A Comparison of American and Chinese Students Perceived Stress Coping Styles and Health Promotion Practices

Li, Y., Lindsey, B. J., Yin, X., & Chen, W. (2012).
A comparison of American and Chinese students’ perceived stress, coping styles, and health promotion
practices.
Journal of Student Affairs Research and Practice, 49(2), 211–227.
doi:10.1515/jsarp-2012-6298
Available at http://journals.naspa.org/jsarp/vol49/iss2/art6/
Innovations in International Feature
A Comparison of
American and Chinese
Students’ Perceived
Stress, Coping Styles,
and Health Promotion
Practices
Ying Li, Western Washington University
Billie J. Lindsey, Western Washington University
Xiaoqin Yin, Zhejiang University City College
William Chen, University of Florida
A cross-sectional survey utilized the Perceived Stress Scale, Brief COPE, and
Health Promotion Lifestyle Profile II to ascertain similarities and differences
between American (n = 319) and Chinese (n = 335) college students
and between higher and lower stressed students in both samples. The
results suggested the existence of a country difference in terms of perceived
stress level, stress coping strategies, and health promotion practices. Similar
Ying Li, Department of Physical Education, Health, and Recreation, Western Washington University. Billie J. Lindsey,
Department of Physical Education, Health, and Recreation, Western Washington University; Xiaoqin Yin, Department
of English, Zhejiang University City College. William Chen, Department of Health Education and Behavior, University
of Florida.
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American and Chinese Students’ Stress
differences were also observed between higher and lower stressed students,
regardless of country.
College life can be a uniquely stressful time in young adult lives. College student stress
has been associated with physical illness, depression, anxiety, suicide, substance abuse, problem
eating behavior, relationship problems, violence, and academic impairment (Flynn, 2000; Pawlow,
O’Neil, & Malcolm, 2003; Robotham & Julian, 2006). Due to the link between stress and poor
mental, physical, and social well-being, understanding how students cope with stress and en-
gage in health practices that may mitigate stress becomes an important focus of inquiry. The
study presented here investigated the perceived stress, stress coping strategies, and health pro-
motion practices of college students from two countries with very different cultures: the United
States and China. A cross-cultural comparison provides insight into factors related to stress and
stress prevention. It also may help American faculty members and administrators better under-
stand and assist the increasing numbers of foreign students, particularly mainland Chinese, who
represent the largest population of international students in the United States (Yan & Berliner,
2009).
American Students and Stress

The 2008 American College Health Association National College Health Assessment II
(NCHA II), a nationwide survey administered to 26,685 students from 40 colleges and universi-
ties, found that at some time during the prior year, 9.3% of students felt tremendous stress, 41.1%
felt higher than average stress, 39.5% felt average stress, and 10.1% reported less than average or no
stress (American College Health Association, 2009). In the same survey, 30.6% of students felt so
depressed it was difficult to function, 47.0% felt things were hopeless, 87.4% felt overwhelmed by
all they had to do, 81.9% felt exhausted, 59.7% felt very lonely, 63.7% felt very sad, and 6.4% seri-
ously considered suicide. Slightly more than 10% of students reported being diagnosed or treated
for depression within the previous 12 months.
Academic-related activities, financial problems, and social relationships are significant
sources of stress for students. According to the NCHA II, 45.2% of students reported that their
studies were traumatic or very difficult to handle, followed by finances (35.5%), intimate relation-
ships (33.8%), family problems (28.4%), and other social relationships (26.7%). Career-related
issues were reported as traumatic or very difficult to handle by 22.2%. Other studies identified
the transition to college, parental pressure, fear of failure, and career decisions as sources of stress
for college students (Robotham & Julian, 2006).
A student’s ability to cope with stressful events and situations is paramount to academic
success and personal well-being. Investigations of American students’ stress-coping strategies
have revealed the degree of stress a student experiences may relate to the use of different types
of coping strategies (Arthur, 1998). Studies have supported that managing stress through active
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problem solving results in better health and academic performance (Soderstrom, Dolbier, Leifer-
man, & Steinhardt, 2000; Struthers, Perry, & Menec, 2000).
Chinese Students and Stress

Similar to their American peers, Chinese college students also experience stress, but to a
lesser degree. Zhang, Che, Li, and Zhang (2006) studied stress among 2,007 students from 13 uni-
versities. Among these students, 0.3% reported severe levels of stress, 8.4% high stress, and 49.3%
mild stress. Depression also poses a problem for Chinese students. Luo and Ma (2004) reported
that 55.4% of Chinese college students showed depressive symptoms. Song et al. (2008) found
that 24.6% of first-year students experienced depressive symptoms indicating mild depression
and 8.9% experienced depressive symptoms associated with major depression.
Sources of stress for Chinese students are similar to American students’ sources of stress. C.
Wang (2005) found concern about one’s future career and/or finding a job as the primary sources
of stress for Chinese students. Zhang et al. (2006) found that Chinese females were more likely to
experience stress related to academics and future careers, whereas males were more likely to experi-
ence stress related to relationships, family, and health. Other demographic factors, besides gender,
may also play an influential role in Chinese students’ stress. Students who are only children, hail
from urban or suburban areas, and who attend more prestigious universities tend to experience
lower stress than do students who have siblings, come from rural areas, and attend less selective
universities (Fang, Yu, Yang, & Chen, 2008; Zhang et al., 2006).
Similar to American students, Chinese youth apply multiple coping strategies when faced
with stress (X. Liu, Tein, & Zhao, 2004). Coping strategies for Chinese students are generally di-
chotomized into two groups: positive and negative (Jin et al., 2009). The positive coping style was
reported to have a positive effect on subjective well-being (Chen, Ma, & Fan, 2009). In contrast,
negative coping, particularly avoidant, was associated with an increased risk for internalizing and
externalizing problems (X. Liu et al., 2004).
Purpose of Study
Students from both the United States and China may experience increasing levels of stress
during the next few years. For American students this may be due to the economic crisis that has
led to increases in tuition, decreases in financial aid, and/or poorer job prospects (Borbely, 2009;
Fuller, 2010; Johnson, Oliff, & Koulish, 2008). For Chinese students this may be due to career-
related concerns and increasing competition for positions (Luan, 2009). Due to the negative effects
of too much stress and the likelihood that stress is increasing, we designed this study to answer
the following questions:
1. What is the level of perceived stress reported by American and Chinese students?
2. Are the levels of perceived stress, stress coping strategies, and health practices dif-
ferent between students from the United States and China?
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3. How do students who experience lower stress compare with students who expe-
rience higher stress on chosen coping strategies and health practices?
Answers to these questions may provide college and university health care providers, counselors,
social workers, health educators, and student affairs professionals, both in the United States and
China, important information about student health needs and problems related to stress and
stress prevention.
Methodology
Participants
The participants were undergraduate students from a Pacific Northwest university and a
university located in eastern China with approximately equal student numbers (12,000). For both
campuses, contact was made with instructors of required general education courses. These in-
structors gave permission to administer the survey during class time. Initially, 407 American and
349 Chinese students participated in the study. Of the 756 questionnaires distributed, 654 were
completed and returned for a response rate of 86%. The final sample included 319 students from
the American university (61% female, 39% male) and 335 students from the Chinese university
(42% female, 58% male).
Procedure
Prior to data collection, students were informed of the purpose and confidential nature of
the study and signed an informed consent form. The paper–pencil survey of 105 items was adminis-
tered in classrooms in mid-October, 2008. The survey took approximately 30 minutes to complete.
The data were entered into SPSS 16.0 and analyzed. Descriptive statistics, including mean, mode,
and standard deviation, were used to report the stress level among participants. Due to the exis-
tence of multiple dependent variables, MANOVAs (multivariate analysis of variance) were used
to assess the differences between American and Chinese students’ responses on perceived stress,
health promotion practices, and stress coping style. Follow up ANOVAs were applied to identify
the country differences at the subscale level for perceived stress, health practices, and stress coping
style. To remove the effects of different stress levels, MANCOVAs (multivariate analysis of covari-
ance) were employed to examine the differences in the stress coping and health promotion prac-
tices between American and Chinese students.
Instruments
Four questionnaires, in Chinese and English, were used in this study, and included demo-
graphic questions (11 items), the Perceived Stress Scale (PSS; 14 items), the Brief Coping Orienta-
tions to Problems Experienced (Brief COPE; 28 items), and the Health Promotion Lifestyle Profile
II (HPLP II: 52 items). Both Chinese (Chu & Gao, 2005; Lee & Yuen Loke, 2005; T. Wang et al., 2005)
and English (Carver, 1997; Cohen, Kamarck, & Mermelstein, 1983; Walker & Hill-Polerecky, 1996)

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versions of the instruments have been used in other studies. Validity and reliability are described
in the description of each instrument.
Perceived Stress Scale. The PSS, developed by Cohen et al. (1983), consists of 14 items
that determine the degree to which respondents find their lives unpredictable, uncontrollable, or
overloaded. Respondents were asked to report on a scale ranging from 1 (never) to 4 (very often) how
often in the previous month they had experienced, in thought and/or feeling, a particular situa-
tion. The sum of the scores (range = 0–56), with reverse scoring on seven items, is considered a
person’s perceived stress level. According to Cohen et al., a score lower than 20 is regarded as low
stress, 20–36 as moderate stress, and above 36 as high stress. The PSS demonstrates good internal
consistency, with a reported Cronbach’s alpha of .85 and a test–retest reliability of .85 over 2 days
and .55 over 6 weeks (Cohen et al., 1983). In this study, the PSS scale demonstrated adequate in-
ternal consistency with Cronbach’s alphas of .84 for the English version and .83 for the Chinese
version.
Brief Coping Orientations to Problems Experienced. The Brief COPE) con-
tains 28 items (cognitive and behavioral) that measure how a person responds to a difficult or
stressful event in life (Carver, 1997; Carver, Scheier, & Weintraub, 1989). Two items each measure
14 subscales: self-distraction, active coping, denial, substance use, use of emotional support, use
of instrumental support (e.g., trying to get advice or help from other people about what to do), be-
havioral disengagement, venting, positive reframing, planning, humor, acceptance, religion, and
self-blame. Using a Likert-type scale ranging from 1 (I usually don’t do this at all) to 4 (I usually do this a
lot), respondents indicated the extent to which they employ a strategy. In this study, factor analysis
of the 14 subscales resulted in two factors: Factor I (defined as Positive/Active Coping) included
self-distraction, active coping, emotional support, instrumental support, reframing, planning, hu-
mor, acceptance, and religion; and factor II (defined as Negative/Passive Coping) included denial,
substance use, behavioral disengagement, venting, and self-blame. The psychometric properties of
this instrument have been found adequate in previous studies: Cronbach’s alpha reliability coeffi-
cients ranged from .50 to .90 (e.g., Carver, 1997). For this study, Cronbach’s alphas achieved similar
performance with a range from .48 to .92 and an overall score of .72.
Health Promotion Lifestyle Profile II. Health promotion practices were mea-
sured using HPLP II (Walker & Hill-Polerecky, 1996). The instrument consists of 52 items that mea-
sure six areas of health practices: health responsibility (such as conducting self- examinations and
asking for second opinions), physical activity, nutrition, interpersonal relations, spiritual growth,
and stress management. Respondents indicate how often they engage in a specific behavior: never
(0), sometimes (1), often (2), or routinely (3). A score for overall health promotion practices was ob-
tained by calculating a mean for an individual’s responses to all 52 items. The score for each aspect
or area of health practice was obtained by calculating the mean of related items. Walker and Hill-
Poloerecky (1996) reported a Cronbach’s alpha above .79 for both the overall scale and the six sub-
scales. The following Cronbach’s alpha coefficients of internal consistency reliability were obtained
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for this sample: total scale .93, health responsibility .81, physical activity .84, nutrition .71, spiritual
growth .83, interpersonal relationships .81, and stress management .72.
Results
Perceived Stress
Students’ scores on the PSS ranged from 4 to 45 with a mean of 22.71 (SD = 7.50), median of
22, and mode of 16 and 23. Over one third (36.2%, n = 237) of the students scored lower than 20,
401 (61.3%) scored between 20 and 36, and 16 (2.4%) scored higher than 36. American students (M
= 23.53, SD = 7.20) scored higher on perceived stress compared to Chinese students (M = 21.77,
SD = 7.66), F = 8.59, p < .005.
Cultural Differences of Perceived Stress, Coping Strategies, and

Health Practices
A one-way MANOVA was conducted to determine if differences existed on perceived stress,
health promotion practices, and stress coping style between American and Chinese students. Sig-
nificant differences were found, Wilk’s = .80, F(4,608) = 38.43, p < .001, partial η2 = .20. Follow-
up ANOVA for each dependent variable demonstrated that American students reported (a) higher
perceived stress, (b) a greater tendency to use both positive/active and negative/passive stress cop-
ing strategies, and (c) more frequent health promotion practices (see Table 1).
Stress Coping Strategies of American and Chinese Students

A MANOVA was used to determine the effect of country on 14 stress coping strategies. Each
strategy consists of two items, with a total possible score of 8. A higher score indicates a higher
frequency of use of the strategy. The effect of country was significant, Wilk’s = .77, F(14, 621)
= 13.66, p < .001, partial η2 = .24. Follow-up ANOVA revealed a difference between American and
Table 1
American Versus Chinese Students’ Perceived Stress, Coping, and Health Practices
American Chinese
Variables M SD M SD F ( p value)
Perceived stress levela 23.53 7.20 21.77 7.66 8.59 (.004)

Health practicesb 1.67 .45 1.36 .379 84.46 (.000)
Active copingc 52.54 8.63 50.48 8.39 8.97 (.003)
Passive copingd 19.26 5.31 18.24 3.91 7.20 (.007)
a
The score for each person ranges from 0–56; the higher the score, the higher the perceived stress. b The score for each person ranges
from 0–3; the higher the score, the greater frequency of health practices. c The score for each person ranges from 9–72; the higher the score,
the greater the frequency of using active coping strategies. d The score for each person ranges from 5–40; the higher the score, the greater
the frequency of using passive coping strategies.

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Table 2
American Versus Chinese Students’ Stress Coping Strategies as Measured by the Brief Coping
Orientations to Problems Experienced
American Chinese
MANOVA MANCOVA
Strategy M SD M SD F ( p value) F ( p value)
Self-distraction 6.05 1.40 5.45 1.55 26.34 (.000) 26.95 (.000)

Active coping 6.33 1.33 6.29 1.46 0.18 (.670) 1.73 (.188)
Denial 3.03 1.36 3.23 1.17 3.90 (.049) 6.06 (.014)
Substance use 3.61 1.95 2.52 1.20 71.25 (.000) 64.79 (.000)
Emotional support 5.95 1.81 5.57 1.56 8.09 (.005) 9.28 (.002)
Instrumental support 6.04 1.70 5.61 1.49 11.40 (.001) 13.34 (.000)
Behavioral disengagement 3.27 1.40 3.43 1.10 2.78 (.096) 6.59 (.011)
Venting 4.64 1.42 4.42 1.40 3.66 (.056) 2.17 (.141)
Positive reframing 5.99 1.45 6.21 1.42 3.63 (.057) 1.24 (.267)
Planning 6.27 1.36 6.49 1.41 4.13 (.042) 1.82 (.177)
Humor 5.56 1.75 5.04 1.48 16.37 (.000) 24.87 (.000)
Acceptance 6.08 1.36 5.95 1.34 1.38 (.240) 3.90 (.049)
Religion 4.24 2.20 4.05 1.51 1.54 (.215) 1.21 (.272)
Self-blame 4.70 1.70 4.82 1.44 0.97 (.326) 3.72 (.054)
Note. The score for each variable ranges from 1–8; the higher the score, the greater the frequency of using the strategy.
Chinese students’ use of seven coping strategies: self-distraction, denial, substance use, emotional
support, instrumental support, planning, and seeking humor in a situation. Compared to
American students, Chinese students were more likely to use the coping strategies of planning (p
= .042) and denial (p = .049). They were less likely to employ self-distraction (p = .000), substance
use (p = .000), emotional support (p = .005), instrumental support (p = .001), or humor (p =
.000) in a stressful situation. There were no differences between American and Chinese students
in terms of the frequency that they used active coping, venting, positive reframing, religion, and
self-blame as strategies to cope with stress (see Table 2). However, controlling for perceived stress
level, a MANCOVA suggested additional differences between American and Chinese students.
Specifically, American students tended to use acceptance more frequently, F = 3.90, p = .049,
whereas Chinese students tended to use disengagement more frequently as a coping strategy, F =
6.59, p = .011. At the same time, the difference between American and Chinese students in terms
of using planning disappeared, F = 1.82, p = .177 (see Table 2).
Health Practices of American and Chinese Students

A one-way MANOVA was conducted to determine the effect of country on six health promo-
tion practice areas: health responsibility, physical activity, nutrition, interpersonal relationships,
spiritual growth, and stress management. Significant differences were found between American
and Chinese students, Wilk’s = .68, F(6,621) = 48.44, p < .001, partial η2 = .32. Follow-up
ANOVA for each dependent variable revealed that American students practiced more health
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Table 3
American Versus Chinese Students’ Health Practices as Measured by the Health Promotion
Lifestyle Profile II
American Chinese
MANOVA
Variables M SD M SD F ( p-value)
Health responsibility 0.99 0.60 0.69 0.49 46.13 (.000)

Physical activity 1.69 0.72 0.93 0.54 226.43 (.000)
Nutrition 1.70 0.56 1.45 0.49 36.44 (.000)
Interpersonal relations 2.11 0.59 1.86 0.48 37.05 (.000)
Spiritual growth 1.97 0.63 1.69 0.52 34.45 (.000)
Stress management 1.56 0.55 1.51 0.51 1.73 (.189)
Note. The HPLP II scale contains 52 items that measure the frequency (never = 0, sometimes = 1, often = 2, and routinely = 3) of use of
six areas of health practice: health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management.
The score for each area of health practice was obtained by calculating the mean of related items; the higher the score, the more frequent the
use of that group of health promotion practices.
behaviors in all areas except stress management (Table 3). However, after controlling for perceived
stress level, the differences between American and Chinese students’ use of stress management
strategies also became significant: American students used stress management strategies more
frequently than do Chinese students, F = 8.68, p < .005.
Stress Coping Strategies of Lower and Higher Stressed Students

Using the overall mean (M = 22.71) of perceived stress as criterion for grouping, students
with a perceived stress level equal to or greater than 22.71 were considered the higher stress group
(n = 325), and students with a perceived stress level lower than 22.71 were considered the lower
stress group (n = 329). The effect of stress level was found to be significant for both American,
Wilk’s = .76, F(14, 303) = 6.91, p < .001, partial η2 = .14, and Chinese students, Wilk’s =
.81, F(14, 303) = 5.01, p < .001, partial η2 = .15. For the American sample, differences were found
between lower and higher stressed students in 10 of the 14 coping strategies. The four exceptions
were self-distraction, emotional support, instrumental support, and religion. For the Chinese
sample, differences were found between lower and higher stressed students in 12 of the 14 coping
strategies. The two exceptions were venting and religion. Students with higher stress, whether
American or Chinese, reported use of denial, substance use, disengagement, and self-blame with
greater frequency than did lower stressed students. Additionally, higher stressed American
students reported using venting more frequently than did the higher stressed Chinese students.
American and Chinese students with lower stress were more likely to use strategies related to
active coping, positive reframing, planning, humor, and acceptance. Chinese students with lower
stress also used more strategies related to emotional support and instrumental support than did
American students with lower stress (see Table 4).

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Table 4
Higher Versus Lower Stressed Students’ Coping Strategies as Measured by the Brief Coping
Orientations to Problems Experienced
American Chinese
Variables High M (SD) Low M (SD) F ( p-value) High M (SD) Low M (SD) F ( p-value)
Self-distraction 6.15 (1.34) 5.92 (1.46) 2.06 (.152) 5.20 (1.52) 5.64 (1.55) 6.61 (.011)
Active coping 6.10 (1.28) 6.62 (1.34) 12.55 (.000) 5.87 (1.48) 6.62 (1.36) 21.71 (.000)
Denial 3.33 (1.48) 2.66 (1.09) 20.65 (.000) 3.38 (1.17) 3.11 (1.16) 4.20 (.041)
Substance use 3.81 (2.03) 3.37 (1.82) 3.98 (.047) 2.71 (1.35) 2.37 (1.05) 6.23 (.013)
Use emotional support 5.90 (1.72) 6.01 (1.91) 0.26 (.608) 5.34 (1.56) 5.75 (1.54) 5.54 (.019)
Use instrumental support 5.99 (1.62) 6.09 (1.80) 0.25 (.616) 5.43 (1.51) 5.76 (1.46) 3.92 (.049)
Behavioral disengagement 3.60 (1.43) 2.87 (1.25) 22.92 (.000) 3.70 (1.19) 3.22 (0.98) 15.65 (.000)
Venting 4.89 (1.46) 4.33 (1.32) 12.58 (.000) 4.56 (1.49) 4.32 (1.32) 2.40 (.122)
Positive reframing 5.67 (1.46) 6.38 (1.35) 19.51 (.000) 5.74 (1.46) 6.58 (1.28) 30.26 (.000)
Planning 6.11 (1.36) 6.46 (1.34) 5.25 (.023) 6.01 (1.44) 6.87 (1.26) 31.87 (.000)
Humor 5.26 (1.87) 5.91 (1.51) 11.11 (.001) 4.56 (1.45) 5.42 (1.39) 28.79 (.000)
Acceptance 5.72 (1.40) 6.61 (1.17) 28.93 (.000) 5.69 (1.35) 6.16 (1.30) 9.90 (.002)
Religion 4.34 (2.27) 4.11 (2.10) 0.85 (.357) 4.04 (1.56) 4.06 (1.47) 0.01 (.935)
Self-blame 5.25 (1.66) 4.03 (1.55) 47.02 (.000) 5.03 (1.54) 4.66 (1.33) 5.36 (.021)
Note. The score for each variable ranges from 1–8; the higher the score, the greater the frequency of using the strategy.
Health Practices of Lower and Higher Stressed Students

A MANOVA was used to determine the effect of lower or higher stress level on health
practices. The effect of stress level was found to be significant for both American, Wilk’s =
.85, F(6, 309) = 9.21, p < .001, partial η2 = .15, and Chinese students, Wilk’s = .72, F(6, 305) =
20.26, p < .001, partial η2 = .29. Students with less stress participated more frequently in
behaviors related to physical activity, nutrition, interpersonal relations, spiritual growth, and
stress management (see Table 5). This was true regardless of whether students were American or
Chinese. The only behavior that indicated a difference between American and Chinese students
was “health responsibility.” For American students, there was no difference between students
with lower and higher stress levels. However, the difference existed between Chinese students
with lower and higher stress (see Table 5).
Discussion
The research reported here draws an association between country and stress level. Specif-
ically, Chinese students (M = 21.77) reported lower perceived stress levels compared to American
students (M = 23.53). Percentage-wise, 55.5% of Chinese students versus 66.7% of American
students reported scores in the moderate stress range. These results, which echo findings from
previous studies of Chinese students (Crystal et al., 1994; Gerdes & Ping, 1994), may be explained
by Chinese culture. Culture influences the interpretation of, and response to, the environment,
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Table 5
Higher Versus Lower Stressed Students’ Health Practices as Measured by the Health Promo-
tion Lifestyle Profile II
American Chinese
Variables High M (SD) Low M (SD) F ( p-value) High M (SD) Low M (SD) F ( p-value)
Health responsibility 0.96 (0.05) 1.02 (0.05) 0.66 (.416) 0.59 (0.04) 0.76 (0.04) 9.54 (.002)
Physical activity 1.60 (0.05) 1.79 (0.06) 5.51 (.020) 0.78 (0.05) 1.04 (0.04) 18.64 (.000)
Nutrition 1.64 (0.42) 1.77 (0.05) 4.38 (.037) 1.31 (0.04) 1.55 (0.04) 19.67 (.000)
Interpersonal relationship 2.02 (0.04) 2.23 (0.05) 28.68 (.000) 1.63 (0.03) 2.05 (0.03) 92.60 (.000)
Spiritual growth 1.80 (0.05) 2.17 (0.05) 10.70 (.001) 1.41 (0.04) 1.91 (0.04) 71.96 (.000)
Stress management 1.39 (0.04) 1.77 (0.04) 42.44 (.000) 1.25 (0.04) 1.71 (0.03) 79.47 (.000)
Note. The HPLP II scale contains 52 items that measure the frequency (never = 0, sometimes = 1, often = 2, and routinely = 3) of use of
six areas of health practice: health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management.
The score for each area of health practice was obtained by calculating the mean of related items; the higher the score, the more frequent the
use of that group of health promotion practice.
including stressors. Chinese students tend to experience their stress from fewer domains
compared to American students (Crystal et al., 1994). For example, parents in China generally
provide their children financial support to complete their education. In contrast, many American
students work through college to support themselves (American Council on Education, 2006).
Many American students also volunteer to gain field experience, a practice that is uncommon in
China. These multiple sources of stress may complicate American students’ lives and increase
their level of stress.
Both American and Chinese students with similar stress levels used strategies related to
active coping, venting, positive reframing, religion, self-blame, and planning. However, a differ-
ence was observed in the use of other stress coping strategies. American students reported using
strategies related to self-distraction, substance use, emotional support, instrumental support, hu-
mor, and acceptance more frequently than did their Chinese counterparts. Chinese students re-
ported using strategies related to denial and behavioral disengagement more frequently than did
American students. The coexistence of similarities and differences suggests that cultural differ-
ence should not be the only factor examined when comparing coping strategies across cultures.
Other factors, such as personality and gender should also be considered, as literature supports
their influence on coping choices (Brougham, Zail, Mendoza, & Miller, 2009; Carver & Connor-
Smith, 2010). It would be valuable to determine the contribution from major factors such as cul-
ture, personality, and gender in future cross-cultural studies.
In terms of the coping differences and why Chinese students used strategies related to de-
nial and behavioral disengagement more frequently than American students did, the following
explanation may offer some insight. China has been described as a society characterized by collec-
tivism (Hui & Triandis, 1986). Under collectivism, Chinese people prioritize group interest and

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interdependence, and they value compliance to rules and social norms to achieve harmony. Because
of this cultural trait, Chinese people tend to avoid assertive or competitive behaviors that produce
conflict and disharmony (Chiu, Wong, & Kosinski, 1998). This may result in actions, such as “giv-
ing up trying to deal with it” that is described as a “behavioral disengagement strategy” in the Brief
COPE scale.
American and Chinese students’ differences concerning drug use as a coping strategy was
consistent with research from the National Institutes of Health Substance Abuse and Mental
Health Services Administration, Office of Applied Studies ([SAMHSA], 2010) and Hao et al. (2002).
SAMHSA (2010) reported that 7.9% of American adults used illicit drugs in the month prior to
an administered survey. Hao et al. reported an illicit drug use rate of 1.17% among more than
50,000 individuals aged 15 or older in the heavily populated areas of Yunnan, Sichuan, Gansu,
and Gungdong provinces. Due to the history of opium abuse that occurred in the Qing Dynasty
(1636–1909), the government of the People’s Republic of China, founded in 1949, took drug use
very seriously and initiated a nationwide anti-drug campaign (Zhao et al., 2004). As a result,
China enjoyed the reputation of “a country free from drugs” for more than 30 years. The United
States, on the other hand, experienced greater drug tolerance following World War II (Ksir, Hart,
& Ray, 2006). It was during the 1980s that American society became less tolerant of drug use and
increased penalties for violating drug laws (Ksir et al., 2006). During the same period of time,
the situation in China also changed. Influenced by widespread drug abuse globally, drug-related
problems reappeared in China beginning in the late 1980s. Even so, the illicit drug use prevalence
in China is still low compared to that of the United States (Hao et al.; SAMHSA, 2010).
Overall, students from the current study participated in health promotion practices “some-
times,” but not frequent enough to be considered as “often” or “routine.” Compared to American
students, Chinese students participated even less frequently in all health practice dimensions:
physical exercise, nutrition, spiritual growth, health responsibility, interpersonal relations, and
stress management. These findings point to the ongoing challenge universities face in promoting
healthy behavior to college students, a population that is relatively healthy and free from chronic
disease.
Both higher stressed American and Chinese students used negative/passive coping strate-
gies such as denial, substance use, disengagement, and self-blame. These strategies may not be
as effective as active coping, positive reframing, planning, humor, and acceptance, which are the
strategies employed by students who reported lower stress levels. For Chinese students, using
emotional and instrumental support could also indicate effective stress-coping strategies given
that lower stressed students used these methods more often than did higher stressed students.
Higher stressed students from both countries were less likely to practice healthy behav-
iors related to physical activity, nutrition, relationships, spiritual growth, and stress management.
This finding corroborated observations of Hudd et al. (2000): the higher the stress, the more likely
it will be that students report unhealthy behaviors, lower self-esteem, and compromised health
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status. Our research also suggests that a healthy lifestyle might play a role as a stress buffer. How-
ever, this suggestion should be interpreted with caution given that the current study did not ex-
plore or confirm the causal relationship between lifestyle and perceived stress level. It is possible
that students with higher stress levels are not engaged in healthy behaviors because they feel over-
whelmed or due to some other factors completely.
There are several limitations to our study. First, convenience samples were used from two
universities, which limits the generalizability of our findings. However, the results of the current
study are consistent with recent studies that employed random samples (C. Liu et al., 2007;
Nelson, Lust, Story, & Ehlinger, 2008). Second, the participants were students enrolled in required
general education courses. Although it is possible that perceived stress and coping behaviors
would be different for students from these two universities who were enrolled in “major” classes,
general education classes tend to provide a better overall representation of a student population.
Third, though anonymity was employed to encourage honesty in responses, all information was
self-reported and therefore subject to social desirability response bias. Students were apprised,
however, of the importance of the research and the contribution they were making to increase the
understanding of stress across cultures. Fourth, due to the cross-sectional nature of the study,
we cannot conclude that the positive or negative health promotion practices or coping strategies
caused the variability in stress; however, the association points to the likelihood of a strong effect.
Finally, due to the growing economic crisis that corresponded to the study time line, and due to the
fact that the full severity of the crisis was not realized until a few months after the administration
of the student survey, it is possible that the timing of the survey (prior to midterm examinations
and prior to the full impact of the economic crisis), influenced students’ perceived stress.
Implications for Practice

College students, a distinct population, exist in environments conducive to frequent dis-
tress and mental health issues. The results of this specific study suggest that student affairs pro-
fessionals, faculty, and health care providers ought to pay more attention to the relationship of per-
ceived stress, coping strategies, and health practices, especially when students who choose health-
ier lifestyles also report more positive coping strategies and perceive they experience less stress. In-
terventions for the higher stressed student population, regardless of culture, should include train-
ing in personal coping skills that encourage students to learn how to reframe circumstances, see
humor in a situation, plan for change, and learn to accept what cannot be changed. Stress manage-
ment training also should include discussions about substance use, self-blame, denial, and disen-
gagement.
There is increasing attention paid to measuring the effectiveness of stress prevention train-
ing programs for a variety of populations. As a result, evidence is accumulating about the content
and methods to include in such trainings. Bodenmann, Perrez, Cina, and Widmer (2002) found
that participants with 6 hours of stress management training used better problem-solving and

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positive self-verbalization following the training. Dysfunctional coping strategies, such as rumi-
nation and blaming, were used less often even 2 years after the training was completed. Flaxman
and Bond (2010) reported a significant reduction in stress following three half-day training ses-
sions that were based on cognitive–behavioral therapy principles and procedures. Additionally,
those with the highest stress reported clinical mental health improvement. Finally, there is con-
tinuing research that supports the effect of mindfulness training on changes in the brain and self-
reported reductions of stress (Hölzel et al., 2011).
Findings from our research and the growing body of work about the effectiveness of stress
management trainings point toward campuses offering a stress management workshop series to
help students better cope with stress. Early workshops in the series could focus on discussions
about the principles of stress, causes of stress, stress and health, and the mind–body connection.
Mindfulness training could be introduced at the initial session. At the first session (or from a pre-
workshop screening), it is important to identify workshop participants’ particular needs related
to stress to tailor subsequent topics in the series (international students would undoubtedly have
unique stressors). Subsequent sessions could include developing skills in time management, fi-
nancial responsibility, goal and priority setting, relaxation, and the importance of physical activ-
ity, healthy eating, and sleep. Sessions dedicated to exploring values and finding meaning may be
equally important. Cognitive–behavioral therapy techniques that address negative thinking pat-
terns, followed by teaching skills to overcome self-defeating thoughts and behaviors, would be in-
cluded in later sessions. Additionally, if the stress management training included students from
different countries, there would be opportunities to explore similarities and differences in stress
as well as approaches to managing stress successfully. For the students who need or want more
practice, or who believe their stress level has not improved, further training could be offered. This
could come in the form of group workshops, one-on-one counseling, bibliotherapy, or newly de-
signed Internet-based strategies (Chiauzzi, Brevard, Thum, Decembrele, & Lord, 2008). Evaluation
of the effectiveness of the trainings should be planned from the onset.
As globalization spreads and faculty and student exchanges increase, this study provides
valuable insight to help campus professionals understand cultural differences related to stress
and health practices. This is especially important for Chinese students, the largest population of
international students traveling to the United States to study. When Chinese students arrive on
American campuses, the new environment, American culture, and language barriers can all prove
to be overwhelming factors that lead to stress. To help Chinese international students experience
a smooth transition, services related to coping and stress reduction should be promoted during
campus orientations. Understanding Chinese cultural coping strategies of “denial” and “disen-
gagement” will be important considerations when planning programs and services.
Creating a campus environment that supports and encourages healthy lifestyle choices
is of paramount importance to students’ well-being and academic success. This study enhances
our understanding of cultural differences and well-being. It can therefore assist student affairs
JSARP 2012, 49(2)


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professionals as they plan programs and services to help students whose stress results in negative
consequences.
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A Comparison of American and Chinese Students Perceived Stress Coping Styles and Health Promotion Practices

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Li, Y., Lindsey, B. J., Yin, X., & Chen, W. (2012).

Innovations in International Feature

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American Students and Stress

212 doi:10.1515/jsarp-2012-6298 http://journals.naspa.org/jsarp

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Chinese Students and Stress

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Cultural Differences of Perceived Stress, Coping Strategies, and

Stress Coping Strategies of American and Chinese Students

Perceived stress levela 23.53 7.20 21.77 7.66 8.59 (.004)

216 doi:10.1515/jsarp-2012-6298 http://journals.naspa.org/jsarp

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Self-distraction 6.05 1.40 5.45 1.55 26.34 (.000) 26.95 (.000)

Health Practices of American and Chinese Students

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Health responsibility 0.99 0.60 0.69 0.49 46.13 (.000)

Stress Coping Strategies of Lower and Higher Stressed Students

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Health Practices of Lower and Higher Stressed Students

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Implications for Practice

222 doi:10.1515/jsarp-2012-6298 http://journals.naspa.org/jsarp

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