Health Educator Believability and College Student Self-Rated Health

Keith J. Zullig, M.S.P.H, Ph.D.Department of Community Medicine

West Virginia University

Background

• Leading modifiable causes of death in the US have remained relatively unchanged since the 1970s:– Tobacco use, poor diet, physical inactivity,

unprotected sexual intercourse, illicit drug use, motor vehicle crashes & alcohol consumption accounted for about 1,000,000 (46.2%) of all deaths in 2000.1

• College campuses are thought to be a subset of the same health issues.

Background• Health Education exists to facilitate voluntary behavior and

is defined as "any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions,”2(p.99).

• A health educator is defined as a highly trained individual who attempts to improve health of others through the use of the educational process.3

• Most agree that a primary goal of Health Education is to improve health status, and providing credible information is a prerequisite.4

Background• One measure of health status is how one

subjectively rates his or her health because of its known predictive ability of life expectancy and mortality.5-9

• This predictive ability has been attributed to one’s ability to rate his or her health in a more dynamic, as opposed to static sense.10

• Thus, the relationship between self-rated health (SRH) and the believability of health-related knowledge received from Health Educators is important to the field.

Study Purpose

• To evaluate the SRH status among college students who report receiving the majority of their health-related information from Health Educators.

• It was expected that differences would exist between three categories of Health Educator believability (believable, neither believable or unbelievable, unbelievable) as related to SRH.

Methods• The 2006 National College Health Association (NCHA)

survey was utilized (N=94,806), which is reported to have acceptable reliability and validity.11,12

• The sample contained students from 117 campuses, 113 of which were 4-year colleges.

• 72 were public• 45 were private

• After removing students that could not rate their health (n=97, .01%), only those with complete information on the variables of interest (n=49,921, 52.7%) remained.

• The other 44,885 (47.3%) reported receiving the majority of their health-related information from other sources.

MeasuresDependent Variable:• “In general, how would you rate your health?”

1. Excellent2. Very good3. Good4. Fair5. Poor

Independent Variable:• “Use the scale below to record the believability of

each source of health information.”– “Health Educators” was one of 14 options.

Table 1: Participant Demographic CovariatesCovariate Information Believable

(N=46887)n (%)

Neutral(N=2781)n (%)

Information Unbelievable(N=253)n (%)

TotalN=49921n (%)

Year in school1st yearSophomoreJuniorSenior5th yearGraduate or professionalAdult specialOther

10733 (22.9)9785 (20.9)9146 (19.5)7438 (15.9)2247 (4.8)6939 (14.8)200 (0.4)399 (0.9)

699 (25.1)649 (23.3)499 (17.9)393 (14.1)147 (5.2)326 (11.7)32 (1.2)36 (1.3)

72 (28.5)64 (25.3)44 (17.4)39 (15.4)7 (2.8)19 (7.5)0 (0.0)8 (3.2)

11504 (23.0)10498 (21.0)9689 (19.4)7870 (15.8)2401 (4.8)7284 (14.6)232 (0.5)443 (0.9)

Full time student 44480 (94.9) 2646 (95.1) 203 (80.2) 47329 (94.8)GenderFemaleMale

31800 (67.8)15,087 (32.2)

1647 (59.2)1,134 (40.8)

145 (57.2)108 (42.8)

33592 (67.3)16,329 (32.7)

Race/EthnicityWhite non HispanicBlack non HispanicHispanic or LatinoAsian or Pacific IslanderNative AmericanOther

33808 (72.1)2945 (6.3)2995 (6.4)4992 (10.6)599 (1.3)1548 (3.3)

1965 (70.7)183 (6.5)186 (6.7)300 (10.7)53 (1.9)94 (3.4)

178 (70.3)17 (6.7)18 (7.1)25 (9.9)4 (1.6)11 (4.3)

35951 (72.0)3145 (6.3)3199 (6.4)5317 (10.7)656 (1.3)1653 (3.3)

International student 2746 (5.8) 220 (7.9) 15 (5.9) 2981 (6.0)Relationship statusSingleMarried/domestic partnerCommitted relationshipSeparatedDivorcedWidowed

24577 (52.4)4243 (9.1)17422 (37.2)161 (0.3)419 (0.9)65 (0.1)

1548 (55.6)231 (8.3)954 (34.3)16 (0.6)25 (0.9)7 (0.3)

143 (56.5)19 (7.5)79 (31.2)5 (2.0)5 (2.0)2 (0.8)

26268 (52.6)4493 (9.0)18455 (37.0)182 (0.4)449 (0.9)74 (0.2)

Fraternity/Sorority Member 4393 (9.4) 319 (11.5) 37 (14.6) 4749 (9.5)

Mean (SD) Mean (SD) Mean (SD) Mean (SD)Mean age 22.3 (5.62) 22.2 (6.35) 21.4 (6.22) 22.4 (5.83)

Table 1 continued: Participant Behavioral CovariatesCovariate Information

Believable(N=46887)n (%)

Neutral (N=2781) n (%)

Information Unbelievable(N=253)n (%)

TotalN=49921n (%)

Smoked (past 30 days)YesYes but not past 30 days

7588 (16.2)13429 (28.6)

599 (21.5)749 (26.9)

53 (20.9)52 (20.6)

8240 (16.5)14230 (28.5)

Alcohol use (past 30 days)YesYes but not past 30 days

32549 (69.4)6440 (13.8)

1897 (68.2)399 (14.4)

150 (59.2)50 (19.7)

34596 (69.3)6889 (13.8)

Physical fighting (past school year)

2895 (6.2) 300 (10.8) 47 (18.6) 3242 (6.5)

Exercise (past 7 days) 36592 (78.0) 2146 (77.2) 150 (59.2) 38888 (77.9)

Depression diagnosis 6989 (14.9) 499 (18.0) 41 (16.2) 7529 (15.1)

BMIOverweightObese

9785 (20.9)4443 (9.5)

637 (22.9)254 (9.1)

59 (23.3)23 (9.0)

10481 (21.0)4720 (9.5)

Mean (SD) Mean (SD) Mean (SD) Mean (SD)

Mean sexual partners (past school year)

1.2 (2.80) 1.4 (4.80) 2.4 (7.15) 1.2 (3.13)

Data Analysis• Bivariate associations between the dependent and

independent variables were analyzed by Spearman Rank correlation and chi-square analyses.

• Multiple logistic regression analysis tested SRH status after adjusting for covariates (all variables in Table 1).

• To limit the threat of Type I errors, alpha levels were set to .01 for all analyses and comparisons with 99% confidence intervals are reported for the regressions.

Bivariate Results• SRH and believability were modestly positively

correlated (r=.06, p<.0001).• Chi-square analysis results are below.

Self-Rated Health Believability of Information Believable Neutral Unbelievable N % N % N %

Excellent 8,018 17.1 414 14.9 36 14.3Very Good 21,146 45.1 1,177 42.3 100 39.4Good 14,206 30.3 904 32.5 78 31.0Fair 3,048 6.5 228 8.2 25 9.9Poor 469 1.0 58 2.1 14 5.4Total 46,887 2,781 253

*Chi-square =110.96, degrees of freedom = 8, p<.0001

Multiple Logistic Regression Results• SRH dichotomized into excellent, very good, and good (referent group)

& compared to fair/poor SRH.

• Those who reported the health-related information received from Health Educators as neutral (neither believable or unbelievable) were approximately 1.3 times (OR= 1.31, CI: 1.15-1.49, p<.0001) more likely to report fair/poor SRH when compared to those who reported the health-related information received as ‘believable.’

• Those who reported the health-related information received from Health Educators as ‘unbelievable’ were approximately 1.8 times (OR= 1.75, CI: 1.10-2.80, p<.0001) more likely to report fair/poor SRH when compared to those who reported the health-related information received as neutral (neither believable or unbelievable).

• Those who reported the health-related information received from health educators as ‘unbelievable’ were approximately 2.3 times (OR= 2.25, CI: 1.44-3.51, p<.0001) more likely to report fair/poor SRH when compared to those who reported the health-related information received as ‘believable.’

Discussion• Most students who report receiving the majority of their

health-related information from Health Educators perceive the information received as credible.

• However, a significant number of college students reported the health-related information received from Health Educators as either neutral (neither believable or unbelievable), or even worse as unbelievable.

• Most importantly, this study suggests that ambivalent or negative perceptions of the health-related information received from Health Educators may have implications for one’s health status.

Discussion

• Most health-related behavior theories posit that knowledge is only one, albeit important, component of health behavior change,13 thus the modest correlation between SRH and Health Educator believability is not surprising.

• However, the regression results suggest the relationship is not spurious.

• The combined results suggest that the field of Health Education, and well-trained Health Educators, can positively influence overall health status of college students.

Discussion• Research has documented the impact of source

credibility on message acceptance14 and typically, high credible sources are more persuasive.15 This credibility/ believability dynamic was observed in this study.

• Filtered through the lens of the TRA, this suggests that the level of believability of the Health Educator represents a multiplicative source impact in determining the subjective norm for most recipients (i.e., college students) to perform health enhancing behavior.

• However, the significant number of students reporting fair/poor self-rated health is concerning.

Limitations• Cross-sectional study design limits causality inferences.

• Those who receive the majority of their health-related information from Health Educators and perceive that information to be credible could also harbor more positive attitudes and practice good health behaviors.

• Data are self-report

• The NCHA survey does not delineate the academic preparation or credentials held by Health Educators.

• Results cannot be considered nationally representative because institutions self select to participate in the NCHA survey.

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