STRESS MANAGEMENT AND HEALTH PROMOTION BEHAVIOURS

IN YOUNG MEN IN TERTIARY EDUCATION SETTINGS

NIKOM MOONMUANG
School of Psychology
Faculty of Arts
Victoria University

SUBMITTED TO SATISFY THE REQUIREMENT FOR THE DOCTOR OF PHILOSOPHY DEGREE

BY RESEARCH

FEBRUARY, 2005

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Student Declaration

I, Mr. Nikom Moonmuang, declare that the thesis entitled Stress management and
health promotion behaviors in young men in tertiary education settings is no more than
100,000 words in length, exclusive of tables, figures, appendices and references. This
thesis contains no material, which has been submitted previously, in whole or in part, for
the award of any other academic degree or diploma. Except where otherwise indicated,
this thesis is my own work.

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Acknowledgment
This research was supported in part by grant from the Faculty of Nursing,
Burapha University. Thanks to Assistant Professor Dr. Suntharawadee Thienpichej, Dean
Faculty of Nursing and all my colleagues, particular from Community Health Nursing
Department, at Burapha University for letting me to study in Australia.
I would like to thank my principal supervisor, Dr. Marion Kostanski, for her
diligent support and professional guidance throughout the study. Without her
encouragement and the enormous amount of patience, this thesis would not have been
completed. As international students in which English as a second language, I would like
to thank Dr. Judith Booth for her helping with the language and helpful comments on the
academic writing. I would like to thank Petre Santry for improving my English speaking.
I would also like to thank Anjela Rojer for her proof reading and helping with the
language. The researcher extends special thanks to Ann Harris for helping in transcribing
data. My appreciation goes to Ms. Rachanee Naksuk who helps me regarding transcribing
data. I would also like to thank Peter Gill for his professional guidance on my thesis
writing up. I would also like to thank Anamai Damnej for friendly helping. I also wish to
acknowledge the male university students from Latrobe University, RMIT, The
University of Melbourne, and Victoria University of Technology for their contributions
to completing the questionnaires and taking part in interviews.
Last and foremost, special thanks are giving to my wife and a beautiful daughter
for their unconditional love and above of all their encouragement, support and strong
belief in me throughout my life that word can not express my love and gratitude.

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Conference Presentation

1.

Health promotion in young men in tertiary education settings at the Impact of

global issues on women and children international conference. February 16-21,
2003 Ambassador Bangkok Hotel, Thailand.

2. Stress management in young men in tertiary education settings. 28, July 2004
Victoria University of Technology, Victoria, Australia.
3.

Stress management and health-promoting behaviors in young men in tertiary

education settings. Association of Pacific Rim University: the 5th Doctoral
Students Conference 9-12 August 2004, University of Sydney, Sydney, Australia.

Table of Contents
Student Declaration .............................................................................................. ii
Acknowledgment.................................................................................................. iii
Conference Presentation ..................................................................................... iv
List of tables and Figures..................................................................................... ix
Abstract................................................................................................................. x
Introduction and background ................................................................................1
1.1 Background ............................................................................................................... 1
1.2 Conceptual framework of the study .......................................................................... 5
1.4 Aims and objectives .................................................................................................. 7
1.5 Significance of the study ........................................................................................... 8
1.7 Contribution to knowledge........................................................................................ 9
Stress and stress management ..........................................................................10
2.1 The concept of stress ............................................................................................... 10
2.1.1 Biological concept of stress.............................................................................. 10
2.1.2 Cognitive concept of Stress .............................................................................. 11
2.1.3 Social concept of stress..................................................................................... 17
2.2 Stress-related outcomes........................................................................................... 19
2.2.1 Systemic or physical stress-related responses .................................................. 19
2.2.2 Psychological or emotional stress-related responses........................................ 22
2.2.3 Behavioral and social stress-related responses................................................. 26
2.3 The concept of coping ............................................................................................. 28
2.3.1 Gender difference in coping styles ................................................................... 31
2.3.2 Personality risk factor....................................................................................... 32
2.4 The concept of stress management.......................................................................... 35
2.4.1 Minimizing the frequency of stress-inducing situation .................................... 36
2.4.2 Increasing resistance to stress........................................................................... 37
2.4.3 Counterconditioning to avoid physiological arousal ........................................ 38
2.5 Gender differences .................................................................................................. 39
Stress in young men and male university students .............................................41
3.1 Mens health............................................................................................................ 41

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3.1.1 Nature: Physiological differences..................................................................... 42

3.1.2 Nurture: Socialization....................................................................................... 44
3.2 Young mens health ................................................................................................ 46
3.3 Stress in young men ................................................................................................ 50
3.3.1 Sources of stress in young men ........................................................................ 55
3.4 Stress in male university students ........................................................................... 61
3.4.1 Student stressors ............................................................................................... 63
3.5 Summary ................................................................................................................. 71
Health promotion.................................................................................................73
4.1 Concept of health and health promotion ................................................................. 73
4.2 Health promotion model (HPM) ............................................................................. 77
4.2.1 Individual characteristics and experiences factors ........................................... 80
4.2.2 Behavior-Specific cognition and affect factors ................................................ 81
4.2.3 Behavioral outcome.......................................................................................... 83
4.2.4 Testing Penders health promotion model........................................................ 84
4.3 Health promotion behaviors and male university students ..................................... 86
4.3.1 Health responsibility......................................................................................... 87
4.3.2 Physical activity................................................................................................ 90
4.3.3 Nutrition............................................................................................................ 92
4.3.4 Interpersonal relations ...................................................................................... 94
4.3.5 Spiritual growth ................................................................................................ 95
4.3.6 Stress management ........................................................................................... 96
4.4 Summary ................................................................................................................. 97
Methodology .......................................................................................................99
5.1 Research design....................................................................................................... 99
5.1.1Quantitative method .......................................................................................... 99
5.1.2 Qualitative method ........................................................................................... 99
5.2 Quantitative method .............................................................................................. 100
5.2.1 Instruments ..................................................................................................... 100
5.2.2 Sample size ..................................................................................................... 104
5.2.3 Procedure ........................................................................................................ 105

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5.3 Qualitative Method................................................................................................ 106

5.3.1 Instruments ..................................................................................................... 106
5.3.2 Sample Size .................................................................................................... 106
5.3.3 Procedure ........................................................................................................ 106
Study One: Quantitative analysis ......................................................................109
Stress management and health-promoting behaviors in male tertiary students 109
6.1 Is the current sample a normative male university student cohort? ...................... 111
6.2 Do demographic variables affect stress (DSI) and health promotion behaviors
(HPLP II)? ................................................................................................................... 112
6.3 What are the most salient subscales of the DSI and HPLP II in regard to male
university students? ..................................................................................................... 117
6.3.1 What are the most salient subscales of the DSI in regard to male university
students? .................................................................................................................. 117
6.3.2 What are the most salient subscales of the HPLP II in regard to male university
students? .................................................................................................................. 118
6.4 Are stress (DSI) and health promotion behavior (HPLP II) related?.................... 119
Study Two: Qualitative analysis of stress management and health-promoting
behaviors in male tertiary students. ..................................................................123
7.1 The meaning of stress............................................................................................ 123
7.2 The sources of stress ............................................................................................. 125
7.2.1. University life stress ...................................................................................... 125
7.2.2 Financial stress ............................................................................................... 131
7.3 How to cope with stress ........................................................................................ 142
7.3.1 University life ................................................................................................. 142
7.3.2 Financial ......................................................................................................... 142
7.3.3 Interpersonal relations .................................................................................... 142
7.3.4. Personal enjoyment........................................................................................ 145
7.3.5 Less Functional Coping Techniques............................................................... 146
7.4 Health promotion behaviors .................................................................................. 151
7.4.1 Exercise .......................................................................................................... 151
7.4.2 A time for relaxing ......................................................................................... 152

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7.4.3 Alcohol ........................................................................................................... 152

7.5 The correlation between perceived stress levels and health promotion behavior . 153
7.5.1 High stress and negative health promotion behaviors .................................... 154
7.5.2 Low stress and positive health promotion behaviors...................................... 158
Discussion ........................................................................................................162
How young tertiary students cope with stress............................................................. 178
Functional strategies utilized to manage stress........................................................ 179
Less functional coping techniques........................................................................... 180
The relationship between stress levels, methods of coping and health promotion
behaviors ..................................................................................................................... 184
Conclusion ........................................................................................................185
Current Knowledge ..................................................................................................... 188
Recommendations ....................................................................................................... 189
Future Directions......................................................................................................... 190
Bibliography ......................................................................................................192
Appendices .......................................................................................................214
Appendix 1: Letter of introduction and questionnaires............................................... 214
Appendix 2: Sample of a participants interview transcript........................................ 224

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List of tables and Figures

Tables
Table 1 t-test statistic for sample size..112
Table 2 Demographic characteristics and one way ANOVA for sample size.114
Table 3 Demographic characteristics and one way ANOVA for sample size.116
Table 4 Factor analysis of content using principle component extraction with varimax
rotation..117
Table 5 Factor analysis of content using principle component extraction with varimax
rotation..118
Table 6 Correlations between the DSI and HPLP II (including subscales).121
Table 7 Correlations between the DSI subscales and HPLP II122

Figures
Figure 1 Conceptual framework of the stress health promotion of young people in tertiary
education settings.6
Figure 2 Stress and health-promoting behaviors framework in young male in tertiary
education settings.186

Abstract
The concept of stress has been identified as being a major protagonist of ill health
and poor sense of wellbeing amongst all ages groups. For example stress has been
identified as being a strong correlate of anxiety and school refusal in primary aged
children; depression, suicidal ideation and physical malaise in adolescents and poor
general health (i.e., colds, headaches, pain and sensitivity, depression, suicidal ideation,
cardiac events, stroke etc.) in older groups. One group which has been identified as being
particularly vulnerable to high levels of stress is male tertiary students. The identified
increase in stress amongst this population has been purportedly associated to the ever
increasing demands and extra pressures that are placed on young men in relation to
tertiary education. The purpose of this study was to test the relationships among stress
and specificity of academic concerns amongst tertiary males. The current study sought to
elucidate what were the particular avenues of concern which resulted in high levels of
stress amongst these young men. Moreover, in order to extrapolate information on how
best to address stress related concerns amongst these young men, a secondary purpose of
the study was to examine the health-promoting behaviors utilized by young men, and
identify areas which may be pertinent to future educational and clinical intervention and
health promotion programs. The participants for this study comprised a cohort of 226
male students from four universities in Melbourne. The theoretical framework for this
study was Penders health-promotion model and Lazarus stress adaptation model.
Instrumentation included the Health-Promoting Lifestyle Profile II (HPLP II) and the
Daily Stress Inventory (DSI).

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Only two demographic factors, nationality and language spoken at home, were
found to differentiate between levels of stress and impact. Students from non-Australian
backgrounds and non-English speaking homes were found to report significantly more
stress events in their daily lives. They were also found to report these events had a higher
impact on them than Australian and English speaking students. Male students in the
current study were also found to report a higher level of stressful events and greater sense
of impact comparable to the normative data. The major factors identified by these young
men were varied stressors and environmental hassles. Whilst issues such as academic
stress associated with specific academic issues examinations and assessment were cited
as sources of stress, these students also indicated that many sources of stress were also
related to self imposed or other influenced pressures such as pressure to succeed, future
career concerns, frustration over services, status and financial concerns were also major
sources of stress which impacted on them strongly.
Analysis indicated that there are two factors related to health-promoting
behaviors namely cognitive/emotional and physical health-promoting behaviors. The
results also indicated that there was an inverse relationship between increases in the
reported experience of stress and health-promoting behaviors, such that those young men
who engaged in positive health-promoting behaviors, such as exercise, good nutrition,
expression of emotions and social collaboration, were less likely to report a high
incidence of impact from sources of stress. Of particular importance, a small proportion
of students who reported higher impact of stress also reported having engaged in suicidal
ideation. Interestingly, a majority of the stresses reported by students were not specific to
academic life; rather they emanated from interpersonal dysfunction, specifically familial

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disruption and intimate relationship breakdown. Similarly, several behavioral methods

identified as coping mechanisms, such as alcohol use, cigarette smoking and drug
ingestion, by these young men, whilst considered normative behavior, are in-fact
contributing to their current identified stressful experiences.
The outcomes of the current study indicate that whilst attention needs to be placed
on the promotion of study and academic related skills, young men require additional
educational and social support in developing health promotion behaviors which are not
deleterious, such as good nutrition, exercise, communication, and interpersonal skills.
Ideologically the emphasis should be placed on prevention where possible, however the
outcomes of the current study indicate that the majority of these issues are not specific to
the individual but require a broader application of health promotion behavior across the
community. Ongoing counseling throughout the education years is desirable, as are
various programs, which address student concerns in relation to their tertiary studies.
Similarly, more public health promotion is required in order to address specific issues
related to interpersonal, gendered and in particular familial issues, which appear to be a
major source of stress for these young men.