The document discusses the importance of citations and references in academic writing, particularly in the context of stress management among college students. It highlights research on the effectiveness of various stress reduction interventions, including cognitive-behavioral techniques and physical activity, which showed significant improvements in perceived stress, test anxiety, and personal burnout among participants over a semester. The study aimed to identify which intervention methods might be most effective in reducing stress levels among college students.

1. Citations and Referencing your source
Citations
In-text citations are used to provide readers with an
understanding of whose work is being discussed and with a way
to find the source on the reference page. Citations can be used
in many ways in text without disrupting the flow of writing.
Generally, in text citations will state the author’s name and the
year of the publication. If there is more than one author all
authors must be listed in the first citation. Multiple authors
after the first citation are listed as et al. An example of an in
text citations would look like this:
Adams, Miller, and Klein (2013) researched the relationship
between anxiety and increased health concerns, including
hypertension.
Or:
Researchers have considered the relationship between anxiety
and increased health concerns, including hypertension (Adams,
Miller and Klein, 2013).
The subsequent citations could then read:
Health concerns shown to be related to anxiety have been
diminished by the development of relaxation techniques,
including progressive muscle relaxation (Adams, et al., 2013).
References
References for journal articles (like the ones you will be using)
generally follow this format:
Author(s). (Date). Title of document. Title of Publication,
Volume(Number). Pages. Doi.
The reference list at the end of a journal article (or your paper)
documents the sources used in the article/paper and provides the
information necessary to identify and retrieve each source.
References cited in text must appear in the reference list;
conversely, each entry in the reference list must be cited in

2. text.The in text citation and reference must be identical in
spelling and year. In general, a reference on a reference page
should contain the author(s) name, date of publication, title of
the work, and publication data. Arrange entries in alphabetical
order by last name of the first author.
A reference page would look like this, for example:
Herbst-Damm, K. L., & Kulik, J. A (2005). Volunteer support,
marital status, and the survival times of terminally ill patients.
Health Psychology, 24, 225-229.
doi:10.1037/0278-6133.24.2.225
Light, M. A., & Light, I. H. (2008). The geographic expansion
of Mexican immigration in the United States and its
implications for local law enforcement. Law
EnforcementExecutive Fourm Journal, 8(1), 73-82.
Sillick, T. J., & Schutte, N. S. (2006). Emotional intelligence
and self-esteem mediate between perceived early parental love
and adult happiness. Journal of Applied Psychology, 2(2),38-48.
Retrieved from http://ojs.lib.swin.edu.au/index.php/ejap
Health Promotion Practice
May 2014 Vol. 15, No. 3 438 –447
DOI: 10.1177/1524839913510316
© 2013 Society for Public Health Education
438
The purpose of this study was to determine whether dif-
fering stress reduction interventions could alter stress
levels experienced by male and female college students
from the beginning to the end of a semester. Components

3. of stress examined included overall perceived stress, test
anxiety, and personal burnout. Participants (N = 531)
were part of courses that during the course of a 16-week
semester focused specifically on cognitive–behavioral
stress management, cardiovascular fitness, generalized
physical activity, or a control with no intervention. In
addition to gender differences, both the stress manage-
ment and physical activity groups had significantly
lower levels of perceived stress, test anxiety, and per-
sonal burnout at the end of the semester. The fitness
group scored significantly lower on perceived stress and
personal burnout, but there was no difference in scores
for test anxiety. The important ramifications of reducing
stress in college students are discussed, including the
pros and cons of implementing differing physical and
psychological intervention modalities.
Keywords: mental health; university/college health;
physical activity/exercise
S
tress is an inevitable aspect of a college student’s
life, and its sources are numerous and diverse
(Brown, 1992). This is in part due to society’s
tendency to consider college entrance as the demarca-
tion to the onset of adulthood; thus, it is assumed that
a sudden increase in one’s level of maturity has taken
place, enabling students to easily handle the college
experience (Ferrante, Etzel, & Lantz, 2002). However,
developmental specialists consider the age range from
18 to 24, categorized as “late adolescence,” to be
fraught with issues such as autonomy from parents,
leaving home, self-sufficiency, gender identity, inter-
nalized moral reasoning, and career choice (Newman &

4. Newman, 2003). Regardless of the perspective taken,
college students are moving into and through a major
developmental period of transition (Darling, McWey,
Howard, & Olmstead, 2007). Any or all of these factors
can lead to students feeling as if they do not have
enough time or energy to cope with the responsibilities
associated with the collegiate experience. Thus, as they
grapple with increased academic, personal, social, and
moral pressures in their lives, these stressors may lead
to increased anxiety, loneliness, depression, hopeless-
ness, headaches, sleep disturbances, colds, and some-
times suicidal ideations (Kelley, 1993; O’Donovan &
Hughes, 2008). Evidence shows that some college stu-
dents are able to adjust to the overwhelming challenges
that arise from this new life experience, whereas others
struggle with the escalating stress. This article addresses
research on health promotion education interventions
for stress reduction among college students, and the
implications for health promotion practice in postsec-
ondary education settings are identified.
The Stress Process
Stress comes in many forms, and college students
are not immune. It is a process whereby a stressor cre-
ates a demand and an individual must respond or react
510316HPPXXX10.1177/15248399
13510316HEALTH PROMOTION PRACTICE / MonthBaghurst,
Kelley / EXAMINATION OF
STRESS IN COLLEGE STUDENTS
2013
1Oklahoma State University, Stillwater, OK, USA
2The Performance Enhancement Group, Inc., Mesa, AZ, USA

5. An Examination of Stress in College Students Over
the Course of a Semester
Timothy Baghurst, PhD1
Betty C. Kelley, PhD2
Authors’ Note: Address correspondence to Timothy Baghurst,
Health and Human Performance, Oklahoma State University,
189
Colvin, Stillwater, OK 74078, USA; e-mail: [email protected]
mailto:[email protected]
http://crossmark.crossref.org/dialog/?doi=10.1177%2F15248399
13510316&domain=pdf&date_stamp=2013-11-14
Baghurst, Kelley / EXAMINATION OF STRESS IN COLLEGE
STUDENTS 439
to its demands. It is a transaction between the environ-
ment or situation and the person, which results in the
perception or cognitive appraisal that the demands of
the situation exceed the individual’s resources availa-
ble to meet or cope with those demands (Kelley, 1994;
Lazarus, 1990). Life stressors may be transient, such as
annoying everyday hassles, or more long term and
potentially traumatic.
Response to such stressors is influenced by both the
way in which events are appraised and an individual’s
effective response capacity. People who sense that they
have the ability and the resources to cope are more
likely to take stressors in stride and take action con-
structively. However, experiences that consistently
lead to a negative stress appraisal can cause both

6. physical and psychological problems over time (Kelley,
2007; Pretzer, Beck, & Newman, 2002).
Stress and College Students
Stress is commonly experienced by college students
and can negatively affect their overall health and well-
ness through a number of ways (e.g., Abouserie, 1994;
Chang, 2006; Dwyer & Cummings, 2001; Everson,
Tobias, Hartman, & Gourgey, 1993; Gan, Shang, &
Zhang, 2007; Giesecke, 1987; Hall, Chipperfield, Perry,
Ruthig, & Goetz, 2006; Hudd et al., 2000; Jacobs &
Dodd, 2003; Labbe, Murphy, & O’Brian, 1997; Misra &
McKean, 2000; Nathan, 2006; Rayle & Chung, 2007;
Weidner, Kohlmann, Dotzauer, & Burns, 1996).
Cognitive interpretation or perception of stress in a
person’s life will generally have both physiological and
psychological effects. Some of the negative physiologi-
cal consequences of ongoing stress include hyperten-
sion, high levels of muscle tension, and lowering of
immune system defenses (e.g., Friedman & Berger,
1991; Kelley, 1994; Methany, Aycock, Pugh, Curlette, &
Silva Cannella, 1986). Psychological effects such as
anxiety, depression, interpersonal problems, and inef-
fective cognitive processes may also be manifested
(e.g., Berger, Friedman, & Eaton, 1988; Kelley & Gill,
1993).
Psychological Interventions and Stress
Researchers have examined the effectiveness that
stress inoculation and skill development training has
on stress levels, concluding that meditation and relax-
ation along with many other psychological variables
can be as effective in reducing stress as exercise

7. (Bahrke & Morgan, 1978; Bruning & Frew, 1987; Decker
& Russell, 1981; Deckro et al., 2002; Hains &
Szyjakowski, 1990; Long, 1988; Long & Haney, 1988;
Quick, 1979; Macan, Shanani, Dipboye, & Phillips,
1990; Misra & McKean, 2000; Russell, 1992; Schwartz,
Davidson, & Goleman, 1978; Winstead, Derlega, Lewis,
Sanchez-Hucles, & Clarke, 1992; Yorde & Witmer,
1980). Thus, in general, any training designed specifi-
cally to improve skills that might mediate, buffer, and
lower stress has the potential to be successful.
However, whether one strategy is more successful
than another has not been well tested.
Physical Activity and Stress
Physical activity is one simple, yet effective means
to reduce stress. For example, Brown (1992) reported
that physical activity and fitness helped mediate the
effects of negative stress in a sample of college stu-
dents, whereas leisure time physical activity was
enough to decrease the effects of daily stressors in
undergraduate college students (Carmack, Bourreaux,
Amaral-Melendez, Brantley, & de Moor, 1999; Nguyen-
Michel, Unger, Hamilton, & Spruijt-Metz, 2006). It is
interesting to note that exercise participation can be
positively influenced by knowledge concerning the
benefits of exercise, which include stress reduction
(Katz, Davis, & Findlay, 2002; Makrides, Veinot,
Richard, McKee, & Gallivan, 1998). This suggests that
education and dissemination of the relationship
between physical activity and stress would be benefi-
cial for college students.
Although physical activity is important to well-
being, cardiovascular exercise (here defined as vigor-

8. ous physical activity) can be more effective in reducing
the effects of physiological and psychological stress
(Berger & Owen, 1988; Crews & Landers, 1987; Long &
Haney, 1988; Norris, Carroll, & Cochrane, 1990;
Schwartz et al., 1978). For example, early research
studies (e.g., Keller & Seraganian, 1984; Sinyor,
Schwartz, Peronnet, Brisson, & Seraganian, 1983) found
that fit participants were able to recover more quickly
from a stressor. It was posited that those fit participants
may have developed a physical conditioning that
allowed them to more quickly cope with the emotional
stressors. A meta-analysis by Crews and Landers (1987)
reported that aerobically fit subjects were more immune
to the psychosocial stress response. Thus, exercise may
act as a coping strategy that reduces the physiological
response to stress and may also function as a protector
by helping to create more effective responses to psy-
chosocial and emotional stress. More recently, VanKim
and Nelson (2013) found that among a large sample of
almost 15,000 students, those who met vigorous physi-
cal activity guidelines had lower levels of perceived
stress and were less likely to report poor mental health
440 HEALTH PROMOTION PRACTICE / May 2014
than those students who were not meeting guidelines
for vigorous physical activity.
Combination Treatments and Stress
Unfortunately, very few research studies have
attempted to determine whether one treatment is more
effective than another within the same study. This
highlights the importance of the present research study

9. in delineating between which method or strategy might
be the most effective stress reducer. In one of the very
few experiments with college students, Berger et al.
(1988) compared exercise, relaxation response, social
interaction, and a no-treatment control group. Exercise
and relaxation groups were found to reduce stress bet-
ter than the social interaction group. However, all three
treatment techniques were significantly more effective
than no treatment at all.
Silvestri (1987) found that an experimental interven-
tion consisting of both exercise and relaxation was
more effective in reducing stress than exercise on its
own. When examining the effects of the psychological
intervention of stress inoculation training and the
physiological intervention of exercise, Long (1988)
found that stress inoculation training coupled with
exercise was the best combination for reducing the
effects of stress than either intervention alone.
Most recently, in their meta-analysis of interven-
tions used to reduce stress among university students,
Regehr, Glancy, and Pitts (2013) reported that a myriad
of interventions could be successful in reducing anxi-
ety, depression, and cortisol production. Interestingly,
it was reported that stress reduction strategies have
been focused more on females than males, and further
research on stress reduction strategies for males is war-
ranted.
Purpose for Present Research
Stress is a process, not a static moment in time, and
a person’s appraisal of it may fluctuate, necessitating
more than one coping strategy be engaged to reduce the
magnitude of a negative stress appraisal (Folkman, &

10. Lazarus, 1985; Kelley, 2007). Thus, stress reduction
using only one technique may not be sufficient to elicit
true reductions in negative perceptions of stress, and
having a large repertoire of coping behaviors may lead
to employing different strategies that may have both
long- and short-term benefits. Therefore, the purpose of
this study was to examine the effect of the intervention
approaches of stress management, cardiovascular fit-
ness, and physical activity on the stress levels of col-
lege students over the course of a 16-week semester.
Participants were assessed on the stress variables
Perceived Stress, Test Anxiety, and Personal Burnout.
It was hypothesized that stress levels (perceived stress,
test anxiety, and burnout) would (1) show the greatest
reduction in the Stress Management group, (2) be lower
at the end of the semester compared to the beginning
for all treatment groups, and (3) be higher at the end of
the semester compared to the beginning for the Control
group.
>>MetHod
Participant Characteristics
Participants were 531 male (n = 293) and female (n
= 238) college students of all levels (freshman, soph-
omore, junior, and senior) from a large Midwestern
university. Participants were from existing courses
within the university curriculum in the major areas
of Stress Management (SM), Physical Activity (PA),
and Cardiovascular Fitness (CV). An additional
Control group (C) was compiled from various aca-
demic courses (history, sociology, and geography)
with no emphasis on stress, fitness, or activity. The
Control group was not assessed for any self-selected

11. activity that they may have participated in during
the study.
For participants to be included in the study, they
had to have completed survey packets at both data col-
lection periods (beginning and end of the semester) and
not be enrolled presently or previously in any of the
intact treatment courses. Participants that did not meet
all inclusion criteria were dropped from the study (n =
70). The final participation rate was 88% for the SM
(n = 124), CV (n = 131), PA (n = 144), and C (n = 132)
groups for a total of 531 students.
Measures
Perceived Stress. Overall perceived stress was assessed
via the Perceived Stress Scale (PSS; Cohen, Kamarck, &
Mermelstein, 1983). The PSS measures perceived stress
including items assessing control, overload, as well as
thoughts and feelings of stressful events and experi-
ences. The scale assessed responses to items with
respect to how respondents “usually felt over the past
3 weeks” or thought about each item. Students used a
Likert-type scale (1 = never to 5 = very often) to esti-
mate “how often” they thought or felt a certain way for
each of the 14 items, and then a total score was calcu-
lated from these responses. The PSS is a short-term
assessment of stress perception (e.g., “In general, how
often have you felt that you were unable to control
important things in your life?”). Good reliability for the
Baghurst, Kelley / EXAMINATION OF STRESS IN COLLEGE
STUDENTS 441

12. PSS (.85) has been found in previous research (Kelley,
1994), and validity was established with a strong cor-
relation between the PSS (r = .89) and the trait portion
of the State-Trait Anxiety Inventory Form Y (Spielberger,
1983). In the present study alpha coefficients were .91
and .93 for the beginning and end of the semester,
respectively, well above the .70 criterion suggested by
Nunnally (1978).
Test Anxiety. The Test Anxiety Survey (TAS) was modi-
fied from the 15-item Sport Competitive Anxiety Test
(Martens, Vealey, & Burton, 1990) to assess the anxiety
students experience as a result of having to perform in a
test- or exam-taking situation in class. The word test was
substituted for compete and competition to increase face
validity for the participants (Kelley, 1996). Students also
responded to statements on a 5-point Likert-type scale
from hardly ever to often, rather than the original 3-point
scale in order to be synonymous with scoring of other
scales. This helps eliminate selection errors by the par-
ticipants that are often caused by making the cognitive
shift back and forth between different Likert-type–for-
matted surveys (Kelley, Hoffman, Gill, & Kang, 1988).
The survey focused on “How often do you feel this
way when you take a test?” For example, one state-
ment was, “Before I take a test I feel uneasy.” Similar
to the measures for perceived stress, the individual
items were summed together to obtain a total. The sur-
vey was designed to draw on the work of Martens et al.
(1990) in identifying personal trait anxiety in associa-
tion with the role of a student in a performance and
competitive task of test taking. The TAS had an alpha
coefficient of .79 and .81 for the beginning and end of
the semester, respectively.

13. Personal Burnout. The Personal Burnout Scale (PBS;
Kelley, 2007) is a 10-item scale designed as an applied
measure of a general sense of burnout. Items in which
“work” or “work-related” factors were the focus were
modified to emphasize a “class-” or “coursework”-
related focus (e.g., “I am becoming increasingly frus-
trated with class related responsibilities”) to increase
the face validity of the instrument for college students.
Participants were asked to rate how characteristic each
statement was in describing how they were feeling right
now or have felt recently on a 5-point Likert-type scale
of not very characteristic at all to very characteristic.
The PBS has demonstrated good reliability (Kelley,
2007), and alpha coefficients were .82 and .84 for the
two data collection periods.
Treatment Groups
There were some predetermined commonalities
between all groups. Recruited participants were
enrolled in three credit hour classes that could be
applied toward fulfilling the general education require-
ments of the university. All classes met 3 days a week
for 50 minutes on a Monday, Wednesday, and Friday
schedule. All instructors agreed to provide the incen-
tive of extra credit for those students that agreed to
participate in the study. To avoid any coercion, each
instructor also provided an alternative means to obtain
the same extra credit value. Groups were randomly
assigned to a treatment.
Stress Management. The SM groups divided their time
between lectures (25%); cognitive–behavioral exer-
cises, concepts, and hands-on participation (25%);
mental and physical relaxation strategies, techniques
instruction, and practice (25%); and exercise and

14. wellness participation (25%). Each student was pro-
vided with a 170-page workbook titled “Exploring
Your Stress: An Introductory Program” designed spe-
cifically for the study and used as the course textbook.
It comprised 13 chapters and 164 exercises and activi-
ties. The chapters in the workbook were: (1) Introduc-
tion to Stress, (2) Stress and Burnout Assessment, (3)
Health and Well-Being, (4) Thought Management, (5)
Coping, 6) Communication, (7) Psychological Needs
and Social Support, (8) Values and Time Management,
(9) Goal Setting, (10) Lifestyle Balance, (11) Stress
Ideas and Suggestions, (12) Fifteen Ways to Relax and
Control Emotions, and (13) Reassessment and Future
Planning. They also received a professionally devel-
oped and produced narrated guidance over a music
background for Progressive Muscle Relaxation and
Autogenic Relaxation. Various handouts, brochures,
and cartoons related to the course content were handed
out as supplemental material. In addition, students
were encouraged to bring in articles they found in
magazines, newsletters, or other literature not used in
the course.
Physical Activity. The PA groups spent approximately
25% of their time in lectures and 75% in activities.
Lectures contained informational facets that covered
an introduction, history, biomechanics, technique,
strategy, and safety of that particular activity. Classes
were offered for a tremendous array of sports and
games, and individuals signed up based on the activi-
ties they wanted to participate in. The activities that
442 HEALTH PROMOTION PRACTICE / May 2014

15. were represented included basketball, volleyball, bad-
minton, table tennis, martial arts, tennis, racquetball,
softball, bowling, soccer, and touch football. The pur-
pose of the physical activity classes was to provide stu-
dents with an opportunity to learn a new sport or
activity that they might wish to pursue as a lifelong
activity. Although there was an imbedded fitness com-
ponent, skill development was the primary objective.
Cardiovascular Fitness. The CF groups also spent
approximately 25% of their time in lectures and 75% in
activities. Lecture content included pre and post fitness
assessments, exercise physiology, biomechanics, exer-
cise psychology, personal program development, and
safety. Both aerobic and anaerobic fitness were empha-
sized, and the focus was improving physical fitness
over participating in a sport, which distinguishes this
group from the PA Group.
Procedures
Following institutional review board approval, par-
ticipants were recruited from university courses that fit
the intervention parameters needed for the study. All
courses were scheduled for the full 16-week semester.
For all groups, the course instructors were contacted
and permission requested to come to their class and
recruit participants. During the first week of the class,
an investigator attended and addressed the class mem-
bers at the beginning of the class period. Participants
were read a statement of the general purpose of the
study, requirements of participation, and informed
consent. Survey packets contained the following: (1)
cover letter, (2) demographic survey, (3) PSS, (4) TAS,
(5) PBS, and (6) informed consent form. Participants
completed the survey during that class, and this pro-

16. cess was repeated at the end of the semester during the
last week of classes before finals.
For the SM courses, a cognitive–behavioral work-
book curriculum was developed in which participants
completed the designated surveys at the beginning and
end of the semester as part of their workbook assign-
ments for the course. An investigator attended the
classes at the end of the semester and collected the
completed pre–post surveys from their workbooks.
Except for the SM class, an instructor attended each
of the selected classes during the second week of the
semester and gave a 30-minute stress management and
test anxiety reduction presentation. At the end of the
presentation, a packet of materials was provided with
information from the presentation with additional
information and exercises. There was no follow-up
presentation, and students were left to read and prac-
tice the material on their own.
>>Results
Descriptive Analyses
Prior to analyses, data were screened for missing
values and violation of assumptions. There were no
missing data. All regression assumptions were exam-
ined for these data, including linearity, normality, and
homogeneity of variance. At baseline, students were
equally grouped with respect to gender, race, and age.
Of the male (n = 220) and female (n = 311) students
who participated, 25% were freshmen, 18% sopho-
mores, 19% juniors, and 38% seniors, with a mean age of

17. 21.4 years. Participants were primarily Caucasian (78%)
and African American (15%) by ethnicity. Most reported
that they were single (91%). Almost half (47%) partici-
pated in a regular program of exercise, and 45% reported
using exercise as a means of reducing their stress.
Demographic Variables
Correlation analyses were used to examine relation-
ships between the demographic variables of race, age,
class in school, living arrangement (e.g., dorm, apart-
ment), number of roommates, participation in a regular
exercise program, whether they exercised to reduce
stress, and strength of religious beliefs to the three
stress indices (perceived stress, personal burnout, test
anxiety). Compared to nonexercisers, those participat-
ing in a regular exercise program were lower in their
perceived stress levels and burnout at the beginning
(r = −.13, p < .01; r = −.12, p < .01) than at the end (r =
−.10, p < .01; r = −.08, p < .05). Furthermore, those who
exercised specifically to reduce stress were higher in
test anxiety (r = .10, p < .01; r = .10, p < .01) than those
using exercise not for stress reduction but for fitness
and enjoyment. Although relationships were present,
multiple regression analyses revealed that the demo-
graphic variables, most notably gender and participa-
tion in an exercise program, accounted for only minimal
variance in perceived stress, F(8, 531) = 3.81, p < .01,
R2 = .06, and test anxiety, F(8, 459) = 3.51, p < .01, R2 =
.06, at the beginning of the semester, and similarly
small amounts in perceived stress, F(8, 531) = 2.67, p <
.01, R2 = .04, and test anxiety, F(8, 531) = 2.75, p < .01,
R2 = .04, at the end of the semester.
Group by Time of Semester Differences

18. A 4 × 2 Group (SM, PA, CF, C) by Time (beginning,
end of semester) repeated-measures multivariate
Baghurst, Kelley / EXAMINATION OF STRESS IN COLLEGE
STUDENTS 443
analysis of variance was conducted with perceived
stress, test anxiety, and personal burnout as the
dependent measures. Results (see Table 1) indicated
significant main effects for Group, Wilks’s Λ = .94,
F(3,531) = 16.13, p < .01; Time, Wilks’s Λ = .91, F(1,
531) = 16.99, p < .01; and Group × Time interaction,
Wilks’s Λ = .99, F(1, 531) = 18.04, p < .01.
Group Main Effect. Examination of the univariate F
revealed significant differences in the overall means for
perceived stress, test anxiety, and personal burnout
when groups were compared to each other. In reference
to perceived stress, the C group (M = 38.6) was higher
than all other groups (SM, M = 35.9; PA, M = 35.0; CF,
M = 35.3). The SM group (M = 33.9) was higher than the
PA (M = 25.9) and CF groups (M = 28.2) on test anxiety,
and the PA group was also lower than the C group (M =
31.6). The SM (M = 30.4) and PA groups (M = 28.8) were
lower than the CF group (M = 33.9) on personal
burnout.
Time Main Effect. Inspection of the univariate F showed
a significant difference in the overall mean for per-
ceived stress. Students were not significantly higher in
perceived stress at the end of the semester (M = 35.0)
than at the beginning (M = 37.4); however, this mean is
moderated by an increase in perceived stress for the C
group but decreases in the other three groups. Test anxi-

19. ety and personal burnout were not significant (Table 2).
Group × Time Interaction Effect. Review of univariate F
values for Group by Time interaction showed that the
SM and PA groups demonstrated significant decreases
in perceived stress, test anxiety, and personal burnout
from the beginning to the end of the semester. The CF
group showed a significant decrease in perceived stress
also but had a significant increase in personal burnout.
The C group showed a significant increase in perceived
stress but had no significant increase or decrease on test
anxiety or personal burnout.
>>discussion
Stress is a complex and multifaceted construct
affected by a wide number of factors (Nguyen-Michel et
al., 2006) and can be particularly evident throughout
the collegiate experience (Ferrante et al., 2002). Thus,
the purpose of this study was to determine whether dif-
fering stress reduction interventions could reduce the
stress levels experienced by male and female college
students from the beginning to the end of a semester.
With respect to our first hypothesis, it was predicted
that stress levels for perceived stress, test anxiety, and
burnout would show the greatest reduction over the
semester in the SM group, which we classified as a
comprehensive, global intervention. Interestingly, both
the SM group and the PA group demonstrated signifi-
cant decreases in all three variables; however, as
hypothesized, the reduction in stress indices was
greater, if only slightly, in the SM group. This finding
is supported by previous research indicating that broad,
universal interventions with a strong cognitive–behav-

20. ioral component can be highly effective in reducing
stress indices (Bahrke & Morgan, 1978; Berger et al.,
1988; Deckro et al., 2002).
Interestingly, the PA group also significantly reduced
their stress indices and only marginally less than the
SM group. Physical activity has been established as an
effective means of stress reduction (e.g., Carmack et al.,
1999; Nguyen-Michel et al., 2006). Thus, practitioners
should consider which method would be the most
effective. For example, the intensive SM course in
addition to the provision of a stress reduction work-
book could be time-consuming and impractical if a
stress reduction program was to be implemented
table 1
overall Means and standard deviations for stress, Management,
Physical activity, cardiovascular Fitness, and
control Groups on stress Variables
Stress Condition
Stress
Management
Physical
Activity
Cardiovascular
Fitness Control
Perceived Stress 35.9 (3.9) 35.0 (5.7) 35.3 (6.6) 38.6 (6.3)*
Test Anxiety 33.9 (5.2) 25.9 (5.8)* 28.2 (6.9)* 31.6 (7.2)
Personal Burnout 30.4 (6.0)* 28.8 (4.3)* 33.9 (7.2) 32.0 (6.7)
NOTE: Higher scores indicate a greater level of stress.

21. *p < .05.
444 HEALTH PROMOTION PRACTICE / May 2014
university-wide. Rather, the provision or requirement
of physical activity during a semester would assist in
student stress reduction without the contact time nec-
essary to deliver a stress management program.
In our second hypothesis, it was predicted that
stress levels for perceived stress, test anxiety, and burn-
out would be lower at the end of the semester com-
pared to the beginning for all treatment groups. All
stress indices were lower in both the SM and PA groups
at semester’s end, but the CF group yielded mixed
results. Although the group participants significantly
decreased levels of perceived stress, text anxiety did
not change, and levels of personal burnout significantly
increased.
Cardiovascular fitness is a frequently used strategy
to reduce stress (e.g., Keller & Seraganian, 1984; Sinyor
et al., 1983). However, our findings suggest that is it
less effective than other methods. This is somewhat
contradictory to the findings of VanKim and Nelson
(2013), who found that students who met vigorous
physical activity recommendations reported lower per-
ceived stress. Although the goals and expected partici-
pation outcomes for the courses in our study were to
achieve these recommendations, it was not measured,
and may explain differences in findings to those of
VanKim and Nelson.
However, results may have differed due to the varied

22. exercise preferences of individuals with respect to
motivation, style, activity, and environment (Brue,
2002). It may be that the focus on fitness rather than
physical activity may be a contributor to personal burn-
out in some, who may have viewed the high intensity
nature of cardiovascular fitness as a stressor rather than
a stress reducer. This could account for the mixed
results, and therefore practitioners should consider
whether cardiovascular exercise is the best method for
lowering stress, particularly if the client is inexperi-
enced or unfamiliar with vigorous physical activity.
Last, the third hypothesis stated that stress levels for
perceived stress, test anxiety, and burnout would be
higher at the end compared to the beginning of the
semester for the C group. This hypothesis was con-
firmed, and the outcome was in contrast to the treat-
ment groups who experienced less stress by semester’s
end. For the C group there was no significant increase
or decrease on test anxiety or personal burnout.
Although we could not account for participants in this
group that already employed stress reduction strate-
gies, it did not appear that the strategies, if used at all,
were particularly effective.
Several limitations in the present study must be
noted. First, we did not ascertain how important the
classes chosen were to the participants. For example, a
student may have been heavily invested in cardiovascu-
lar exercise, or he or she may have been trying to merely
pass a class for credit. Some form of assessment could
have been included with the aim of determining that
level of investment. Second, because the classes were
taught by a variety of instructors, the investment and
outcome in a particular class may have been dependent

23. on instructor attributes or how well the class was taught.
For example, the perception of instructor physique can
positively or negatively affect a student’s learning and
opinion of both instructor and class (Baghurst & Bryant,
table 2
Means and standard deviations for stress Management, Physical
activity, cardiovascular Fitness, and control
Groups on stress Variables for the beginning and end of the
semester
Stress Condition
Stress
Management
Physical
Activity
Cardiovascular
Fitness Control Total Mean
Beginning of semester
Perceived Stress 38.2 (7.1) 37.2 (5.4) 37.4 (4.5) 36.9 (6.1)
37.42
Test Anxiety 39.4 (5.8) 29.6 (6.4) 28.1 (6.2) 31.8 (6.9) 32.25
Personal Burnout 32.9 (5.7) 30.8 (4.8) 31.8 (5.1) 31.9 (6.5)
31.85
End of semester
Perceived Stress 33.7* (6.2) 32.9* (4.7) 33.1* (9.7) 40.2 (6.2)*
35.0
Test Anxiety 28.5* (6.4) 22.1* (3.1) 28.3 (5.7) 31.3 (7.2) 31.40
Personal Burnout 27.8* (4.8) 26.8* (7.2) 35.9* (6.1) 32.1 (5.9)
32.40
NOTE: Higher scores indicate a greater level of stress.

24. *p < .05.
Baghurst, Kelley / EXAMINATION OF STRESS IN COLLEGE
STUDENTS 445
2012). A future study might consider limiting the num-
ber of instructors for greater consistency. Third, this
study’s participants were limited to one large Midwestern
university, and it would be interesting to see whether
similar findings occur in smaller universities in other
parts of the United States and world.
In sum, a combination of stress reduction strategies
may be the most effective means of reducing stress
indices in male and female college students. This
study did not attempt to examine the long-term or last-
ing effects of the various interventions on stress; how-
ever, this would seem a necessary and logical extension
of this preliminary work. Although all treatment
groups were found to reduce one or more indicators of
stress, the combination of psychological stress man-
agement strategies significantly reduced all stress indi-
ces the most.
From a practitioner’s perspective, it is evident that
stress reduction strategies do have an impact on reducing
stress variables in students over the course of a semester,
and those working in the field should be encouraged that
such strategies can be effective. However, although psy-
chological skills training may be marginally more effec-
tive, implementation of such training campus-wide may
not be as practical as physical activity opportunities.
That physical activity classes are almost on par with psy-
chological skills training in reducing stress is very impor-

25. tant to note, as colleges are increasingly reducing or
eliminating physical activity requirements from under-
graduate programs (Cardinal, Sorensen, & Cardinal,
2012). Thus, although academic institutions may be
streamlining the degree plan, they may be doing so to the
detriment of their students’ health.
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A Guide for Chapter Questions, the Written Assignment
Research Review Paper
(50 points)
Purpose:
Address material that can not be covered in class but can benefit
students
Present students with an opportunity to summarize and evaluate
peer reviewed research
Step 1: Students will choose 1 (one) of the following articles to
read and then summarize
Article 1: Feel Good, Do Good Online
Article 2: Test Anxiety
Article 3: Stress and College Students
Article 4: College Students and Coping Strategies
***(a link to these is also in the Instructions for Assignments
and Research Participation folder on Bb)
Step 2: Complete the assignment following the stated format
outlined on the following slides

36. Outline for the paper
This is the EXACT order the paper should be in using these
EXACT headings:
Introduction (1-2 Paragraphs)
Research Review (Minimum of 3 Paragraphs)
Purpose
Method
Results
Conclusion (1-2 Paragraphs)
Details for each of these sections on the next slides
Any example paper is also posted in the Class Assignments and
Research Participation Instructions
Introduction
10 points (1-2 paragraphs)
Summarize your own experience related to the topic of the
article you chose to summarize
Article 1: feel good, do good Article 2: test anxiety
Article 3: stress and college Article 4: college students and
coping
MUST meaningfully use 2 terms from the book in your
discussion. These terms have to be highlighted,underlined, or
bold for full credit on this section of the paper.

37. Ideas discussed in the introduction could include: habits your
have regarding the topic, attempts you’ve made in the past to
improve, or why you chose this article.
Summarize 1 (one) of the research articles from slide 3
The article should be summarized following this outline:
Describe the authors’ purpose
What are their hypotheses? What did they believe they would
find?
Why are they doing this study?
Describe the methods they used in their study
How many participants (will be defined as N)? What were the
participants ages?
What did they do? Did they give surveys, do an experiment,
observe a population?
How long did they do the study?
Describe the results
Were their hypotheses correct? What did they conclude?
What were the limitations of the study? What do they
plan/recommend to do in the future?
Peer Reviewed Research
30 points
(minimum of 3 paragraphs)
Conclusion and Guidelines
Conclusion-5 points (minimum of 1 paragraph)

38. Summarize what you’ve learned from the chapter and the
research. How has it affected you or how can you apply it in
the future?
Format and following guidelines- 5 points
2-3 pages
Writing Quality
Formal language
Times New Roman, 1 inch margins, 12 point font
Used citations (in-text and reference page)
MLA or APA format is acceptable