Exploring stress and coping among urban African American adolescents: the Shifting the Lens study.

INTRODUCTION: Stress can have a significant effect on an adolescent's long-term physical and mental well-being. An understanding of the role of unmanaged stress during early adolescence is critical for the prevention of chronic diseases such as depression. The purpose of the Shifting the Lens study was to explore perceptions of stress, sources of social support, and use of coping strategies among urban African American ninth graders. METHODS: A youth-driven, mixed-method approach was used to assess teens' perceptions of stress. During the 2001-2002 school year, teen participants (N = 26) from East Baltimore, Md, completed questionnaires, audio journals, pile-sort activities, and personal social support network maps. RESULTS: In contrast with existing literature that emphasizes the influence of violence and neighborhood factors on stress among teens, teens prioritized other sources of stress, particularly from school, friends, and family. For support, they relied on different individuals, depending on the source of the stress--friends for romantic relationship stress and family for job, school, and family stress. Sex differences in the coping styles of the participating teens were found. Girls reported more frequent use of support-seeking and active coping strategies than boys. CONCLUSION: The use of multiple data collection strategies to explore stress uniquely contributes to our understanding of how one group of teens perceives and copes with stress. Future research should explore stress from the youth perspective in communities that are similar to East Baltimore, Md. In addition, programmatic recommendations include the need for sex-specific stress management activities and education about youth stress for adults. Community participatory translation interventions based on study findings, such as a youth-produced video and a resource guide for youth service providers, were implemented.

Stress and blood pressure in Kuna Amerinds.

Is migration from isolated indigenous island communities to Panama City associated with an increase in stress? Individuals were randomly sampled from two Kuna communities: 325 individuals in Panama City and 133 on a Caribbean island. Stress was assessed through the Milcom questionnaire, which explores physical symptoms and symptoms relevant to mood and emotional state, and Cantril's ladder, which examines life satisfaction. Physical symptoms were more common in the urban community (p < 0.001), and complaints reflecting mood were also significantly higher on the mainland (p < 0.001); the two measures were highly correlated. While systolic and diastolic blood pressure was higher in the mainland community (p < 0.001), there was no relation between blood pressure level and any index of stress. Despite unambiguous evidence of an increase in stress in migrants to the city, there was no indication that the stress contributed to the rise in blood pressure level. Migration to an urban setting is associated with an increase in physical symptoms and symptoms reflecting depressed mood, suggesting increased stress level. Life satisfaction is less influenced, possibly providing a measure of the degree of stress.

Examining the types of social support and the actual sources of support in older Chinese and Korean immigrants.

This study explored social support domains and actual sources of support for older Chinese and Korean immigrants and compared them to the traditional domains based on mainly White, middle class populations. Fifty-two older Cantonese and Korean speaking immigrants participated in one of eight focus groups. We identified four similar domains: tangible, information/advice, emotional support, and companionship. We also identified needing language support which is relevant for non-English speaking minority populations. Participants discussed not needing emotional support. These Chinese and Korean immigrants had a small number of actual sources of support, relying mainly on adult children for help with personal situations (e.g., carrying heavy groceries, communicating with physicians) and friends for general information/advice (e.g., learning how to speak English, applying for citizenship) and companionship. Immigrant Asians are caught between two different traditions; one that is strongly kinship oriented where needs and desires are subordinated to the interests of the family and one that values independence and celebrates individuality. Despite their reticence in asking for help outside the family, elders are seeking help from other sources, such as ethnic churches and the government.

Effects of NOS3 Glu298Asp polymorphism on hemodynamic reactivity to stress: influences of ethnicity and obesity.

Studies on the associations between the nitric oxide synthase gene (NOS3) Glu298Asp polymorphism and hypertension status or blood pressure (BP) levels have had inconsistent results. Potential moderating influences of ethnicity, sex, and obesity on the effects of the NOS3 polymorphism have not been examined. We evaluated the influence of these factors on associations between the NOS3 polymorphism, nitric oxide metabolites (NOx), and hemodynamics at rest and during stress. Subjects were 235 African American (AA) and 262 European American (EA) young adults (18.5+/-2.6 years). Hemodynamic measurements and blood samples for NOx assays were taken before and after a competitive video game challenge. Glu298Asp polymorphism was detected by polymerase chain reaction-restriction enzyme digestion assay. A regression model was built using genotypes, ethnicity, sex, and obesity (body mass index >85th percentile) and their interactions controlling for age; 20.1% of AAs and 49.8% of EAs were carriers of the Asp allele. AAs, regardless of obesity status, exhibited high diastolic blood pressure (DBP) reactivity unless they were nonobese and noncarriers of the Asp allele. EAs exhibited lower DBP reactivity unless they were obese Asp allele carriers. AA nonobese carriers exhibited the greatest total peripheral resistance reactivity. Obese Asp allele carriers exhibited the greatest increases in cardiac output and the greatest decrease in NOx to the stressor. Results indicate the importance of examining impact of BP control-related genetic polymorphisms within the context of moderating factors such as adiposity and ethnicity.

Gender and ethnic differences in urinary stress hormones: the population-based Chicago Health, Aging, and Social Relations Study.

Gender and ethnic disparities in cardiovascular disease and mortality have spurred interest in the epidemiology of stress hormone production. Greater disease burden among men and blacks raises the possibility of gender and ethnic differences in stress hormone production. The purpose of this study was to determine whether urinary stress hormones were higher among men and blacks in a population-based sample. Urinary hormone analysis permits a time-integrated assessment of the stress response system. However, differences in collection and standardization strategies have led to inconsistent findings. Subjects were an ethnically diverse population-based sample of 229 men and women aged 50-67 yr who provided an overnight urine specimen. Urine concentration was standardized using a traditional creatinine-based approach as well as a new method that accounts for muscle mass. With the use of creatinine standardization, no gender or ethnic differences were noted in epinephrine or cortisol production. Norepinephrine levels were higher among women compared with men (P = 0.001), however. After accounting for muscle mass, we found that both epinephrine (P = 0.018) and norepinephrine (P = 0.033) levels were higher among men compared with women. No significant differences in cortisol production were found by gender or ethnicity. The consistency of these results with previous studies of 24-h urine samples suggests muscle mass should be accounted for when comparing overnight urinary hormone values across gender and ethnicity.

Effect of cortisol on muscle sympathetic nerve activity in Pima Indians and Caucasians.

The hypothalamo-pituitary-adrenal axis and sympathetic nervous system (SNS) interact to maintain cardiovascular and metabolic homeostasis, especially during stress. Pima Indians have a low SNS activity, which may contribute to both their increased risk of obesity and reduced risk of hypertension. Although glucocorticoids inhibit SNS activity, Pima Indians are not hypercortisolemic compared with Caucasians. This does not exclude the possibility that the SNS is more responsive to an inhibitory effect of cortisol in the former than in the latter group. We measured fasting plasma ACTH and cortisol and muscle SNS activity [muscle sympathetic nervous system activity (MSNA), microneurography] in 58 males [27 Pimas/31 Caucasians]. Seven Pimas and 12 Caucasians were randomized to a double-blind, placebo-controlled, cross-over study to examine the effect of overnight partial chemical adrenalectomy (metyrapone) followed by cortisol replacement (hydrocortisone) on plasma ACTH, cortisol, and MSNA. There were no ethnic differences in fasting plasma ACTH or cortisol, but MSNA adjusted for percent body fat was lower in Pimas than in Caucasians (P < 0.006). No correlation was found between fasting cortisol and basal MSNA. Administration of metyrapone did not lead to significant changes in MSNA. In response to a hydrocortisone infusion, MSNA decreased in Pima Indians (P = 0.03) but not in Caucasians (P = 0.7). Our data indicate that the low SNS activity that predisposes Pima Indians to obesity is not due to a tonic inhibitory effect of cortisol. However, an acute release of cortisol is likely to more effectively contain sympathoexcitation during stress in Pima Indians than in Caucasians, which may be an important mechanism of cardioprotection in this Native American population.

"He is everything": religion's role in the lives of immigrant youth.

Using emergent theme analysis of qualitative interview data in combination with quantitative survey data, the role of religion in the lives of immigrant youth was explored. Latino, Haitian, and Chinese teenagers described, in their own rich words, the significance of religion to them; their responses are reflected in themes that point to the potential protective role of religion for some immigrant groups.

Impaired stress-induced pressure natriuresis increases cardiovascularload in African American youths.

BACKGROUND: We hypothesized that impaired stress-induced pressure natriuresis increases blood pressure (BP) load. METHODS: The 118 African American youths were brought into similar levels of sodium balance. The protocol consisted of a 2-h baseline period, a 1-h stress period (competitive video games), and a 2-h recovery period. RESULTS: Normal pressure natriuresis (n = 80) resulted from a resistance-mediated (r = 0.23; P <.03) increase in BP (P <.001). In contrast, impaired pressure natriuresis (n = 38), leading to an extended period of elevated BP (P <.05), resulted from a volume-mediated (r = 0.55; P <.002) increase in BP (P <.001). CONCLUSIONS: Impaired stress-induced pressure natriuresis may contribute to the development of essential hypertension, particularly in African Americans.

A prospective study of psychosocial job strain and birth outcomes.

We conducted a prospective study in Alabama to examine the relation between job strain during pregnancy and birth outcomes. We hypothesized that maternal jobs high in demands and low in control would lead to lower birth weight in offspring. The sample consisted of 480 black and white women, 20 to 34 years of age receiving early prenatal care. Adjusting for standard covariates, women with high strain jobs had babies with birth weights 190 gm lower than those born to mothers in low strain jobs or unemployed (95% CI = 48 gm, 333 gm). Black women experienced a greater effect from job strain than white women.

Physiological stress responses in Filipino-American immigrant nurses: the effects of residence time, life-style, and job strain.

OBJECTIVE: The purpose of this study was to evaluate the relationship between measures of Americanization (the adoption of American life-style and culture) and physiological measures of stress in Filipino-American immigrants. METHODS: Ambulatory blood pressure monitors and timed urine collections were used to evaluate blood pressure and urinary catecholamine excretion across the work, home, and sleep daily settings among 31 healthy, premenopausal, immigrant Filipino-American women employed as nurses or nurse's aides. Migration history and life-style were evaluated from questionnaire responses. Reported job strain, decision latitude, and psychological demand were obtained from the Job Content Questionnaire. RESULTS: Immigrants who had lived longer in the United States had elevated norepinephrine levels in the work and home settings (p < .05), higher diastolic blood pressure during sleep (p < .01), and lower dips in blood pressure during sleep (p < .05). Job strain measures were not related to blood pressure, catecholamine excretion rates, or residence time in the United States. CONCLUSIONS: The results suggest that indicators of stress increase as a function of time since immigration, although this result is not explained by self-reports of identification with Filipino or American life-style or by measures of job strain.

Racial differences in hemodynamic responses to environmental thermal stress among adolescents.

BACKGROUND: Previous studies by our laboratory and others have shown that blood pressure (BP) responses to many short-term laboratory stressors are greater in black than in white children. We sought to determine the cardiac and vascular contributions to these differences in BP reactivity and whether racial differences in vascular reactivity involve excessive vasoconstriction or deficient vasodilation. METHODS AND RESULTS: We evaluated BP, heart rate, and impedance cardiographic measures of preejection period (PEP) and total peripheral resistance (TPR) in healthy black (n=76) and white (n=60) adolescents (mean age, 14.8 years) during passive exposure to a vasoconstrictive cold chamber (8 degrees C to 10 degrees C) and a vasodilatory heat chamber (40 degrees C to 42 degrees C). Results indicated greater decreases in PEP and increases in TPR in blacks than whites during cold exposure (P<0.05) but no group differences during heat exposure. Covariance analyses indicated that the racial differences during cold exposure probably reflected greater beta-adrenergic cardiac reactivity and alpha-adrenergic vasoconstrictive reactivity in blacks than whites. CONCLUSIONS: Blacks and whites exhibited comparable myocardial and vasodilatory responses to heat stress, but blacks exhibited heightened myocardial and vasoconstrictive reactivity to cold stress. These results suggest that the locus of racial differences in vascular reactivity involves vasoconstrictive rather than vasodilatory function. The pattern of racial differences during cold stress raises the possibility that both myocardial and vasoconstrictive mechanisms may contribute to the increased risk of hypertension in blacks.

Ethnicity and socioeconomic status: impact on cardiovascular activity at rest and during stress in youth with a family history of hypertension.

OBJECTIVE: The purpose of the present study was to examine the potential interaction of ethnicity and SES on hemodynamic functioning at rest and during acute stress in normotensive adolescents with a family history of essential hypertension (EH). DESIGN: The influences of ethnicity and socioeconomic status (SES) on cardiovascular function were evaluated at rest and in response to five different laboratory stressors. METHODS: 110 (50 female) Caucasian and 162 (85 female) African-American normotensive youth (initial age 11.2+/-2.4 years) with a family history of essential hypertension (EH) were tested on two occasions, an average of 2.5 years apart. Based on previous findings, it was predicted that African Americans, particularly those of low SES, would exhibit higher resting blood pressure (BP) and greater cardiovascular reactivity to acute laboratory stressors than would Caucasians. RESULTS: As predicted, African-American youth exhibited higher resting diastolic blood pressure (DBP) and total peripheral resistance (TPR) than Caucasians on both visits (both Ps<.04). African Americans exhibited greater systolic blood pressure (SBP) reactivity than did Caucasians to the video game stressor during both lab visits (both Ps<.02) and greater heart rate reactivity during the first lab visit (P<.01). African Americans exhibited greater SBP and/or DBP, and TPR reactivity to the cold pressor during the first lab visit and the parent-child discussion during the second visit (all Ps<.03). CONCLUSION: As predicted, African Americans exhibited higher resting BP and TPR, and greater cardiovascular reactivity than Caucasians. Although not in the predicted direction, a pattern of interactions began to emerge on the second evaluation. For example, upper SES youth exhibited greater heart rate reactivity compared to all other groups on the social competence interview and parent-child discussion stressors. Further study is needed to clarify the role cardiovascular reactivity may play in the link between ethnicity, SES, and cardiovascular disease risk.

Racial differences in endothelin-1 at rest and in response to acute stress in adolescent males.

Blacks exhibit greater vasoconstriction-mediated blood pressure (BP) increases in response to stress than do whites. Endothelin-1 (ET-1), a potent vasoconstrictive peptide, has been proposed as having a role in racial differences in stress reactivity. We evaluated the hemodynamic and plasma ET-1 levels of 41 (23 whites, 18 blacks, mean age 18.6 years) normotensive adolescent males at rest and in response to a video game challenge and forehead cold stimulation. Measurements were performed at catheter insertion and before and immediately after the 2 stressors, which were separated by 20-minute rest periods. Blacks exhibited higher absolute levels of diastolic blood pressure, total peripheral resistance index, or both in response to catheter insertion and to the video game challenge and during recovery from video game challenge and cold stimulation (P<0. 05 for all). Blacks exhibited higher absolute levels of ET-1 at every evaluation point (P<0.05 for all) and greater increases in ET-1 in response to both stressors (ps<0.05). These findings suggest that altered endothelial function may be involved in racial differences in hemodynamic reactivity to stress and possibly in the development of essential hypertension.

Stressors and coping strategies among successful female African American baccalaureate nursing students.

Interview and descriptive methods were used to investigate the stressors and coping strategies of academically successful African American female baccalaureate nursing students (N = 23) in the three predominantly Caucasian universities in South Carolina. The study addressed three questions: 1) What are major stressors for African American female students? 2) Which coping strategies do these students use? and 3) Which coping strategies do these students find to be most successful? Major stressors identified, both by priority and frequency of occurrence, were academic in nature, followed in descending order by environmental, financial, interpersonal, and personal stressors. Coping strategies used with the greatest regularity and success were active coping (taking action to remove or circumvent the stressor), seeking social support for instrumental reasons (seeking assistance, information, or advice about what to do from someone in a position to help), and seeking social support for emotional reasons (getting sympathy or emotional support from someone). Behavioral disengagement, denial, and alcohol-drug disengagement were reported to be unsuccessful coping strategies in the majority of instances.

Cardiovascular reactivity to stress and left ventricular mass in youth.

We studied the relationships of cardiovascular reactivity during mental stress with left ventricular mass index in a group of prepubertal children 8 to 10 years old and in a group of peripubertal or postpubertal adolescents 15 to 17 years old. One hundred fifteen participants, varying in age group, sex, and race (black and white), took part in a laboratory stress protocol consisting of a reaction-time task, a mirror tracing task, a cold forehead challenge, and a stress interview. Cardiovascular measures included blood pressure and heart rate, as well as cardiac output, stroke volume, total peripheral resistance, and preejection period obtained noninvasively with impedance cardiography. Measures of left ventricular mass were made by echocardiography. Results indicated that across all participants, left ventricular mass index was associated with cardiovascular responses during the mirror tracing and cold forehead tasks, especially with those responses reflecting increased vasoconstriction. Subgroup analyses showed that these associations were significant for males and sometimes adolescents but not for females and children. As mirror tracing and cold forehead tasks most consistently produce alpha-adrenergic activation, the results suggest a model in which vasoconstriction due to mental stress is related to increased left ventricular mass in susceptible individuals, even at a young age.

Burmese political dissidents in Thailand: trauma and survival among young adults in exile.

OBJECTIVES: This study assessed the self-reported mental health, physical health, and social functioning of young adult political exiles and relates their psychiatric symptoms to their trauma and survival strategies. METHODS: A 1992/93 survey of Burmese who fled to Bangkok, Thailand, after participating in a 1988 uprising against Burma's government elicited information on employment, education, disability, trauma, survival strategies, and depressive and posttraumatic stress symptoms. RESULTS: The 104 participants reported a mean of 30 trauma events, including interrogation (89%), imprisonment (78%), threats of deportation (70%), and torture (38%). Many reported poor health and lack of social supports, but few reported substantial social disability. The prevalence of elevated symptom scores was 38% for depressive symptoms and 23% for criterion symptoms of posttraumatic stress disorder. Symptoms of avoidance and of increased arousal were the most strongly related to cumulative trauma. Two survival strategies, camaraderie and a Buddhist concept of self-confidence (weria), were associated with somewhat reduced levels of both classes of symptoms. CONCLUSIONS: Burmese political exiles in Thailand are young adults adversely affected by severe trauma. Their psychosocial well-being may deteriorate further without legal protections to reduce the continuing stress and violence.

Stress, social support and pregnancy outcome: a reassessment based on recent research.

We present an assessment of studies published in the last decade that consider the relationship of stress and social support to preterm delivery or fetal growth retardation. Included in the review are all reports on the direct effects of stressors or psychological distress; the indirect effects of stressors or distress through health behaviours such as smoking; and the direct and buffering effects of social support. Although an important stimulus for recent stress research has been the attempt to explain racial and social class differences in birth outcome, the recent data show that stressful life events during pregnancy, though more common in disadvantaged groups, do not increase the risk of preterm birth. In contrast, intimate social support from a partner or family member appears to improve fetal growth, even for women with little life stress. Questions unanswered by the research to date are whether elevated levels of depressive symptoms affect pregnancy outcome, either directly or by encouraging negative health behaviours, and whether chronic (vs. acute) stressors are harmful. Additional research is also needed to determine whether psychosocial factors interact with specific clinical conditions to promote adverse pregnancy outcomes. Focusing on intimate support and how it benefits pregnancy outcome could lead to the design of more effective interventions.

Interactive influences of ethnicity, gender and parental hypertension on hemodynamic responses to behavioral challenge.

To determine the independent and interactive influences of ethnicity, gender and parental hypertension on the magnitude and patterning of hemodynamic responses to standardized laboratory stressors, 112 normotensive, young adult African-American and Caucasian subjects (56 women, 56 men) completed a four-task protocol: three psychological stressors (the Stroop Color Word task, mental arithmetic and mirror tracing) and the forehead cold pressor test. Blood pressure (BP), heart rate (HR) and impedance derived measures of cardiac pre-ejection period and stroke volume were measured at rest and during each task; calculated indices of cardiac output and total peripheral resistance were also computed. Women responded to the psychological stressors with significantly larger increases in HR and cardiac output, less change in total peripheral resistance and greater attenuation of cardiac pre-ejection period than did men; however, blood pressure responses did not vary by gender, ethnicity or parental history of hypertension. Across tasks, African Americans showed larger elevations in total peripheral resistance than did Caucasians; conversely Caucasian subjects showed a more pronounced cardiac responsivity to stress, as evidenced by an elevated cardiac output and concomitant decrease in cardiac pre-ejection period, compared to their African-American counterparts. The ethnic differences in reactivity to psychological stressors were more apparent among males, while the gender differences were generally more pronounced among African Americans. Finally, the cold pressor test elicited larger increases in systolic blood pressure (SBP) among Caucasian subjects with family history positive (FH+), relative to family history negative (FH-) subjects, and also caused a greater reduction in HR among males compared to females.