Lifestyle behaviours including tobacco use, poor diet, physical inactivity and excessive alcohol consumption are identified as health-risk behaviours (World Health Organisation, 2010). College years often coincide with the transition from adolescence to adulthood and are a vulnerable period when young people make lifestyle decisions that once established persist into later adulthood, affecting lifelong health (Bell and Lee, 2006). Across the OECD countries, 62% of young adults are expected to enter university and 17% to enter vocationally oriented programmes (OECD, 2012). Attention to promotion of health and well-being among this population is essential, because the evidence suggests that their lifestyle behaviours are problematic.
Alcohol consumption among higher education students is a matter of public health concern, particularly hazardous drinking. Cigarette smoking (Thompson et al., 2007), cannabis use (Lee et al., 2013), unhealthy diet/eating patterns (Dodd et al., 2010) and low levels of physical activity (Greene et al., 2011) are also problematical among this population group. Health adverse behaviours are interwoven, for example alcohol consumption adversely influences other lifestyle behaviours including eating habits (Lloyd-Richardson et al., 2008), smoking (Reed et al., 2010) and physical activity (Musselman and Rutledge, 2010). Thus, risk behaviours often aggregate in clusters with synergistic effects on health (Dodd et al., 2010).
Stress, defined as ‘a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being’ [(Lazarus and Folkman, 1984), p. 19], is acknowledged as a major part of the student experience Stress is linked to psychological distress (Watson et al., 2008) and other adverse consequences on students' health and well-being (Stixrud, 2012) which impacts academic achievement (El Anasari and Stock, 2010). Psychological distress is an emotional state characterized by symptoms of depression and anxiety (Barlow and Durand, 2005) which is experienced in response to stress and is associated with a perceived inability to cope effectively (Ridner, 2004).
The factors that contribute to psychological distress include a range of academic- and course-related stressors (Pryjmachuk and Richards, 2007), as well as the transition from home to college (Lawrence et al., 2006) and into adulthood (Kwan et al., 2012). Other stressors include lack of financial certainty, poor employment prospects, increased pressure to do well and technological overload (Stixrud, 2012). Nursing and teacher education students are exposed to additional practicum-related stressors which contribute to their perceived stress and vulnerability to psychological distress. These include managing disruptive students (Chaplain, 2008) and dealing with death and dying.
Distress experienced by higher level students is linked with the adoption of risk behaviours, including smoking (Sun et al., 2011), hazardous drinking (Butler et al. 2010) and poor dietary habits (Tavolacci et al., 2013). However, the clustering of stress and coping with health-risk behaviours among higher level students is underexplored and is particularly deleterious to health. Dodd et al. have cautioned against ignoring stress which may be an underlying cause of the adoption of multiple unhealthy behaviours (Dodd et al., 2010). A further concern is that the means of coping with stressful situations are often characterized by escape avoidance actions that are in fact health-risk behaviours. Hence, while the evidence points to the fact that stress and unhealthy behaviours aggregate in clusters, not enough is known about the role coping plays in this process. Therefore, an examination of lifestyle and its relationship with psychological distress and coping among higher education students is the focus of this study. A detailed understanding of the extent to which multiple risk behaviours (substance use, physical activity and diet) aggregate, as well as their association with psychological distress and coping in higher education contexts, is important. It could assist in establishing if high- or low-risk groups can be identified. This knowledge could be used to guide health promotion interventions which can potentially promote health gain and enhance academic achievement.
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