Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Method/Measurements: A cross-sectional correlational design explored the relationships between decision-making, health-risk behaviors and social support systems in college freshmen. The aims of the study were: 1) to explore the relationship between decision-making and health-risk behaviors among college freshmen; 2) to determine whether or not family support and social support jointly predict decision-making among college freshmen; and 3) to ascertain whether or not the effect of family support on decision-making is different for male and female college freshmen. Measurement was collected at one time-point and participants in this study completed on-line questionnaires through a web-based online survey software application with measures of the following variables: decision-making (Adolescent Decision-Making Questionnaire); health-risk behavior (Adapted National Youth Risk Behavior Survey); and family support and social support (Multidimensional Scale of Perceived Social Support). A convenience sample of 200 freshmen aged 18 to 19 years participated from a local, private Catholic university located in Chicago. This study was approved by the institutional review board at Loyola University Chicago. Data Analysis: The primary study hypothesis was that decision-making will be associated with health-risk behaviors in college freshmen. SPSS Statistics version 24 was used to perform all statistical analyses. To test the primary hypothesis, the analysis included descriptive statistics on all study variables and correlations. Findings include positive decision-making was associated with a decrease in health risk behavior, and negative decision-making was associated with an increase in health risk behavior. The secondary and tertiary hypotheses were tested using linear regression and multiple regression analyses. Family support and social support was found to be significant predictors of positive decision-making and negative decision-making . Hence, social context played a significant role that impacted freshmen decision-making. Also, the effect of family support on positive decision-making was the same for male and female college freshmen and was statistically significant. Correspondingly, regression analysis results found that family support predicted negative decision-making in female college freshmen. Together, these findings extend the evidence that adolescence involves a period of developing decision-making processes which may help explain health-risk behavior, and more specifically, findings demonstrate a synergistic impact of social support systems on decision-making in college freshmen. Nursing and Healthcare Implications: Overall, findings from this study support the need to identify and implement interventions that may be developed to improve freshmen's decision-making skills and to enhance their ability to exercise mature control over their own behavior, leading to better early college experiences. Integrated care team models, comprised of nursing professionals, especially nurse practitioners along with mental health professionals and health promotion educators have been shown to be effective in improving college students' physical, psychological and emotional health. Ultimately, nurse practitioners have the unique opportunity to develop evidence-based practice guidelines to improve freshmen's decision-making and coping skills while engaging in simultaneous collaborative care. The overall benefit could potentially reduce freshmen health-risk behavior thereby achieving positive health outcomes and successful educational outcomes that, in turn may result in improved undergraduate retention rates. This research, while making an important contribution to the literature, contributes to the health of college freshmen by highlighting key social support systems, hence focusing efforts on strengthening decision-making and coping skills in this subset of students.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Included in

Nursing Commons