1. OBJECTIVES / HYPOTHESIS Co-occurring Health Risk Behaviors
The Association of Co-occurring Health Risk Behaviors and Mental Health in College Students
Hailey Loreth, Laila McGeorge, Tracy Nguy, & Abdullah Alavi
Mentor: Dr. Jessica Samuolis, Psychology Department, Sacred Heart University
INTRODUCTION
METHODS
RESULTS
The ACHA-NCHA II survey assesses the physical and psychological health of college students. The items utilized in the current study assessed binge drinking, physical activity, nutrition, sleep, and mental health. The binge drinking item assessed the number of times of drinking 5 or more drinks of alcohol in one sitting, with a response set ranging from ‘not applicable’ to ‘10 or more times’. The physical activity items measured the number of days of moderate-intensity and vigorous-intensity exercise over the past seven days. The consumption of servings of fruit and vegetables was assessed with one item with a response set of ‘0 servings per day’, ‘1-2 servings per day’, ‘3-4 servings per day’, or ‘5 or more servings per day’. Sleep was assessed with one item asking the number of days in the past seven days of getting enough sleep so that you felt rested. The mental health scale included 11 items that accessed negative affect symptoms such as feelings of worthlessness, feeling very sad, very lonely, and having overwhelming anxiety. The number of negative affect symptoms endorsed in the last twelve months and the number of symptoms in the last 30 days were totaled to generate two composite scores.
Linear regression analyses were run to test if co-occurring risk behaviors were associated with mental health symptoms (see Table 3). Analyses were run for the total number of mental health symptoms in the past 30 days and the past 12 months. Results indicate that co-occurring risk behaviors predict mental health symptoms for both timeframes.
National data indicates that large numbers of college students are engaging in health risk behaviors (ACHA, 2018). Specifically, 27% report binge drinking within the past two weeks, 70% report consuming two or fewer servings of fruits and vegetables per day, 89% report getting five or fewer days of enough sleep to feel rested, and only 54% meet the latest guidelines for physical activity (ACHA, 2018). A number of studies have linked particular health risk behaviors with mental health symptoms among college students. For example, one study found an association between binge drinking and anxiety (Cranford, Eisenberg, & Serras, 2009). Additionally, sleep quality has been associated with depression symptoms (Peach, Gaultney, & Gray, 2016). Research has also shown that health risk behaviors often co-occur in a patterned way among college students (Laska et al., 2009), and certain patterns of clustering are more likely to be associated with mental health issues (Champion et al., 2018). In light of high rates of mental health symptoms among college students (ACHA, 2018) and the nature of risk behaviors as modifiable or preventable, the association between health risk behaviors and mental health is an important area of research that warrants further investigation. The purpose of the current study is to identify prevalence rates of four common health risk behaviors, examine the extent to which these health risk behaviors co-occur, and to determine if there is an association between the co-occurrence of multiple risk behaviors and mental health symptoms. Results are expected to inform the design and delivery of prevention programming targeted to college students.        
Table 3. Linear Regression Analyses Predicting Mental Health Symptoms in the Past 30 days and in the Past 12 months
Variable B
Std. Error
Beta t p
Mental Health Symptoms (Past 30 Days)
Health Risk Behaviors
.400
.126
.168
3.184
.002
Mental Health Symptoms (Past 12 Months)
.543
.138
.206
3.935
.000
RESULTS
DISCUSSION
Frequency analyses were run to identify the prevalence rates of the four risk behaviors (see Table 1). The categorization of at risk for the four risk behaviors was informed by national guidelines where possible (i.e. CDC (2017), AHA (2007), etc.). Health risk behaviors were totaled and ranged from 0-1 (No co-occurring risk behaviors) to 4 (4 co-occurring risk behaviors). Frequency analyses were run to analyze the rates of co-occurring health risk behaviors (see Table 2).
The findings of the current study indicate that a large percentage of students in the sample reported two or more co-occurring health risk behaviors. Students who reported engaging in multiple risk behaviors experienced more mental health symptoms. There were several limitations to the study. Although national guidelines (i.e., CDC (2017), AHA (2007), etc.) were consulted for determining at-risk status for the four risk behaviors, in some cases categorization differed somewhat from guidelines due to the wording/response choices of the items utilized on the ACHA. Since the study included more females than males and the majority of participants were white, the generalizability of the results are limited. The findings point to the need for colleges and universities to provide preventative measures for students that address a range of risk behaviors. Clinicians who treat students presenting with mental health issues should also assess a range of risk behaviors. More research is needed to further understand the connection between risk behaviors and mental health.
Table 1. Prevalence Rates of Risk Behavior
OBJECTIVES / HYPOTHESIS
Identify prevalence rates of four risk behaviors: binge drinking, inadequate levels of physical activity, poor nutrition, and poor sleep.
2. Identify prevalence rates of co-occurring risk behaviors.
Test whether college students who exhibit multiple co-occurring risk behaviors report more mental health symptoms.
Risk Behavior
Categorization
Percentage
Binge Drinking No
One or More Times
57.2%
42.2%
Nutrition
3 or More Servings
2 or Fewer Servings
31.6%
68.1%
Sleep
5 or More Days
4 or Fewer Days
30.5%
68.7%
Physical Activity
Adequate Moderate/ Vigorous
Inadequate Moderate/ Vigorous
45.2%
54.2%
METHODS
Participants
This research study included 367 college students from a mid-size liberal arts university in the northeast region of the United States. The sample included:
79% Female, 88% White
20% Freshmen, 31% Sophomore, 27% Junior, 19% Senior, and 1% 5th Year Undergraduate
99% Enrolled Full-time
53% Residing on Campus
20 Average Age
Procedures
An online survey was sent out to students in the Spring of A raffle for twenty $25 Amazon gift cards was offered as an incentive to participate. The appropriate Institutional Review Board process was completed.
REFERENCES
American College Health Association. American College Health Association-National College Health Assessment (ACHA-NCHA), Spring 2018 Reference Group Data Report. 
American Heart Association (AHA). (2017).
basics/aha-recs-for-physical-activity-in-adults.
Center for Disease Control (CDC). (2017). Sleep and sleep disorders: How much sleep do I
need?
Champion, K. E., Mather, M., Spring, B., Kay-Lambkin, F., Teesson, M., & Newton, N. C. (2018). Clustering of multiple risk behaviors among a sample of 18-year-old Australians and associations with mental health outcomes: A latent class analysis. Frontiers in Public Health, 6, 1-11. 
Cranford, J. A., Eisenberg, D., & Serras, A. M. (2009). Substance use behaviors, mental health problems, and use of mental health services in a probability sample of college students. Addictive Behaviors, 34,   
Laska, M. N., Pasch, K. E., Lust, K., Story, M., & Ehlinger, E. (2009). Latent class analysis of lifestyle characteristics and health risk behaviors among college youth. Prevention Science, 10,   
Peach, H., Gaultney, J. F., & Gray, D. D. (2016). Sleep hygiene and sleep quality as predictors of positive and negative dimensions of mental health in college students. Cogent Psychology, 3,   
Table 2. Prevalence Rates of Co-occurring Health Risk Behaviors
Co-occurring Health Risk Behaviors
Percentage
No Co-occurrences (0-1)
22.4%
2 Co-occurring Health Risk Behaviors
30.5%
3 Co-occurring Health Risk Behaviors
30.0%
4 Co-occurring Health Risk Behaviors
             15.8%