways to manage stress?
Yes=1
No=2

Q6 PostPSALearned Range 1-2

List two things that you have learned about stress management among college students.
Yes=1
No=2

Attitude
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Q11 Comfortability: Range 1-2
Are you comfortable using resources on campus to help you manage stress?
Yes=1
No=2

Q12 EffectonStudyHabits: Range 1-2

Do you feel that stress affects your study habits?
Yes=1
No=2

Q13 BenefitofonCampusResources: Range 1-3

If you have ever participated in stress a management event on campus, do you feel it
was beneficial?
Yes=1
No=2
Not Applicable=3

Q14 Intimidation: Range 1-2

Do you feel intimidated accessing the resources available to manage stress at CSUSB?
Yes=1
No=2

Q2 PostPSAPreceptionChange: Range 1-2

After watching the PSA, has your perception change about accessing the resources
available to manage stress at CSUSB?
Yes=1
No=2

Q3 PostPSAStudyHabits: Range 1-2

After watching the PSA, do you feel that stress affects your study habits?
Yes=1
No=2

Q8 PostPSAFeedback Range 1-2

Do you have any comments or feedback about our topic?
Yes=1
No=2

Self-Efficacy

Q15 ImpactonSleep: Range 1-2

Does stress affect your sleep?
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Yes=1
No=2

Q16 UseofAlcahol: Range 1-2

Have you ever sought alcohol as a form of relieving stress?
Yes=1
No=2

Q17 WeeklyPhysicalActivity: Range 1-4

How much physical activity do you engage in on a weekly basis?
15 minutes=1
30 minutes=2
45 minutes=3
60 minutes=4
More than 60 minutes=4

Q18 CounselingSession: Range 1-2

Have you ever attended a free counseling session for stress management at CSUSB?
Yes=1
No=2

Q7 PostPSAPlan Range 1-4

After watching our PSA, how do you plan to handle stress in the future?
Physical Activity=1
Counseling=2
Emotional Support=3
2 or more activities=4