A Comprehensive Examination of the Health Knowledge, Attitudes and Behaviors of Students Attending Historically Black Colleges and Universities

Abstract

There is limited information about African American students attending Historically Black Colleges and Universities (HBCUs) in the areas of health behavior, health knowledge, and attitudes. To fill this gap, a comprehensive examination of first-year students was undertaken at a consortium of HBCUs. A non-random sample of 1,115 freshmen were administered a survey that assessed several domains including: (1) demographics, (2) general health, (3) smoking habits, (4) disease risk, (5) weight perception, (6) physical activity, (7) perceived stress, (8) eating habits, (9) social support, (10) personal/family medical history, (11) leadership, (12) domestic violence, (13) substance use, and (14) sexual behavior. In general, most students knew about health behaviors and disease risk. Areas that warrant further exploration include physical activity, sexual behavior, and drug use. The analyses provide key information for health education and prevention.

Among the main contributors to ill health are lifestyle choices and behaviors. Risk factors such as little physical activity, poor diet, tobacco use, substance abuse, and risky sexual behaviors all contribute to health problems.^1–2 Disparities between the health of the well-to-do and that of those who are less well off, and between majority group members and members of racial and ethnic minority groups, are core problems for public health policymakers in the U.S.³ Healthy People 2010, the nation’s plan for public health, defines specific steps towards the elimination of such disparities and lists a number of risk reduction objectives and recommendations that target critical lifestyle elements as leading health indicators.⁴ Healthy People 2010 presents two overarching goals for improving the health of the nation: (1) to eliminate health disparities and (2) to increase years of productive life. The Healthy People 2010 agenda identifies over 467 objectives, 28 focus areas, and 15 health indicators. By addressing lifestyle factors, especially within minority populations, ill health and the health disparities associated with it can be reduced.

Establishing life-long positive health behaviors at an early age will provide some protection from chronic disease and is part of the rationale for the monitoring of youth health behavior as expressed in the Centers for Disease Control and Prevention’s (CDC’s) Youth Risk Behavior Surveillance Reports. “Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, are interrelated, and are preventable.”^{5, p. 1} Prevention programs must begin early in life, before risk-taking behaviors cement themselves as a part of an individual’s behavioral repertoire.

This study seeks to understand the dynamic relationships between the individual, the college environment and the acquisition of health behaviors over the course of continued exposure to the college setting. Therefore, the theoretical underpinnings for this study incorporate explanatory constructs from several complementary models and theories including the Health Belief Model,⁶ with its focus on individual behavior and beliefs, a social ecological perspective with its focus on the contributions of the environment to health status and health behavior,^7–8 and Bandura’s Social Cognitive Theory (SCT)^9–10 which addresses the connections between personal factors, environmental factors, and behavioral factors. Bandura’s SCT describes learning in terms of the interrelationship among behavior, environmental factors, family issues and personal factors. This perspective offers additional connectivity and convergence of factors important in the acquisition and sustainability of health behaviors related to specific health disparities, including tobacco use, nutrition, HIV/AIDS, and other health inequalities.

In addition, an examination of the social determinants of health^11–12 further supports the influence of social conditions as major determinants of health. Our examination of these theoretical constructs offers us a framework by which we can further elucidate risk and protective factors experienced by African American students, introduced to the challenges of the college environment, on the formation of lifelong health behaviors.

Entering students matriculating at Historical Black Colleges and Universities (HBCUs) bring with them a health status similar to that of other adolescents and young adults, i.e., they are generally healthy. They have also been exposed to many of the environmental influences related to health attitudes and behaviors associated with inner-city life, single-parent households, and varying economic circumstances. Here, we wish to establish a basic snapshot of the health knowledge, health attitudes, and health behaviors of these entering students that upon further examination will yield a systematic documentation of health indicators, healthy activities, and risk factors. Understanding the influence of the college setting on the formation, acceptance, and sustainability of health behaviors will provide the institutions and researchers with baseline data from which to plan health promotion and intervention activities tailored to fit the needs of this unique population.

Many studies that examine African American college students are conducted on majority White campuses that have small African American student populations.^13–22 Few comprehensive health studies have been conducted at HBCUs, although there has been a recent increase in attention to this population and the number of published studies is increasing.^23–32 Health research studies that have been conducted with African American college students often examine topics of popular and scientific interest including HIV/AIDS, attitudes towards condoms, sexually transmitted disease knowledge and behaviors (including perception of risk), cigarette smoking and other substance use, and weight-related body image.^23–32

One of the most comprehensive studies assessing the health of African American college students specifically was the National College Health Risk Behavior Survey conducted by Fennell in the mid-1990s.²³ Nine-hundred and ninety-six Black students attending eight HBCUs in seven different states were surveyed. This survey assessed the following: unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases or infections (including HIV); unhealthy dietary behaviors; and physical activity.²³ The majority of the students were under the age of 21 (84.2%), sexually active (82.5%), and reported using a condom during their last intercourse (59.6%). Approximately one third (29.5%) of the women viewed themselves as overweight and the women were significantly less likely than the men to have engaged in physical exercise during the previous week.²³

In the 1990s, Ford and Goode surveyed health behaviors of 224 undergraduates at an HBCU, using an original health assessment questionnaire.²⁴ Most of the respondents were freshmen or sophomores (70%) who reported being sexually active (74.1%) and using condoms during their last sexual encounter (61.1%). Approximately one third (29.2%) of the women and a quarter (26.4%) of the men viewed themselves as overweight. However, less than half of the women reported some type of daily exercise, compared with 60.8% of the men.²⁴

With the exception of the Fennell and Ford and Goode studies conducted in the 1990s, there have been no other studies that have collected health knowledge, attitude, and behavior information on incoming students at HBCUs across a wide range of health topics. In this article, the results of a study intended for developing a comprehensive health database that measures health status and behaviors of college students attending a consortium of HBCUs in a southeastern state are reported. Because this involved a purposive sample, no attempt is made to generalize these findings to non-participants from these institutions or to any other HBCU students.

Findings from this study should provide important information on the health knowledge, attitudes, and behaviors of students who attend these HBCUs and will serve as the foundation for the development of institution-specific disease prevention and health promotion interventions.

Methods

Study site and sample

During the fall of 2004, the Health Behavior Survey (HBS) was administered to a convenience sample of students attending six private HBCUs in a large metropolitan city of a southeastern state. These institutions requested anonymity upon agreeing to participate in the survey project. The institutions provide undergraduate, graduate, and professional degree programs. At the time of the survey, these institutions enrolled slightly more than 8,500 (8,633) undergraduate students. According to statistics published on college websites and in college fact books, 56% of the undergraduates (n=4,834) were female and 44% (n=3,799) were male. The vast majority of the students were African American, although some (less than 1%) international, White, Asian, and Latino/Latina students attended the schools. The characteristics of the convenience sample for the survey are described below.

The study was exempted by the Institutional Review Board of the Morehouse School of Medicine, and representatives from the administration of each institution approved the project. A recruitment strategy and timetable for voluntary survey administration was developed separately for each institution to maximize participation. The incentives offered to students for participation in the survey varied by institution and included i-pod raffles, meals, cash donations ($1,000) to the class with the greatest number of participants, and other tailored incentives. The overall response rate for 2004 was 15% (n=1,303) with 90% (n=1,173) of these respondents being first-year students (52% male and 48% female).

Questionnaire

Each institution designated one or more administrators/representatives to participate in designing the questionnaire. This group met regularly for nine months to develop, construct, and suggest methods to pilot-test the survey. Most of the survey questions were taken from the Centers of Disease Control Youth Risk Behavior Surveillance System annual survey, the Behavior Risk Factor Surveillance System (adult survey), or other validated tests and scales (e.g., perceived stress, safe sex)^33–35 that had been published in the literature. Each institution also offered questions of particular interest to them, as seen in the section on clergy leadership and community involvement below.

The Health Behavior Survey was a voluntary, anonymous self-report, 169-item questionnaire that took 30–45 minutes to complete. The questionnaire was divided into two sections. The first section collected information on several domains: demographics; history of smoking; general health; disease risk reduction knowledge; weight perception; physical activity; eating habits; perceived stress; clergy/leadership, domestic violence, alcohol consumption, sexual behavior, substance use, and personal/family medical history. The second section of the survey included a request for permission to contact the respondent to ascertain whether they were interested in participating in future studies. If the student agreed to participate in future research, they were asked to provide contact information. A separate sheet was provided for this purpose in order to maintain anonymity.

General health was assessed with a single item, “Would you say that in general your health is.…” The response categories were excellent, very good, good, fair, poor and don’t know. There were a total of nineteen questions that assessed knowledge of reducing the risk of disease. Nine of the questions had a true/false format, seven had a yes/no format, and the remaining three had a multiple choice format. Physical activity was assessed with five questions concerning physical activity in the preceding seven days. Perceived Stress was measured using a scale developed by Cohen et al.³³ In addition to the scale, three items were added to the survey to measure how often students felt that they were able to relax and how often they perceived that things in their lives had turned out well. Five items were used to measure perceived social support at college. Respondents were asked about people they relied on (e.g., faculty, class advisor, administrators, fellow students, and significant others or friends) in certain situations such as when things get tough in school or when needing help with personal problems. The responses were measured on a seven-point Likert-type scale ranging from 1 (always) to 7 (not applicable). One of the institutional representatives felt it was important to ask students about their opinions about clergy, the role of clergy in health behaviors and health promotion, as well as assessing student participation in community/civic affairs. Experience of domestic violence was assessed using a 13-item measure with four response categories: often, sometimes, rarely, and never. The questions assessed whether a partner had ever committed abusive behavior. Substance use was assessed with questions from the CDC 2001 Youth Risk Behavior Survey (www.cdc.gov/yrbss).

Data collection

The survey was administered and monitored by staff trained by the Public Health Sciences Institute (PHSI) at Morehouse College. Questionnaires were administered in classes, and general assemblies under the direction of an institutional contact person and in the presence of a trained research staff person. All participants were fully informed about the purpose and nature of the survey and what participation required of them. Students were provided the opportunity to refuse to participate in the survey, to skip any items, and to ask any questions.

Results

Demographic characteristics

Of the 2,432 first-year students at least 18 years of age eligible for this study, 46% completed the HBS in the first wave of data collection (in the 2004–2005 academic year). The mean age of respondents was 18.5 years. Male students constituted 52% of the sample (17 students did not indicate their sex). For purposes of comparison, the data from the HBS study will be compared to data from the American College Health Association (ACHA) survey of college students.²² In some cases, the questions asked in the instruments were not identical, and in those cases, the comparisons must be interpreted with caution. For the ACHA sample (2004–2005 academic year) there were 371 Black students (Black first-year students only, with foreign students excluded) and the mean age was 18.33, with 63% being female.

The vast majority of HBS participants (96%) self-identified as African American. Less than 1% each identified as White, Hispanic/Latino, Asian Pacific Islander, or American Indian/Native American. Only 2% identified as Other. All of the ACHA students identified as Black. Most (87%) of both studies’ samples lived on campus.

Approximately 50% of the students reported annual family incomes between $25,000 and $84,999. The majority of students (54%) reported their parents’ annual income between $25,000 and $84,999, while nearly half (46%) reported that they did not know their parents’ annual income. Overall, the mother’s reported level of education (completed) was slightly higher than the father’s as measured by college and graduate school completion (see Table 1). Parental income was not asked on the ACHA survey.

Table 1.

Demographics

Variable	N	%
Gender
Male	574	52
Female	528	48
Race/ethnicity
African American	1055	96.1
White	9	.8
Asian/Pacific Islander	4	.4
Native American	1	.1
Hispanic/Latino	7	.6
Other	22	2.0
Family income ($)
<5,000	25	4.1
5,000–24,999	72	11.8
25,000–44,999	111	18.2
45,000–64,000	102	16.7
65,000–84,000	91	14.9
85,000–100,000	69	11.3
>100,000	139	22.8

General health

The majority of the students surveyed reported their overall health status as very good (40.8%), excellent (28.2%), or good (24.2%). Only 5.9% rated their health as fair, and 0.5% rated their health as poor. Males were more likely to rate their health as excellent (34.3%%) or very good (41.6%) than females (chi square = 29.3, p<.0001). Females were more likely than males (chi square = 29.3, p<.0001) to rate their health as good, fair, or poor (see Table 2). Among students in the ACHA sample, 92.8% reported their health as excellent or very good/good.

Table 2.

Health Status and Health Behaviors

	Overall (%)	Males	Females	P-value
General health
Excellent	289 (28.5)	182 (34.3)	107 (22.2)	<0.0001
Very good	409 (40.3)	221 (41.6)	188 (38.9)	<0.0001
Good	245 (24.2)	101 (19.0)	144 (29.8)	<0.0001
Fair	61 (6.0)	23 (4.3)	38 (7.9)	<0.0001
Poor	5 (.5)	2 (.4)	3 (.6)	<0.0001
Don’t know	5 (.5)	2 (.4)	3 (.6)	<0.0001
Tobacco use
Never smoked	706 (71.4)	369 (70.8)	337 (72)	.150
Current smoker	28 (7.8)	19 (9.6)	9 (5.6)	.150
Close friend smokes	505 (52.2)	296 (59.0)	209 (44.8)	<.0001
Siblings smoke	336 (34.9)	161 (32.1)	175 (37.9)	.105
Knowledge of health related problems
Fat intake	650 (65.5)	318 (62.4)	332 (68.9)	.049
Sugar intake	708 (71.6)	338 (66.1)	370 (77.4)	<0.0001
Sodium intake	559 (56.6)	246 (48.3)	313 (65.3)	<.00001
Low intake of fruit and vegetables	230 (23.2)	14 (24.0)	106 (22.3)	.761
Fiber intake	186 (18.9)	101 (19.8)	85 (17.9)
How interested are you in changing your habits to help avoid getting heart disease?
Extremely interested	431 (45.5)	201 (41.4)	230 (49.8)
Somewhat interested	313 (33.1)	182 (37.5)	131 (28.4)
Neutral	69 (.07)	44 (9.1)	35 (7.6)
Somewhat uninterested	30 (.03)	31 (.06)	38 (.08)
Extremely uninterested	55 (.06)	27 (5.6)	28 (6.1)
Missing
How much do you feel you really know about how to reduce your chances of having a heart attack or stroke?
A great deal	67 (7.1)	41 (8.4)	26 (5.6)
A lot	168 (17.7)	104 (21.4)	64 (13.8)
Some	444 (46.7)	220 (45.2)	224 (48.4)
A little	228 (24.0)	105 (21.6)	123 (26.6)
Not at all	43 (4.5)	17 (3.5)	26 (5.6)
Weight perception
Very underweight	11 (.01)	8 (1.6)	3 (.6)
Slightly underweight	162 (16.3)	108 (21)	54 (11.4)
About the right weight	510 (51.6)	284 (55.3)	226 (47.6)
Slightly overweight	259 (26.2)	98 (19.1)	161 (33.9)
Very overweight	47 (4.7)	16 (3.1)	31 (6.5)
Physical activity
Participated in vigorous physical activity that made them sweat for at least 30 minutes on each of three or more days	412 (42)	260 (51)	152 (31.6)	<.0001
Participated in moderate physical activity for 30 days that did not made them sweat or breathe hard	726 (73.6)	363 (71.3)	363 (76.1)
Participated in strengthening and toning exercises during the past seven days	579 (58.6)	392 (77.2)	187 (39.0)	<.0001
Played on at least on organized sports team in the past year	549 (56.2)	328 (65.5)	221 (46.4)	<.0001
Watched one hour or less of television on an average school day	337 (34.3)	256 (50.3)	81 (17.1)	<.0001
Perceived Stress
Bothered by stress in last 30 days
Extremely/very much	103 (10.7)	54 (11.5)	49 (10.1)	.001
Quite a bit	138 (14.5)	51 (10.9)	87 (17.9)
Some	201 (21.1)	93 (19.8)	108 (22.3)
Little	367 (38.5)	184 (18.6)	183 (37.7)
Not at all	145 (15.2)	87 (18.6)	58 (12.0)
Drug use
Tried using following substances at least once:
Marijuana	353 (39.0)	176 (39.7)	177 (38.3)	.009
Cocaine	20 (.022)	16 (.03)	4 (.008)	.054
Sniffing glue or other inhalants	27 (.03)	21 (.05)	7 (.015)	.015
Heroin	13 (.014)	8 (.019)	6 (.01)	.151
Methamphetamines	19 (.02)	14 (.03)	5 (.01)	.082
Ecstasy	29 (.03)	17 (.04)	12 (.03)	.743
Steroids
Injection drugs
Used marijuana in the preceding 30 days	158 (17.7)	90 (20.9)	68 (14.7)	.087
Sexual behavior
Sexual behavior
Engaged in sexual intercourse	607 (66.6)	317 (70.4)	290 (62.9)	.016
Condom use at last sexual encounter	447 (51.9)	228 (53.8)	219 (50.1)	.110
Type of birth control used at last sexual encounter Condoms	398 (46.8)	209 (49.6)	189 (44)
Birth control pills	82 (9.6)	37 (8.8)	45 (10.5)
Depo-Provera	12 (1.4)	3 (.7)	9 (2.1)
Withdrawal	45 (5.3)	23 (5.5)	22 (5.1)
Other	18 (2.1)	7 (.8)	11 (2.6)
Have been or have gotten someone pregnant	72 (.08)	32 (.075)	40 (.09)

Tobacco use

Of the 1,040 respondents who reported on smoking history, the majority (71.4%) reported never smoking tobacco. Only 389 students responded to the question regarding whether they currently smoked. Current smoking was reported by 7.8% of the respondents. This rate was slightly lower than the 8.2% reported by students in the ACHA sample. Approximately 35% of the participants reported that their parents or siblings smoked cigarettes and 52.2% reported that a close friend smoked. The only significant gender difference found was on whether close friends smoked. Approximately 59% of males reported having a friend who smoked (chi square = 28.8, p<.0001).

Knowledge of health problems

A significant number of students possessed some knowledge of the association between eating habits, health, and disease (see Table 2).

Eating habits and their relationship to cancer and heart disease were assessed using a yes/no format. Concerning cancer, the respondents were likely to believe that eating more fiber (53%, n=553), and more fruits and vegetables (62.9%, n=657) would reduce the chances of contracting cancer. Additionally, the majority of respondents believed that eating more fiber (51.5%, n=539), less sugar (50%, n=521), less salt (60.5%, n=635) and more fruits and vegetables (67%, n=703) would help prevent heart disease.

Weight perception

A small majority of participants (51.6%,) described their weight as about right. There were 259 (26.2%) students who reported they were slightly overweight, compared with 77.8% of first-year Black students responding to the ACHA survey. Of those who responded they were slightly overweight, significantly more were female (62.9%, n=175). There were 47 students (4.8%) who reported being very overweight; 66.7% were females and 33.3% were males (chi squared = 53.3, p<.0001). When asked what they were trying to do about their weight, 40.6% (n=426) of the participants reported trying to lose weight while 26.9% (n=282) were trying to gain weight. Gender differences were again observed with more females trying to lose weight (64.8%) and more males trying to gain weight (77%) (Chi-squared = 118.9, p<.0001) (see Table 2).

Physical activity

Physical activity was assessed with five questions concerning physical activity in the preceding seven days. Approximately 42% (n=438) of students reported participating in vigorous physical activity that made them sweat for at least 30 minutes on each of three or more days. Significantly more females (69.7%, n=358) reported zero to two days (chi squared = 66.6, p<.0001) than males. Forty-eight percent (n=501) reported participating in moderate physical activity for at least 30 minutes that made them sweat or breathe hard. There were no significant gender differences. Strengthening and toning exercises during the past seven days were engaged in by 34% (n=357) of the respondents on three or more days. There were significant gender differences, with 80.3% (n=414) of females reporting zero to two days, compared with 52.5% (n=281) of males (chi-squared = 165.4, p<.0001). Over half of the participants, 54.9% (n=583), reported that they had played on at least one organized sports team in the past year. Males were significantly more likely to have played on one or more teams (64.4%, n=340) than females (45%, n=231, chi squared = 61.2, p<.0001). One question measured inactivity by assessing the amount of television watched on an average school day. Approximately 49% (n=374) reported watching television one hour or less during a school day. Males (64.5%, n=273) were significantly more likely to watch one hour or less of television than females (31.8%, n=101, chi squared = 144, p<.0001).

Domestic violence

Nearly four out of ten (38.1%) of the students reported never having a partner check up on them or want to know where they are at all times. Ninety percent of the students reported never having their partner slap, punch, kick, bite, choke, or burn them. One percent reported their partner often threatening to hurt themselves, their partner, their partner’s children, or other family members or friends.

Nearly one of ten (9.6%) reported often checking up on their partners and wanting to know where they are at all times. Again, 90% reported no incident of physical violence against their partner (slapped, kicked, bit, choked, or burned). Approximately 4% reported either often or sometimes threatening to hurt themselves, their children, or other family members or friends.

Drug use

Overall, the reported use of mind or mood-altering substances was low (see Table 2). Marijuana was the drug of choice for the students in this sample. Approximately 18% of the students had used marijuana in the preceding 30 days and 7.6% used it on school property in the past 30 days. According to the respondents, nearly 14.6% reported being offered, sold, or given illegal drugs on school property within the preceding 12 months.

Sexual behavior

In this initial study, the focus of the research was on heterosexual behaviors. Sixty-seven percent of respondents reported that they’d had sexual intercourse at least once in their lives. Among the participants who had ever engaged in sexual intercourse, the average age of sexual debut was 15 (SD or standard = 1.61 years). Males reported more lifetime and recent partners than females. The average number of lifetime sexual partners reported was three (SD=1.85), and the average number of sexual partners in the past three months was 1.62 (SD=1.12). Only 9% reported having drunk alcohol or used substances before their last sexual intercourse. Most (71%) reported that they had used a condom during their last sexual intercourse and relatively few female respondents (or the heterosexual partners of male respondents) used oral contraceptives during the last sexual intercourse. The most common form of birth control at last sexual encounter reported was condoms (63%) followed by birth control pills (13%), withdrawal (7.1%), Depo-Provera (1.7%), and other (3.2%). The majority of participants (87%) reported that they have never been or gotten someone pregnant. Among those who had, 8% (n=50, 30 females and 20 males) had been or had gotten someone pregnant once and 4% (9 females and 14 males) had been or had gotten someone pregnant at least twice. One percent (all male) of the sample reported not being sure (see Table 2).

According to the ACHA data, 38.4% of the students used a condom at last sexual intercourse and 76% used birth control pills. More students in the HBS sample used a condom, but fewer used birth control pills at last intercourse.

Condom attitudes

Attitudes towards condoms differed between males and females. T-tests revealed that males were significantly more favorable towards condoms than were females i.e., they had higher scores on the Condom Attitudes Scale (t=7.316, p<.01). The mean score for males was 33.2 (N=288, SD=8.7) and the means score for females was 27.5 (N=275, SD=9.8).

Perceived stress

The scores ranged from 25 to 62 (out of possible scores ranging from 14 to 70). The mean (for sexually initiated first-year students only) score was 39.07 (SD=6.075). Females reported significantly higher levels of perceived stress than did males (Table 3).

Table 3.

Perceived Stress for Sexually Initiated First Year Students Only

Perceived stress scale	N	Mean (SD)	t-Statistic	P-value
Male	276	38.0 (5.7)	−4.2	<.0001
Female	273	40.2 (6.2)	NA	NA

NA = not applicable

SD = standard

Over half, 59.4%, reported that they had been able to relax in the last month either all of the time, very often, or fairly often. Only 22% reported that things in their lives had not turned out well all of the time, very often, or fairly often. Table 4 reports the statistically significant difference between males and females for one of the items (not included in the perceived stress scale): Females were more likely than their male counterparts to report that they were bothered by stress (in the last 30 days) some, quite a bit, or very much (chi squared = 22.406, p<.0001).

Table 4.

Perceived Stress—Bothered By Stress in the Last 30 Days—Sexually Initiated Only

Response	Male (n) %	Female (n) %	Total (n) %
Extremely	(10) 3.2	(4) 1.3	(14) 2.2
Very much	(22) 7.0	(30) 9.6	(52) 8.3
Quite a bit	(31) 9.8	(57) 18.3	(88) 14.0
Some	(65) 20.6	(76) 24.4	(141) 22.5
Just a little	(125) 39.6	(112) 35.9	(237) 37.7
Not at all	(63) 19.9	(33) 10.6	(96) 15.3

Discussion

There have been numerous epidemiological studies on the health behaviors of college students including, perhaps most notably, the National College Health Assessment conducted by the American College of Health Association and the National College Health Risk Behavior Survey (NCHRBS) conducted by the Centers for Disease Control and Prevention. With some exceptions, few studies (including 2006 ACHA data) have reported data about a wide range of health knowledge, attitudes, and behaviors on large samples of African American students or students attending HBCUs. Hence, this survey provides unique data on African American freshmen students attending HBCUs in the southeastern United States. The findings from this study may be used to guide longitudinal intervention planning and implementation at HBCU institutions and provide insight into health disparities research in general. The preliminary analysis of the HBS data provides key information for specific areas of health education and promotion and disease prevention and intervention.

Some of our findings are consistent with the trends found in other national datasets. The majority of the students believed that they were in good to excellent health, although some gender differences were demonstrated. Female students were more likely than male students to view themselves as being in fair or poor health. A significant number of the students reported some knowledge or awareness of health and disease and the relationship between eating habits, health, and disease (particularly heart disease and cancer).

Despite nearly one-third of the students being classified as overweight according to their body mass index, the majority of students reported their weight as being just right, and as expected, there were some gender differences observed. Female students were more likely than male students to view themselves as slightly overweight or very overweight. Female students were also more likely than male students to report that they were trying to lose weight. This finding is similar to other published findings concerning weight among students attending HBCUs.^25–26 Physical activity is one of the most critical lifestyle contributors to health disparities, particularly in the African American community, that can be positively changed if interventions are successfully implemented.³⁵ Although female students reported that they were trying to do something about their weight, they engaged in less vigorous physical activity, engaged in less strengthening and toning exercises, played on fewer organized sports teams, and watched more television than male students.

In addition to weight and exercise, it is well documented that disparities exist between Blacks and Whites with regard to sexually transmitted infections. Most respondents to this survey (71%) reported fewer sexual partners in the course of their lives than were reported on average in other college datasets, including Black samples in the NCHRBS. These findings indicate that students who attend HBCUs may have fewer risk behaviors in comparison with their counterparts, although the rate of sexually transmitted infections (STI) at HBCUs appears inconsistent. Some data indicate that STI rates at HBCUs are comparable to other types of institutions, indicating that STI susceptibility may be more a function of sexual networks than of risk behaviors.^36,37

As for stress, female students reported higher levels of perceived stress than male students reported and were more likely to report that they had been bothered by stress in the preceding 30 days. Respondents affirmed the importance of clergy and lay leadership being involved in the development and promotion of health education. In addition to health-seeking behaviors, another method for coping with stress may be substance use. Substance use remains a major public health threat on most college campuses. Previous research has shown that alcohol, tobacco, and illicit substance use is lower on HBCU campuses than at predominately White institutions.³⁸ Smoking remains one of the greatest causes of preventable deaths and has a synergistic effect with other health-compromising behaviors. Smoking enhances the detrimental effects of other risk factors. Our findings support epidemiological datasets such as the National College Health Risk Behavior Survey and other HBCU findings that demonstrate that African Americans smoke less tobacco than their White counterparts.^27–31

Limitations

There are several limitations in our study. First, we collected data from a convenience sample; therefore, these data may not be generalizable to the general population of first-year students attending HBCUs.

Second, given the self-administration format of the survey and its length (50 minutes), there were high rates of skipped and/or missing data in certain survey modules. A revision of the questionnaire is currently in progress to address these concerns. Lastly, this was a cross-sectional survey which provides a snapshot of the students’ perceived and self-reported health behaviors. Temporal patterns are not determinable and were beyond the score of the current investigation. However, the purpose of this baseline data is to provide information that will inform more in-depth cohort studies.

In light of these limitations, this is a useful health survey conducted in a unique environment. These results have significant value for directing the development of health promotion interventions and services for an impressionable student body. Furthermore, the results indicate clear directions for campus administrators and educators as they design new programs and interventions to address several health issues. While students can benefit from a focus on educational issues associated with the importance of knowing their own health history, the relationship of early behaviors with chronic health problems, and learning more about the proliferation of health disparities remains underdeveloped. This population can become not only health advocates for personal health issues but also peer health educators for their contemporaries as they become role models for others in taking on leadership roles in eliminating racial/ethnic disparities and improving the quality of life of vulnerable populations.