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STRESS AND ACADEMIC PERFORMANCE: A STUDY AMONG PRESCIENCE STUDENTS IN UiTM NEGERI SEMBILANRafidah Kamarudin1, Azizah Aris2 and Nor aini Ibrahim3Academy of Language Studies, Universiti Teknologi MARA Negeri Sembilan Faculty of Information Technology and Quantitative Science, Universiti Teknologi MARA Johor 3 Faculty of Information Technology and Quantitative Science, Universiti Teknologi MARA, Shah Alam, MALAYSIA2 1

ABSTRACT The present study is carried out to find out if there is any significant difference in the level of perceived stress among the students at the beginning, middle and end of the semester. We would also like to find out whether there is a correlation between the students level of perceived stress at the three different periods (beginning, middle, end of semester) on their academic performance. The final objective is to determine the possible stress factors that the students perceived may contribute to their academic performance and the association between academic performance and stress factors. A total of 242 Pre-Diploma Science students in June-Nov 05 intake at UiTM Negeri Sembilan involved in the study. Besides descriptive statistics like percentages, a chisquare test, a Wilcoxon Sign Rank test, and Spearman Rank correlation were also used to analyze the data. The results showed that students did experience stress but at a moderate level. There was a significant difference between the level of perceived stress at the beginning and middle of semester but no significant different between the level of perceived stress at the middle and end of the semester. We also found out that there was no correlation between the level of perceived stress at the beginning and middle semester with the students academic performance but there was a significant correlation between the level of perceived stress at the end of semester and students academic performance. Majority of the students reported of not getting enough sleep and nutrition problem throughout the semester. However, results shows that none of the stress factors discussed affected the students academic performance. Keywords: Perceived stress, Stress Factors, Academic Factors, Academic performance

1. INTRODUCTION 1.1 Background of the study Learning and memory can be affected by stress. Although an optimal level of stress can enhance learning ability (Kaplan & Sadock, 2000), too much stress can cause physical and mental health problems (Niemi & Vainiomaki, 1999), reduce students self esteem (Linn & Zeppa, 1984; Silver & Glicken, 1990) and may affect students academic achievement. 1.2 Problem Statement University students have many obstacles to overcome in order to achieve optimal academic performance. A number of researches have been done looking at the correlation of many stress factors that university students experience and the effects of stress on their GPA (Hatcher and Prus, 1991; Hammer, Grigsby and Woods, 1998; Trockel, Barnes and Egget, 2000; Calderon, Hey and Seabert, 2001; Kelly, Kelly and Clanton, 2001). However, a review of literature indicates that not much have been prioritized on the stress-related research. Moreover, majority of the investigation has taken place in the United States of America (USA)Paper number: 3003584

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and the emphasis was placed more on the students in the medical field. The researchers have found out that there is not much research conducted in our local universities particularly in the Universiti Teknologi MARA (UiTM) itself pertaining to this issue. Therefore, it is timely to conduct a research to examine this particular issue as findings from the present study would benefit various parties in the university especially the Students Affair Division (HEP) and the Academic Affair Division (HEA) in planning and conducting necessary programmes for the students so that stress-related factors could be reduced and better academic performance could be achieved by the students. 1.3 Objectives of the Study

This study attempts to find out if there is any significant difference in the level of perceived stress among the Pre-Science students in UiTM Negeri Sembilan at the beginning, middle and at the end of the semester. In addition to that, we would like to find out whether there is a correlation between the students level of perceived stress at the three different periods (beginning, middle, end of the semester) on their academic performance. Our final objective is to determine the possible stress factors that the students perceive may contribute to their academic performance. In addition to that, the association between the academic performance and the identified stress factors would also be explored. 2. LITERATURE REVIEW A frequently reported source of stress that most undergraduate students experience is receiving a lower grade than they expected (grade pressure) (Ratana Saipanish, 2003; Evans & Fitzgibbon, 1992; Kohn & Frazer, 1986). Too much stress can interfere students preparation, concentration, and performance but positive stress can be helpful to students by motivating them to peak performance (Pfeiffer, 2001). Students also have a fear of failure in relation to their grades and academic work. To fall short of their own or others expectations in school, job, athletics, or any other activity one risks both external and internal costs: threat to academic or career prospects, disapproval, rejection, humiliation, guilt and blow to the self-esteem (Schafer, 1996). Those studies carried out with medical students show that in the academic area, heavy work load, examinations and meeting deadlines for assignments were the most common causes of stress (Evans & Fitzgibbon, 1992; Kohn & Frazer, 1986). This is further supported by Ratana Saipanish (2003) who conducted a study on 686 medical students in the Faculty of Medicine; Ramathibodi Hospital, Thailand and finding has also shown that academic problems were found to be a major cause of stress among all students. The results indicated that the most prevalent source of academic stress was test/exam. Obviously, test or exam anxiety is one of the main causes to academic stress and most university students seem to be more emotionally vulnerable due to examinations. Increased anxiety from tests has a debilitating effect on students performance. When information generated by worrying about the test reduces the capacity available for performing the task, the result is that performance breaks down and the result becomes self-confirming (Fisher, 1994). Academic stress pervades the life of students, and tends to impact adversely their mental and physical health, and their ability to perform schoolwork effectively (Clark & Rieker, 1986; Felsten & Wilcox, 1992). Stress associated with academic activities has been linked to various negative outcomes such as poor health (Greenberger, 1981; Lesko & Summerfield, 1989), depression (Aldwin &Greenberger, 1987), and poor academic performance (Clark & Rieker, 1986; Linn & Zeppa, 1984). For example, Lesko and Summerfield (1989) found a significant positive correlation between the incidence of illness and the number of exams and assignments. Similarly, Aldwin & Greenberger (1987) found that perceived academic stress was related to anxiety and depression in college students. A number of studies have found a relationship between stress and poor academic performance (Clark & Rieker, 1986; Linn & Zeppa, 1984; Struthers, Perry & Menec, 2000). Felsten & Wilcox (1992) found a significant negative correlation between the stress levels of college students and their academic performance. In a similar study, Blumberg and Flaherty (1985) found an inverse relationship between selfPaper number: 3003584

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reported stress level and academic performance. Struthers et al. (2000) also reported that a high level of academic stress was associated with lower course grades. Students experience a high level of academic stress due to exams, assignments, time pressure, grade pressure and uncertainty. In short, this stress has a detrimental effect on the academic performance. 3. METHODOLOGY 3.1 The Subjects The subjects involved in the present study will be limited to the Pre-Diploma Science Students in UiTM Negeri Sembilan. The objectives this programme are to help weak-students in their academic especially in the science subjects. The programme is designed as a preparatory and remedial course before entering the Diploma courses in any UiTM campuses throughout the country. In other words, it is a bridging programme from the secondary school level to the diploma level which helps to prepare the students for the various science and technological-based courses available in UiTM. The students are then able to pursue into the Diploma programme if they obtained a Cumulative Grade Point Average (CGPA) of 3.00 in the first semester. However, they have to undergo for the second semester if their CGPA is below than the required point. Since the population size for the Pre-Diploma Science students in June Nov 05 intake at UiTM Negeri Sembilan is only 242, therefore all of them are chosen as subjects for the survey. Out of 242 students, 88 students did not answer the questionnaires completely; hence it left the researchers with 154 responses to be further analyzed. 3.2 The Instrumentation

A structured self-administered questionnaire was developed as a mode of data collection. The questionnaire comprised of three sections: Section A was the Students Profile. This section was developed by the researchers and participants were asked to report data about themselves such as their names, class groups, genders and previous schools. This information is required to allow matching of data in the three stages of the data collection with the academic performance data. Section B was the Perceived Stress Scale (PSS), developed by Cohen, Kamarck & Mermelstein (1983). PSS was chosen in this study because this scale is the most widely used psychological instrument for measuring the perception of stress. It is designed to measure the degree to which respondents found their lives "unpredictable, uncontrollable, and overloading" (Cohen, Kamarck & Mermelstein, 1983). The scale also includes a number of direct queries about current levels of experienced stress. It was designed to be used in communities whose samples have at least a junior high school level of education which is equivalent to the Pre-Diploma level. The items can be easily understood and very general in nature that they are free of content specific to any subpopulation groups. The PSS is a 14-item scale that can be administered in just a short time and is easy to score. The PSS questions inquire the respondents feelings and thoughts during a certain time frame. The information obtained will help to determine the level of stress they perceived at that particular time. In each case, a five-point Likert-type scale ranging from 1 (Never) to 5 (Very Often) was used and respondents were asked on how often they felt a certain way. PSS scores were obtained by reversing the scores on the six negative items, (e.g., 1=5, 2=4, 3=3, 4=2, 5=1), and then summing across all items. Items 4, 5, 6, 7, 9, 10, 12 and 13 are the positively stated items. Individual scores on the PSS can range from 14 to 70 with lower scores indicating lower perceived stress and higher scores indicating higher perceived stress. Initial reliability coefficients, obtained by Cohen, Kamarck, and Mermelstein (1983) ranged from 0.84 to 0.86. Test-retest correlation was 0.85. In 1988, the psychometric properties of the PSS were again explored . Cronbach's alpha coefficient for the internal reliability of the PSS14 was 0.75.Paper number: 3003584

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Section C was the Stress Factors Survey. This section requires the participants to identify the factors of stress that they experience during the given time frame. Several factors of stress were listed down in the questionnaire and respondents may indicate more than one factor, which they perceive relevant to them. The section was developed by the researchers and the sources of stress were gathered from the literature review in the second chapter. The stress factors focused in this study are limited to those discussed by Cohen, Kamarck & Mermelstein (1983). Thus, other stress factors such as environment are not included in this study. Besides the questionnaire, the students academic performance is obtained from their Grade Point Average (GPA), which is a common measure of academic performance used in the higher learning institutions. The reason of obtaining their GPAs is to find out whether stress that they experienced leaves an impact on their academic performance. 3.3 The Procedures This study utilized a self-reported questionnaire survey procedure. The 4 page questionnaire prepared by the researchers were distributed to the students at three different times; one month after the semester started (beginning), one week after the semester break (middle) and the final one was given after their final exam ended (end). The purpose of doing this is to answer the first objective of the study, which is to identify the trend of stress among the students throughout that particular semester. In order to reduce and control non-response error, the questionnaires were delivered and collected personally by the selected lecturers during classes. Questionnaires were administered during the same week to minimize the effect of varying stress levels that may occur and also under the same basic conditions. Respondents were informed to read the instruction written in the questionnaire carefully. Then they were required to complete the questionnaire during the given time. The students were not given any extra marks for participating in this survey. 4. RESULTS AND DISCUSSIONS 4.1 Respondents Profile Out of 242 students who answered the questionnaire, only 154 (63.6%) of them responded to the questionnaire completely and only these completed questionnaires will be used for further analysis. From the total of 154 students, 77.9% of them were females while 22.1% were males. This is a common scenario in higher institutions throughout the country whereby the proportionate is usually imbalance between males and females. In other words, the percentage of females is always outnumbers the males. Majority (87%) of the respondents came from the non-boarding schools and only a small percentage (13%) of them came from the boarding schools. Since the majority of the students came from the nonboarding schools, this means they have no experience of staying away from their families and being independent compared to those who came from the boarding schools. 4.2 Students Academic Performance Students academic performance refers to the Grade Point Average (GPA) obtained from the Academic Affair Division (HEA) UiTM Negeri Sembilan. The GPA was based on the students academic performance in their final examination results for that particular semester. The results comprised of five compulsory subjects namely Mathematics, Physics, Chemistry, Biology and English Language. Table 1 represents the students Grade Point Average (GPA) in the final examination of the respective semester.

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Table 1: The Students Academic Performance CGPA 3.50 - 4.00 3.00 - 3.49 2.50 - 2.99 2.00 2.49 0.00 1.99 Total Frequency 37 65 31 10 11 154 Percent 24.0 42.2 20.1 6.5 7.1 100

The table above indicates that in general, we can say that the students performance is good, where majority (66.2%) of them scored Grade Point Average (GPA) of 3.00 and above. Out of this number 24% of them achieved 3.50 and above which indicates excellent academic achievement. Only 13.6% of the students scored GPA less than 2.00. This shows that the number of low academic achievers is very low. 4.3 Questionnaire Design A set of questionnaires namely the Perceived Stress Scale which was developed by Cohen, Kamarck & Melmelstein, (1983) were used to elicit the data specifically to refer to the students lifestyles in that particular semester. The questionnaires were distributed at the beginning of the semester, middle of the semester and at the end of the semester. Reliability test was run to identify whether the students were consistent in answering the questions. The reliability coefficient was calculated in the 14 item scale in the questionnaire to look at the internal consistency in the Perceived Stress Scale level. In general, the reliability less than 0.6 are considered poor (Sekaran, 2000). From the reliability test, the Cronbach alpha values are greater than 0.6 in all the three period of time, thus, the Cronbach alpha are considered to be adequate and the students answers are considerably reliable (Cronbach Alpha for beginning semester was 0.666, middle semester was 0.776 and end semester was 0.758). 4.4 Level of Perceived Stress A non-parametric test was used to test the significant differences between the level of perceived stress at the beginning and middle of semester as well as at the middle and end of the semester. Since no assumption of normality was needed and the data was dependent thus, a Wilcoxon Signed Rank Test was used. 4.4.1 Level of perceived stress at the beginning and middle semester In order to look at the differences between the level of perceived stress at the beginning and middle of the semester, we postulate the hypothesis below: H0: There is no significant difference between level of perceived stress at the beginning and middle semester. H1: There is a significant difference between level of perceived stress at the beginning and middle semester.

From Wilcoxon Sign Rank test, the result shows that the null hypothesis was rejected (p < 0.05). This indicates that there is a significant difference between the level of perceived stress at the beginning and middle of the semester at alpha 0.05 levels. Meanwhile, the negative Z-score implies that the level of perceived stress faced by students at the beginning semester is less compared to the stress level at the middle of the semester.Paper number: 3003584

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4.4.2 Level of perceived stress at the middle and end semester The same test as above was applied to look at the significant difference between the level of perceived stress at the middle and end of the semester. There is no significant difference between level of perceived stress at the middle and end H0: of semester. There is a significant difference between level of perceived stress at the middle and end of H1: semester. The result indicates that we failed to reject the null hypothesis since the p-value is greater than 0.05. This indicates that there is no difference between level of perceived stress at the middle and end of semester. Thus we concluded that the level of perceived stress experienced by the students from the middle towards the end of the semester was higher than the level of stress at the beginning of the semester. 4.4.3 Level of Perceived Stress and Academic Performance

Spearman Rank Correlation was used to test whether there are any significant differences between the level of perceived stress and the students academic performance. H0: No correlation between levels of perceived stress for beginning, middle, and at the of end of the semester with the students academic performance. Based on the test results from Spearman Rank correlation, there is no correlation between level of perceived stress at the beginning and middle semester with the students academic performance. The test results also show that there is a significant correlation between perceived level at the end of semester and the students academic performance at 0.05 level. The rho value is 0.206 shows that there is a weak negative correlation between level of perceived stress at the end of semester and students academic performance. This implies that when the level of perceived stress is higher, the academic performance will be lower. Thus, we can conclude that the even though the level of stress faced by the students at the middle towards the end of the semester was higher than the stress level at the beginning of the semester, but it did not affect the students overall academic performance. This was probably due to the low level of stress indicated by the mean score of 39.16 out of the total score of 70. 4.5 Stress Factors Survey Questionnaires were given to the students at the beginning, middle and at the end of the semester. They were asked to identify the stress factors that might contribute to their academic performance at the three different periods of time throughout the semester. There were eleven-stress factors listed in the questionnaire and the students may indicate more than one-stress factors. 4.5.1 Stress Factors at the beginning, middle and end of semester

The table below shows the percentage of students who experienced different stress factors at three different periods of time throughout the semester namely beginning, middle and end of the semester.

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Table 2: Percentage of students having stress during the semester Percentage of Students Stress Factors Nutrition Sleeping too much Not getting enough sleep Problems with boyfriend/ girlfriend Class Attendance Problems with roommate Over Exercising Not enough exercising Social Activities Finances Course load Begin Semester 53.2 21.4 58.4 6.5 4.5 28.6 1.3 44.2 23.4 31.8 44.8 Middle Semester 53.9 23.4 57.1 7.8 3.2 18.2 0.6 50.0 25.3 41.6 32.5 End Semester 51.9 20.1 53.9 10.4 5.3 30.5 1.3 55.8 20.1 26.6 37.0

Based on the table, it shows that majority of the students (more than 50%) claimed that they were not getting enough sleep at the three different periods of time throughout the semester, with 53.4%, 57.1% and 53.9% respectively. This is followed by the nutrition factor, with 53.2%, 53.9% and 51.9% respectively. Thus, we conclude that most of the students did not satisfy with the food provided at the college dining hall. In addition, the students also claimed that they did not have enough exercises as shown in the table 2 above. This is probably due to the limited sports and recreational facilities and activities available for the students in the campus. Other factors namely sleeping too much, problems with girlfriends/boyfriends, class attendance, problems with roommate, over exercising, social activities, finances and course load did not really contribute to stress among the students. Chi-Square test of independence was used to test whether students grade (GPA) do not depend on the occurrence of stress factors. Since the questionnaires were distributed at the three different periods of time throughout the semester namely, at the beginning, middle and end of the semester, therefore, the number of occurrence of each stress factors is categorized as below: Table 11: Explanation of Factor Occurrences Factor Occurrence Never Sometimes Often Very often Explanation The stress factor never exist at all 3 periods The stress factor occurred once The stress factor occurred twice The stress factor occurred at all 3 periods

H0: Grade does not depend on the number of occurrence of stress factors H1: Grade depends on the number of occurrence of stress factors From results of the Chi-Square test, it shows that none of the p-values were less than 0.05 which means that we failed to reject the null hypothesis at alpha 0.05 levels. Thus, we conclude that students grade achievement (GPA) does not depend on the number of occurrence of each stress factors throughout the semester. In other words, we can say that none of the stress factors mentioned above affects the students academic performance.

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5. CONCLUSIONS 5.1 Discussions and Implications In general, we can conclude that students did experience stress but at a moderate level with the total score of 37.9 at the beginning of the semester, followed by 39.17 at the middle of the semester, and 38.4 at the end of the semester out of the total score of 70. This implies that the students did not experience stress as a major problem even though this is their transition period from school to university life. The possible reason is probably due to the small student population in the campus which is only 242 of them and the ratio between students and lecturers approximately 10:1. Therefore the relationship among themselves as well as with the lecturers is much closer. Another possible reason is the course workload is not much different with the secondary school level (SPM). From the analysis, we conclude that the level of perceived stress experienced by the students from the middle towards the end of the semester was higher than the level of stress at the beginning of the semester. The possible explanation to this situation is, at the beginning of the semester, the students were not yet given any tests, quizzes and exam. However starting from the middle towards the end, more tests, quizzes and exam came into their life. This probably contributes to higher stress level among the students compared to the stress level at the beginning of the semester. Our second objective was to find out whether there is a correlation between the students level of perceived stress at the three different periods of time (beginning, middle, and at the end of the semester) on their academic performance. Based on the test results, we found out that there is no correlation between the level of perceived stress at the beginning and middle semester with the students academic performance. Results of the present study correlates with the findings in a study conducted by Womble, L.P. (2003) who also found out that students stress was not significantly correlated with students GPA. However, we found out that there is a significant correlation between the level of perceived stress at the end of semester and the students academic performance. The rho value is 0.206 which implies that when the level of perceived stress is higher, the academic performance will be lower. However, it is important to note that the correlation is rather weak. The implication is that the stress level that they experienced was not that high to the extent that they cannot cope with their academic activities. Hence, it is not surprising that more than half (66.2%) of them scored GPA 3.00 and above and out of this number 24% of them achieve Deans List of GPA 3.5 and above. Our final objective is to determine the possible stress factors that the students perceive which may contribute to their academic performance. Based on the results, it shows that majority of the students (more than 50%) claimed that they were not getting enough sleep at the three different periods of time throughout the semester, with 53.4%, 57.1% and 53.9% respectively. This is followed by the nutrition factor, with 53.2%, 53.9% and 51.9% respectively. Thus, we conclude that most of the students did not satisfy with the food provided at the college dining hall. In addition, the students also claimed that they did not have enough exercises. This is probably due to the limited sports and recreational facilities and activities available for the students in the campus. Other factors namely sleeping too much, problems with girlfriends/boyfriends, class attendance, problems with roommate, over exercising, social activities, finances and course load did not really contribute to stress among the students. In addition to that, the association between the academic performance (GPA) and the identified stress factors were also explored. Results shows that students grade achievement (GPA) does not depend on the number of occurrence of each stress factors throughout the semester. In other words, we can say that none of the stress factors mentioned above affects the students academic performance. This supports the findings by Jerome (1996) and Ryan (2004) who were also unable to show a significant relationship between academic achievement and exercise. 5.2 Suggestions and Recommendations Based on the findings and discussions above, we would like to bring forward several suggestions and recommendations to relevant authorities. First of all, it is suggested that the current student and lecturerPaper number: 3003584

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ratio available in the campus to be maintained. This is because results show that this is one the possible reasons that contribute to the low level of stress experienced by the students. This is important as it can ensure high academic performance among the students. This means instead of completing the course in 2 semesters, they can complete it in 1 semester. We also would like to suggest to the Students Affair Division (HEP) to consistently plan suitable activities or programs for the students such as organizing talks on motivation, time management and study skills. Such programs and activities would help to reduce the level of stress or at least they know how to control their stress as it would directly contribute to their academic achievement. It is also suggested that Students Affair Division (HEP) to continuously monitor students food intake provided at the dining hall. This is essential because good nutrition would contribute to good health which indirectly may result in producing good academic performance. In addition to that, sports and recreational facilities or activities should also be upgraded to provide more opportunities for the students to get involved in sports and recreational activities. Obviously, getting involved in those activities is one of the possible ways to help students to reduce their stress. REFERENCES Aldwin, C., & Greenberger, E. (1987). Cultural differences in the predictors of depression. American Journal of Community Psychology. 15, 789-813. Blumberg, P., & Flaherty, J.A. (1985). The influence of non-cognitive variables on student performance. Journal of Medical Education. 60, 721-723. Calderon, K.S. Hey, W., & Seabert, D. (2001). Perceived Stress and locus of control difference between employed and non-employed college students: Implication for increasing internal locus of control group. Students Affair Journal Online. http://sajo.org (10 March 2006) Clark, E.J. & Rieker, P.P. (1986). Gender differences in relationships and stress of medical and law students. Journal of Medical Education. 61, 32-40. Cohen, S., Kamarck, T. & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behaviour. 24, 4, 385-396. Evans, E.J & Fitzgibbon, G.H. (1992). The dissecting room: Reaction of first year medical students. Clinic Anatomy. 5, 311-320. Felsten, G. & Wilcox, K. (1992). Influences of stress and situation-specific mastery beliefs and satisfaction with social support on well-being and academic performance. Psychological Reports. 70, 291-303. Fisher, S. (1994). Stress in academic life. New York: Open University Press. Greenberg, J. (1981). A study of stressors in the college population. Health Education. 12, 8-12. Hammer, L.B., Grigsby, T.L. & Woods, S. (1998). The conflicting demands of work, family and school among students at an urban university. The Journal of Psychology. 1323, 220-227. Hatcher, L. & Prus, J.S. (1991). A measure of academic situational constraints: Out-of class circumstance that inhibit college student development. Educational & Psychological Measurement. 51, 953-963. Jerome, J.C. (1996). The relationship between regular exercise and academic achievement. Masters Abstracts. 35, 1, 37.Paper number: 3003584

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Kaplan, H.I. & Sadock, B.J. (2000). Learning theory. In synopsis of Psychiatry: Behavioral Sciences/Clinical Psychitry (8th edit.) Philadelphia: Lippincott Williams & Wilkins. 148-154. Kelly, W.E., Kelly, K.E. & Clanton, R.C. (2001). The relationship between sleep length and grade-pointaverage among college students. College student Journal. 35, 84-88. Kohn, J.P. & Frazer, G.H. (1986). An academic stress scale: Identification and rated importance of academic stressors. Psychological Reports. 59, 415-426. Lesko, W.A. & Summerfield, L. (1989). Academic stress and health changes in female college students. Health Education. 20,1, 18-21. Linn, B.S. & Zeppa, R. (1984). Stress in junior medical students: relationship to personality and performance. Journal of Medical Education. 59, 7-12. Niemi, P.M. & Vainiomaki, P.T. (1999). Medical students academic distress, coping and achievement strategies during the pre-clinical years. Teaching & Learning in Medicine. 11, 3, 125-134. Pfeiffer, D. (2001). Academic and environmental stress among undergraduate and graduate college students: a literature review. http://www.uwstout.edu/lib/thesis/2001/2001pfeifferd.pdf (10 March 2006). Ryan, M.I. (2004). The relationships among stress of living situation, health and academic performance. Manuscript of National Undergraduate Research Clearinghouse. http://clearinghouse.missouriwestern.edu/listal.asp. (10 March 2006) Schafer, W. (1996). Passing the test of college stress. In W. Schafer (Ed.), Stress management for wellness. Orlando; Harcourt Brace. 543-563. Silver, H.K. & Glicken, A.D. (1990). Medical student abuse: Incidence, severity and significance. The Journal of the American Medical Association. 263, 527-532. Struthers, C.W., Perry, R.P. & Menec, V.H. (2000). An examination of the relationships among academic stress, coping motivation and performance in college. Research in Higher Education. 41, 581-592. Trockel, M.T., Barnes, M.D. & Egget, D.L. (2000). Health related variables and academic performance among first-year college students: Implication for sleep and other behaviors. Journal of American College Health. 49, 125-140.

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