Since the Ottawa Charter for Health Promotion was published in 1986, much has been written about Comprehensive School Health (CSH) as it applies to K-12 schools. Schools are a logical choice of setting for the promotion of public health (Samdal & Rowling, 2013), since after the home and family, they are the most important environment for children (Martin & Arcand, 2005). There is also a great opportunity within schools to implement principles associated with CSH such as physical education, health and nutrition services, counselling and psychological services, and family-community involvement (Samdal & Rowling, 2013). It is established that one’s health affects one’s ability to learn, and that one’s education has an impact on one’s health (Bassett-Gunter, Yessis, Manske, & Stockton, 2012, p. 2).
But a growing body of research has demonstrated that at the post-secondary level, students are suffering from stress, anxiety, depression and other mental health issues (McKean, 2011). In Quebec this year, 176 777 students are registered throughout the 48 colleges in the network (Fédération des CÉGEPS, 2016). These students, typically beginning college life at the age of 16 or 17, are at the age when mental disorders often manifest themselves (McKean, 2011), and are often for the first time living away from home and dealing with a multitude of new stressors. Are these students, who are actually some of the least likely to meet physical activity, sleep, and nutrition requirements (Versaevel, 2014), benefiting from the theory and implementation of Comprehensive School Health? How are the principles of CSH reflected currently in CEGEPs, and how can they be further integrated into policy and programs?
A look at the statistics shows us that the 15-24 year old age group are not necessarily well set-up to deal with the stressors of Cegep life. While Cegep students tend to have better lifestyle habits overall than do the general 15-24 year old population (Fédération des cégeps, 2010), they still score low on general lifestyle habit indicators.
About 50% of 15-24 year olds consume only half of the recommended daily amount of fruits and vegetables (Fédération des cégeps, 2010). Many Cegep students are living away from home for the first time, and no longer have their parents providing healthy meals and snacks for them. The higher cost of produce, and the perceived difficulty in preparing them, keeps students away from these foods, and pushes them towards more processed foods.
Physical activity is known to prevent disease and improve concentration, creativity, memory, and academic success; however, only 59% of 18 to 24 year olds identify as “physically active” (Ministère de l’éducation, du loisir et du sport, 2007). While this number is higher in Cegep students, many are still choosing inactive transport and inactive leisure activities. As for overweight and obesity rates, while this number decreases with the amount of schooling, in Quebec, 32.6% of youth aged 15-24 were overweight in 2004 and 6.9% of that population qualified as obese (Fédération des cégeps, 2010).
Also in Cegep, students are exposed to alcohol, drugs, and sexual activity and are more and more willing to experiment with those. The age group in Quebec with the highest rate of consumers of alcohol (89%) is 20-24 years old (Fédération des cégeps, 2010).
Sleep is another important factor that contributes to physical, emotional, and mental health, including stress and academic performance (Versaevel, 2014). While lack of sleep is probably not new to most Cegep students, post-secondary students often have lifestyle habits that can lead to chronic sleep deprivation (Versaevel, 2014). This is also related to part-time jobs that are held by 72% of Cegep students (Fédération des cégeps, 2010).
Le syndrôme de la première session or “first semester syndrome” has been suggested (Roy, Mainguy, Gauthier, & Giroux, 2005) as a symptom of the difficult transition that students make in going from high school to Cegep. In moving away from home, students find themselves at a new school, in a new town, far from their families and their friends. Roy (2005) suggests that these stressors, added other academic and life stressors, contribute to the higher dropout rate in first semester, as well as lower academic performance. Other lifestyle habits could also be affected, as students have less mental space and actual time for physical activity, proper nutrition, and sleep.
It’s clear, then, that the Cegep population is in need of a holistic, systems-wide approach that encompasses mental, physical, and emotional well-being in order to positively affect retention rates and academic success (Canadian Association of College & University Student Services and Canadian Mental Health, 2013). In looking at my own Cegep, and in referring to the principles and pillars of CHS/HPS, I was able to identify several measures that have been put in place to address these concerns, and some areas that could use some work.
Cegeps have all put in place a “Student success plan”. The plan at my Cegep aims to prioritize student success and engagement as well as community engagement with the college (Cégep de la Gaspésie et des Îles, 2012). This plan is used by all stakeholders at the Cegep to ensure that strategies are implemented in an school-wide manner. Some of the principles of the Success Plan include:
- curricular, extra-curricular and intra-mural activities to increase student engagement and a feeling of belonging;
- Particular attention to first-semester students and a personalized follow-up for all students;
- All personnel involved in the implementation of the plan.
The plan translates into direct action in the creation of the student schedules; the design of the physical environment; the involvement of students and staff in extra-curricular activities, clubs and events; and providing support services for students with special needs.
The school also has several resources related to sexual and mental health. A nurse is on site once a week for STI prevention, education and treatment. There is a social worker in the residence as well as one available to all students on appointment. A suicide prevention and education committee has been put in place.
The physical environment of the school is important, and steps have been taken to create bright, spacious study rooms and student life spaces such as the cafeteria and locker areas. A network of hiking trails with a lookout has also been constructed behind the school and green space abounds.
With a small student body, it is difficult to offer a wide range of clubs and activities. There are a couple of sports teams and recreational sports that students can participate in. There is an active student association and many interesting socio-cultural clubs and groups. One that stands out is the “Cellule Interculturel” or intercultural group; this group was created in response to the relatively large proportion of international students at our Cegep and aims to connect students from different cultures through discussion, activities, workshops and events. These groups and clubs are often coordinated by a teacher who takes on the task as part of her workload – in other words, the school is financially supporting such initiatives).
While many steps have been taken to address student success, engagement, mental health, and retention, I would suggest that a wider, whole-school approach to health and wellness should be implemented.
One element that is in development at the Cegep level is the idea of cross-curricular, or common competencies. These competencies, strongly present in the Quebec Education Plan (for primary and secondary schools), can be a uniting force for school personnel, who are all responsible for the development of these competencies. At the moment, five common competencies[i] have been identified by the Minister of Education but they are not required to be assessed in Cegeps. I would suggest that, according to a Healthy School Community approach, these common competencies could help to include the “everyone” pillar of HPS in teaching and learning (Bassett-Gunter, Yessis, Manske, & Stockton, 2012). It could also help to integrate learning across subjects and across disciplines. In addition, common competencies could allow for the “health-education synergy” called for by the Healthy School Community approach (Bassett-Gunter, Yessis, Manske, & Stockton, 2012).
Addressing the issue of physical activity and lifestyle behaviours should be done on an institutional level, with all personnel (teaching and support staff) involved in the promotion of positive lifestyle choices. On a policy level, the Cegep should enforce an emphasis on fresh fruits and vegetables at the cafeteria and could perhaps even subsidize the potentially higher cost of these. Workshops should be offered to students newly away from home, on how to cook with fresh produce, legumes, and lean meats. Since the cost of healthy food items is often higher than that of prepared and processed foods, a partnership with the local grocery stores could result in a discount for students on produce, or perhaps more radically, an open-dumpster policy that would encourage students to come and pick over about-to-be-discarded food (that hasn’t actually made it to the dumpster yet) and take it home for free!
A major barrier to regular physical activity is long, cold winters and the high cost of a gym membership. Studies have demonstrated that using campus recreation facilities increase feelings of belonging, connection to peers, mental and physical health, retention rates, and academic performance (Cressy, 2011). By offering significant discounts to all students on memberships to the weight room, pool, and gymnasium, students could exercise regularly even in the colder months. As well, introductory fitness, sport, or dance classes could be offered for free to allow students to begin forming positive physical activity habits (Cressy, 2011).
Mental health issues are significant in Cegep and the lifestyle behaviours of 17-24 year olds don’t help. According to McKean, promising practice in the prevention of mental health issues includes “screening & early detection, help-seeking, supporting students with mental illness/disability, student services, and academic policies” (2011). In addition, as Versaevel (2014) concludes, “creating a campus environment that supports students in managing stress, eating nutritiously, being physically active, and getting adequate sleep will enable students to maximize their intellectual functioning and scholastic achievements”. This must be done through a whole-school, all-personnel approach to health and education, by implementing policy and integrating health and educational objectives into all activities at the Cegep.
[i] The competencies are: Solve problems; Use creativity; Adapt to new situations; Exercise sense of responsibility; and Communicate (Ministère de l’éducation, loisir, et sport, 2009)
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Roy, J., Mainguy, N., Gauthier, M., & Giroux, L. (2005). Étude comparée sur la résusite scolaire en milieu collégial selon une approche d’écologie sociale. Cégep de Saite-Foy, Sainte-Foy.
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