Facts and Stats

We’re in data collection mode in the Wellness Education Office, participating in the American College Health Association’s National College Health Assessment (NCHA). It asks about a wide variety of health behaviors, attitudes and experience – everything from wearing a helmet when you ride a bicycle to feeling overwhelmed and exhausted, from cold/flu/sore throat to alcohol consumption. From this survey we get data like this:

And this:

So… what do numbers like this really mean, and how accurate are they?

Well it’s important to remember that these statistics don’t tell us what students DO, they tell us what students REPORT doing. And the two are not necessarily the same thing. People might try to “fake good” or “fake bad,” they might give answers that they feel are expected of them or “socially appropriate,” and they might just plain old not really remember how much they weigh or how much they smoked, drank, or felt overwhelmed in the last two weeks, 30 days, or 12 months.

A particular problem with drinking is the whole concept of “a drink.” As a college health educator, when I hear “a drink,” I think of .6oz of ethanol, which is the amount of alcohol in 12 ounces of beer, 5 ounces of wine and 1.5 ounces of 80 proof liquor. But what does a student think “a drink” means? Is a mixed drink with 3 shots in it “a drink”… or is it 3 drinks? Technically it’s 3, but will a student report it that way?

Another thing to be cautious about is known as “response bias.” These data tell us about the people who completed the survey, but what do they tell us about all those people who DIDN’T complete the survey? In 2011, only about 20% of the students who were invited to take the survey actually did. Can we generalize to the whole population based on the responses of students who took the time to complete a 20-30 minute survey?

So there are enough grains of salt that you need to take when thinking about these data that you might almost start to worry about your sodium intake.

But.

There is reason to believe that people are as truthful as they can be, and there are ways to use the data that help to minimize the shortcomings of survey research.

For example, the survey asks questions like, “Has XYZ health issue (infectious disease, sleep, alcohol, gambling, whatever) interfered with your academics in the past 12 months?” And then it also asks for a person’s overall GPA. And sure, people might misreport their drinking or their GPA, but if you’re looking at the RELATIONSHIP between two variables, then the actual value of those variables isn’t so important. So, though students may not report that alcohol has interfered with their academics, it turns out there is a direct, linear correlation between GPA and frequency of heavy drinking: the more a person drinks, the lower their GPA. (No surprise there.) As long as we assume that there’s not a huge difference in the way heavy drinkers report their GPAs compared to non-heavy drinkers, we don’t need to worry overmuch about how accurate those numbers are.

So the data allows us to fact-check students responses and reduce the noise and user error inevitable in survey data. For all its faults, NCHA data is the best thing we’ve got for getting a POPULATION-LEVEL VIEW of students’ health behaviors, attitudes, and experiences. Quantitative data gives us a superficial but comprehensive overview of the topics it surveys. Like a 100-level course, it’s an introduction; once you get to the 400-level classes, you find out that it’s really much more complicated than that, but you can’t understand the 400-level stuff before you master the basics.

Is there a place in evaluation research for one-student-at-a-time anecdotal evidence? Absolutely, and we collect qualitative data. Individual student narratives tell us a lot about the kinds of paths students might take, the kinds of experiences they might have, and they richly illuminate the data. But just as what’s true at the population level isn’t necessarily true for a given individual in that population, what’s true for an individual isn’t necessarily true for anyone else in the population. We can get the most efficient and informative snapshot or cross-section of students’ health behaviors, attitudes, and experiences when we use the broad-stroke instruments wisely and cautiously.

Anyway. If you get an email from me that says, “Smith College Health Assessment – please participate!” I hope you’ll consider actually participating. It’ll help make the data more reliable, and more reliable data means more reliable wellness- and health-related programming on campus.

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what NOT to say to a friend in distress

A bit of science that seems to be really helpful to a lot of students is the difference between “emotion coaching” and “emotion dismissing.”

John Gottman’s lab studied families – parents and children – and noted two general styles of communication around emotions. He called them “meta-emotions.” See, your emotions are how you feel – happy, sad, angry, lonely, disgusted, anxious, etc. Meta-emotions are how you feel about how you feel.

Like, “I’m feeling jealous that my ex is here with their new partner,” is your emotion. “I judge and blame myself for feeling jealous because I really *ought* to be over it by now” is your met-emotion. How you feel about how you feel.

Negative meta-emotions – “emotion-dismissing” – are things like blaming or judging yourself for a feeling or being afraid of a feeling. Positive meta-emotions – “emotion-coaching” – involves being aware of your feelings and accepting your feelings, welcoming them even.

Feeling bad about feeling bad just drains you of energy. Accepting your feelings frees up that energy so that you can use it for recovery.

It goes like this:

Emotion Dismissing Emotion Coaching
Just ignore  subtle or lower-intensity negative emotions.

Negative emotions are toxic.

Negative emotions are punished—even if there is no misbehavior.

“You can have any emotion you want, and if you choose to have a negative one, it’s your own fault.”

Introspection to understand what one feels is a waste of time, or possibly even dangerous.

Feel bad about feeling bad.

“Get over it.”

“C’mon, give me a smile, honey!”

Pay attention to lower-intensity emotions to prevent escalation.

Negative emotions are natural and healthy.

Negative emotions are discussed, given names, and empathized with.

“Negative emotions happen sometimes because bad things happen sometimes.”

Introspection to understand what one feels helps you have a sense optimism, control, and effective coping.

Feel accepting of feeling bad.

“Move through it.”

“You cry all you need to, honey.”

And it turns out that emotion-coaching unambiguously results in better outcomes than emotion-dismissing.

So. To be a good friend to someone who is suffering, avoid saying things that minimize their experience, stuff like “It’s okay” or “It’s not that bad” or “You’re all right” or “Don’t worry about it” or “It could be worse.”

Instead, acknowledge how much the person is hurting and let them know it’s okay that it hurts. “I can see how hard this is for you.” “or “This is important to you.” Or “You’re allowed to hurt.” Or “Sometimes life is supposed to hurt. When you lose something that’s important to you or when you’re afraid about the future, it’s hard. It’s only right that it should hurt.”

And you can also offer hope, along with empathy: “It sucks now, and it may suck for a while yet to come, and it will get better.” Or “You’re strong enough to survive this and find your way through.”

Waking up too early?

Your Question: I seem to have developed an internal alarm clock that wakes me up at 4 o’clock in the morning. It’s really starting to negatively affect my life. Is there any way that I can change this? I’ve tried every single trick in my book to sleep but they don’t work once I wake up.

The too-early internal alarm clock is often the byproduct of stress. Heightened levels of adrenaline and cortisol make it more difficult for your body to stay asleep as you get to the shallow end of the sleep cycle.

The fact that you’re writing this right at the START of the semester (rather than at the end, when people are likely to be way more stressed) could mean that missing the routine of the semester messed up your biological clock. If that’s the case, then your sleep should sort itself out now that it has a routine to tell it what to do.

It sounds like there’s really two things you need to work on: (1) falling back asleep when you wake up too early and (2) not waking up too early in the first place.

First, when you wake up at 4am, you’re almost certainly not fully rested, so it WANTS to go back to sleep. The worst thing you can do is go, “CRAP I’M AWAKE ALREADY!” and get frustrated.

The best thing you can do is to be calm and relaxed so you don’t knock yourself out of the sleepy zone, and then allow yourself to fall back asleep. Waking up doesn’t actually disrupt the quality of your asleep until you stay awake for longer than about 30 minutes, so there’s no need to panic.

So when you wake up, just notice that you’re awake and welcome this opportunity to practice falling asleep. Breathe slowly and deeply, paying close attention to your breathing. The breathing itself will relax you, and paying attention to your breath means you’re NOT paying attention to stuff that worries you. Your mind will wander – that’s normal and natural – so you’re job is to notice that your mind wandered, tell yourself “I can think about that another time,” and gently return your attention to your breath. This is called “mindfulness,” paying attention to what your brain is paying attention to.

Or: As you’re lying there, think about what it feels like to be really sleepy. What kinds of things does your body do? Do your eyelids feel heavy? Do your muscles feel warm and relaxed? Does your face sort of droop and sag? If you were sitting in class and trying NOT to fall asleep, what kinds of things would you be fighting. Try to reproduce those things you would be fighting. You’d be surprised how well this works.

Or: Imagine yourself in the most relaxing and peaceful place you’ve ever been. It might be a sandy beach or a forest or your bed at home or anywhere. Really notice all the beautiful, comforting things about this place, and notice how comfortable and peaceful you feel there. Heck, even if you don’t fall asleep, you’ll still feel good!

If it’s been half an hour and you still can’t get to sleep, what you need to do is transition your brain out of wakeful, activated state to the calm, quiet pre-sleep state. There are lots of things that can help with this:

  • Get up and do something relaxing like reading or listening to music. Avoid stuff that involves bright light (TV, computer) or work.
  • Take a very warm shower, which will artificially raise your core body temperature. As your temp drops, your body will be triggered to sleep.
  • If you’re worried about things you need to do tomorrow/later today, get up and write a list. Writing things down means the piece of paper can hold your to-list, so your brain doesn’t have to.
  • Practice mindfulness meditation, so you learn how to shut off your brain (see breathing exercise above).

Again, the WORST thing you can do it get frustrated about not being asleep. Waking up is not in itself a problem; it’s STAYING awake that becomes a problem, and a primary cause of staying awake is getting frustrated about the fact that you’re awake. Which is an annoying catch-22, but at least it’s simple to fix!

As for preventing the too-early wake up, the approach is to keep everything else about your sleep routine consistent. Don’t get out of bed until the time when you WANT your internal alarm to go off. This helps teach your body when it’s SUPPOSED to wake up. Keep your bedtime the same. For now, avoid napping. Usually napping is excellent, but until you get your sleep at night on track, it’s better to save sleep for nighttime.

Physical activity before noon often helps to stabilize your body clock, and eating meals at regular times helps too (at least this one will be pretty easy).

If this keeps going for more than a month and none of the above helps, check in with health services. Let them know everything you’ve tried. There might be a medical issue that you haven’t noticed. Waking up too early is actually a pretty common sleep problem among college students, and it’s generally very responsive to the behavioral approach I’ve described here. But occasionally medical intervention is necessary.