DEVELOPMENT OF A wEe SITE FOR ASSESSMENT 1 -' , ‘ 0E HEALTH RISK SENAVIORS IN COLLEGE STUDENTS?"- I Scholarty Project for the Degree of M S N MICHIGAN STATE UNIVERSITY JAYNE D PETTINGA ’ ‘ 1998 N LIBRARY Michigan State University PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. MAY BE RECALLED with earlier due date if requested. DATE DUE DATE DUE DATE DUE t0? 0 3 .0 JUN (ii 200‘ orn g» 52‘ 90117 a?! 5’ ~ “V" 09 2.5 DZ 6/01 c:/C|RC/DaieDue.p65op.15 DEVELOPMENT OF A WEB SITE FOR ASSESSMENT OF HEALTH RISK BEHAVIORS IN COLLEGE STUDENTS By Jayne D. Pettinga A SCHOLARLY PROJECT Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN NURSING College of Nursing 1998 ABSTRACT DEVELOPMENT OF A WEB SITE FOR ASSESSMENT OF HEALTH RISK BEHAVIORS IN COLLEGE STUDENTS By Jayne D. Pettinga Since recent literature continues to demonstrate that college students engage in behaviors which increase their likelihood of adverse health outcomes, the development of a Web site for self assessment in this population is discussed. The Health Belief Model is used to guide this project because it emphasizes beliefs and perceptions as influencing decisions about disease preventing behaviors. College student development and health concerns are discussed as they relate to their engagement in health promoting and disease preventing behaviors. The health risk assessment Web site was developed with the goals of providing a highly visible cue to take preventive action, increase knowledge of disease severity and disease susceptibility related to risky behaviors, remove some of the barriers to obtaining health services, and influence beliefs about the benefits of taking health promoting and disease preventing actions. Suggestions for APNs working with college students are offered. ACKNOWLEDGMENTS In retrospect, the day I walked in on Kathy Dontje unannounced seems providential. Her willingness to discuss my ideas with me that day and her timely suggestions throughout the following months encouraged me in this work. I might still be wandering about on the Internet looking for the perfect health risk assessment if she had not intervened as my project chairman and guided me in more productive paths. I also wish to extend my heartfelt thanks and appreciation to Dr. George Allen and Dr. Mary Jo Amdt for their willingness to provide assistance in their areas of expertise. With the committee’s support and guidance in developing the health risk assessment Web site, I was able to give the Hope College students and health clinic staff a tool which may prove useful in changing risky behaviors and improving health care. I would also like to express gratitude to John Kermiet from Olin Health Center for sharing the LIBRA tool with me. Libra provided the model for the Risky Business site. Without the assistance of Becky Van Dyke and John Bandstra of Computer Information Technology, a Web site on Hope College campus would not have been possible. Their combined expertise with computer technology has been invaluable. Finally, I would like to thank my husband, Fred, and children, Dean, Mark, and Anna. Their patience and understanding during the months when I endlessly discussed risky behaviors has been exemplary. Living with a graduate student who was also a working wife and mother has at times been a risky business for them. iii TABLE OF CONT ENT S LIST OF FIGURES ........................................................................... v INTRODUCTION ............................................................................. 1 Statement of the Problem .............................................................. 3 Purpose of the Project .................................................................. 4 CONCEPTUAL FRAMEWORK ............................................................ 5 Health Belief Model .................................................................... 5 Definitions of the Concepts ............................................................ 7 The Modified HBM for College Student Health Risk Behaviors ................. 9 Limitations of the HBM ................................................................ 12 LITERATURE REVIEW ...................................................................... 14 Health Risk Behaviors ................................................................. 14 College Student Development ........................................................ 17 Health Assessment Web Site as Cue to Action ...................................... 19 Health Risk Appraisals ................................................................. 20 PROJECT DEVELOPMENT ............................................. 22 Health Risk Appraisal Search ......................................................... 22 Development of the Risky Business Web Site ...................................... 24 Assessing Risky Behaviors ........................................................... 26 Project Evaluation ...................................................................... 31 NURSING IMPLICATIONS ................................................................ 32 The APN as Educator .................................................................. 32 The APN as Researcher ................................................................ 33 The APN as Administrator ............................................................ 34 CONCLUSIONS ............................................................................... 36 LIST OF REFERENCES ..................................................................... 37 APPENDIX: RISKY BUSINESS ........................................................... 43 iv LIST OF FIGURES Figure l - The Health Belief Model .......................................................... 6 Figure 2 - The Modified Health Belief Model for College Student Health Risk Behaviors ........................................................................... IO INTRODUCTION As early as the 1960's, an alarming trend could be seen in adolescent health. Researchers alerted us to the increasing morbidity and mortality in the adolescent age group while all other age groups were experiencing a decline in morbidity and mortality rates (Irwin & Millstein, I986; Tinsley, Holtgrave, Reise, Erdley, & Cupp, 1995). Almost as alarming as this trend in negative health outcomes for adolescents was the discovery of the causes. Adolescent risk-taking behaviors were associated with the majority of adolescent morbidity and mortality (Irwin & Millstein, 1986; Hofferth, Kahn, & Baldwin, 1987). Behaviors such as unprotected sexual activity, substance abuse, and motor/recreational vehicle accidents were associated with more than 50% of the morbidity and mortality in this age group (Irwin & Millstein, 1986; Hofferth, Kahn, & Baldwin, 1987). While previous generations had health risks related to exposure to infectious diseases, modern adolescents faced threats to their health which were rooted in these volitional behaviors. Some of these behaviors led to short term adverse outcomes such as sexually transmitted diseases (STDs), unintended pregnancies, and motor vehicle accidents (MVAs). Lack of exercise, poor diet, and smoking are examples of risky behaviors that increased the risk for chronic adult illness such as lung cancer or heart disease. Unfortunately, recent literature demonstrates little improvement in this disconcerting data. The Youth Risk Behavior Surveillance System (YRBSS, Kann et al., 1995) was developed by the Centers for Disease Control and Prevention (CDC) to measure progress towards achieving national health objectives (Healthy People 2000, 1990). Since 1990, regular surveys have been conducted at both national and local levels to monitor priority health risk behaviors among youth and young adults. In I995 the YRBSS included the National College Health Risk Behavior Survey (NCHRBS) which assessed the same priority health risk behaviors among college students (Douglas et al., 1997). Both the YRBSS and the NCHRBS demonstrated that adolescents and college aged students continue to participate in a number of high risk health behaviors (Douglas et al., 1997; Kann et al., 1995). The consequences of risky health behaviors in adolescence are of concern to health professionals, parents, educators, and policy makers. Since these behaviors are associated with preventable morbidity and mortality, the United States Preventive Services Task Force Guide to Preventive Services (USPSTF, 1996), the American Academy of Pediatrics' Clinician's Handbook of Preventive Services (American Academy of Pediatrics, 1994), and the American Medical Association's Guidelines for Adolescent Preventive Services (American Medical Association, 1994) recommend that all adolescents be counseled on alcohol, tobacco and other drug use, nutrition, exercise, unintended pregnancy, and sexually transmitted diseases. Advanced Practice Nurses (APNs) share these concerns. Addressing adolescent risky behaviors challenges APNs to use the skills of assessment for risky behaviors, anticipatory guidance to prevent negative short and long term health outcomes, and education for disease prevention and health promotion. However, reaching the adolescent population with health promotion and disease prevention messages can be difficult. Various methods have been employed to try to reduce adolescent engagement in risky behaviors. Public health announcements, ”Just Say No" campaigns, educational pamphlets, health education classes, canned curricula, and professional consultations have all been met with varying degrees of success and failure (Furby & Beyth-Marom, 1992; Scott & Ambroson, 1994). Hope College is a small private liberal arts college in West Michigan. This college, affiliated with the Reformed Church of America, averages about 2700 students per year. The health care practices and health risk behaviors of Hope students have never been officially surveyed, however informal health clinic statistics (McKay, 1996) indicate Hope College students are at risk for health problems similar to all other college students. The Hope College health clinic staff consider their roles as both educators and clinicians. Each encounter with a student is viewed as an opportunity to assess health promoting behaviors and encourage disease preventing behaviors. When students first visit the Hope College Health Center (HCHC), specific attention is given to screening for exercise and nutritional behaviors. hi gh-risk sexual activity, substance abuse. tobacco use, and safety behaviors. This affords some opportunity for education with a focus on development of healthier lifestyles. In addition, discussions are held in residence balls on student-selected topics. However, the only students who benefit from these interactions are those who present in the HCHC with a health concern or attend a residence hall discussion. Many students never come to the clinic. Those who do come may not disclose information which they feel is embarrassing or associated with illegal behavior. One-on-one education is very labor intensive and consequently an expensive method of educating a campus of 2700 students. Clinic staff suspect that the dormitory lectures are often attended by those least likely to need the information presented. Statement of the Problem The college years are a time when high risk behaviors may develop. The older adolescent who is typical of college students is transitioning from childhood to young adulthood. No longer under direct parental supervision and facing an environment with new social and academic pressures, many students experiment with new behaviors (Douglas et al., 1997). Higher education is an important setting in which to attempt to reduce health risk behaviors, but this is not a simple task. Part of the difficulty lies in reaching a population of 2700 students with limited staff and resources. Secondly, it is difficult to get the attention of students who may be at risk for health problems but who have no current symptoms of disease. Finally, student interests are often consumed with multiple developmental and educational tasks, leaving little time to address health promotion or disease prevention. One way to potentially affect this age group is to provide information about the health risks associated with high risk behaviors using the relatively new medium of the intemet. This newer medium may be useful to provide anonymity for the adolescent seeking information about health risk behaviors. Purpose of the Proiect The purpose of this project was to develop a Web site targeted to college students who are aged 18-22 years. The goals of this project are to: (a) provide a highly visible cue to take preventive action, (b) increase knowledge of disease severity and disease susceptibility related to risky behaviors, (c) remove some of the barriers to obtaining health information, and (d) influence beliefs about the benefits of taking health promoting and disease preventing actions. The desired outcome of this project is to make a contribution towards both decreasing the frequency with which college students engage in high risk behaviors and increasing the frequency with which they participate in health promoting behaviors. CONCEPTUAL FRAMEWORK Health Belief Model How can APNs modify the prevalence of risk taking behaviors in college aged students? The Health Belief Model (HBM) provides a framework to guide this project. The HBM (Janz & Becker, 1984; Rosenstock, 1974) originated from efforts to explain preventive health behavior. According to this model, individuals may take action to avoid disease if they value the goal of health and believe that their behavior will help them achieve that goal. The HBM enables one to see the relationships between perceived threat of disease, perceived benefits of preventive action, perceived barriers to preventive action, and the likelihood of taking recommended preventive health action (see Figure 1). Individual belief about personal susceptibility to disease or injury and belief about the perceived seriousness of a particular disease or injury combine to produce a perceived personal threat of disease or injury. Rosenstock (1974) describes perceived susceptibility as an individual's subjective risk of contracting a condition. Perceived seriousness of a health problem is related to both the clinical consequences as well as other difficulties the individual believes may be encountered as a result of the health problem. Rosenstock points out that both susceptibility and severity are at least partly dependent on knowledge. The combination of perceived severity and susceptibility produces a perceived threat of disease. However, as Rosenstock describes it, the perception of the benefits of taking the desired preventive action is tempered by the perception of the barriers to taking that action. This cost—benefit analysis contributes to the path of action chosen by the individual. The Individual Perceptions erceived Susceptibililty 0 Disease "X" erceived Seriousness f Disease "X" Modifying Factors Demographic variables (age, sex, race, ethnicity, etc. Sociopsychologic variables (personahty, socral class, peer and reference group _ pressure, etc.) Structural variables (knowledge about the disease, prior contact with the disease, etc.) Likelihood of Ac tion Perceived benefits of preventitive action. minus Perceived barriers to preventive action —>[Perceived Threat of Disease X f Likelihood of Taking Recommended Preventive Health Action Cues to Action Mass media campaigns Reminder postcard from physician or dentist Advice from others Illness of family member or friend Newspaper or magazine article Figure 1. The Health Belief Model as predictor of preventive health behavior (Rosenstock, 1974). model depicts the balance between perceived benefits of taking preventive health action and the barriers to taking that action. One additional concept discussed by Rosenstock is the cue to action. A cue to action is considered a vital stimuli to launch health promoting or disease preventing behavior. Cues to action may include mass media, advice from others, and written material. The variables of the HBM are depicted in Figure l. The HBM has been used successfully to describe a positive relationship between health beliefs and the likelihood of initiating preventive health practices. Janz and Becker (1984) evaluated ten years of research using the HBM. Janz and Becker found substantial evidence of the usefulness of the HBM as a framework for understanding individual health related decision-making. These researchers evaluated studies related to seat belt use, exercise, nutrition, smoking, and alcohol use. The variables of barriers, susceptibility, and benefits were most consistently associated with taking preventive health action. Janz and Becker emphasized that the HBM is predicated on the premise that cues to action are widely prevalent. Janz and Becker emphasized that when cues to action are not present, the HBM is not likely to be relevant in explaining behavior. Definitions of the Concepts The concepts of concern in developing this project are knowledge, beliefs, health behavior, and adolescent health risk behaviors. Based upon the literature, conceptual definitions are offered to facilitate understanding in this project. These concepts are discussed within the framework of the Health Belief Model. Knowledge. Knowledge has been variously defined as the state of understanding, as cognition, and as the mental processing and selective use of information. Marion (1990) refers to the process of knowing as a mental act of developing judgements about various types of information which are responsible for a client's perception of health and the choice of behavior to change that health status. In this project, knowledge related to health risk behaviors is defined as understanding information which affects decision making about health risk behaviors. Biliis; Beliefs are defined as convictions that something is true. In the language of the HBM, beliefs are called perceptions (Janz & Becker, 1984). In this project, beliefs about health risk behaviors are defined as an individual's perception about vulnerability to a health risk, severity of a health risk, benefits of health behaviors, and barriers to health behaviors . Health Behavior. Health behavior has been defined in nursing literature as using health care services, compliance with medically prescribed regimens, actions taken to prevent illness, and actions taken to achieve a higher level of wellness (Berger & Walker, 1997). The concept of preventive health behavior has been defined as patterns of response relating to health when the person has no specific symptoms (Yoder, Jones, & Jones, 1985). In this project, health behavior is defined as both the initiation of preventive behaviors (eating a nutritious diet, exercising, seat belt use, bike helmet use, motorcycle helmet use, contraceptive use, and condom use) and avoidance of risky behavior (alcohol use, drug use, and tobacco use). Health Risk Behaviors. Risky behavior implies action or inaction that incurs a chance of danger, injury, or loss (Furby & Beyth-Marom, 1992). Irwin and Millstein (1986) defined risk-taking behavior in the adolescent population as " young people with limited or no experience engaging in potentially destructive behaviors with or without understanding the immediate or long-term consequences of their actions (p. 828)." Targeting college aged students, the period of interest will be from 18-22 years of age. The definition of health risk behaviors for this project will be action or inaction of 18-22 year olds that incurs a chance of injury, loss, or danger. The specific health risk behaviors of concern with college students are the same behaviors monitored in the YRBSS and NCHRBS previously mentioned. These behaviors are safety behaviors, tobacco use, alcohol and other drug use, sexual behaviors, dietary behaviors, and exercise behaviors. The Modified HBM for College Student Health Risk B_eh§viors Utilizing variables from the HBM, a modified HBM for assessing health risk behaviors of college students was developed by this writer (Figure 2). Placed in this framework, a Web site addressing college student health risk behaviors can be conceptualized as a cue to action. It is the cue to action that is the component of the HBM most relevant to this project. As a cue to action, the Web site goal is to provide the trigger to take preventive action and health promoting action. For example, college students have been shown to be knowledgeable about the dangers of cigarette smoking and the benefits of regular exercise; however this knowledge has not always translated into action (Delene & Brogowicz, 1990). A cue to action is predicted by the HBM to be necessary to set the process of behavior change in motion. Scott and Ambroson (1994) studied substance abuse prevention programs with college students and found that peripheral or environmental cues were the most influential in forming student attitudes about alcohol and other drugs. Beliefs about perceived threat of problems related to health risk behavior are influenced by knowledge. Knowledge of susceptibility to and severity of health risks related to personal behavior patterns has been shown to influence positive changes. A study of college student behaviors in preventing HIV infection found that perceived severity of disease was a positive predictor of adopting safer sexual practices (Yep, 1993). Conversely, lack of knowledge is associated with risky sexual behaviors (Marion, 1990). A study by Kin gery, Pruitt, and Hurley (1993) showed that knowledge led to behavior change, most significantly in the areas of safety behaviors, prevention of STDs, and nutritional behaviors. Adler, Kegeles, Irwin, and Wibbelsman (1990) found that adolescents do behave in a rational manner regarding contraceptive use. These researchers cite attitudes about specific contraceptive methods, beliefs about the consequences of using a particular method, and the values adolescents ascribe to those consequences as predictors of contraceptive use. Although primarily functioning as a cue to action, the Web site will Individual Perceptions erceived Susceptibililty f problems related to ealth risk behaviors erceived Seriousness f problems related to ealth risk behaviors IO Modifying Factors Demo oraphic variables (col ege students aged 18- -22) Sociopsychologic variables (peer pressures) Structural variables knowledge about both health risk behaviors and health behaviors.) Likelihood of Ac tion Perceived benefits of engaging in healtl behaviors minus Perceived barriers to engaging in healtl‘ behaviors if N // erceived Threat of roblems related to ealth risk behavior Web site for self-assessment of college student health risk behaviors Likelihood of adopting health behaviors and decreased likelihood of engaging in health risk behaviors Figure 2. HBM adaptation. The Modified Health Belief Model for College Student Health Risk Behaviors. II provide information about disease severity and disease susceptibility associated with each of the targeted behaviors. Perception of threat of health risk based on knowledge is predicted to positively influence the likelihood of health behaviors. Individual perceptions about susceptibility to health risk behavior problems will be targeted with a self -risk assessment. According to the US. Preventive Service Task Force (1996), the most effective interventions are those which target personal health behaviors such as tobacco use. poor diet, physical inactivity, alcohol use, and lack of contraceptive and condom use. The modifying factors which affect assessment of perceived threat of problems related to health risk behavior are varied. Age, sex, peer pressure, college enrollment, habit, pleasure, and previous knowledge of health risks associated with risky behaviors all may be factors influencing perceptions. For example, the relatively young age of this population may interfere with an accurate self assessment of their susceptibility to heart disease or lung cancer. On the other hand, the sexually active female student's perception of threat of disease may be enlightened by the knowledge of her increased vulnerability to sexually transmitted disease relative to her physical immaturity (Cowan & Mindel, 1993). Tinsley et al. (1995) studied the self-reported decision-making influences of adolescents using both personality and environment as variables. Personal concern about health and social influences (teachers, friends, parents, and media) were found to be negatively related to risky behaviors and positively related to preventive behavior. Experience with risky or preventive behavior that was associated with enjoyment was a strong predictor of continued engagement in such behavior. Although modifying factors are important, the only factor accessible to influence by the Web site is knowledge. Research based information about health behaviors will be provided. The HBM postulates a barrier/benefit analysis affecting the likelihood of engaging in health behaviors. Research has shown that individuals who expressed belief in the benefits of health promotion behaviors were more likely to engage in those behaviors 12 (Yoder, Jones, & Jones, 1985). The Web site will present information about the benefits of health behaviors. Barriers to health behaviors have been reported to be the most important variable to predict engagement in health behaviors (Janz & Becker, 1984). Research has shown that adolescents typically encounter four barriers when attempting to consult with health professionals about health concerns: physical barriers such as access and transportation, economic barriers such as how to pay for care, legal barriers such as problems related to risky or possibly illegal behaviors, and psychological barriers such as fear of medical treatment or loss of control and privacy (Settertobulte & Kolip, 1997). Many of these barriers can be avoided by the Web site. Widespread computer access on the college campus makes the intemet accessible to most college students without further physical or economic limitations. Information can be obtained anonymously and privacy can be maintained. Limitations of the HBM One of the limitations of the HBM is the assumption that health is highly valued by most adolescents. The value each site visitor places on personal health cannot be determined. As a psychosocial model, the HBM is limited to accounting for the variance in health behaviors that can be explained by beliefs (Janz & Becker, 1984). The HBM does not incorporate coping skills or the cognitive level of college students. Adolescent preoccupation with the immediate consequences of his or her actions hinders the rational decision-making skills on which the model is based (Hiltabiddle, 1996). It also does not account for behaviors rooted in addictive habits, such as tobacco and alcohol addictions. In the case of addictive behaviors, the psychosocial decision making process is not the primary factor accounting for behavior (Rosenstock, 1997). The HBM has been limited in its usefulness because it is avoidance oriented (Rosenstock, 1997). As such, it is less predictive of health promotion behaviors. College 13 students have not been shown to have significant concerns about chronic disease prevention (Delene & Brogowicz, 1990). However, many of the behaviors addressed in this project are both health promoting and disease preventing. For example, regular daily exercise and balanced dietary behaviors promote health and wellness as well as prevent future disease. Health promotion and disease prevention involves a complicated web of knowledge, beliefs, and behavior. The specific variables involved in working with college aged students add even more complexity to the process. However, the HBM is helpful in keeping focused on the crucial importance of beliefs and behavior in the efforts to improve health. LITERATURE REVIEW Health Risk Behaviors The risky behaviors of high school students are similar to those of college students. Data from the YRBSS (Kann et al., 1995) and the more recent NCHRBS (Douglas et al., 1997) will be used to understand current behavior patterns. While the target group in this project is the college aged student, research from younger age groups is included because of the similarity of the behavior patterns. One area addressed in both of these reports which was not addressed in this work is the category of intentional injury. Behaviors assessed under this general heading include carrying a weapon, participating in physical fights, rape, and suicide ideation or suicide attempts. It was decided by the writer that these behaviors would not be included in this project for several reasons. First of all, a Hope College task force offers yearly training and inservicing of students in the area of sexual aggression. The students involved in the training sessions provide effective residence hall follow-up throughout the school year. The Hope College Counseling Center provides yearly screening related to stress management which includes screening for depression and suicidal risk. Frnally, little data exists to suggest that physical violence and carrying of weapons has ever been a concern on Hope's campus. The current policy of dealing with these issues through the campus public safety department appears to be satisfactory. Exercise and Dietary Behgviors Disease preventive behaviors and health promotive behaviors were assessed in the recent YRBSS report (Kann et al., 1995). While over 33% of youth perceived themselves to be overweight, only 15% reported meeting dietary guidelines for fruits and vegetables, and 66% reported frequent high fat meals. Forty percent were attempting weight loss at the 14 15 time of the survey. Sixty-six percent were engaged in regular exercise (defined as twenty minutes of aerobic activity at least three times per week) and 52% were in daily physical education classes. According to the NCHRBS (Douglas et al., 1997), about 3-4% of college students reported bulimic behaviors and only 38% reported regular physical activity. One fifth of all college students surveyed were overweight as determined by their body mass index (BMl). A majority reported high fat foods in their diets while a minority reported meeting National Cancer Institute guidelines for five or more fruits and vegetables per day. Alcohol and Other Drug Use The YRBSS data illustrated the problems associated with adolescent alcohol use. Seventy-five percent of all adolescent deaths were from 4 causes: motor vehicle accidents, homicide, suicide, and other unintentional injuries (Kann et al., 1995). Kann et al. reported that alcohol use and marijuana use were associated with much of this mortality: half of all high school students reported using alcohol in the last month, 30% reported heavy drinking in the same period (defined as more than five drinks per occasion), and drinking or marijuana use was strongly associated with motor vehicle accidents. The NCHRBS data (Douglas et al., 1997) revealed that about one third of college students engaged in episodic heavy drinking (consuming five or more drinks of alcohol on at least one occasion during the 30 days preceding the survey). Recent research demonstrated that unsafe and unplanned sexual activity was associated with binge drinking (Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994). Tobacco Use Cigarette smoking has been identified as the single largest preventable cause of disease and premature death in the United States (US. Surgeon General, 1989). About 14% of high school students and 16% of college students reported recent regular cigarette smoking (YRBSS, NCHRBS). Chassin, Presson, Sherman, and Edwards ( 1990) found that adolescent exposure to cigarette smoking significantly increased the risk for regular 16 adult smoking. Even light, experimental use (smoking only a few cigarettes) doubled the adult smoking risk. About 30% of both college and high school students had smoked at least one cigarette in the 30 days prior to these surveys. Sexual Beh_avior Analyzing three decades of data, Hofferth, Kahn, and Baldwin (1987) found that more and more young teenagers were becoming sexually active, with a corresponding high risk of pregnancy because of irregular contraceptive use. Kann et al. (1995) reported that more that 50% of high school students had ever had sexual intercourse and 20% reported having more than 4 partners. Only 50% of the sexually active reported using condoms and of those who did use contraceptives, less than 20% did so regularly. Among college students, 86% reported they had ever had sexual intercourse, 34.5% reported having six or more partners in their lifetimes, and less than 30% of the sexually active reported using condoms (Douglas et al., 1997). One million adolescents become pregnant every year and more than ten million develop sexually transmitted diseases each year (Kann et al., 1995, Green, Johnson, & Kaplan, 1992). Early age of first sexual intercourse is associated with an increased number of sexual partners and an increased risk of acquiring sexually transmitted diseases (Cowan & Mindel, 1992). Self Care Behgviors The 1995 YRBSS data demonstrated a lack of self care behaviors in the adolescent population. Thirty-five percent of adolescents reported riding with someone who had been drinking, 19% reported never using seatbelts whether driving or riding with someone else, and 93% of bicycle riders and 40% of motorcycle riders reported never wearing a helmet (Kann et al., 1995). The NCHRBS data (Douglas et al., 1997) pointed to similar problems in the college population. About 10% of college students reported rarely or never using a seat belt and 34% of those who rode motorcycles did not wear motorcycle helmets. More than one fourth of all college students reported recently driving a car after consuming alcohol. 17 College Sudent Development Much research has been done which focuses on the development of adolescents and risk-taking behaviors. Some risk—taking in this population seems to be important developmentally. Irwin and Millstein (1986) report that multiple developmental needs are met with risk-taking behavior. Adolescent risk-taking fulfills developmental needs related to mastery, individuation, and autonomy. Mastery of new skills requires some testing of limits, taking risks, and experimentation. Approaching adulthood, adolescents may seek to master the developmental task of intimacy and identity formation by taking risks in relationships with the opposite sex. The perception that sexual activity is an adult behavior may encourage adolescents to engage in it to facilitate one's transition to adulthood (Furby & Beyth-Marom, 1992). Development of autonomy may require risk-taking to see what the adolescent is personally capable of . The factors which contribute to risk-taking behaviors in adolescence are intensified in the college years. College students are completing many of the tasks of adolescence and are anxious to establish themselves as adults (Wright, 1996). This transition is highly stressful for many students. Research by Chickering (1990) asserts that college students are rapidly developing along seven vectors: 1) developing competence; 2) developing autonomy; 3) developing purpose; 4) developing integrity; 5) managing emotions; 6) establishing identity; and 7) freeing interpersonal relationships. The dramatic changes taking place in the lives of college students are occurring in a new environment. No longer under direct parental supervision and facing multiple new pressures, students live and study in an environment where the use of intoxicating substances is legal and prevalent for many of their peers (Prendergast, 1994). This may contribute to substance abuse. The connection between substance abuse and both motor vehicle accidents and unintended sexual behaviors has already been discussed. Type of residence has even been shown to influence dietary behaviors in college students (Beerrnan, Jennings, & Crawford, 1990). Scott & Ambroson (1995) suggest that the dramatic changes college students experience 18 without direct parental influence may encourage them to turn to their peer groups more aggressively than they normally would. Consequently, peer pressure may exert exceptional influence to adopt risky behaviors. Since the environmental and developmental pressures can be significant for college students, little cognitive nor emotional energy may be left for them to contemplate issues of health behaviors or health risk behaviors. Nevertheless, research does provide some insight into which health issues concern college students the most. Surveying college students about their health concerns, Delene and Brogowicz (1990) found that issues of body image, physical fitness, personal attractiveness, and weight control were most important to students. These concerns may motivate students to engage in health promoting behaviors or may contribute to unhealthy dietary practices. Takanashi (1993) asserts that the community of influence in which adolescents grow up such as schools, colleges, families, and media, and the congruence among these key social organizations can make a significant difference in the life experiences and future well-being of young people. This period of life offers opportunities to prevent damaging outcomes and to assist young people towards a successful future. Takanashi cautions that while we know more today about how to educate healthy young people, we have not been willing to put that knowledge into practice. After studying the healthcare needs, attitudes, and behaviors of college students from many institutions, Delene and Brogowicz (1990) suggested that media alternatives should be investigated and aggressive health promotion messages developed in order to better maximize health care resources and match services with student needs. These researchers suggest that a ”climate of care" may be more effective than a programmatic response. They further suggest that this "climate of care" can be manifested through available campus communication systems which may be less threatening than solo participation in health center programs. I9 _nglth Assessment Web Site as Cue to Action One of the cues to action in the Health Belief Model can be the media. Researchers speculate that mass media may be the biggest educator in today's society (Davies, 1993). Si gnorielli (1990) found that the media were an important source of sexual information for adolescents because of the nonthreatenin g storytelling style. It is important to assess the impact of the media and decipher the messages the media portrays about high risk behaviors. According to Si gnorielli, sexual content occurs in 9 out of 10 prime time dramatic programs but no significant content relating to contraception or sexually transmitted diseases could be found. Advertisers promote products like alcohol and cigarettes by linking them with concepts critical to late adolescence such as social acceptance, enhanced body image, and heightened sexuality (Tinsley, Hol grave, Reise, Erdley, & Cupp, 1995). Si gnorielli reported that alcohol is used more than any other TV beverage. Kilboume (1991) reported that advertisers want adolescents to believe multiple myths about alcohol use. Some of these myths are: 1) drinking alcohol is a risk-free activity; 2) an individual cannot survive without drinking; 3) problem—drinking behaviors are normal; and 4) alcohol is a magic potion that can transform you and provide you with happiness, prestige, wealth, sophistication, and sexual satisfaction. Davies (1993) points out that foods marketed in the media for young people are not nutritionally balanced and often high in calories and fat. At the same time, the media image of the ideal body encourages adolescents to lose weight. While there has been a steady decline Since the 1950's in the use of cigarettes in most entertainment programming (Si gnorielli, 1990), there is some evidence that youth are smoking more cigars as a result of intemet smoking promotions (Schwartz, 1997). Since the influence of the media may be profound, cues to action which trigger behaviors conducive to maintaining and promoting health are needed. Recent work done at the Conference on Adolescent Development (Roberts, 1993) focused on a positive approach to viewing the influence of media with adolescents. The same principles that 20 operate to influence youth to acquire negative beliefs and behaviors from media messages may engender positive beliefs and behaviors. Generally, the media of concern to researchers has been limited to television, music, and movies. Recent research has been found relating to the possible influence of the intemet. Izenberg and Lieberman (1998) cite data about the volume of people using the intemet: 60 million Americans are currently on-line and 70 million are predicted to be online by 1999. These same authors investigated the most frequent purpose of intemet use: 82% of intemet users were looking for information, 75% used the intemet for educational purposes, and 42% used the intemet to retrieve health information. Since many people currently use the intemet and the number of people using the intemet is expected to grow, it is important to evaluate the effectiveness of this tool. Soloway and Wallace (1997) caution that pursuing serious inquiry on the Web is currently a very difficult task. Soloway and Wallace found that problems in navigating and remembering sites, lack of Web organization, and the objectionable content of some sites limit the usefulness of the Web for educational pursuit. For the purposes of this project, the Web site addressing health risk behaviors would have to be well organized, easily accessed, and have links with established credibility and reliability. mm Risk Apprg'gaig According to Berger and Walker (1997), one of the tools often used to assess personal behaviors is the Health Risk Appraisal (HRA). HRAs were developed in the 1970's to assess lifestyle behaviors associated with an increased risk of preventable death. HRAs have been used to personalize risk estimates based on individual characteristics and behaviors. HRAs can be used to tailor health communication to individual circumstances in order to increase the effectiveness of health education. The personal appraisal is intended to improve health and survival rates by reducing or eliminating known precursors to disease. Using epidemiological computer programs, the HRA compares an individual's characteristics to national mortality statistics. A personalized estimate of the risk of dying 21 within the next 10 years from one of the most frequent causes of death is calculated by the computer program. Kirscht (I989) expressed concern about the reliability of these instruments in changing perception of risk or leading to behavior change. Kirscht noted that risk information alone is not a sufficient basis for action in many circumstances. The work of Killeen ( 1989) supported cautious use and interpretation of HRAs although a concern with social desirability or looking good in front of others affected the accuracy of self-reported alcohol and tobacco use. Sexual behaviors would also be subject to the same bias. PROJECT DEVELOPMENT The focus of this project is to develop a Web site with the goals of: (a) providing a highly visible cue to take preventive action, (b) increasing knowledge of disease severity and disease susceptibility related to risky behaviors, (c) removing some of the barriers to obtaining health services, and (d) influencing beliefs about the benefits of taking disease preventing and health promoting behaviors. A necessary first step was the development of a Health Clinic Web page from which the link to the health risk assessment page could be made. An interactive question and answer link through which students could ask specific questions of health clinic staff was also developed. Finding an appropriate tool for college health risk assessment proved to be complicated. _He_alth Risl_< Appraisal SEQ; Berger and Walker (1997) provide an overview of HRAs that have demonstrated adequate reliability, validity, and effectiveness. The following were viewed and evaluated for use in this project. The CDC Youth Risk Behavior Suveilance Survey (YRBSS), while targeting the specific behaviors which are of concern for this project, was too lengthy (over 70 questions with an estimated time for completion of 45 minutes) and was targeted for a 7th- grade level. The CDC is currently modifying the questionaire for college populations. The Lifestyle Assessment Questionnaire (National Wellness Institute, 1991) which included a college version for use with young adults was judged to be both too lengthy and too broad. This questionnaire has 100 questions and focuses on six dimensions of wellness, not all of which were of concern in this project. For example, one of the dimensions assessed is occupational wellness, and another dimension includes questions 22 23 about conservation efforts, social justice, and communication patterns. The Personal Lifestyle Questionnaire (Brown, Muhlenkamp, Fox & Osborn, 1983) did not address sexual behaviors specifically, nor was it targeted for use with the college age population. The failure to find an appropriate HRA to use on the Web with college students in conjunction with previously mentioned concerns about the effectiveness of these instruments in the college population caused this researcher to be cautious about using these tools. According to John Kermiet, a health educator at Michigan State University (MSU), the Olin Health Center staff at MSU experienced similar problems when trying to find an instrument to assess risk behaviors of MSU college students. After a futile search of available instruments, Olin health education services developed the LIBRA computer program which stands for Lifestyle/ Behavioral Risk Assessment. This program addressed most of the behaviors of concern for this project. The format of LIBRA compares reported behaviors with desired behaviors and then explains the possible consequences of continuing with the chosen behaviors. The feedback provided to students focuses on immediate health risks as well as adverse risks for academic performance, self-esteem, nutrition, and fitness. However, the LIBRA tool was currently being modified by the Olin staff to increase its effectiveness. An extensive search of intemet HRAs was conducted with little success. While many sites were found which addressed singular health risk behaviors, only one site was found which addressed most of the behaviors of concern in this project. This site, called the You First HRA, was developed by Greenstone Healthcare Solutions in Kalamazoo, MI (1997). The You First HRA was judged to be too broad in that it targeted the entire 17-70 year old population and too brief in that it did not evaluate sexual behaviors. However, the format and the link with CDC data banks were very appealing. This tool also provided links with other reliable intemet sites for health information. 24 Development of the Risky Business Web site Since an existing instrument could not be found, the Risky Business Web site (see Appendix) was developed by modifying the LIBRA questionnaire and feedback responses to meet the specific needs of the Hope College student population. The questions target eating behaviors, exercise behaviors, alcohol and drug use, tobacco use, sexual behaviors, and two self-care or safety behaviors. In attempting to construct a Web site which would positively influence adolescent health outcomes, knowledge of media which attracts the attention of the targeted population was important. A highly successful campus wide campaign to decrease binge drinking behavior on the campus at Northern Illinois University began with multiple campus surveys to guide the work (Haines, 1996). The information obtained from these surveys was relevant for the health risk assessment Web site. Haines used four rules of message development: keep it simple, tell the truth, be consistent, and highlight the norm of moderation. Haines found that 80% of students preferred obtaining information about drug and alcohol use from a daily student newspaper. The newspaper was selected over all other methods of self education such as lecture, workshop, health fair, health professional, faculty, staff, or peer educator. The campus newspaper avoids the four barriers to obtaining health information which were listed earlier. The use of the intemet for such information was not addressed. However, the written information presented in newspapers could easily be dispensed on the intemet. The Risky Business Web site has two major advantages over the campus newspaper. The Web site can be interactive and can be updated frequently as health research and information changes. Haines (1996) also surveyed students to find out which sources of health information were viewed as the most believable. The results showed that students believed printed material over other media, and health professionals more than peers, friends, or other interpersonal sources. Whether students would view intemet material with the same confidence was uncertain. However, the Risky Business site is accessed from the health clinic page and the health professionals who contribute to the information are credited. Haines (I996) also found in working with focus groups to plan his campaign that the credibility of the message was enhanced by indicating the source of the data. The more scientific the data, the more credible the students rated it. Silly, satirical, cute, or juvenile formats worked against the scientific credibility of the message. The students also felt that photos of students or people who looked like them attracted more attention than any other design element. The work of Wolfe (1998) provides criteria intended to help health-care consumers evaluate Web sites for reliability. Her criteria are also useful in the development of health information Web sites. Similarly to Haines'( I996) rules of message development, Wolfe recommends that the authority of the site creator be considered. Someone with the health credentials of APN or M.D. would be more trustworthy. Wolfe also states that the information is more reliable if the site is sponsored by a trustworthy organization. A university, college, or government agency are examples of organizations one could trust. Wolfe suggests that the grammatical accuracy of the site information may be a reflection of the accuracy with which the author compiled the medical information. Citing the references used in site development lends credibility to the reliability of the information provided. The completeness of the information presented refers to coverage, another criteria for evaluation of site quality. The relevance of the site page can be considered in relation to the stated purpose of the page as well as the usefulness of the information for the targeted population. Another criteria to consider in developing a health information web site would be how current the site is, when it was developed, and how recently it was updated or reviewed. A final criteria in Wolfe's work is termed usability which refers to the ease with which the site can be navigated, the logical arrangement of the content, and the quality of site graphics. In order to attract and keep the college student's attention, the health risk assessment Web page incorporates pictures of typical Hope College students engaged in 26 various behaviors. Information is provided about the site author, including her credentials, as well as the date the site was created. As previously mentioned, the site is accessed from the HCHC page which reflects college support for the information in the site. The scientific sources of health information contained in the site are clearly credited. Health topics are covered succintly. A visitor desiring more information can use active hyperlinks to reliable sites. The format is simple. Students are asked 23 questions related to the targeted health risk behaviors. Each question can be answered either yes or no. Based upon their answers, the student will receive responses which either affirm their health behaviors or indicate risks associated with their behaviors. Risky behaviors are addressed and alternative healthy behaviors are suggested. Reliable Web links for further information about each behavior are included. In this format, the intemet user can use health information to predict personal health outcomes associated with both risky behavior and health promoting behavior. Internet use can be anonymous. The privacy of those who access health information on the proposed Web site will be maintained. However, mention will be made on the Web page of the intent to count the number of those who access the site to assess the value of this medium for educational purposes. Assessing Risky Behaviors The link to this site was named Risky Business. This name was chosen in the hope that college students who were involved in risky behaviors might be drawn to a site which implied that content might be interesting to them. An overview of content development of the Risky Business Web site follows. Eating Habits The review of literature identified body image as the priority health concern of college students and poor dietary patterns as a frequent problem in this population. There are six questions relating to eating habits. The first four questions assess whether overall dietary patterns meet guidelines of the US Preventive Services Task Force (USPSTF, 27 1996). The last two questions assess satisfaction with current weight and indications of eating disorder behaviors. The response begins with a general statement about the impact of a healthy diet on overall health, appearance, energy, and mood. The food guide pyramid provides a visual cue to guide daily dietary needs. A response indicating a general dissatisfaction with body weight results in information about criteria for healthy body weight, including an interactive tool for assessing body mass index. Information about weight loss programs is provided through a link with the National Institute of Health. The hours of availability as well as the free services of the health clinic nutritionist are explained. A response indicating eating disorder behaviors is followed up with information about available campus help through the counseling and health centers as well as Web links for further information. Exercise I-I_abits The first three questions relating to exercise behaviors assess the exercise patterns of the college student in relation to the guidelines from the US Preventive Services Task Force (1996). The fourth question assesses students use of steroids to enhance strength and performance. Responses begin with a general statement about the multiple benefits of exercise for disease prevention and health promotion with an emphasis on concepts critical to this population (appearance, weight, energy, stress, and performance). Responses indicating deficiencies in exercise patterns will elicit information about aerobic exercise, flexibility and strength training, and the availability of free campus resources to pursue exercise. This removes the cost barrier identified in the literature review. A concern with physical fitness was identified in the literature review as a significant health concerns of the college student population. A response indicating use of steroids is followed with information about the risks of steroid use and the availability of confidential advice in the health clinic. Further resources relating to exercise can be found through the links provided at the end of this section. 28 Alcohol and Other Drug Use The literature review identified alcohol use and abuse as a major problem in the college population. The interrelationship of alcohol use with other risky behaviors was also established (Prendergast, I994; Wechsler et al., 1994). The first question in this section assesses whether a student uses any alcohol or drugs. The next four questions determine signs of alcohol abuse. These questions assess health risks related to chronic alcohol consumption and frequent binge drinking. The CAGE (Ewing, 1984) and AUDIT (Saunders, Aasland & Babor, 1993) screening tools are well established questionnaires for use in the adult population. However, these questionnaires have been challenged for use in younger populations because younger people are less likely to manifest the symptoms of physical dependence appearing on questionnaires designed for adults (Brower & Severin, 1997). An adolescent specific questionnaire was viewed (POSIT, 1991) but this tool was far too lengthy at 16 questions to fit the design objective of this project. The abuse behavior of concern in this population has been defined in the literature review as binge drinking. The goal of the questions selected was to differentiate students at risk for health problems related to binge drinking versus moderate alcohol use. The US Department of Health and Human Services (DHHS) defines moderate drinking as no more than two drinks per day for men and no more than one drink per day for women (Brower & Severin, 1997). There were variations in the literature about the exact definitions of binge drinking behavior, but the DHHS recommendation to screen for at-risk drinking as more than three drinks per day for women, and more than four drinks per day for men guided this project. For simplicity, a single question related to amount per occasion assesses both genders, but information in the response will differentiate gender specific guidelines. In assessing chronic abuse potential, the limit was set at 7-10 drinks per week instead of the DHHS guideline of 12 per week because of discrepancies in the literature about what constitutes heavy chronic use in this age group (Prendergast, 1994; Brower & Severin, 1997; USPSTF, 1996). Two questions, one each from the CAGE and AUDIT screening tools, 29 were adapted for use in this project. These questions assess a student's feelings of guilt or shame, and loss of memory of the drinking event. Answering yes to either of these questions is further evidence of problem alcohol use. The last two questions in this group relate to the well documented health risks of combining alcohol or other drug use with driving. Strong warnings about these behaviors are combined with advice about techniques for avoiding this lethal combination of risky behaviors. Smoking Habits Five questions were used to address smoking behaviors, level of nicotine addiction, and desire to quit smoking. The Fagerstrom Test (as cited in Smith, Pomerleau, & Wadland, 1997) is a six question test commonly used to assess nicotine dependence. This tool was evaluated for use with this project. However, the computer programming to incorporate this type of test was complicated. The tool would be most useful in helping a health practitioner to determine the level of nicotine dependence in an identified smoker in order to plan appropriate interventions. Since the primary goal of this project is to provide a cue to action, it was decided by this researcher that self-assessment of level of nicotine dependence could be accomplished with two questions rather than the full six used in the Fagerstrom Test. Smoking more than 20 cigarettes per day and smoking within 30 minutes of waking in the morning are indications that someone has an addiction which may require medical intervention for successful smoking cessation (Smith, Pomerleau, & Wadland, 1997). Students who indicate smoking at a level considered to be less than addictive are provided with information about the risks of any tobacco use, the benefits of quitting, side effects of quitting, and practical stop smoking tips. Student responses indicating addictive use will receive this same information as well as additional information about medications to improve the success rate of smoking cessation efforts. Web links are provided which address smoking cessation along with frequently asked questions and answers about smoking. The question of desire to quit could be most useful in planning health interventions. 30 Sexual Health There are only three questions relating to risky sexual behaviors. College administrators and public relations personnel carefully scrutinized the content in this area because of the moral and value implications involved with human sexuality. An attempt was made to incorporate Christian beliefs without alienating students who may have different values and beliefs. A general statement about the value of abstinence is presented to all responders. If a student indicated they were sexually active, they were questioned about the use of contraceptives to prevent unintended pregnancy. The student is also asked whether they take steps to prevent STDs. Students whose responses indicate they do not use contraceptives are provided with information about unintended pregnancy rates in their age group as well as a site link for contraceptive information. The services of the health clinic are discussed, including the availability of a gynecologist to provide women's health exams. If a student's response indicates sexual contact without protection from STDs (ie. condoms), information about the risk of STDs in this age group is provided along with the prevalence rates for STDs and health consequences of STDs. The availability of STD testing at the health clinic is also discussed. Web links for further comprehensive information about STDs are provided. W The behaviors of concern in this project are driving without a seat belt and biking without a helmet. These behaviors are related to motor vehicle accidents, the leading cause of death in this population as evidenced by the literature review. If students indicate either of these behaviors, information is provided about risks in this population related to traffic accidents and the improved survival rates with seat belt use. While no data is presented about the prevalence of head injuries from bicycle accidents or motorcycle accidents in this population, the improved survival rates in either of these types of accidents with helmet use is provided. 31 Proiectflaluation Project evaluation is in questionnaire form. At the end of the assessment and feedback responses, seven questions solicit information regarding understanding of the information presented, ease of site use, helpfulness of site links, and trust in the reliability of site information. Students are also asked if they would like to see information on the site condensed or expanded. The hit count which indicates the number of site visitors will also be used to evaluate the effectiveness of this tool in reaching a large percentage of the college population. NURSING IMPLICATIONS There are multiple nursing implications for the use of the health risk assessment Web site in the college health setting. The Web site can assist the APN in education, research, and administration. The APN as Educator APNs have a great interest in furthering the education of clients. During the college years, Hope students are learning at an accelerated rate about a vast array of topics. Health education may not be of the greatest interest to them considering the wealth of information they deal with on a daily basis. Yet as mentioned earlier, the decisions they make or fail to make about health behaviors can have a significant impact on their current and future health. APNs need to continue to look for innovative ways to reach this at risk population. APNs practicing in the college health setting see many students for reasons both related to and unrelated to health risk behaviors (Wright, 1996). As previosly mentioned, the United States Preventive Services Task Force Guide to Preventive Services (USPSTF, 1996), the American Academy of Pediatrics' Clinician's Handbook of Preventive Services (American Academy of Pediatrics, 1994), and the American Medical Association's Guidelines for Adolescent Preventive Services (American Medical Association, 1994) all recommend that adolescents be counseled at every encounter about their health risk behaviors. The APN in the college setting attempting to provide appropriate preventive education to each student is limited in this effort by time. Each student appoinment is scheduled for approximately 20 minutes. The intemet site can be a convenient resource for the busy APN for professional inquiry, as well as a referral source for clients needing 32 b) 'u-J further screening and information. The intemet site could be modified for use while waiting for an appointment. A waiting room computer terminal could provide immediate printouts of selected information. Research indicates that repeated counseling messages regarding adolescent health risk behaviors are much more effective than single attempts to motivate behavioral change (Steiner & Gest, 1996). Steiner and Gest's research suggests that adolescents may be more willing to discuss health risk behaviors formerly viewed as taboo if they have been counseled about their behaviors in the past. If the APN directs a student to use the Risky Business site for health risk assessment, future joint discussions may be more productive. This may make one-on-one education which is limited by time constraints more efficient. Haines' work ( I996) reminds the APN to consider the mood of health education. The playfulness of this age group might make it feasible to generate activity at the HRA site by publishing clues in the student newspaper, encouraging site browsers to find specific information in the Web site and report to the health clinic for a prize. A contest could be held and prizes awarded for correctly answering a health quiz based on site information. Specific health behavior questions of concern to site users could be addressed by having an e-mail address or link at the end of the site which would forward questions to the APNs. The information obtained from the evaluation of the site could be used in planning future educational programs. There may be a lack of awareness among health care providers about the use of computer technology in the health care setting. The APN using a health assessment Web site such as Risky Business can educate other professionals about the benefits and feasibility of using this technique in their personal practice settings. The APNas Researcher The APN has the responsibility of advancing knowledge through research. Since little research has been done in evaluating the intemet method of health risk assessment as well as intemet sites as cues to action, APNs can use research skills to advance work in 34 this area. With the current project, data will be gathered which will inform health clinic staff of the volume of intemet users who access this site. The site could also be modified to determine the percentage of users that complete the entire questionnaire and receive the feedback information. Information obtained from users after they access the site should be used to guide site modifications as indicated by feedback data. Another option would be to develop a feedback questionnaire to be mailed out to students to assess student response to the site. Areas of interest to evaluate include the ease of site use, the perceived value of the information provided, the level of student confidence in the reliability of the information provided, and the perceived value of the intemet links for more in depth health information. Longitudinal studies would be helpful in determining if changes in health beliefs and health behaviors occur as a result of the health risk assessment. In the future, it is possible that the site could be modified to gather demographics, statistics and risk data. This would enable programs to be developed which would address risks specific to the Hope College population. However, this would require testing the assessment tool for reliability and validity. Also, the ethical issues of gathering information from students require that they be notified of the intent to compile data from their answers. One of the concerns in using the Risky Business Web site to gather data is the difficulty of safeguarding the anonymity of the sample. The technological component is also more complicated with data collection. As new health information and research is published, the site can be easily changed to reflect the most current data. For instance, recent CDC data indicate the rate of teenage sexual intercourse has gone down for the first time in many years ("Poll shows decline", 1998). Highlighting this information gives credence to the social norm of making good health decisions. Publication of this information on this site shortly after release to the public affirms that the site is current. '9.) U1 The APN as Administra_to_r College administrators and APNs share the dual goals of reaching students during their years of higher education and reducing health risk behaviors among them. Equipped with knowledge of health promotion and disease prevention, the APN is able to assist with the development of policy in these areas. Funding targeted towards health promotion and disease prevention will be easier to obtain if the APN continues to present research which justifies the need for such expenditures as well as demonstrates the effectiveness of such efforts. Developing policy to maintain student safety as well as planning health education curriculum is within the scope of the APN's practice. CONCLUSIONS The design of a Web site to allow self risk assessment in the college student population is postulated to provide a cue to action to increase the likelihood of educated decision making about engagement in risky behavior. It is hoped that increasing the access to health information specifically geared to the college student intemet user may significantly decrease the frequency with which they engage in self-destructive behavior. Providing information about available resources for dealing with identified health problems related to risky behaviors may decrease the morbidity and mortality associated with adolescent behaviors. This project will not be able to demonstrate such results. The effect the information has on the behavior of those who access the site will not be measured. However, accurate information has been shown to affect perceptions, perceptions affect decision making, and educated decisions may produce better health outcomes for college students. While much work remains to be done to decrease the health problems in this age group, the Risky Business Web site is one more piece in the complicated puzzle of health behavior change. 36 LIST OF REFERENCES Adler, N. E., Kegeles, S. M., Irwin, C. E., & Wibbelsman, C. (1990). Adolescent contraceptive behavior: An assessment of decision processes. Journal of Pediatrics, I 16(3), 463-471. American Academy of Pediatrics. (1994). 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Nicotine and smoking. In D. J. Knesper, M. B. Riba, & L. Schwenk (Eds.) Primag Care Psychiatg (pp.295-308). Philadelphia, PA: W. B. Saunders. Soloway, E. & Wallace, R. (1997). Does the intemet support student inquiry? Don't ask. Association for Computing Machinery, 40(5), 11-16. 42 Steiner, B. D., & Gest, K. L. (1996). Do adolescents want to hear preventive counseling messages in outpatient settings? Journal of Family PLactice, 43 (4), 375-381. Takanishi, R. (1993). Changing views of adolescence in contemporary society. T_eachers College Record, 94 (3), 459-465. Tinsley, B. J., Holtgrave, D. R., Reise, S. P., Erdley, C., & Cupp, R. G. (1995). Developmental status, gender, age, and self-reported decision-making influences on students risky and preventive health behaviors. Health Education Quarterly, 22 (2), 244- 259. U.Sg)reventive services tax force guide to clinical preventive services (2nd ed.).( 1996). Baltimore, MD: Williams & Wilkins. US. Surgeon General. (1989). Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. (DHHS Publication No. CDC 89- 8411). Washington, DC: US. Government Printing Office. Wechsler, H., Davenport, A., Dowdall, G. Moeykens, B., & Castillo, S. (1994). Health and behavioral consequences of binge drinking in college: A national survey of students at 140 campuses. Journal of the American Medical Association 272 (21), I672- 1677. Wolfe, G. (1998). Development of a web site to provide information to health-care consumers on the basics of evaluating information on the worldwide web. [ On-line]. Available: www.msu.edu/~wolfegay. Wright, S. (1996). Alcohol abuse among college students: Implications for nurse practitioners. Journal of the American Academy of Nurse Practitioners 8 (10), 483-488. Yep, G. A. (1993). HIV prevention among Asian-American college students: Does the health belief model work? Journal of American College Health, 41 (3), 199-205. Yoder, L. E., Jones, S. L., & Jones, P. K. (1983). The association between health care behaviors and attitudes. H_ealth Values, 9(4), 24-31. APPENDIX 43 Hope College Health Clinic home pagEQ about hope Q admissions Q academic deptSQ affiliations Q athletics Q calendars & events Q campus officesd campus hospitalityQ van wylen libraryQ alumniQ public relationSQ search Q knowhopeQ http://www.hope.edu/admin/healthclinic/ HEALTH CLINIC Welcome to LifeLines the Home Page of Hope College Health Services . In formation - regarding our hours, fees, services,and staff. . Ask I.i l‘iel.in€S - where questions of interest to students and/or questions commonly asked by students, will be answered by Health Service medical and nursing staff. . "Wellness Notes" - where every other week a new topic related to college health will be briefly reviewed. . Risky Business - where you can go for several personal lifestyle assessments. Also check here for information about other health-related websites of interest to Hope students. *I'l‘l‘lflllupe College, llnllanrl. .N-lichigan, 40423, USA. (616)105-786II Hope College Health Clinic: Risky Business http://www.hope.edu/admin/healthclinic/risky/ RISKY BUSINESS home page Q about hope Q admissions Q academic deptSQ affiliatior15Q athletics Q calendars & eventsQ campus officesfl campus hospitalityQ van wylen libraryQ alumni Q public relationsQ search Q knowhopeQ How does your current lifestyle and behavior impact your personal wellness? The purpose of these pages is to help students like you become aware of the risks associated with your personal behaviors which may impact your success today as a college student as well as your current and future health. By taking these quick, confidential 1 minute tests, you can self-assess your own, individual health risks. Immediate research based feedback will be provided after you complete the self-assessment. Information is included about resources available to help with health concerns. Related web links can be found at the end of each page. Self-assessment using this format is completely confidential. The number of "hits" on this site will be counted to assess the use of this format, but site visitors cannot be identified. Good health is at the center of everything that is important to you. Find out how to improve the quality of your life and maybe add years to your life. Note: The information on this web page is for informative purposes only and does not substitute for professional advice. The information provided should not be used for diagnosing or treating a health problem or disease. If you have a health problem, you should consult your health care provider. Hope College Health Clinic: Risky Business http://www.hope.edu/admin/healthclinic/risky/ 0 Eating Habits o Smeking Habits . Exercise Habits 0 Sexual Health . l‘ohol an he“ run. 0 ‘ lf- "Ire l-bit. When you are finished, please consider spending a few more minutes to evaluate this tool. For more irjbrmation about this sits: @1998 Hope College, Holland, A-Iichigan, 49423. U.S.A. (616) 395-7860 Hope College Risky Business: Eating Habits LLth; 1.. t, http://wwwhope.edu/admin/healthclinic/risky/eating.html RISKY BUSINESS home paged Eating Habits about hopeQ admissionsQ Do ou academic deptsQ y affiliationsQ 1. generally eat at least 3 meals a day? athletics Q 0 Yes 0 No calendars & events ‘ 2. 3de9mpt to eat foods from each of the food groups every campus officesd 5y?“ 0 No campus hospitalityQ 3. choose high fiber foods such as whole grain breads, van wylen libraryd cereals, fruits, vegetables, and dried beans each day? alumniQ OYes ONO l' l - 4. limit high fat/high cholesterol foods such as red meats, pub 'c re anon: ‘ eggs and fried foods, choosing fish, poultry without skin, sear c ‘ lean meats, and low-fat milk/cheeses instead? knowhopeQ OYes O No 5. generally feel satisfied with your weight? OYes ON 0 6. have a pattern of eating binges followed by self-induced '- l ( purging (using vomiting, laxatives, or diuretics)? OYes ONo ' ”HON Am'I Doing? II Reset Form I "I'I‘Iii I lope CIIIII‘lLI‘, IIHIIIIIHI, Alitllillrttl, 4943?}, l.l.S..-\. .6161 "I‘l‘i-TIIIIII Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi RISKY BUSINESS home paged Eating Habits about hopeQ d o I a T's-5mm" General Statement academic deptSQ affiliations 4 Eating habits over a lifetime have a very significant impact on your athletics ‘ health. Appearance, energy, and mood are all enhanced with a well-balanced diet. All of the nutrients needed for optimum calendars 8‘ “ems ‘ functioning are available through the foods you eat. campus officesfl campus hospitalityQ van wylen libraryQ alumniQ public relationsQ searchQ Many combinations of food can lead to a well-balanced diet. The food guide pyramid is an outline of what to eat each day based on dietary needs. It helps you to choose a healthful diet that is right for you. Basically, start with plenty of rice, breads, cereals, vegetables, and fruits. Add 2-3 servings from the meat group and 2-3 servings from the milk group. Remember to go easy on the fats, oils, and sweets, the foods from the small tip of the pyramid. fats. Oils .9 Streets LSE 8PM“ _f Mull. Yogurt, 8 Cheese Group 2-3 SERVING? Heat. Poultry. Fish. Dry Beans, Ems. & Nuts (imup 2-{1 SER‘E'INGS Vegetable Group ’ 'r' .“ _ Frail (sump 3-5 SERVING? If. . . ,1 _‘ . - ' ' 2-4 MINING? Broad. Ger-ea]. Nice. I Ma (i'oup (H I 8mm Your Results 0 Your responses indicate your present eating habits place you at nutritional risk. Your daily food choices point to nutritional deficiencies or excesses that can impact your Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi present and future health. It is time to re-evaluate your dietary practices and seek out assistance from the resources available at Hope College. Information is available in the health clinic. You may also schedule an appointment with Sheila Kennedy, a registered dietician who can be contacted through the health clinic. Call 395-7585. Your response indicates you may have a pattern of skipping meals. Instead of promoting weight loss, skipping meals actually makes one's body more efficient at storing calories by slowing the metabolism. Consequently, skipping meals may make weight loss more difficult. Eating regular balanced meals helps to stabilize weight and metabolism, and controls extreme hunger which so often results in overeating or making poor food choices. Your response indicates you could improve your diet by selecting foods from all the major food groups every day. No one food supplies all the nutrients needed for good health. To get all the nutrients you need on a daily basis, learn to eat a balanced diet as recommended with the food guide pyramid. Your response indicates your diet may be too low in fiber. A wide variety of fiber-rich foods such as oatmeal, cereals, brown rice, beans, peas, lentils, and fresh fruits and vegetables should be included in your diet every day. Inadequate fiber has been linked to a number of diseases, including heart disease, obesity, diabetes, and some forms of cancer. Your response indicates your diet may be higher in fats than is recommended. Reduced intake of dietary fat, especially saturated fats, reduces the risk of coronary heart disease. Heart disease is the leading cause of death in the United States. Students at Hope College have the opportunity to have cholesterol levels measured in health dynamics class. Knowing your cholesterol level gives you an idea of how well your body metabolizes the fats you ingest. The American Heart Association recommends limiting your fat intake to less than one third of your total calories. One way to track fat calories is to read food labels and try to select foods whose fat content is responsible for less than 30% of the total calories. The AHA. also recommends that saturated fats be limited to less than 10% of total calories. Cholesterol should be limited to less than 300 mg per day. To achieve these goals, try to eat more fish, poultry without skin, leans meats, and low-fat dairy products. Your response indicates you generally feel dissatisfied with your weight. It is important to be realistic when evaluating one's weight. Psychosocial pressure for thinness can distort one's view of healthy weight goals. The criteria for healthy body weight can vary somewhat, but body mass index (BMI) is a helpful and widely accepted tool for assessing whether you are in your desirable weight range. BMI of less than 20 is a health risk for being underweight. BMI of 26-29 is at Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi risk for being moderately overweight and BMI of > 29 is considered very overweight. 0 Click here to determine your body mass index If you feel you need to lose weight and want to plan a successful weight loss program, help is available through the health clinic. Appointments can be scheduled with Sheila Kennedy, a registered dietician, by calling 395-7585. Sheila is available on Thursdays for counseling and also works with the food service on campus and will be able to advise students on meal-planning while at Hope as well as teaching lifelong healthy eating habits. 0 Click here for weight loss information . Your response indicates you may be at risk for developing eating behavior problems. College life can be more stressful than home life and can exacerbate disordered eating patterns. Disordered eating behaviors such as bulimia and anorexia are psychologically dangerous. They can also cause multiple physical problems which may become life-threatening. However, these behaviors can be changed. At Hope, confidential help is available through both the health clinic (395-7585)and the counseling center(395-7945). Sometimes medication is helpful, but often counseling and nutritional support are the most effective. An eating disorder support group may be organized through the counseling center again this year. If you are suffering with any of these symptoms, do not hesitate to ask for help. Many students have taken advantage of the help available during these years to deal with these problems and some of them are willing to talk with current students. Web links for further information: Take some more quizzes: 0 Eating Habits o Smeking Habits . Exercise Habits 0 Sexual Health. o Aleehel and Othe: Dmgs . Self-Ca re Ha bits When you are finished, please consider spending a few more minutes IQ evaluate this 1,991. @1998 Hope College, Holland, Michigan, 49423, U.S.A. (616) 395-7860 Hope College Risky Business: Exercise http://www.hope.edu/admin/healthclinic/risky/exercise.html RISKY BUSINESS 4 home pageq Exercise Habits about hopeQ admissionsQ , Do you... academic deptsQ affiliationsQ l. engage in 30 minutes of moderate intensity exercise on at athletich least 3 days of the week? calendars & eventsQ OYes . O NO. . . . , 2. engage In a routine to maintain or Improve strength at least campus officesfl twice a week? campus hospitalityQ 0 Yes 0 No van wylen libraryd 3. engage in a routine to maintain or improve flexibility at alumni ‘ least twice a week? ublic relations OYes .0 N0 p T 4. use sterords to enhance strength and performance? search Q OYes ONo knowhopeQ s“““‘a3;‘a;. TESIEIETW“ .‘i "iiié'é'éEMEcs'Einw S‘I‘I‘Ii’i I IIIPt‘ (trilogy, IIIIlIdIII'I. .\li(lri:;r'!."l, 491-123, I,.I..'S.:\. it'r'llii- fI‘IS-Tiilill Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi RISKY BUSINESS home pageQ about hopEQ admissions Q academic deptsQ affiliationsQ athletics Q calendars & events Q campus offices! campus hospitalityQ van wylen libraryQ alumniQ public relationSQ search Q Exercise General Statement The physical and psychological benefits of exercise are well established. Regular vigorous exercise can greatly reduce a person's risk of heart disease, hypertension, obesity, diabetes, osteoporosis, and mental health disorders. Exercise can make a person feel and look better, improve muscle tone and flexibility, help control weight, increase energy, promote better sleep, decrease stress, and ultimately improve performance of daily activity. Your Results . Your response indicates your level of aerobic exercise is too low to benefit your heart and lungs. With regular exercise, you can improve your long-term health. Any type of exercise provides some degree of benefit. No clear minimal intensity of physical activity required for benefit has been defined. However, the greatest benefits from exercise are obtained with daily, sustained (for at least 30 minutes), large muscle exercise (such as running, walking, swimming, aerobic dance, skating, biking, rowing, and cross-country skiing). The exertion level should be such that your heart rate is 80% of your maximum heart rate. A simple method to calculate this rate is to subtract your age from 220 and multiply that number by 80%. For example, an 18 year old's goal: 220-18=202 202x .80=162 beats per minute This person should try to work out at a heart rate of 160 beats per minute. 0 Your response indicates you may be able to improve muscle tone, maintain joint flexibility, and build endurance with additional workouts. To guard against aches and injuries to Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi muscles and joints, do stretching exercises 3 or more times a week. Stretch every part of your body slowly, without bouncing, and without crossing the "line of pain". Hold each stretch for 20-30 seconds. Always stretch after vigorous activity. Major muscle groups can be strengthened with resistance training such as calisthenics or weight lifting. A reasonable goal is to work out twice a week doing 8 exercises that work major muscle groups. Each exercise is repeated 8-12 times. The Dow center has a weight room, indoor track, pool, and stationary bikes. An experienced staff can help you plan a fitness program. Take advantage of this great facility and service while you are a student at Hope to develop fitness habits to last a lifetime. Your response indicates you have used steroids. Steroids can be harmful at any level of usage. The more frequent the use, the greater the risk of kidney damage and other health problems, such as: I” deterioration of the testes, decreased sperm production, and impotence. acne and early hair loss. elevated blood pressure and early heart disease. possible liver tumors and failure of liver function. stunted growth and permanent short stature in children and teenagers. increased aggressive behavior. EDP-PF" Z"? Other than to treat disease under medical supervision, no use of steroids is acceptable. If you have firrther questions about this, arrange for a confidential interview in the health clinic. Call 395-7985. Further information about exercise can be obtained through the following links: o HealthAnsweIs Exereise Take some more quizzes: 0 Eating Habits 0 Smoking Habits . Exereise Habits o xr l ealtl . Aleehel and Other [hugs o Self-g fa re Habits When you are finished, please consider spending a few more minutes to evaluate this teol. ("1998 Hope College, Holland, A-lichigan, 49423, U.S.A. (616) 2395-7860 Hope College Risky Business: Alcohol and Other Drugs http://www.hope.edu/admin/healthclinic/risky/alcohol.html RISKY BUSINESS ‘ I‘D»? frCDFI-t'oi om pages Alcohol and Other Drugs about hope Q admissionSQ Do ou academic deptSQ y affiliationsQ I. avoid using any alcohol or drugs? athletics Q 0 Yes 0 N o calendars & events ‘ 2. dank morghan 7-10 drinks per week? ff- Yes No _ campus 0, IcesQ 3. drink more than 3 drinks per occasron? campus hosprtahtyQ OYes O No van wylen libraryQ 4. experience blackouts (loss of memory) after drinking alumniQ alcohol? public relations Q 0 Yes 0 No search ‘ 5. gigggence guilt/anxiety/shame after using alcohol or other knowhope Q 0 Yes 0 No 6. operate motor vehicles when under the influence of alcohol or other drugs? 0 Yes 0 No 7. ride with vehicle operators who are under the influence of alcohol or other drugs? 0 Yes O No I How Am I Doing? Ii Reset Form—“l ’- "1991} l lope College, Holland, .‘Nlitllitldll, 4042”,, ILSA. (616} i'I‘Ifi-Tt'dfll Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi RISKY BUSINESS home page Q about hoPEQ admissions Q academic deptsQ affiliationsQ athletics Q calendars & events Q campus officesfi campus hospitalityQ van wylen libraryQ alumni Q public relationSQ search Q General Statement Every individual must make important personal choices regarding the use of alcohol. Underage drinking and use of street drugs are behaviors which Hope College does not support. However, for students who are 21 or older it is important to be knowledgeable about the potential effects of alcohol in order to avoid the risky behaviors which lead to alcohol abuse. Any amount of alcohol affects the way the brain works. At low levels, alcohol is more of a stimulant because it depresses the inhibitory centers of the brain. At higher doses, alcohol is a depressant which means that it slows down the nervous system. Alcohol affects almost every organ system in the body. Short term use can cause nausea, vomiting, and headaches. Longer use can cause serious irreversible brain damage, liver disease, heart disease, ulcers, and cancers. Substance abuse and dependence affect between 17 and 27% of Americans over their lifetime. In addition to the physical problems, multiple social problems are associated with substance abuse. Your Results . Your response indicates you have a pattern of drinking or other drug use that places you at risk for multiple adverse consequences. Drinking more than 4 drinks per occasion for men, or 3 drinks per occasion for women is considered binge drinking. This behavior is associated with: Getting hurt or injured (23%) Damaging property (22%) Getting into trouble with authorities (11%) Doing something you regret (63%) Missing classes(61%) Getting behind in schoolwork(46%) Engaging in unplanned sexual activity(41%) Driving under the influence(74%) OOOOOOOO Hope College Risky Business http:.l/www.hope.edu/admin/healthclinic/risky/risky.cgi 0 Riding with a driver who was drunk( 51%) (Source:Wechsler et al., (1994). Health and behavioral consequences of binge drinking in college. W (21),l672-1677.) Individuals with an alcohol disorder have a sixfold greater prevalence of another drug disorder than those who do not have an alcohol disorder. Any illicit drug use has potential for great physical and social harm. If you have questions about the physical effects of illicit drug use, click on this link for more information. If you have identified yourself as possibly having a problem with alcohol or drug use, you are encouraged to seek help soon to prevent both short and long term consequences. Early treatment may prevent major problems in the future. Confidential help is available through both the health clinic (395-7585) and the counseling center (395-7945). Local help is also available through Alcoholics Anonymous. Call 392-3360. 0 lick here 0 Click here to link with the National Institute on Alcehel Abuse and Aleebelism Your response indicates you are at great risk of serious or even fatal harm. Accidents are the number one cause of death for people in your age group. Mixing drinking and driving places you at great risk of dying in a motor vehicle accident. Alcohol abuse contributes to almost half of motor vehicle fatalities, the most important cause of death among young Americans. (Source:Wechsler et al., (1994). Health and behavioral consequences of binge drinking in college. IAMAZZZ(21),1672-1677.) Take no more chances with your own or someone else's driving. If you have consumed alcohol and feel any effects from it, wait at least 1 hour before driving. If you are out with friends, choose a person who won't drink on this occasion to drive for those who do. For your own safety as well as others on the road, do not drink and drive or ride with someone who does. Take some more quizzes: Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi 0 Eating Habits o Smeking Habits o Exereise Habits . x ' H 'II 0 Alcohol and Other Drugs 0 Self-Care Habits When you are finished, please consider spending a few more minutes to cvzlrluatc this tool. Irif‘1998 Hope College, Holland, Michigan, 49423, U.S.A. (616) 305-7860 Hope College Risky Business: Smoking home page Q about hope Q admissions Q academic deptsQ affiliations Q athletics Q calendars 8: eventsQ campus officesQ campus hospitalityQ van wylen libraryQ alumni Q public relations Q search Q knowhope Q http://www.hope.edu/admin/healthclinic/risky/smoking.htrnl RISKY BUSINESS Smoking DO you... 1. Smoke cigarettes? OYes ONO If you smoke, do you... a“ l --. 2. 3. smoke less than 20 cigarettes per day? OYes ONO smoke more than 20 cigarettes per day? OYes ONO . have a cigarette within 30 minutes of waking in the morning? OYes ONO . desire to quit smoking? OYes ONO w-o--. A...-.--~-.MI-‘.a- _--~-. . -. -:-.o- .g- ..z-_ .w-.-- .How Am I Doing? I; Raset Form 1 "1319918 I Illpt‘ College, lltIlIaIIt'I, \lir lri;;..r'r, 4'i-l'.’ ‘I, l!.S..-‘\. {616? jl‘l'I-TIIMI Hope College Risky Business home page Q about hopeQ admissions Q academic deptsQ affiliationSQ athletics Q calendars & eventSQ campus OffiCES‘ campus hospitalityQ van wylen libraryQ alumni Q public relationsQ search Q http://www.hope.edu/admin/healthclinic/risky/risky.cgi . Your response indicates that your use of tobacco may have reached the addictive level. The longer your use continues, the harder the habit is to quit, and the greater your risk Of developing associated health problems. Each day, approximately 6,000 teenagers try their first cigarette, and half Of them go on to become daily, long-term smokers. The Centers for Disease Control and Prevention estimates that about 5 million persons who were younger than age 17 years in 1995 will die prematurely from smoking-related illness. More than 82% of adult smokers report starting to smoke before the age of 18 years. (Source: The Great American Smokeout. MMWR. 1996;45: 961-974.) Tobacco in any form contains nicotine, one Of the most addictive, dependency-causing drugs known. Milligram for milligram, nicotine is 10 times more potent than heroin. Nicotine enhances mental functioning while producing a calming effect. Unfortunately, nicotine use has numerous well-documented other effects. Cigarette smoking is the most devastating preventable cause Of disease and premature death in the United States. 0 Smoking accounts for more than 30% Of all cancer related deaths. 0 Cigarette smoking significantly increases the risk Of heart disease. This is true for those who smoke as little as 4 cigarettes per day. 0 Peptic ulcer disease, cataracts, reduced fertility in women, osteoporosis, ow birth weight babies, and complicated pregnancies are also associated with smoking. (Source: Herfindal, E.T., & Gourley, D.R. (Eds.) W W (6th ed.). Baltimore: Williams & Wilkins.) Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi Are you ready to stop smoking? 0 Click here to learn about methods to stop smoking. You may be able to quit on your own, but a stop-smoking program can also help. Several programs are available locally. At Holland Community Hospital's Center for Good Health, four individual sessions are available for a fee (maximum Of $65, dependent on financial need). Call 394-3344. At Ottawa County Health Department, 8 group sessions are available for $65. Call 393-5772. Your pattern Of tobacco use indicates significant addiction. Medications combined with professional counseling are most effective for people addicted to nicotine. Recent data indicates that treatment with nicotine patches or nicotine gum may double or triple long-term cessation rates. Before using patches or gum, remember to stop all nicotine products to avoid nicotine toxicity. The patch must be used on clean, dry, skin sites that are alternated daily. The patch is generally used for 6-8 weeks over which time the dosage Of nicotine is weaned. Nicotine gum should be chewed slowly to allow absorption.The gum may be used for up to 3 months. W . These medications are approved for use to aid in smoking cessation. They may be used in combination with the nicotine patch. These medications need to be started 2 weeks prior to attempting to quit. The medications are used for 7-12 weeks and require a prescription. The following web—sites may also be helpful: 0 ,ii in T 'c se 0 itin'n 1w ' u likan Take some more quizzes: o Ea ting HabltS o stkillg Piflbllfi . Exercise Habits . Sexual Health lcoh l'ni th me o Self-Care Habits When you are finished, please consider spending a few more minutes IQ evaluate this $952!. Hope College Risky Business: Sexual Health http://www.hope.edu/admin/healthclinic/risky/sex.html RISKY BUSINESS “or film... - .- 4 ome pageQ Sexual Health about hopeQ acad:::;::;: 1. Are you sexually active? Yes No affiliations Q 0 O athletich If you are or have been, do you... calendars & eventsQ , 2. use an effective method Of birth control every time? campus officesd campus OSP'ta “Y‘ 3. take precautions to minimize your exposure to sexually van wylen libraryQ transmitted diseases? alumniQ OYes ONO public relationsQ ......-_-_,-- ..---.-...-_,.__.. -._...--- ...-_..- searchQ How Am I Doing? Reset Form I knowhopeQ "I998 I Illpt‘ (SlilItfgt‘, IIHIIMKI, .‘\iiCIIij.‘;.m, 4942‘}, LI.S.:\. Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi RISKY BUSINESS home page Q about hopeQ admissions Q academic deptSQ affiliations Q athletics Q calendars & eventSQ campus officesi campus hospitalityQ van wylen IibraryQ alumniQ public relations Q search Q Sexual Health General Statement For many students, college is a time to examine personal values. It may also be the time of life when sexual desires are very strong. Sexuality is a basic yet complicated part of our humanity. It is critical that discussion of the issues surrounding human sexuality takes place. Decisions with enormous implications for future health and happiness should not be made haphazardly, without knowledge and forethought. At Hope College, the Christian lifestyle is an integral part of the campus community. Casual sexual relations are not consistent with this Christian lifestyle. The Biblical directive to respect and care for others applies to all our human relations, especially to intimate relationships. Choosing abstinence until marriage gives you 100% protection against unintended pregnancy. It can also give you 100% protection from sexually transmitted diseases, including HIV/AIDS. It can give you time to get to know the person you may spend the rest of your life with, allowing the maturation of your relationship without the powerful feelings associated with sexual intercourse. Choosing abstinence now doesn't mean that you stop being a sexual person. Sexuality is more than sexual intercourse and sexual behavior is not an all or nothing thing. The health risks associated with sexual contact may not be well known to the majority of college students. Many students continue to put themselves and others at risk for unintended pregnancy as well as serious or even fatal health problems because of their sexual practices. Hope College Risky Business http://www.hope.edu/admin/healthcIinic/risky/risky.cgi Your Results . Your response may indicate a lack of awareness of the risks involved in unprotected intercourse. Your actions place you at risk for having to deal with an unintended pregnancy. The rates of unintended births among adolescent girls and women aged 15-24 years are higher than any other age group. In 1988, nearly two thirds of the births in this age group were unintended. Choosing to become abstinent is still a choice for you. Perhaps your experiences are prompting you to reevaluate your decision to become sexually active. Abstinence provides 100% protection from unintended pregnancy. If you choose to remain sexually active, there are an assortment of effective contraceptive methods. Some are available over the counter while the most effective methods require a prescription. For women, this usually requires an examination. These exams are available at the health clinic and you can call for an appointment and fee schedule (395-7585). If selecting, obtaining, and using birth control seems too serious, too risky, too complicated, or too embarrassing, you need to think again about your decision to be sexually active. . Your response indicates you are at risk of developing a sexually transmitted disease (STD). Every sexually active adolescent is in the group at greatest risk for acquiring STD's. Men and women under 25 account for two thirds of all cases of chlamydia and gonorrhea. Chlamydia infections can be present without noticeable symptoms, yet jeopardize future fertility. Men and women under 35 account for two thirds of newly reported HIV infection. HIV is the virus which may be present in the body for years without symptoms and then develop into the deadly disease of AIDS. Herpes simplex virus causes a chronic infection which can lead to periodic painful genital blisters. HPV or human papilloma virus is the most commonly diagnosed viral STD in the US. It causes genital warts and is strongly associated with cervical cancer. Unfortunately, persons infected with these diseases may have no visible symptoms. You cannot tell from outward appearances who is infected with a fatal disease, who has only mild disease, and who is not infected at all. Research indicates that of those college students who report being sexually active, only about 25% report consistent condom use. STD's are spread from person to person through close contact and the exchange of body fluids. Consistent and appropriate use of latex condoms reduces (but does not eliminate) the risk of many STD's. While even less effective than male condoms, female condoms and diaphragms with spermicide can decrease the risk of some STD's. Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi If you may have been exposed to an STD, get medical care now. The consequences of SIDS in infected individuals range from mild symptoms treated with antibiotics to the nearly uniformly fatal outcomes of HIV infection. Many STD's can be cured if treated early. The Health Clinic offers confidential testing for and education about STD's. Call for an appointment (395-7585). Further information about STD's o CDC Division ofSTD Treatment and Prevention 0 American Social Health Association site 0 STD Risk Proliler Take some more quizzes: . Eating Habits 0 Smoking Habits 0 Exercise Habits 0 Sexual Health . Alcohol and Other Dmgs o Self-Care Habits When you are finished, please consider spending a few more minutes to evaluate this tool. « '1998 Hope. College, Holland, Michigan, 49423, U.S.A. (616) 1395-7860 Hope College Risky Business: Self-Care Habits home page Q about hope Q admissions Q academic deptsQ affiliations Q athletics Q calendars 8: events Q campus offices‘ campus hospitalityQ van wylen libraryQ alumni Q public relations Q search Q knowhopeQ "519913 I hit»: (:‘iilleg‘x, llt'illt‘mtl, .\li(fil'|ij.‘;.tzt, 49-123, http://www.hope.edu/admin/healthclinic/riskylselfcarehtml RISKY BUSINESS Self-Care Habits Do you... I. wear a seat-belt every time you drive or ride in a motorized vehicle? OYes ONO 2. wear a helmet every time you ride a bike or motorcycle? OYes ONO How Am I Doing? ‘ ll Reset Form I USA. 'JrlhijiUS-7WIGU Hope College Risky Business http://www.hope.edu/admin/healthclinic/risky/risky.cgi RISKY BUSINESS home page Q about hopeQ admissions Q academic deptSQ aifiliationsQ athletics Q calendars & eventSQ campus officesfl campus hospitalityQ van wylen libraryQ alumniQ public relations Q search Q Self-Care Habits General Statement Individual actions play a major part in influencing and maintaining overall personal health. Acceptance of the challenge to develop daily habits which may contribute to good health is everyone's responsibility. Your Results 0 Your response indicates that you resist or are careless about seat belt use. Automobile accidents are the leading cause of death and injury for persons under age 25. Studies have shown that safety belts decrease traffic fatalities by about 50% and the severity of injuries related to traffic accidents. Seat belt use is also a Michigan law. Take this simple precaution every time you ride in a car. 0 Your response indicates you may be taking unnecessary risks while riding a bike or motorcycle. Bicycle helmets reduce head injuries among bicyclists by 63-85%. Head injury rates are reduced by about 40-75% among motorcyclists who wear safety helmets. Click here for more infomiation Take some more quizzes: Hope College Risky Business http:;’/www.hope.edu/admin/healthclinic/risky/risky.cgi 0 Eating Ha bits 0 Smoking Habits . Exercise Ha bits 0 xua alth 0 Alcohol and Other Drugs . Self-Care Habits When you are finished, please consider spending a few more minutes to evaluate this tool. @1998 Hope College, Holland, h-lichigan, 49423, USA. (616) 395-7860 Hope College Risky Business: Evaluation home pageQ about hopeQ admissions Q academic deptSQ affiliationsQ athletics Q calendars & eventsQ campus offices! campus hospitalityQ van wylen libraryQ alumni Q public relationsQ searchQ knowhopeQ '.("19‘)8|I«’i[)e College, Holland, Mirltigan, 4942'}, USA. http://www.hope.edu/admin/healthclinic/risky/response.htrnl RISKY BUSINESS Evaluation . Did you find the assessment easy to use? 0 Yes O No . Did you find the information presented helpful? 0 Yes O No . Did you use any of the suggested links to other intemet sites? 0 Yes O No . Did you find the intemet sites linked with this site helpful? 0 Yes 0 No . Did you trust the reliability of the information you read here? 0 Yes O No . Would you like to see the information on this site expanded? 0 Yes O No . Would you prefer to see the information on this site condensed? 0 Yes O No I Submit Form [Reset Form : {bib} LI‘IS-7Bfil'l Hope College Health Clinic: About Risky Business http://www.hope.edu/admin/healthclinic/risky/about.html RISKY BUSINESS home pageQ about hope Q admissions Q academic deptSQ aifiliationsQ athletics Q calendars & events Q campus officesd campus hospitalityQ van wylen libraryQ alumniQ public relationSQ search Q knowhopeQ About the Risky Business Site A longterm interest in college student health prompted the development of the Risky Business site. The text of the Risky Business site was developed by Jayne D. Pettinga, BSN, while pursuing the degree of Masters of Science in Nursing. The page was completed in October, 1998. The Hope College Health Clinic appreciates the contributions of many individuals in developing the Risky Business site. We especially acknowledge: John Bandstra of Computer Information Technologies for designing the Risky Business Web page. Rebecca VanDyke, also of Computer Information Technologies, for designing the Hope College Health Clinic Web page and providing the technological advice to plan the Risky Business page. John Kermiet, of Olin Health Center at Michigan State University, for sharing LIBRA, the Lifestyle/Behavioral Risk Assessment Tool used on the MSU. campus. Amy Blair, of the Michigan State University Library Office of Outreach Services for providing help with all aspects of this research. References Brower, K. J ., & Severin, J. D. (1997). Alcohol and other drug related problems. In D. J. Knesper, M. B. Riba, & L. Schwenk (Eds.) Win10! (P11309842). Philadelphia, PA: W. B. Saunders. Cowan, F. M. & Mindel, A. (1992). Sexually transmitted diseases in children: Adolescents. WM, 141-147. Douglas, K. A., Collins, J. L., Warren, G, Kann, L., Gold, R., Clayton, 8., Ross, J. G., & Kolbe, L. J. (1997) Results from the 1995 national college health risk behavior survey. Joumalof Ammcanmlsgeflealthfi (9), 55-66. Ewing, J. A. (1984). Detecting alcoholism. The CAGE questionnaire loumaLofAmencmMedicaLAssomanomZfl, 1905- 1907. The Great American Smokeout. MMWR. 1996,45: 961-974. Haines, M- P- (1996). W Hope College Health Clinic: About Risky Business httpz//www.hope.edu/admin/healthclinic/risky/about.html drinkingatsollegesandunixersities (Publication No ED/OPE/96- 18). Washington, DC: US GovemmentPrinting Office. Herfindal, E. T., & Gourley, D. R. (Eds. ) (6th ed. ). Baltimore: Williams & Wilkins. Larson, D. (1997). Smoking cessation. MW] (6) 57-80. Smith, M., Pomerleau, O. F., & Wadland, W. (1997). Nicotine and smoking. InD. J. Knesper, M. B. Riba, &L. Schwenk (Eds.) WHOp 295-308). Philadelphia, PA: W. B. Saunders. v 'v . . . . v 'v mend ed.) Baltimore, MD: Williams & Wilkins. Vanderwater-Piercy, K. (1995). Freedom from smoking. Adyance (10) 41-52. Wechsler et al., (1994). Health and behavioral consequences of binge drinking in college. lAMAJlZ (21),l672-1677. 01998 Hope College, Holland, Michigan, 49423, USA. (616) 3935-7861)