Student Wellness:
Applying Public Health Approaches
to Build a Healthy Campus

By Christine Hsieh’11
“We hope to convey some level of confidence and calmness to a place that can be very frenetic at times,” says William Kernan, Ed.D., director of Columbia University Medical Center’s Center for Student Wellness. Once a Bard Hall music room, Dr. Kernan’s multi-tasking space has a sprawl of computer equipment at one end, a seating area at another, shelves full of books that reflect his background in education and research, and a scattering of items gathered during his time abroad as a Peace Corps volunteer in Malawi and nutrition specialist in Liberia.
    “I’m a big believer that most of the negative consequences related to our health are due to our stress level, so the idea of reducing anything that a particular person sees as stressful is, to me, a no-brainer.”
   When Dr. Kernan set about this task just over five years ago armed with objectives developed by the P&S Student Wellness Committee, he moved beyond the conventional strategies deployed at student health centers nationwide. Instead of emphasizing broader issues such as sexual health and substance abuse, he decided to narrow his focus. “We want to help students deal with those things that directly impact their learning,” he says. “How does a healthy campus environment help you to do what you’re here to do successfully? We decided to use a public health approach, in that we intervene at the individual level, we intervene at the group level, and we intervene at the population level.”
   The Center for Student Wellness originally counseled only medical students, but has since expanded to include all students enrolled in medical center degree programs. The data collected by Dr. Kernan in partnership with the Student WellnessStudent Health Service show a marked increase in utilization from year to year, especially among the medical students.
   The most pressing concerns addressed at the center revolve around academic and interpersonal issues (usually in equal measure), which Dr. Kernan tackles from four angles. He works on a number of projects exclusive to P&S, such as the Big Sibs program, the Peer Support Network, and several academic projects (residency mock interviews and board preparation for second-year students, to name a few). He and his colleague, social worker Deborah Levi, influence individual change via wellness counseling sessions; they run Wellness Works! health classes and workshops in conjunction with the student health service to reach out on the group level; and their Healthy Campus Initiatives strive to make a difference among the population as a whole, through the Students At Risk faculty program or pushing for healthier vending machine options around campus, for example.
   “There are so many barriers to help-seeking. A lot of them are up here,” he says, pointing to his head, “and they’re really hard to break down. So that’s something we continually think about. We know that health education shouldn’t always be about changing individual’s behaviors but working with groups and communities.”
   Essentially, Dr. Kernan thinks of the Center for Student Wellness as a triage center, and he encourages students to view it as a place to find out where and how they might deal with their concerns. A great strength of the center is its wellness counseling, which differs from psychotherapy in that it’s based on behavior change theories (such as the transtheoretical model for change) and employs such methods as motivational interviewing. “Wellness counseling has a whole theoretical and practical standpoint,” Dr. Kernan explains. “We always want people to leave with a plan. A lot of what we do is build intrinsic motivation. We’re helping people identify their locus of control.”
   Helping students break down internal and external obstacles to learning is a key goal for the center, and stress management is an important first step. “Stress is a really ubiquitous term — you define it in a different way than I do — but it has serious health effects,” he says. “We are now in a place where we understand the science of stress. We know what it does in all the different systems of the body, and we know that it can be triggered by lots of different things.”
   Romantic relationships — or the lack thereof — are a huge contributing factor, but other elements of loneliness and social isolation are also important. “Social support is a major determinant of many psychosocial outcomes in our lives: our happiness, our base level anxiety, our base level pessimism and optimism,” says Dr. Kernan. “We help people understand what options are available to them. When people have options, people feel better by virtue of the fact that they have options. There are options for almost every concern someone could bring into the office.”
   His belief in this has spurred a number of research studies and papers, and Dr. Kernan travels to conferences and other schools to present his ideas. In fact, the center was the first wellness program of its kind for medical students, and Dr. Kernan has been actively spreading the word. He has several papers in the works based on his experiences with the center, addressing crucial issues seen at the center: the support available to students and how to facilitate access to these resources; the impact of quality of life, fitness, and nutrition on students training in the health professions; and what medical students perceive as having an impact on their learning capabilities.
   “We believe that proving a linkage between health and learning and how it can actually have positive outcomes and odds of success is really important, because the health promotion in the college health literature is lacking in research that proves that,” Dr. Kernan says. “We often say that you have to be healthy in order to learn, and in order to learn well, you kind of have to have skills in taking care of yourself.”
   Dr. Kernan believes that this approach takes the center beyond simply health education and into health promotion. “There’s a big disconnect between knowledge and behavior, and helping people develop skills helps them deal with that disconnect,” he explains. “It’s something you’ll experience a lot as a physician. Regardless of the type of physician you become, you’re going to have patients who need to change their behavior in order to better their health. You’re not going to know how to help them, because the only help is the help they have intrinsically. What you can help them do is develop the motivation to change it.”
   Dr. Kernan’s pilot study of medical students’ perceptions of the academic impact of various health issues was published in Academic Psychiatry in January 2008. A paper about nursing students is scheduled for the September 2008 issue of Nurse Educator, and he is working on manuscripts about dental and occupational therapy students.


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