Main Article Content

Marc Lucente
Jeffrey Krabbe


Wellness, Medical Education


OBJECTIVE: To determine the relationships between wellness knowledge, attitudes, and behaviors in a chiropractic student population.

METHODS: Students at a chiropractic college were administered a validated Wellness Knowledge, Attitude, and Behavior Instrument (WKABI). The WKABI instrument measures knowledge, attitudes, and behaviors in the intervention areas of physical activity, nutrition, and stress management. Scores were tabulated for each section. Demographics were included as part of the instrument. Spearman’s Rho correlations, standard deviation, and mean were used to analyze the data.

RESULTS: Knowledge scores were significantly correlated with attitude scores and were also significantly correlated with behavior scores. Attitude scores were significantly correlated with behavior scores as well. Mean scores for all subjects on the knowledge, attitude, and behavior sections were 77.3%, 86.6%, and 65.9% of the highest possible scores, respectively.

CONCLUSION: Significant relationships exist between wellness knowledge, attitudes, and behaviors of students at a chiropractic college. Further research will be required in this population to identify what other factors may influence wellness behaviors.


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1. US Burden of Disease Collaborators. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA 2018;319(14):1444-1472
2. Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 2014;384(9937):45-52
3. Ford ES, Bergmann MM, Boeing H, Li C, Capewell S. Healthy lifestyle behaviors and all-cause mortality among adults in the United States. Prev Med 2012;55(1):23-27. doi:10.1016/j.ypmed.2012.04.016
4. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960–1962 through 2017–2018. NCHS Health E-Stats 2020.
5. Lovic D, Piperidou A, Zografou I, Grassos H, Pittaras A, Manolis A. The growing epidemic of diabetes mellitus. Curr Vasc Pharmacol 2020;18(2):104-109. doi:10.2174/1570161117666190405165911
6. International Diabetes Federation. IDF Diabetes atlas, 10th ed. Brussels, Belgium: 2021. Accessed December 10, 2021. https://www.diabetesatlas.org
7. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2022 update: a report From the American Heart Association. Circulation 2022;145(8):e153-e639. doi:10.1161/CIR.0000000000001052
8. Centers for Disease Control and Prevention. Underlying cause of death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed March 12, 2020
9. Virani SS, Alonso A, Aparicio HJ et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation 2021;143:e254–e743
10. Assmann G, Cullen P, Jossa F, Lewis B, Mancini M. Coronary heart disease: reducing the risk: the scientific background to primary and secondary prevention of coronary heart disease a worldwide view. Arteriosclerosis Thrombosis Vasc Biol 1999;19(8):1819-1824
11. Bae EJ, Park NJ, Sohn HS, Kim YH. Handgrip strength and all-cause mortality in middle-aged and older Koreans. Int J Environ Res Public Health 2019;16:740. doi: 10.3390/ijerph16050740

12. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR et al. Chronic kidney disease and cardiovascular risk: Epidemiology, mechanisms, and prevention. Lancet 2013;382:339–352. doi: 10.1016/S0140-6736(13)60595-4
13. Halpin HA, Morales-Suárez-Varela MM, Martin-Moreno JM. Chronic disease prevention and the new public health. Public Health Rev 2010;32:120–154. doi: 10.1007/BF03391595
14. Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Health Aff 2002;21:245–253. doi: 10.1377/hlthaff.21.2.245
15. Strine TW, Chapman DP, Balluz LS, Moriarty DG, Mokdad AH. The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among US community-dwelling adults. J. Community Health 2008;33:40–50. doi: 10.1007/s10900-007-9066-4
16. Ramanathan R, Desrouleaux R. Introduction: the science of stress. Yale J Biol Med 2022;95(1):1-2
17. Mayer FB, Santos IS, Silveira PSP et al. Factors associated to depression and anxiety in medical students: a multicenter study. BMC Med Educ 2016;16:282–282
18. Ibrahim AK, Kelly SJ, Adams CE, et al. A systematic review of studies of depression prevalence in university students. J Psychiatr Res 2013;47:391–400
19. Dyrbye LN, Harper W, Durning SJ, et al. Patterns of distress in US medical students. Med Teach 2011;33(10):834–839. doi:10.3109/ 0142159X.2010.531158
20. Ribeiro ÍJS, Pereira R, Freire IV et al. Stress and quality of life among university students: a systematic literature review. Health Professions Educ 2018;4:70–77
21. Nelson MC, Story M, Larson NI, Neumark-Sztainer D, Lytle LA. Emerging adulthood and college-aged youth: An overlooked age for weight-related behavior change. Obesity 2008;16(10):2205-2211
22. American College Health Association. American College Health Association - National College Health Assessment spring 2006 reference group data report (abridged). J Am Coll Health. 2007;57(5):477-488
23. Buckworth J, Nigg C. Physical activity, exercise, and sedentary behavior in college students. J Am Coll Health 2004;53(1):28-34
24. Howitt S, Ethridge E, Nelson E, Gotuaco M, Demello L. Exercise prescription: perceptions and physical activity habits in chiropractic students at CMCC. J Can Chiropr Assoc 2016;60(4):286-293
25. Hawk C, Long CR, Perillo M, Boulander KT. A survey of US chiropractors on clinical preventive services. J Manipulative Physiol Ther 2004;27(5):287-98
26. Heller JR, Sarmiento AL. Health behaviors of culturally diverse inner-city community college students. J Am College Health 2016;64(8):651-663
27. Hopper MK, Moninger SL. Tracking weight change, insulin resistance, stress, and aerobic fitness over 4 years of college. J Am Coll Health 2017;65(2):81-93. doi:10.1080/07448481.2016.1238385
28. Scott-Sheldon LA, Carey KB, Carey MP. Health behavior and college students: does Greek affiliation matter?. J Behav Med 2008;31(1):61-70. doi:10.1007/s10865-007-9136-1
29. Tran DT, Zimmerman LM, Kupzyk KA, Shurmur SW, Pullen CH, Yates BC. Cardiovascular risk factors among college students: Knowledge, perception, and risk assessment. J Am Coll Health 2017;65(3):158-167. doi:10.1080/07448481.2016.1266638
30. Turner JC, Shu J. Serious health consequences associated with alcohol use among college students: demographic and clinical characteristics of patients seen in an emergency department. J Stud Alcohol 2004;65(2):179-183. doi:10.15288/jsa.2004.65.179
31. World Health Organization Constitution. 2005. Accessed December 10, 2021. https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
32. Bart R, Ishak WW, Ganjian S et al. The assessment and measurement of wellness in the clinical medical setting: a systematic review. Innov Clin Neurosci 2018;15(9-10):14-23
33. Hawk C, Schneider M, Evans MW Jr, Redwood D. Consensus process to develop a best-practice document on the role of chiropractic care in health promotion, disease prevention, and wellness. J Manip Physiol Ther 2012;35(7):556–67
34. Jamison JR, Rupert RL. Maintenance care: towards a global description. J Can Chiropr Assoc 2001;45(2):100–105
35. Maiers M, Agaoglu M, Brown R et al. Chiropractic in global health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap 2018;26:26. doi:10.1186/s12998-018-0194-y
36. Contento, I. An overview of nutrition education: facilitating why and how to take action. In: Content’s (Eds.). Nutrition education: linking research, theory, and practice, 2nd ed. Sudbury, MA: Jones & Bartlett Publishers, 2011:49
37. Dinger MK, Watts PR, Barnes JT. Development of the Wellness Knowledge, Attitude, and Behavior Instrument. Measurement Phys Educ Exercise Sci 1998;2(2):69-83
38. Woomer SR. The effect of wellness knowledge on physical activity and nutrition behaviors of college age students. [Master’s thesis]. Charleston, IL: Eastern Illinois University; 2003
39. Askegaard, ML. The impact of a college wellness course On wellness knowledge, attitude, and behavior. [Master’s thesis]. Grand Forks, ND: University of North Dakota; 2000
40. United States Food & Drug Administration. Changes to the nutrition facts label. fda.gov. https://www.fda.gov/food/food-labeling-nutrition/changes-nutrition-facts-label Updated March 7, 2022. Accessed May 12, 2022
41. Krabbe JP. Nutritional knowledge in the chiropractic student population. Nutritional Perspectives: Journal of the Council on Nutrition. 2019;42(2):18-24.
42. Spronk I, Kullen C, Burdon C, O’Connor H. Relationship between nutrition knowledge and dietary intake. Br J Nutr 2014;111(10):1713-1726
43. Worsley A. Nutrition knowledge and food consumption: can nutrition knowledge change food behavior? Asia Pacific J Clin Nutr 2002:11(Suppl):S579-S585
44. Staser KW, Zollinger TW, Saywell RM, Kunapareddy S, Gibson PJ, Caine VA. Dietary behaviors associated with fruit and vegetable consumption, Marion County, Indiana, 2005. Prev Chronic Dis 2011;8(3):A66
45. Barbosa LB, Vasconcelos SML, Correia LOS, Ferreira RC. Nutrition knowledge assessment in adults: a systematic review. Cien Saude Colet 2016;21:449-462
46. Lawrence K, Pelly F, Rocks T. Nutrition Knowledge of dietetic undergraduate students: An exploratory study. Nutr Dietetics 2016;73:260-267
47. Grand S, Morehouse-Grand K, Carter S. Chiropractic intern attitudes, beliefs, and future practice intentions with regard to health promotion, wellness, and preventive services. J Chiropr Educ 2016;30(2):152-157. doi:10.7899/JCE-15-10
48. Evans MW, Ndetan H, Williams RD. Intentions of chiropractic interns regarding use of health promotion in practice: applying theory of reasoned action to identify attitudes, beliefs, and influencing factors. J Chiropr Educ 2009;23(1):17-27. doi:10.7899/1042-5055-23.1.17
49. Rank MP, de la Ossa PP. Stress and burnout in chiropractic students of European chiropractic colleges. J Chiropr Educ 2021;35(1):14-21. doi:10.7899/JCE-19-7
50. Fishbein M, Ajzen I. Predicting and changing behavior: the reasoned action approach. Taylor and Francis, 2010.
51. Sheeran P, Maki A, Montanaro E et al. The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: A meta-analysis. Health Psychol 2016;35(11):1178-1188. doi:10.1037/hea0000387
52. Schäufele I, Janssen M. How and why does the attitude-behavior gap differ between product categories of sustainable food? Analysis of organic food purchases based on household panel aata. Front Psychol 2021;12:595636. Published 2021 Feb 16. doi:10.3389/fpsyg.2021.595636
53. Elhaffar G, Durif F, Dubé L. Towards closing the attitude-intention-behavior gap in green consumption: A narrative review of the literature and an overview of future research directions. J Cleaner Production 2020;275:122556. 10.1016/j.jclepro.2020.122556.
54. Scalco A, Noventa S, Sartori R, Ceschi A. Predicting organic food consumption: A meta-analytic structural equation model based on the theory of planned behavior. Appetite 2017;112:235-248. doi:10.1016/j.appet.2017.02.007
55. Van Doorn J, Verhoef PC. Drivers of and barriers to organic purchase behavior. J Retail 2015;91:436–450. 10.1016/j.jretai.2015.02.003
56. Tandon A, Dhir A, Kaur P, Kushwah S, Salo J. Behavioral reasoning perspectives on organic food purchase. Appetite 2020;154:104786. 10.1016/j.appet.2020.104786
57. Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychol Bull 2006;132(2):249-268. doi:10.1037/0033-2909.132.2.249
58. Song Z, Baicker K. Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial. JAMA 2019;321(15):1491–1501. doi:10.1001/jama.2019.3307
59. Schutt A, Chretien KC, Woodruff JN, Press VG, Vela M, Lee WW. National survey of wellness programs in U.S. and Canadian medical schools. Acad Med 2021;96(5):728-735. doi:10.1097/ACM.0000000000003953
60. The Council on Chiropractic Education. Standards for doctor of chiropractic programs and requirements for institutional status. Scottsdale, AZ.:45-47