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Stress and illness in adolescence: issues of race and gender.

Research has indicated that stress is a contributory factor in a variety of physical and mental health problems (Brantley & Jones, 1993; Holmes & Masuda, 1974; Newberry, Baldwin, Madden, & Gerstenberger, 1987). The notion that life events contribute significantly to the development of physical and psychological disorders has spawned a diagnostic category called "psychological factors affecting physical conditions" in the Diagnostic and Statistical Manual of Mental Disorders (Third Edition, Revised).

One period of life characterized by rapid physiological, social, and cognitive changes that may generate stress is adolescence. According to Nielsen (1987), the adolescent is faced with numerous demands (e.g., family, school, peer groups), and "miscoping"' responses to these demands (e.g., truancy, drug abuse, isolation) can intensify the stressful transition to adulthood. Although most adolescents are free of serious health problems, studies have consistently shown a positive correlation between the accumulation of recent negative life events and reported psychological and physical health problems (see review by Johnson, 1986). For example, Greene, Walker, Hickson, and Thompson (1985) found that life stress was positively associated with recurrent pain and behavioral problems among adolescents seen at an outpatient clinic.

To date, there has been limited research on individual differences (e.g., race and gender) that may influence the experience of stress and subsequent illness among adolescents. With regard to gender, research on adults has shown that men and women tend not to differ on the number of undesirable life events experienced. However, women tend to be more vulnerable when such events occur to someone in their "social network" (Kessler & McLeod, 1984). More specifically, women appear to be more sensitive to the quality of interpersonal relationships than are men. For example, McIntosh, Keywell, Reifman, and Ellsworth (1994) reported greater stress due to sexism, lack of free time, and lack of time spent with spouse among female law students as compared with-their male counterparts. In addition, the female students displayed more depression and physical symptoms at the end of the semester. Similarly, adolescent females have been found to be more reactive to stressful life events affecting other individuals than are their male counterparts (Gore, Aseltine, & Colten, 1993).

With regard to race, Veroff, Douvan, and Kulka (1981) concluded that adult African-Americans tend to experience greater stress than do their Euro-American counterparts. Further, the realities of discrimination create a high base level of stress among adult African-Americans, which may contribute to their increased risk for disease, instability, and premature death (Gary, 1993). African-American male adolescents are faced with additional stressors (e.g., fewer job opportunities, lower income, increased exposure to violence), which may place them at greater risk for developing hypertension (Hediger, Schell, Katz, Gruskin, & Eveleth, 1984) and recurring symptomatology (Jones, 1989).

The purpose of this study was to further assess the stress-illness relationship, specifically with respect to race and gender, among adolescents. Since it is well documented that the measurement of adolescent stress is complex (Newcomb, Huba, & Bentler, 1981; Youngs, Rathge, Mullis, & Mullis, 1990), two different stress inventories were used. In order to measure the amount of readjustment or change associated with a given experience, a life event survey was administered. In order to take into account differences in cognitive appraisal, participants were asked to complete a perceived stress questionnaire. It was hypothesized that reported stress levels would be positively associated with reported symptomatology, and that there would be significant differences on the dependent measures as a function of race and gender.

METHOD

Subjects

After obtaining informed consent, 119 students (54 females and 65 males) from two predominantly Euro-American public high schools located in the southeastern United States participated in the study. This sample represented approximately 95% of the students contacted. Demographic data collected consisted of race, gender, age, and socioeconomic status (parents' occupation and educational level). Approximately 63% of the adolescents were Euro-American, 32% were African-American, and 5% were of other racial backgrounds. The average age was 16.3 years (SD = 1.54, range = 14 to 19 years), and 46% of the sample participated in junior varsity or varsity sports. Because socioeconomic status (SES) has been reported to be a moderator with regard to the stress-race relationship (Ulbrich, Warheit, & Zimmerman, 1989), these data are presented in Table 1.

Instruments

In a congregated setting, participants were administered four questionnaires (by two trained interviewers) designed to measure levels of stress, anxiety, and illness. The data were collected during summer school, and students were assured that their responses would remain confidential. Most took approximately 25 minutes to complete the inventories.

The questionnaire used to assess stressful life events (within the last year) was developed by Lewis, Siegel, and Lewis (1984). It contains 20 items concerning sources of distress for children (e.g., separation of parents, changing schools, moving) and has been frequently used to assess adolescent stress (Brown & Siegel, 1988; Norris, Carroll, & Cochrane, 1992). A five-point scale (never, once or twice, sometimes, often, and all the time) was used to score the items. Further, participants were asked to complete the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983). This subjective stress measure consists of 14 items that ask respondents to record how often they experienced certain situations (also rated on a five-point scale). With both measures, higher scores reflect greater stress levels.
Table 1. Socioeconomic Data (%) by Race

Father's Occupation and Educational Level

African-Americans (n = 34) Euro-Americans (n = 69)

Unemployed 2.90 8.69
Unskilled 8.82 7.24
Skilled 61.76 47.82
Professional 26.47 36.23
Some High School 14.00 11.59
Completed HS 50.00 30.43
Attended College 17.64 23.18
Completed College 11.76 20.28
Graduate Work 5.88 14.49

Mother's Occupation and Educational Level

African-Americans (n = 36) Euro-Americans(n = 72)

Unemployed 13.88 12.55
Unskilled 11.11 8.33
Skilled 33.33 29.16
Professional 41.66 50.00
Some High School 16.66 15.27
Completed HS 22.22 34.72
Attended College 47.22 33.33
Completed College 11.11 6.94
Graduate Work 2.77 9.72


Anxiety was measured using the trait portion of the State-Trait Anxiety Inventory (Spielberger, Gorsuch, Luschene, Vagg, & Jacobs, 1983). A score is created by summing the 20 items. Physical health was measured with a modified version of the Seriousness of Illness Rating Scale (Wyler, Masuda, & Holmes, 1968). Items that did not pertain to an adolescent population (e.g., menopause) were deleted from the survey. The total scale consisted of 117 items, and the overall score was obtained by summing the number of symptoms reported by the respondent during the last year.

RESULTS

Item analyses were completed and Cronbach's alphas were generated for life events (.75), perceived stress (.75), and trait anxiety (.88). The number of participants available for each measurement varied due to missing data on certain items. The means and standard deviations for each dependent variable are presented in Table 2.

Chi-square with Cramer's V was used to examine possible race and gender differences for social class. No significant differences were found.

Table 3 shows the intercorrelated scores for all four variables. Overall correlational analysis (Pearson) revealed that perceived stress and life events were positively correlated with trait anxiety (r = .530 and .529, p [less than] .001, respectively). Life events and trait anxiety were positively correlated with illness (r = .255, p [less than] .05, and r = .355, p [less than] .001, respectively).
Table 2. Overall Means and Standard Deviations (n = 119)

 Mean SD

Perceived Stress 19.870 4.492
Life Events 47.096 8.999
Trait Anxiety 41.645 9.439
Illness 10.230 5.920
Table 3. Overall Correlation Analysis for Stress, Anxiety, and
Illness (n = 111)

 1 2 3 4

1. Perceived Stress - .131 .530(**) .028
2. Life Events - - .529(**) .255(*)
3. Trait Anxiety - - - .355(**)
4. Illness - - - -

* p [less than] .05; ** p [less than] .001


In addition, separate correlational analyses were conducted for the major variables based on race (Table 4) and gender (Table 5). Perceived stress and life events were found to be significantly related to trait anxiety for African-Americans (r = .600 and .475, p [less than] .001, respectively) and Euro-Americans (r = .525 and .566, p [less than] .001, respectively). Similar results were found for gender. Data analyses yielded a significant relationship between life events and symptomatology for Euro-Americans (r = .350, p [less than] .001) and female adolescents (r = .288, p [less than] .05) only.

A multivariate analysis of variance (MANOVA) was performed to examine the relationship between race and gender with regard to the dependent variables. The number of students from the other racial backgrounds (5%) was deemed too low to make comparisons according to race/ethnicity.

Means and standard deviations are presented in Tables 6 (race) and 7 (gender). Wilks's lambda was significant for race, F(5, 93) = 3.90, p = .003; gender, F(5, 93) = 2.72, p = .024; and Race x Athlete interaction, F(4, 44) = 3.73, p = .01. In follow-up univariate analyses, females reported more symptomatology (p [less than] .001) than did males. African-Americans reported significantly less symptomatology (p [less than] .001) than did Euro-Americans. Further, African-American athletes (n = 29) reported significantly more life event stress (p [less than] .05) than did Euro-American athletes (n = 23). There were no significant gender differences on measures of stress.
Table 4. Simple Correlation Coefficients for Race

African-Americans (n = 38)

 1 2 3 4

1. Perceived Stress - .294 .600(**) -.121
2. Life Events - - .475(**) .061
3. Trait Anxiety - - - .107
4. Illness - - - -

Euro-Americans (n = 73)

1. Perceived Stress - .107 .525(**) .149
2. Life Events - - .566(**) .350(**)
3. Trait Anxiety - - - .461(**)
4. Illness - - - -

* p [less than] .05; ** p [less than] .001


DISCUSSION

There is a considerable amount of data to support the stress-illness relationship for adults. The purpose of the present study was to further examine the relationship between stress and illness, specifically with respect to race and gender, among adolescents. No significant race or gender differences in reported stress and anxiety levels were found. However, African-American adolescents reported fewer physical symptoms than did their Euro-American counterparts. Further, female adolescents reported significantly more physical symptoms than did males. Overall, life event stress and anxiety were positively related to reported symptomatology. This finding in particular is consistent with previous studies on adolescent stress and well-being (Colten & Gore, 1991; Compas, Wagner, Slavin, & Vannatta, 1986; Newcomb et al., 1981; Siegel & Brown, 1988). Upon closer examination, the results from the present investigation do not support such a relationship with respect to African-Americans and male adolescents; there were no significant relationships between the stress and illness measures for these groups.
Table 5. Simple Correlation Coefficients for Gender

Males (n = 65)

 1 2 3 4

1. Perceived Stress - .170 .530(**) -.045
2. Life Events - - .573(**) .118
3. Trait Anxiety - - - .156
4. Illness - - - -

Females (n = 54)

1. Perceived Stress - .179 .649(**) .193
2. Life Events - - .496(**) .288(*)
3. Trait Anxiety - - - -.406(**)
4. Illness - - - -

* p [less than] .05; ** p [less than] .01
Table 6. Means and Standard Deviation by Race

 African-American Euro-American

 (n = 38) (n = 73)

 Mean SD Mean SD

Perceived Stress 20.73 4.01 19.53 4.47
Life Events 47.18 6.95 47.58 10.00
Trait Anxiety 41.18 8.68 41.97 9.38
Illness 8.36 5.20 12.73 6.03
Table 7. Means and Standard Deviation by Gender

 Males (n = 65) Females (n = 54)

 Mean SD Mean SD

Perceived Stress 20.48 5.19 19.69 3.50
Life Events 46.06 8.52 48.64 9.50
Trait Anxiety 39.93 8.85 43.35 9.32
Illness 7.57 5.41 12.68 6.17


Few empirical studies have examined the role of race as a factor in stress. It is commonly assumed that African-Americans and other minorities are exposed to more life event stress than are Euro-Americans due to inequities within the social structure (McAdoo, 1982). According to Jones (1989), urban African-American youths tend to be faced with more negative social problems, which often lead to a poor mental health trajectory. With regard to stress, there is evidence that African-American adults and adolescents tend to report a higher frequency of negative life events and daily hassles as compared with their Euro-American counterparts (Jung & Khalsa, 1989). However, no evidence of racial differences in reported stress levels was found here. This is consistent with Biafora, Warheit, Vega, and Gil (1994), who reported only one stressful life event (death related) to be significantly greater for African-American adolescents than for other racial groups (Hispanics and Euro-Americans).

The racial similarities in this investigation, with regard to the experience of stress, could be attributed to low statistical power or to similar socioeconomic status. Upon closer examination, the number of Euro-American adolescents was double that of African-American adolescents. This may have yielded insufficient power to obtain significant differences. Yet, despite the small number of African-Americans, racial differences were found in reported symptoms. A more plausible explanation may be that of similar SES. Over 80% of fathers and 75% of mothers among both racial groups were reported to have skilled or professional occupations. According to Neighbors (1986), when socioeconomic status is controlled, racial differences tend to disappear with regard to psychological distress.

Despite the racial similarities in SES, in the present study African-American athletes reported a higher frequency of life event stress than did Euro-American athletes. This finding needs to be interpreted with caution. Although the number of athletes constituted approximately 46% of the sample, the majority were football players. Thus, the difference in reported stress levels may be a function of the type of sport. Nonetheless, the success of the African-American athlete in America is well established (Ashe, 1988). Within professional sports, African-Americans are very visible as compared with other professional fields. One could argue that participation in athletics for the African-American adolescent represents the opportunity for greater economic equality and thereby may generate greater stress. For example, Edwards (1984) reported that African-American families tend to provide more rewards for sports-related goals than for other activities. Further studies are needed to determine the extent to which the increase in reported stressful life events among adolescent African-American athletes can be attributed to professional sports aspirations.

Interestingly, the data indicated that there was no significant relationship between reported stress levels and symptoms among the African-American adolescents. This unexpected finding is difficult to explain considering the similarities in reported stress levels among the racial groups. Specifically, African-American adolescents reported significantly less symptomatology than did their Euro-American counterparts. These findings are inconsistent with previous research (Billingsley, 1992; James, 1994) reporting that African-Americans suffer disproportionately from cardiovascular disease and substance abuse, which have been linked with heightened environmental stress.

One explanation for the nonsignificant stress-illness relationship among African-American adolescents may be the implementation of different coping or resilience mechanisms. For example, religion plays a vital role in the lives of many African-Americans (Locke, 1992). According to Neighbors, Jackson, Bowman, and Gurin (1983), African-Americans are twice as likely to rely on prayer in the face of socioeconomic hardships as are Euro-Americans. Similarly, Ulbrich et al. (1989) noted that African-Americans may be "protected" from the negative effects of certain types of stressors to the extent that they attribute them to be outside their control. However, another plausible explanation may be that total self-disclosure of ill health was appraised as threatening by the African-American adolescents in particular. According to Outlaw (1993), African-Americans tend to distrust the health care system based upon past injustices (i.e., unauthorized experimentation on African-Americans). Perhaps this perception is applicable to general inquiries about health. Further studies are needed to determine whether racial differences in the stress-illness relationship can be explained by factors not adequately measured in this study, such as health behaviors and coping styles.

As for gender, adolescent females tend to show greater reactivity to stressful events involving individuals within their social networks as compared with males. However, both groups appear to be similar with regard to negative life events that happen to themselves (see review by Leadbeater, Blatt, & Quinlan, 1995). Likewise, no significant gender differences were found here for either measurement of stress - stimulus (number of life events experienced) or cognitive orientations (perceived stress). Therefore, the findings seem to suggest that the general experience of stress during adolescence is consistent across gender. However, the instruments used in the present study do not specifically measure social network stress (e.g., school, parents, peers, money, sexual relationships) as classified by Daniels and Moos (1990).

In contrast, a few studies have shown that adolescent females report more negative life events than do their male counterparts (e.g., Groer, Thomas, & Shoffner, 1992). Further, adolescent females tend to be more susceptible to the adverse effects of stress than are males (Johnson, 1986). However, Wagner and Compas (1990) examined the role of gender in moderating the relationship between stress and psychological symptoms during adolescence. Although girls reported more negative life events than did boys, there was no significant difference in the strength of the stress-illness relationship as a function of gender. In other words, they reported no evidence of one gender being at greater risk than the other for developing psychological symptoms in response to life stress. The results of the present investigation contradict their findings.

One explanation often given as to why females manifest increased symptomatology associated with stress involves socialization (Kessler & McLeod, 1984; Reskin & Coverman, 1985). Specifically, sex roles differentially expose the sexes to stressful events which may adversely affect well-being. For example, Frank, McLaughlin, and Crusco (1984) examined the effect of sex role orientation on symptom distress among college students. They found that masculine women reported less psychological distress, while feminine men reported greater psychological distress. In the present study, adolescent males and females did not differ with respect to the experience of stress. However, adolescent females did report a greater number of symptoms. based on the data, it is not clear whether differences in symptomatology can be attributed to sex role orientation or to differential awareness of one's body. Previous studies (e.g., Cohen, Brownell & Felix, 1990) have shown that preadolescent and adolescent females tend to be more aware of physical symptoms than are male adolescents. Future studies should consider sex role orientation and self-awareness as possible moderators of the stress-illness relationship among adolescents.

In sum, the data from this preliminary study indicate racial and gender differences with regard to the stress-illness relationship. Although the sample size was relatively small, significant findings did emerge which warrant further investigation. For example, empirical research is scant concerning the type of situations African-Americans view as stressful and the coping strategies used. The findings of the present study seem to suggest racial differences regarding the effects of stress which may be attributed to different coping styles among adolescents. Qualitative research would be useful in exploring the cognitive aspects of stress appraisal and coping within this population.

The authors wish to thank Ann Reed for her assistance with the statistics.

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Author:Baldwin, Debora R.; Harris, Shanette M.; Chambliss, Lana N.
Publication:Adolescence
Date:Dec 22, 1997
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