The Relationship Of Daily Stress And Health-Related Behaviors To Adolescents' Cholesterol Levels

Adolescence, Summer, 1998 by Chris A. Coleman, Alice G. Friedman, Richard G. Burright

ABSTRACT

It has been well established that some of the major risk factors for coronary heart disease are related to lifestyle, that is, behaviors that are potentially modifiable. Although studies have identified psychosocial stress as a factor associated with elevated cholesterol levels in adults, this relationship has not been thoroughly examined in adolescents. The present study investigated the relationship between daily life events and total cholesterol levels among 104 high school students. The contributions of health-related behaviors, such as dietary patterns, physical activity, smoking, and television viewing, were also examined. Hierarchical multiple regression analyses showed that scores on a scale of daily life events explained a significant portion of the variance in cholesterol measurements. However, when the sample was stratified by gender, this effect remained significant for adolescent females but not males. Overall, females reported a greater degree of negative health behaviors than did males. Implica tions of these findings are discussed.

Several large-scale studies have shown that children and adolescents with elevated cholesterol levels tend to maintain these elevations into adulthood (Lauer, Lee, & Clarke, 1988; Webber, Srinivasan, Wattigney, & Berenson, 1991). Elevated serum cholesterol has been identified as a primary risk factor associated with the development of coronary heart disease (CHD) through the process of atherosclerosis (Castelli et al., 1986). Further, data have indicated that atherosclerosis begins before the age of 20. These findings have fueled interest in early assessment and intervention for CHD.

Treatments for adolescents with elevated cholesterol levels have focused on dietary and pharmacological interventions (National Cholesterol Education Program, 1991). However, some researchers have expressed concern over these approaches (Schoen, 1992), arguing that dietary interventions among adults typically have resulted in cholesterol reductions of only 5-10% (see Newman, Browner, & Hulley, 1990), and that placing children on restrictive diets not only may be difficult to implement and maintain (Read, Harveywebster, & Usinger-Lesquereux, 1988), but also may hinder growth and lead to negative labeling by peers (Newman et al., 1990; Lifshitz & Moses, 1989).

These concerns have led health investigators to expand the search for factors associated with adolescent cholesterol levels. Such factors have included physical activity, television-viewing habits, and smoking (Durant, Linder, Harkess, & Gray, 1983; Wong et al., 1992; Dwyer, Rieger-Ndakorerwa, Semmer, Fuchs, & Lippert, 1988). Despite a substantial literature base among adults suggesting a relationship between psychological stress and total cholesterol, the role of stress on adolescent cholesterol levels is often overlooked (see Dimsdale & Herd, 1982, for review; Tucker, Cole, & Friedman, 1987; Troxler & Schwertner, 1985). Although the exact mechanisms responsible for the relationship are still a matter of debate, it has been suggested that stress precipitates an arousal response that leads to increases in circulating catecholamines, which may raise plasma lipid levels (Van Doornen & Orlebeke, 1982; Dimsdale & Herd, 1982).

One reason the link between adolescent stress and cholesterol has yet to be thoroughly examined is that the development of methods for measuring stress among adolescents has lagged behind that of adults (Johnson, 1986). Further, it appears that work-related stressors are more clearly associated with cholesterol elevations (Friedman, Rose-man, & Carroll, 1958; McCann, Warnick, & Knopp, 1990), and corollary sources of stress among adolescents have only recently been recognized (Johnson, 1986; Compas, 1987).

The adolescent years are associated with numerous biological, psychological, and social changes. The family, school, peers, and other interpersonal domains can all be sources of stress (Compas, 1987). Stressful events encountered by adolescents have been shown to be related to psychological as well as physical problems (Johnson, 1986). It has been suggested that frequent minor stressors, such as daily hassles, may be better predictors of mental and physical difficulties than are major but more infrequent life events, such as the death of a loved one (Kanner, Coyne, Schafer, & Lazarus, 1981; DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982; Compas, 1987).

Among adults, stress and other potentially modifiable variables, such as diet, smoking, and activity level, appear to be important contributors to elevated cholesterol levels (Jenkins, 1988). The present study was designed to examine whether such factors present a risk for adolescents. Specifically, the relationship of stress, dietary fat, activity level, sedentary behavior, and smoking to total serum cholesterol levels among healthy adolescents was investigated.

METHOD

Subjects

The initial sample consisted of 119 New York high school students from an upstate, middle-class community. Six students did not return the proper consent forms, 2 declined to participate, 6 provided insufficient information on their questionnaires, and 1 disclosed she was pregnant, leaving 104 students for the final analyses.