College Students’ Trauma and Stress Enhance Benefits of Warm-Tone Syllabus

Food Insecurity on College and University Campuses: A Context and Rationale for Solutions

Differences in stress levels between junior high school students and college students during online learning

Background: Neck pain (NP), one of the most reported musculoskeletal disorders, is a major cause of illness and absence from university lessons among students. The COVID-19 pandemic affected higher education from university lessons among students. The COVID-19 pandemic affected higher education institutions worldwide. Academic studies shifted to online-learning, changing students’ habits and lifestyle. Data demonstrated that the pandemic and consequent lockdowns can affect people’s physical and mental well-being. Thus, the aim of this study is to evaluate the impact of COVID-19 pandemic and lockdown on the level of neck pain and shoulder pain among college students compared to the pre-epidemic period.
 Methods: A descriptive study was conducted in the form of an online questionnaire survey that included sociodemographic data, Neck Disability Index (NDI) and Perceived Stress Scale (PSS)
 Results: A total of 100 students were recruited. Among them the mean, standard deviation, median and the mean percentage of the stress level regarding neck pain among college students. The findings reveals that the majority of the college students, 49 (49%) had low stress level, 31 (31%) had moderate stress level and 20 (20%) had high stress regarding neck pain. The mean score for the stress level was 12.56 with a mean % of 44.12 whereas a median and standard deviation was 12 and 9.75 respectively. It can be concluded that higher the mean scores mean higher the stress level among the students. It indicates that any changes in stress level will affect the neck pain automatically among college students. Therefore, their online sessions will also get influenced due to neck pain in a given study. It is evidenced that these factors were influenced by stress level regarding their neck pain among college students during their online sessions. It is evidenced that any changes in stress level will also influenced more in the pain Intensity, lifting, concentration, work, sleeping and recreation activities as compared to other factors among college students during their online sessions in a given study.
 Conclusion: The purpose of the study was to investigate impact of covid-19 pandemic and lockdown on the level of neck pain and shoulder pain among college students. The statistical results have shown that about 49% had low stress levels, about 31% had moderate stress levels and 20% had high stress regarding neck and shoulder pain among the students. It can be concluded that the higher the mean scores value higher the stress level among the students. It is evidenced in other research that these factors were influenced by stress level regarding their neck pain among college students during their online sessions.

Food Insecurity Among College Students with Disabilities During the COVID-19 Pandemic Krista M Soria (bio) and Vanessa Coca (bio) Over the last several years, scholars have drawn attention to the growing rates of food insecurity among college and university students in the US (Broton & Goldrick-Rab, 2018; The Hope Center for College, Community, and Justice [The Hope Center], 2021). Food insecurity is a multifaceted concept commonly defined as the limited availability of nutritious foods, the uncertain ability to acquire nutritious foods, or the inability to acquire nutritious foods (Anderson, 1990). Food insecurity also constitutes interrupted eating patterns or a reduction in the quality of diet due to the lack of resources to access nutritious food (Coleman-Jensen et al., 2020). An estimated 40% of undergraduate students experience food insecurity (The Hope Center, 2021). Although research on food insecurity in college students is expanding, examinations into whether there are different rates of food insecurity by students' demographic characteristics have focused primarily on students' race/ethnicity, age, income or socioeconomic status, and sex or gender (The Hope Center, 2021; Morris et al., 2016; Wood & Harris, 2018). At present, researchers have not focused on food insecurity rates among college students with disabilities. The omission of food insecurity research on college students with disabilities is concerning due to the prevalence of students with disabilities in higher education—nearly one in five undergraduates has a disability (National Center for Education Statistics [NCES], 2021). Due to many forms of oppression, including ableism, racism, classism, and more, students with disabilities encounter more barriers in higher education, leading to reduced degree completion rates (Lett et al., 2020; NCES, 2022). Food insecurity is a factor associated with lower degree completion rates among students and is one of many factors that could exacerbate the existing disparities in degree completion rates (Wolfson et al., 2021). The topic of food insecurity is even more important to examine during the initial semesters of the COVID-19 pandemic when college students experienced significant and sudden financial hardships (Soria et al., 2022; The Hope Center, 2021). Therefore, the purpose of this study was to examine whether college students with disabilities had significantly different odds of experiencing food insecurity compared to their peers when controlling for additional demographic variables and COVID-19 experiences. CONCEPTUAL FRAMEWORK We used Glover and colleagues' (2020) conceptual framework for mitigating the equity harms of COVID-19. The model stipulated [End Page 102] that inequitable COVID-19 policies may have generated additional harms to individuals who were already marginalized, oppressed, and disenfranchised prior to the pandemic, including individuals with disabilities. Exacerbated food insecurity rates among marginalized groups (such as students with disabilities) during the pandemic may be a manifestation of pre-existing intersectional forms of oppression (i.e., ableism, racism) coupled with inequitable COVID-19-related policies. Glover et al. cited demographic variables associated with COVID-19 equity harms, including disability, employment, race/ethnicity, gender, and family education, and we used many of those demographic variables in our analysis. METHODOLOGY: INSTRUMENT, SAMPLE, MEASURES, AND ANALYSIS We used data from the 2020 #RealCollege Survey, which was administered to 1.84 million college students at 130 community and technical colleges and 72 four-year colleges in 42 states from September to November 2020. The response rate averaged 10.6% (N = 195,629), although only a smaller subset of 70,210 students who were also enrolled in spring 2020 answered the COVID-19-specific items (Table 1). The survey assessed students' food security using the U.S. Department of Agriculture's (USDA, 2012) 18-item set of questions (full items and methodology for summing the scale are available online via The Hope Center, 2021). The scale had excellent reliability in this study (α = .924) and can be converted to a four-level measure of food security level (i.e., very low, low, marginal, or high; The Hope Center, 2021). However, we dichotomized the results to provide a snapshot of whether students experienced food insecurity (0 = student is food secure [marginal or high food security], 1 = student is food insecure [very low or low food security]). Students reported demographic characteristics, which we converted using effect coding except in the case of dichotomous variables (e.g., full...

Engaging in physical activity is commonly regarded as beneficial to health. However, exercise addiction may arise when enthusiasm for exercise reaches a level that disrupts life balance and overall well-being. Factors influencing college students' exercise addiction remain largely unknown. Participants aged 18-23 years (N = 384) underwent body measurements, and sex-adapted silhouettes were employed to assess their level of body dissatisfaction. The Exercise Addiction Inventory was used to investigate the level of exercise addiction among college students. We used t-tests to compare sex differences in BMI, body fat percentage, body dissatisfaction levels, stress levels, and exercise addiction among college students. Chi-square's test was used to compare differences between males and females in terms of BMI, physical activity levels, stress, and exercise addiction ratings. The exercise addiction level of college students was used as the dependent variable in multiple regression analysis, and BMI, muscle mass, body fat percentage, exercise score, stress level score, and body dissatisfaction level score were used as predictors. The results of multivariate regression analysis revealed sex differences in physical activity scores, stress levels, body dissatisfaction, and exercise addiction levels, with males consistently exhibiting significantly higher scores than females. In males, body dissatisfaction scores and stress were significant predictors of exercise addiction. Among females, physical activity scores, stress, body dissatisfaction, and body fat percentage were identified as significant predictors of exercise addiction. College students confront risks in relation to exercise addiction. High stress levels and body dissatisfaction may be important causes of exercise addiction. The male students had higher body dissatisfaction, stress levels, and risk of exercise addiction than the female students. With a change in female bodily aesthetics in terms of a shift from a primary focus on thinness-related beauty to having a thin and toned body, the risk of exercise addiction in female college students may increase.

Stress, Anxiety, and Weight Gain among University and College Students: A Systematic Review

Expanding Agency:Centering Gender Identity in College and University Student Records Systems Jodi L. Linley (bio) and Cindy Ann Kilgo (bio) For many years, I felt that my gender identity did not quite reflect who I was; however, I was not able to verbalize or even completely conceptualize this feeling until my third year of doctoral study. At the 2015 ACPA Convention, I attended an educational session where space was held for trans folx in the audience. After attending this session, I felt empowered to share my gender identity as genderqueer with a small group of friends and colleagues at the Convention. Upon return to the University of Iowa (UI), I shared my gender identity with friends and colleagues at my institution. I started asking people, including faculty whose courses I was taking, to refer to me with genderneutral pronouns. I realized that UI had no policies or procedures in place for students to share their pronouns with faculty or staff, so I decided to contact all of my professors to let them know about my pronouns in the hopes that they would accurately use them. Despite being a doctoral student in a program where I knew all the program faculty, I still felt nervous contacting each person. Unfortunately, most trans* students must repeatedly share their name and pronouns each semester with a new set of faculty, a situation that can range from uncomfortable to dangerous (Beemyn, Curtis, Davis, & Tubbs, 2005). Upon realizing that UI lacked policies and procedures for students to share their gender identity and pronouns with faculty and staff, I started inquiring about how to create gender-expansive policies. This article details the process we—a doctoral student at the time, and a faculty member—engaged in to change the ways the university asks for and reports student name, gender pronouns, sex, and gender identity. One year after we initiated the process to create new policy, changes were actualized in the University student records systems and admission applications. CONTEXTS FOR INITIATING CHANGE There is a burgeoning body of literature on the experiences of trans* collegians that tells a coherent story: the campus climate for trans* students is not supportive or affirming and is often hostile and unwelcoming (see Beemyn & Brauer, 2015; McKinney, 2005; Nicolazzo, 2016; Rankin, Weber, Blumenfeld, & Frazer, 2010). Trans* students face messages and practices that promote compulsory heterogenderism (Nicolazzo, 2017) at all important junctures of the college-going process, from high school guidance counseling to the admission application process, from college [End Page 359] transition to college engagement (Marine, 2017). Trans* students are emotionally and physically exhausted from having to constantly face the gender binary discourse on campus (Nicolazzo, 2016). Despite overall negative climates in educational contexts, another emerging body of literature illustrates the ways trans* college students engage kinship networks as pathways to successfully navigate oppressive collegiate contexts (Nicolazzo, 2016). More specifically, trans* college students have found and have created kinship networks in material, virtual, and affective domains (Nicolazzo, Pitcher, Renn, & Woodford, 2017). While trans* students have mobilized resiliency in environments where their gender identities are not recognized and affirmed, "education efforts to improve understanding and acceptance of transgender people are crucial" (National Center for Transgender Equality, 2016, p. 5). College student educators have the potential to assuage the burden faced by trans* students in college, including faculty whose central role in fostering college student success has long been established in the higher education literature (see Pascarella & Terenzini, 2005). For trans* college students in one study, students whose faculty used their name and pronouns correctly perceived their faculty as supportive of their success (Linley et al., 2016). But how do faculty know students' names and pronouns? And once they know, how will they use them? Beemyn and Brauer (2015) recommended that collegiate student records systems have fields in place for faculty and staff to be able to easily access students' names and gender pronouns. At UI, we sought opportunities to facilitate faculty and staff access to trans* students' names and pronouns of reference as well as opportunities to educate the campus community about trans* identities. The outcome we ultimately pursue is eradication of systemic oppression of trans* people in higher education; the initiative described...

A significant number of college students experience varying levels of stress, anxiety, homesickness, and depression which may negatively impact their academic performance or personal functioning. However, many college students do not seek professional help from campus counselors. Recent research supports the effectiveness of counseling centers in reducing the effect of stress, anxiety, homesickness, and depression on the students’ well-being. The purpose to the current study was to analyze students’ reports on their levels of stress, anxiety, homesickness, and depression, grouping them based on previous counseling participation. It was hypothesized that those who had gone to counseling or were currently attending counseling would report better overall improvement than those students who had never attended counseling. The following study included college students at a Southeastern university who have attended counseling or were currently attending counseling through the services provided by the University, or from any outside service. A group of students who had never attended counseling previously also participated. The research assessed varying levels of mood and academic performance and any differences between the groups. To gather a broader scope of knowledge, the study investigated demographic information and potential hindrances to treatment. It also focused on any barriers that would impact the likelihood of counseling attendance, and the manner in which students learned about the services offered. It was found that those students who attended six or more counseling sessions reported more positive perceived change in their levels of depression, anxiety, and stress than did students who attended five or fewer counseling sessions. Most students reported that they would not attend counseling due to not having enough time and suggested online or weekend sessions. Finally, students stated that they predominantly learned about services from advertisement. KEYWORDS: Counseling; College Students; Depression; Homesickness; Anxiety; Stress; Mood; Academic Performance

The peak of vulnerability to behavioral and mental disorders occurs during college, making this a crucial time for development. College students have a worse quality of life (QoL) in terms of mental health compared to the general population. There is a need for information regarding QoL related to stress in students, as studies discussing QoL and stress in college students are still lacking. This study aims to analyze the relationship between QoL and stress levels in college students. A cross-sectional survey design was used in this study, involving 249 college students at higher education institutions in East Java, Indonesia. The data samples were collected based on demographic characteristics, using the QoL scale from WHOQOL-BREF and the Depression, Anxiety, and Stress Scale-21 to assess the correlation between QoL and stress levels among college students. The results showed that the stress levels of college students were classified as normal (54.6%), mild (17.3%), moderate (17.3%), severe (8.4%), and extremely severe (2.4%). A significant negative correlation was observed between all domains of QoL and stress: Physical (-0.630), Psychological (-0.658), Social Relationship (-0.564), and Environment (-0.584). These results indicate that as QoL increases, stress scores decrease. Attention should be paid to providing appropriate interventions related to college students' quality of life. Further research is needed to gather detailed information on existing QoL domains, particularly those focusing on students’ needs, current information developments, and demographic characteristics.

Stress is a process that involves the perception of and response to pressure and is often related to eating behaviour. For college students, academic stress could be one factor that affects eating behaviour. So far, no longitudinal study has directly compared the same respondents’ stress levels and eating behaviours in different years of study. Thus, this study aimed to examine changes in stress levels and eating behaviour during college students’ third and final years and determine the correlation between stress levels and eating behaviour. We asked 89 undergraduate students (27 males and 62 females) to complete a questionnaire on their stress levels using the Perceived Stress Scale (PSS-10) and their eating behaviour. Our results showed that students had significantly higher stress levels during the final year than in their third year. Our results also showed that during the student’s final year, there was a significant increase in eating when feeling stressed, overeating, eating fast food, and skipping meals compared to their third year. There was also a significant decrease in healthy food consumption during the final year compared to the third year. During the third year of study, stress levels were increased by academic workload pressure; meanwhile, during the final year of study, they were affected by sex and undergraduate thesis pressure. These results indicate that differences in academic pressure in different years of study can influence stress levels and eating behaviour in college students.

College students deal with various events that can increase stress levels and negatively impact their lives. The study aimed to investigate the effect of solution-focused brief counseling (SFBC) on reducing college students' stress levels. The hypothesis suggested a decrease after comparing the stress level with SFBC before the intervention. The Participants consisted of 6 active postgraduate psychology students with moderate and high-stress levels. Furthermore, the study used a one-group pretest-posttest design, and the data were obtained through the Stress Scale for College Students (SSCS) and interview. The intervention used SFBC, and was conducted in four meetings. In analyzing the data, the Wilcoxon Signed Ranks Test was used to determine the difference in experimental group values between before and after the intervention. The result showed that there are differences in stress levels before and after the procedure, and its drastic decrease in participants was observed after the intervention.

The COVID-19 pandemic disrupted the lives of college students in many ways, especially a decrease in leisure time exercise and an increase in sedentary behavior resulting in an increase in stress, particularly in college students enrolled at a Hispanic-serving Institution in New York City. The objective of this quantitative study was to investigate the impact of the COVID-19 pandemic on college students’ physical activity, sedentary behavior, and perceived stress. A questionnaire was administered to 883 college students to collect leisure exercise and sedentary behavior prior to March 2020 and in April 2022, along with the impact of the pandemic on stress in April 2022. Findings indicated that the closures and isolation guidelines during the pandemic negatively impacted Black, Indigenous, and people of color’s (BIPOC) physical activity and sedentary behavior similarly to their White peers. Without the facilities and services that higher education institutions normally provide, such as recreational and fitness programming, college students were left on their own to find ways to maintain their active routines, which resulted in higher levels of stress after 2 years of campus closures. Governmental and higher education leadership should better consider the impact of closing their college campuses and limiting access to essential services on college student health and well-being in future acute health crises, particularly among the most vulnerable populations.

ABSTRACTThis study examines the effect of short-term adventure-based outdoor programs (AOP) on reducing college students’ stress levels. The effects of sex and different outdoor adventure activities in stress reduction are also evaluated. Thirty-three college students participated in selected short-term backpacking, canoeing, and kayaking programs. Student's salivary samples were collected to evaluate physiological stress response (as measured by levels of cortisol) and their psychological stress levels were collected through a modified 12-item questionnaire. Stress responses were measured at three different time points, including the second weekly meeting in the classroom, before the field trip, and at the conclusion of the field trip. Findings suggest that short-term AOP affords opportunities for college students to be away from daily challenges, and in turn reduce college students’ psychological stress levels and provide a temporary relief of physiological stress levels. No significant differences in college students’ stress levels were found between sex and different outdoor adventure activities.

Review question/objective What is the effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep behavior practices and/or sleep quality of college students? The review objective is to identify, appraise and synthesize the best available evidence on the effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep behavior practices, and/or sleep quality versus traditional strategies. Background Sleep is a physiological state occurring in alternation with wakefulness, and its duration and quality are equally important for the quality of life of an individual.1 The World Health Organization (WHO) along with other organizations have realized the importance of sleep and its direct correlation to health.2 According to WHO, one-third of the lifespan is spent asleep, a state that is crucial for physical, mental and emotional well-being.2 The WHO and the National Sleep Foundation, a nonprofit organization dedicated to improve sleep via sleep education based in the United States (US), recommend that adults should be receiving an average of seven to nine hours of sleep per night.1,3 A reduction in sleep hours and sleep quality has a direct effect on lifestyle.1,3 Poor sleep health can have severe consequences for the individual as well as society.3,4 Sleep health is essential for overall health, quality of life and safety. The Institute of Medicine (IOM), an independent nonprofit organization dedicated to provide advice and answers about health in the U.S., reports that approximately 20% of automobile accidents are caused by drivers' drowsiness.5 Healthy People 2020, a US based initiative aimed at improving the nation's health, recognize that drowsy driving causes vehicular crashes and its objective is to reduce the rate of vehicular crashes per 100 million miles traveled that are due to drowsy driving.3,4 Sleepiness from any cause can compromise memory, grades, perception of effort and driving performance.6,7,8 The individual can experience a poorly functioning immune system, emotional instability, memory deficits and poor concentration.3 Approximately half of the world's population is at risk for some kind of sleep disorder and the cost to society is over $18 billion from a loss in productivity and mass transportation accidents.2 The National Center on Sleep Disorder Research (NCSDR) estimates that 70 million Americans suffer from sleep problems, and nearly 60 percent have a chronic disorder.9 Satisfactory sleep is comprised of numerous aspects, such as sleep quality and quantity.6 These factors are affected by, but are not limited to, the following: consumption of alcohol, caffeine and drugs, establishing a regular relaxing bedtime routine, reducing lighting, the use of technology and being aware of environmental noise.6 For the past 20 years, researchers have found a reduction in the average number of hours of sleep among college students.10 College students are notorious for sacrificing sleep to study, socializing during the week, and then sleeping long hours on weekends along with the consumption of alcohol, drugs and caffeine.5,7,10,11 Many of these behaviors are not reflective of sleep hygiene practices that facilitate sleep health.7 Sleep hygiene is “…a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness”.12(p1) Sleep practices are behaviors that an individual carries out to facilitate sleep health. These practices include: maintaining regular sleep wake times, limited alcohol, caffeine and nicotine use prior to bed time, regular sleep wake schedules, and sleep environments conducive to sleep.3 In 2000, a study found that 68.3% of college students reported poor sleep health as a result of inappropriate sleep behaviors that do not reflect sleep hygiene practices.7,8 Among college students, 50% reported daytime sleepiness while 70% experienced insufficient sleep.6 Poor sleep has been ranked the third most common impediment among college students and has been associated with deficit in attention, reduction in academic performance, impaired driving, risk-taking behavior, depression, impaired social relationships and poorer health.8,11,13 College students may have limited knowledge about sleep health and sleep hygiene practices that supports sleep health. This limited knowledge may lead to poor sleep behavior practices ultimately leading to poor sleep health resulting in diminished quantity and quality of sleep. Efforts to improve the overall health status of college students in the United States (US) began with Healthy Campuses in 2007. Healthy Campuses is closely aligned with Healthy People 2020 using Healthy People as a guiding framework.14 Healthy Campus 2020 is an initiative that reflects the work of higher education professionals representing numerous organizations and disciplines. The vision of Healthy Campus 2020 is to promote campus communities in which all members live long, healthy lives.15 Overarching goals guide the work of the Healthy Campus initiative15 and specific health objectives have been developed to track and measure successful attainment of these goals.16 One of the major student objectives pertaining to sleep health is Health Impediments to Academic Performance.17 Under this objective there is a series of sub-objectives. Sub-objective 1.2 states: “reduce the proportion of students who report that their academic performance was adversely affected by sleep difficulties in the past 12 months”.17(p1) Sleep health is important not only for health, quality of life and safety but also for optimal academic performance in college students.10 Gilbert and Weaver described how sleep deprived college students performed poorly academically. These students had poor concentration, often missed classes due to sleepiness and as a result had lower grade point averages, and more course incompletes, drops and withdrawals than participants with little sleep deprivation and good sleep quality.10 Furthermore, without interventions that promote sleep hygiene practices and sleep health, there is the potential for later diagnosis of sleep disorders such as delayed sleep phase disorder and insomnia, both common to the population of college students.8 Hershner and Chervin6 found that there was a significant link between lack of sleep and academic performance. They hypothesized that effective interventions which focus on improving sleep behavior and disseminating sleep knowledge could help to improve academic performance among this population.5–8,10,11,18,19 Studies that have looked at sleep education programs have demonstrated positive outcomes. For example, a sleep 101 program for college students described improved sleep hygiene knowledge, reduced maladaptive beliefs about sleep, and a decrease in sleep disturbances.20 Other studies have also revealed the potential benefits of formal sleep education with a curriculum based on sleep hygiene practices versus informal advice delivered via verbal prompts from school staff and professionals.5,7,8,16,17 Formal sleep education programs on sleep, sleep health, and sleep hygiene practices developed for the college student population may increase this population's knowledge on sleep and sleep hygiene practices.17 The implementation of formal health promoting sleep education programs that focus on sleep hygiene practices is a strategy that has the potential to facilitate sleep health.7,10,13,16,20–24 A search of the Cochrane Library of Systematic Reviews, Medline, CINAHL and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports found no systematic review on the effectiveness of sleep education programs on sleep hygiene knowledge, sleep behavior practices, and/or sleep quality in college students or in any other specific population. A systematic review on sleep education is necessary in providing valuable, evidenced based information concerning the impact of sleep education on college students. Inclusion criteria Types of participants This review will consider studies that include all undergraduate or graduate college students, male or female, and of all ages, cultures and ethnicities. All undergraduate and graduate college students will be considered for inclusion due to pre-existing behaviors and circumstances that occur when a student enters into the college environment, for example, late night sleep patterns due to studies and socializing as previously discussed in Background. Pre-existing knowledge on sleep hygiene practices, diagnoses and treatments are not considered in this systematic review as confounding variables as the entire population is exposed to the contexts and risks for poor sleep health. Types of intervention(s) This review will consider studies that evaluate formal sleep education programs that include a curriculum on sleep hygiene practices that is designed to facilitate sleep health including but not limited to: maintaining regular sleep wake times, limited alcohol, caffeine and nicotine use prior to bed time, regular sleep wake schedules, and sleep environments conducive to sleep.3 Formal educational delivery will include, for example: college courses/seminars that are delivered face-to-face, web-based computer programs, and/or a combination of these delivery methods. The formal sleep education program may be delivered any time throughout the participants' college experience. Comparator intervention This review will consider as a comparator no sleep hygiene education as an intervention. Types of outcomes This review will consider studies that include the following primary outcome measures: Sleep hygiene knowledge - measured by tools such as the Sleep Hygiene Awareness and Practices Scale (SHAPS). The SHAPS contains three sections: sleep hygiene awareness and knowledge, sleep hygiene practices and caffeine. The first section has 13 items to measure participants' knowledge of activities that disrupt sleep. The second section assesses caffeine knowledge and has 19 items to measure participants' awareness of food, beverages or drugs that disrupt sleep. The final practice section of this instrument contains an additional 19 items asking participants how many nights per week where they engage in activities that promote or inhibit sleep.7,20,25 Sleep hygiene behavior - measured by tools such as the Sleep Hygiene Awareness and Practices Scale (SHAPS) and the Sleep Habits Surveys (SHS). The Sleep Habits Surveys consists of 10 fill-in-the-blank items that ask for estimates of respondents' sleep habits, such as bed times, rise times and total sleep times for both weeknights and weekends.25 Sleep quality - measured by tools such as the Pittsburg Sleep Quality Index (PSQI). The Pittsburg Sleep Quality Index (PSQI) measures and assesses sleep patterns. It is a self-rated instrument with 19 items designed to assess sleep and sleep disturbances over a period of one month.7,10,11,20,25 Types of studies This review will consider both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials and quasi-experimental studies. In the absence of the above other designs will be considered for inclusion, including before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies. Search strategy The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review. Non-English studies will be excluded due to limited language proficiency of the review team. Studies published from the year 1980 will be considered for inclusion in this review. This year was identified as the target start date as it has been noted that the trend of poor sleep among college students began in the 1980s. Hicks, Fernandez and Pellegrini conducted surveys and noted a trend of reported sleep problems beginning in the late 70s and 80's in which “24% of the respondents were dissatisfied with their sleep and in 1988, 53% were dissatisfied with their sleep”.23(p660) The databases to be searched include: CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Academic Search Complete, PsycINFO, Healthsource Nursing/Academic edition, ProQuest Central, and PubMed and ERIC. The search for unpublished studies will include: New York Academy of Medicine, ProQuest Dissertations and Thesis, Google Scholar Advance, Virginia Henderson Library of Sigma Theta Tau, Robert Wood Johnson Institute Initial keywords to be used will be: college students, sleep, sleep education programs, sleep hygiene, sleep practices, sleep quality Assessment of methodological quality Quantitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion until consensus is reached, or with a third reviewer. Data extraction Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Additionally, attempts will be made to obtain data missing from the study report(s) by contacting the appropriate author(s). Data synthesis Quantitative data will, where possible be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different study designs included in this review. Where statistical pooling is not possible the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate. Conflicts of interest The authors have no conflict of interest to declare. Acknowledgements We would like to thank Jennifer Rosenstein MLS, MA for her input and guidance with the construction of this protocol. We would like to thank Noreen McGuire MLS, MA, Assistant University Librarian for Collection Development, for her guidance and extensive assistance with literature searches and databases. This review will partially fulfill degree requirements for successful completion of the Doctor of Nursing Practice Program at Pace University, College of Health Professions, New York, NY, for SD, CF-J, MK and IU.

Impact of a Yoga and Meditation Intervention on Students' Stress and Anxiety Levels