The Society for Social Work and Research

2013 Annual Conference

January 16-20, 2013 I Sheraton San Diego Hotel and Marina I San Diego, CA

Cumulative Stress Implications for Adolescent Health and Academic Success

Friday, January 18, 2013: 10:00 AM
Marina 4 (Sheraton San Diego Hotel & Marina)
* noted as presenting author
Dana Prince, MPH, Doctoral Student, University of Washington, Seattle, WA
Paula S. Nurius, PhD, Professor, University of Washington, Seattle, WA

As the erosive effects of stress on health become better understood, focus is shifting to lifecourse models of additive risks that may heighten vulnerability for adverse health and social functioning. In addition to discrete stressful events, an incremental ‘weathering’ of adult health appears to be associated with parameters of social disadvantage such as poverty and minority status (Geronimus et al, 2006). The current study applies cumulative stress theories combining psychosocial and neurobiological explanations for stress effects to youth from a school-based sample. The study’s purpose is to test for evidence of early stage health and functioning decrements across multiple domains, highlighting academic success as one critical pathway to subsequent health behaviors, care access, and improved health (WHO report 2011).  


Data derive from five waves of a study of educational attainment and transition to adulthood among 9,600 high school seniors in the Northwest. Participant average age was 18, 54.6% were female, approximately 40% were students of color, and nearly 30% were from immigrant families. The Stress Index was a summative count of 11 stressors (social disadvantage, stressful events) which, using Finkelhor’s poly or multiple adversity exposure scoring protocol, specified three stress exposure groups: Low (43%), Med (29%) and High Poly (28%). Six domains of psychosocial functioning were assessed, using predominantly common metrics and Likert-based scales, all with satisfactory psychometric properties: Physical health (4 scales; e.g., BMI); Emotional health (3 scales; e.g., self-esteem); Family health (4 scales; e.g., parental connection), Social health (2 scales; e.g. sense of belonging), Academic health (4 scales; e.g. GPA) and School problems (2 scales; e.g. suspensions). We hypothesized differences would exist between groups across each health domain as a function of poly-adversity (cumulative stress) status. To test our hypothesis, we conducted MANOVAs for each of the 6 domains; followed by individual ANOVAs on domain scales and post-hoc tests for specific group-to-group comparisons (applying Bonferroni adjusted alpha levels).



MANOVA tests for each of the 6 domains achieved significance (p<.001), reflecting omnibus negative health trends associated with greater stress exposure.  ANOVA tests for each scale within the 6 domains achieved significance, with the exception of antisocial academic beliefs. Between group (Tukey) contrasts were also significant, reflecting incremental effects from Low to Med to High Poly groups as a function of stress exposure levels. 

Conclusions and Implications:

These findings reflect highly concerning, consistent trends of stepped patterns of poorer health and functioning in adolescence—notably, in a general population school sample with high generalizability—as a function of what has been framed as stress load. Findings of such broad-based differences suggest developmental trajectories across childhood wherein stress effects cascade through both psychosocial and neurobiological processes, creating weathering dysregulations that serve as childhood roots of physical, mental, and social health disparities (Schonkoff et al, 2009). The paper will conclude with social work preventive and resilience promoting interventions at various developmental junctures to reduce stress exposures and ameliorate stress effects, with special emphasis on this developmental cusp in the transition to emerging adulthood.