American Journal of Health Education

The American Journal of Health Education (AJHE) is the only refereed journal of its kind to cover today’s health education and health promotion issues head on with timely, substantive, and thought-provoking articles.

May / June 2026 (Volume 57, Issue 3)

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Free Access Article

Beyond COVID-19: Changes in Mental Health, Hopelessness, and Subjective Social Status Among College Students in Rural Settings

Lei Xu, Shayla Sanders, Qiang Wu, Ryan Martin, Julianna Nieuwsma & Leslie E. Cofie

Background: Subjective social status (SSS) and hopelessness are linked to anxiety and depression, yet research among undergraduates – particularly considering the COVID-19 pandemic – is limited. This study examined associations among SSS, hopelessness, depression, and anxiety during and after the pandemic.

Methods: Cross-sectional surveys were conducted at a Southeastern U.S. university in 2021 (N = 1,602) and 2024 (N = 972). Measures included anxiety (GAD-7), depression (PHQ-9), SSS (MacArthur Scale), and hopelessness (Brief-H-Neg). Higher scores indicated greater distress, social status, or hopelessness. Linear regression models assessed associations.

Results: In 2021, 82.3% reported moderate to severe depression and 63.0% anxiety. By 2024, depression rose slightly (83.0%) and anxiety increased to 70.3%. Mean depression scores increased (p <.0001), anxiety remained stable (p = .7712), hopelessness declined (p <.0001), and SSS improved (p <.0001). Hopelessness correlated positively with anxiety (r = 0.60) and depression (r = 0.53), while SSS correlated negatively with both (p <.001). Regression analyses confirmed that lower SSS and higher hopelessness predicted greater distress. Female and lower-income students reported higher distress.

Translation to Health Education Practice: Despite improvements in hopelessness and SSS, mental health concerns remain widespread, highlighting the need for targeted prevention and treatment strategies in university settings.

Research Articles

Beyond COVID-19: Changes in Mental Health, Hopelessness, and Subjective Social Status Among College Students in Rural Settings

Lei Xu, Shayla Sanders, Qiang Wu, Ryan Martin, Julianna Nieuwsma & Leslie E. Cofie

Personal and Communal Responsibility to Mitigate COVID-19 Spread on a University Campus

Fredanna D. M. McGough, Paul E. Richardson, Lindsey R. Bell & Michelle M. Barthet

Higher Education Leaders’ Perspectives of Student Opioid Misuse and Opioid Overdose Prevention Programs at U.S. Colleges and Universities: An Exploration of Implementation Facilitators and Barriers

Christina E. Freibott, Adison Hicks, Noel Vest, Michael D. Stein, Rachel C. Shelton & Sarah Ketchen Lipson

Distracted Driving Behaviors Among Young Drivers: A Study of Risk Perception and Effectiveness of Prevention Strategies

Theresa M. Enyeart Smith & Catherine M. Foster

Mapping the Research Landscape: A Bibliometric Analysis of Yoga Interventions within Educational Contexts

Kashinath Boral, Krishna Kanta Mondal & Himadri Borah

EduDiaCare for Individuals with Type 2 Diabetes: Development, Content Validation, and Acceptability Testing

Nida Ul Hasanat, Martaria Rizky Rinaldi, Gilles van Luijtelaar & Kwartarini Wahyu
Yuniarti

Commentary: Leveraging AI Avatars for Safe Sleep Education: Combating SIDS Misinformation Through Interactive, Culturally Responsive Tools

Aysha Jawed