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A description of healthy adolescents’ perceptions of stress : causes, symptoms, responses and outcomes Bowering, Alice Jean 1984

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A DESCRIPTION OF HEALTHY ADOLESCENTS' PERCEPTIONS OF STRESS: CAUSES, SYMPTOMS, RESPONSES AND OUTCOMES by ALICE JEAN BOWERINO B.S.N., U n i v e r s i t y of B r i t i s h Columbia, 1962 A THESIS SUMBITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE FACULTY OF GRADUATE STUDIES <School of N u r s i n g ) We accept t h i s t h e s i s as conforming to the requ i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA September 1984 (£), A l i c e Jean Bower i n g , 1984 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y a v a i l a b l e for reference and study. I further agree that permission for extensive copying of t h i s thesis f o r s c h o l a r l y purposes may be granted by the head of my department or by h i s or her representatives. I t i s understood that copying or p u b l i c a t i o n of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date DE-6 (3/81) i i A b s t r a c t T h i s e x p l o r a t o r y study d e s c r i b e s h e a l t h y a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s , the c a u s e s , symptoms, r e s p o n s e s , and outcomes. D i f f e r e n c e s in t h e i r p e r c e p t i o n s based on t h e i r age and sex are d e s c r i b e d as w e l l as t h e i r p e r c e p t i o n s of the r e l a t i o n s h i p between s t r e s s and h e a l t h . ft q u e s t i o n n a i r e was developed as a p a r t of t h i s s t u d y . F o r t y - s i x i n d i v i d u a l s , ages 14 to 18, in Y.M.C.ft. groups, responded to the q u e s t i o n n a i r e . Four respondents <9%) r e p o r t e d e x p e r i e n c e with a s t r e s s mangement c l a s s . R e s u l t s of the study i n d i c a t e the m a j o r i t y of respondents p e r c e i v e d s t r e s s as r e l a t e d to h e a l t h and as a t o p i c of c o n c e r n . The respondents i d e n t i f i e d causes of s t r e s s r e l a t e d t o s c h o o l / u o r K , the f a m i l y , a u t h o r i t y f i g u r e s , p e e r s , i n t e r p e r s o n a l r e l a t i o n s h i p s , and p e r s o n a l s e n s i t i v i t y . P h y s i o l o g i c a l symptoms uere the most f r e q u e n t l y noted; a f f e c t i v e symptoms the l e a s t . A v a r i e t y of b e h a v i o r s , i n c l u d i n g some n e g a t i v e h e a l t h b e h a v i o r s , uere r e p o r t e d as responses to s t r e s s . The response r e s o u r c e s which f a c i l i t a t e the management of s t r e s s , d e s c r i b e d in the l i t e r a t u r e , uere i d e n t i f i e d by the m a j o r i t y of p a r t i c i p a n t s . P a r t i c i p a n t s uere Knowledgeable of s t r e s s outcomes. When the answers were compared, s i g n i f i c a n t d i f f e r e n c e s based on sex and age uere noted f o r s i x items. There was a l s o a t r e n d f o r responses to vary a c c o r d i n g to sex and age. The r e s u l t s are e x p l a i n e d in terms of the f a c t o r s which i n f l u e n c e p e r c e p t i o n : t i m e , p h y s i c a l s t a t e , e x p e r i e n c e , and the concept of the s e l f . F u r t h e r i n v e s t i g a t i o n of a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s i s recommended and s t r e s s management e d u c a t i o n f o r a d o l e s c e n t s may be warranted. F u r t h e r development of the q u e s t i o n n a i r e f o r s t r e s s management e v a l u a t i o n or f o r s t r e s s c o u n s e l i n g i s su g g e s t e d . i i i Table of Contents A b s t r a c t 1 1 Table of Contents i i * L i s t of T a b l e s v i i L i s t of F i g u r e s x Acknowledgements. x i CHAPTER I INTRODUCTION 1 Background of the Problem.... 1 Statement of the Problem • 4 Purpose of the Study 4 Theoret i c a l Framework 5 Def in i t ion of Terms •• 9 Assumpt ions 11 L i m i t a t i o n s of the Study 11 O r g a n i z a t i o n of the Study... 11 CHAPTER II REVIEW OF THE LITERATURE 13 F a c t o r s I n f l u e n c i n g P e r c e p t i o n 13 S t a t e of the I n d i v i d u a l 13 Exper ience 14 Time 14 The S e l f 15 H i s t o r i c a l Development of the S t r e s s Concept 17 Causes of S t r e s s 20 Research P e r t a i n i n g to the A d u l t 20 Research P e r t a i n i n g to the A d o l e s c e n t 21 Summary • • • 25 Symptoms of S t r e s s - 26 Research P e r t a i n i n g to the A d u l t 26 Research P e r t a i n i n g to the A d o l e s c e n t 29 Summary 29 iv Responses -to S t r e s s • 30 Research P e r t a i n i n g to the A d u l t 30 Response b e h a v i o r s 30 Response r e s o u r c e s 32 Research P e r t a i n i n g to the A d o l e s c e n t 35 Summary 3? Outcomes of S t r e s s 37 Research P e r t a i n i n g to the A d u l t 37 Research P e r t a i n i n g to the A d o l e s c e n t 38 Summary 40 Summary of the L i t e r a t u r e Review 40 CHAPTER III METHODOLOGY 42 S u b j e c t s 42 P o p u l a t i o n . . . . - •• 42 Sample 43 Cr i t e r i a f o r P a r t i c i p a t ion .......... 43 S e l e c t i o n Procedure 43 E t h i c a l C o n s i d e r a t i o n s 44 Q u e s t i o n n a i r e Development....... 44 Process 45 Content 45 Format 46 P i l o t Study 47 Data C o l l e c t i o n 47 Data A n a l y s i s 48 Summary of the Methodology 49 CHAPTER IV STUDY RESULTS AND DISCUSSION 50 D e s c r i p t i o n of the Sample 50 Responses to the Q u e s t i o n n a i r e 52 Ad o l e s c e n t P e r c e p t i o n s of the S t r e s s T o p i c 53 Ad o l e s c e n t P e r c e p t i o n s of the Causes of S t r e s s 55 D e s c r i p t i o n of T o t a l Sample •• 55 Open-ended responses 55 Closed-ended responses 57 D i s c u s s i o n • 57 D e s c r i p t i o n of Subgroups Based on Demographic V a r i a b l e s 68 Sex 60 Age 64 Sex and age.. • 68 Summary • • • 7 1 A d o l e s c e n t P e r c e p t i o n s of the Symptoms of S t r e s s 72 D e s c r i p t i o n of T o t a l Sample 72 Open-ended responses 72 Closed-ended responses 73 D i s c u s s i o n . 75 D e s c r i p t i o n of Subgroups Based on Demographic V a r i a b l e s 76 Sex 76 Age 79 Sex and age 82 Summary 34 Ad o l e s c e n t P e r c e p t i o n s of the Responses to S t r e s s . . . . . . . . 85 D e s c r i p t i o n of T o t a l Sample............... 86 Open-ended responses 86 Closed-ended r e s p o n s e s . . 88 D i s c u s s i o n 89 D e s c r i p t i o n of Subgroups Based on Demographic V a r i a b l e s 93 Sex 93 Age 98 Sex and age . 103 Summary 107 Ad o l e s c e n t P e r c e p t i o n s of the Outcomes of S t r e s s 109 D e s c r i p t i o n of T o t a l Sample 109 Open-ended responses 109 Closed-ended responses 110 D i s c u s s i o n . I l l D e s c r i p t i o n of Subgroups Based on Demographic V a r i a b l e s 113 Sex 113 Age 115 Sex and age 117 Summary 119 Summary of the Study R e s u l t s and D i s c u s s i o n 120 v i CHAPTER V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS 123 Summary and C o n c l u s i o n s . . . . . . . . 123 I m p l i c a t i o n s . . . . . . . . ••• 138 Recommendations f o r F u r t h e r R e s e a r c h . . . . 132 REFERENCES 135 Appendix A- L e t t e r of E x p l a n a t i o n and Consent... 150 Appendix B: Request to Agency..... 152 Appendix C- Agency Consent.... 154 Appendix D- Review Comments to Q u e s t i o n n a i r e D r a f t . . 156 Appendix E: Sample Q u e s t i o n n a i r e 159 Appendix F: Open-Ended Responses to Causes of S t r e s s s Frequency and C a t e g o r i e s 170 Appendix 6: Open-Ended Responses to Symptoms of S t r e s s ! Frequency and Categor i e s 173 Appendix H: Open-Ended Answers to Responses f o r S t r e s s ! Frequency and Categor i e s 175 Appendix I! Open-Ended Responses to Outcomes of S t r e s s : Frequency and C a t e g o r i e s . . . 173 v i i L i s t of Tab l e s Table 1 D e s c r i p t i o n of Respondents: Age by Sex <N=45) 51 £ D e s c r i p t i o n of Respondents: Grade by Sex <N=45> 51 3 Causes of S t r e s s : C a t e g o r i e s , T a b u l a t i o n and Content Summary ( N=46) . . . 56 4 Causes of S t r e s s : Frequency in Rank Order <N=46> 58 5 S e l e c t e d Causes of S t r e s s : Frequency by Sex 61 6 Summary of Chi Square A n a l y s i s : S e l e c t e d Causes by Sex <N=45> 6£ 7 S e l e c t e d Causes of S t r e s s : Frequency by Age 65 8 Summary of Chi Square A n a l y s i s : S e l e c t e d Causes of S t r e s s by Age <N=45> 66 9 S e l e c t e d Causes of S t r e s s : Frequency by Sex and by Age..... 69 10 Summary of Chi Square A n a l y s i s : S e l e c t e d Causes of S t r e s s by Sex and by Age <N=45).... 70 11 Symptoms of S t r e s s : C a t e g o r i e s , T a b u l a t i o n and Content Summary <N=46) 73 1£ Symptoms of S t r e s s : Frequency in RanK Order <N=46>... 74 13 S e l e c t e d Symptoms of S t r e s s : Frequency by Sex. 77 14 Summary of Chi Square A n a l y s i s : S e l e c t e d Symptoms of S t r e s s by Sex <N=45) 78 15 S e l e c t e d Symptoms of S t r e s s : Frequency by Age........ 80 16 Summary of Chi Square A n a l y s i s : S e l e c t e d Symptoms of S t r e s s by Age <N=45) 81 17 S e l e c t e d Symptoms of S t r e s s : Frequency by Sex and by Age 83 18 Summary of C h i Square A n a l y s i s : S e l e c t e d Symptoms of S t r e s s by Sex and by Age <N=45).. 84 v i i i Table 19 Responses to S t r e s s ! C a t e g o r i e s , T a b u l a t i o n and Content Summary <N=46> 87 20 Response B e h a v i o r s to S t r e s s : Frequency in RanK Order <N=46> 88 21 Response Resources f o r S t r e s s : Frequency in RanK Order <N=46).. S0 22 S e l e c t e d Response B e h a v i o r s to S t r e s s : Frequency by Sex 94 23 Summary of Chi Square A n a l y s i s : S e l e c t e d Response B e h a v i o r s to S t r e s s by Sex <N=45>... 95 24 S e l e c t e d Response Resources f o r S t r e s s : Frequency by Sex 96 25 Summary of Chi Square A n a l y s i s : S e l e c t e d Response Resources f o r S t r e s s by Sex <N=45>.. 97 26 S e l e c t e d Response B e h a v i o r s to S t r e s s : Frequency by Age SS 27 Summary of C h i Square A n a l y s i s : S e l e c t e d Response B e h a v i o r s to S t r e s s by Age <N=45)...100 28 S e l e c t e d Response Resources f o r S t r e s s : Frequency by Age 101 29 Summary of Chi Square A n a l y s i s : S e l e c t e d Response Resources f o r S t r e s s by Age <N=45>..102 30 S e l e c t e d Response B e h a v i o r s to S t r e s s : Frequency by Sex and by Age 104 31 Summary of C h i Square A n a l y s i s : S e l e c t e d Response B e h a v i o r s to S t r e s s by Sex and by Age <N=45> 105 32 S e l e c t e d Response Resources f o r S t r e s s : Frequency by Sex and by Age 106 33 Summary of Chi Square A n a l y s i s : S e l e c t e d Response Resources f o r S t r e s s by Sex and by Age <N=45) 107 ix Tab 1 e 34 Outcomes of S t r e s s ! C a t e g o r i e s , T a b u l a t i o n and Content Summary <N=46) 110 35 Outcomes of S t r e s s ! Frequency in RanK Order <N=46)...111 36 S e l e c t e d Outcomes of S t r e s s : Frequency by Sex 113 37 Summary of Chi Square A n a l y s i s ! S e l e c t e d Outcomes of S t r e s s by Sex <N=45> 114 38 S e l e c t e d Outcomes of S t r e s s : Frequency by Age........ 115 39 Summary of Chi Square A n a l y s i s : S e l e c t e d Outcomes of S t r e s s by Age <N=45) 116 40 S e l e c t e d Outcomes of S t r e s s : Frequency by Sex and by Age 118 41 Summary of Chi Square A n a l y s i s : S e l e c t e d Outcomes of S t r e s s by Sex and by Age <N=45)..119 L i s t of F i g u r e s F igure 1 Diagram of S t r e s s Components x i ftcKnowl edge merits S i n c e r e a p p r e c i a t i o n i s extended to my t h e s i s committee members: to Dr. Ka t h l e e n Simpson, f o r her encouragement, a v a i l a b i l i t y , and guidance; and to Ray Thompson, committee member, f o r h i s p a t i e n c e and e d i t o r i a l a s s i s t a n c e . I would 1iKe to thanK the Y.M.C.ft. of G r e a t e r Vancouver and i t s s t a f f f o r t h e i r c o o p e r a t i o n , and the many young p a r t i c i p a n t s who p r o v i d e d the impetus f o r t h i s s t u d y . Without t h e i r c o o p e r a t i o n , t h i s study would not have been p o s s i b l e . I would a l s o 1iKe to thanK those who o f f e r e d t h e i r a d v i c e and a s s i s t a n c e and to R. J . C r a i g f o r h i s c r i t i c a l review of the manuscr i p t . F i n a l l y , c r e d i t must be gi v e n to my f a m i l y , and to L o m e , e s p e c i a l l y , f o r t o l e r a n c e and unending f a i t h . 1 CHAPTER I I n t r o d u c t ion S t r e s s f o r a d o l e s c e n t s and a d u l t s r e s u l t s from l i v i n g with a c o n s t a n t demand f o r change and a d a p t a t i o n . The concept of s t r e s s is 1inKed to p h y s i c a l and mental h e a l t h ; i t s management can be seen as a f u n c t i o n of l i f e s t y l e . Because the h e a v i e s t burdens of i l l n e s s and m o r t a l i t y today are r e l a t e d to i n d i v i d u a l l i f e s t y l i n g b e h a v i o r s (Hamburg, E l l i o t t & P a r r o n , 1982, p. 3; L a l o n d e , 1974; U n i t e d S t a t e s Department of H e a l t h E d u c a t i o n & W e l f a r e , 1979), nurses have an i n t e g r a l r o l e in f a c i l i t a t i n g h e a l t h y l i f e s t y l i n g p a t t e r n s in t h e i r goal to help a d o l e s c e n t s a c h i e v e and m a i n t a i n optimum h e a l t h . More s p e c i f i c a l l y , t h i s i n c l u d e s h e l p i n g a d o l e s c e n t s manage s t r e s s . ft b a s i s f o r n u r s i n g i n t e r v e n t i o n i s an u n d e r s t a n d i n g of the p e r s p e c t i v e s a d o l e s c e n t s have towards s t r e s s . For purposes of t h i s s t u d y , s t r e s s i s c o n s i d e r e d to be s i t u a t i o n s , e v e n t s , or o c c u r r e n c e s which b r i n g about a change in normal f u n c t i o n i n g . It i s a broad c o n s t r u c t c o n s i s t i n g of f o u r components: c a u s e s , symptoms, r e s p o n s e s , and outcomes. Each, in t u r n , i s i n f l u e n c e d by a d o l e s c e n t p e r c e p t i o n s . BacKground of the Problem The e x p e r i e n c e of t h i s i n v e s t i g a t o r suggests t h a t a d o l e s c e n t s have l i m i t e d Knowledge and u n d e r s t a n d i n g of s t r e s s . Because they may not i d e n t i f y i t s c a u s e s , or i t s symptoms, t h e i r responses may i n c r e a s e t h e i r d i f f i c u l t y in managing s t r e s s ; they may not even a s s o c i a t e a change in h e a l t h s t a t u s with a s t r e s s f u l s i t u a t i o n . S t r e s s f o r a d o l e s c e n t s i s s i g n i f i c a n t . A dolescence i s c h a r a c t e r i z e d by r a p i d growth with i n d i v i d u a l 1 y - t i m e d changes in p h y s i c a l , c o g n i t i v e , and p s y c h o s o c i a l f u n c t i o n i n g <J. F. ftdams, 1976; ftdelson, 1980; Howe, 1980; D. Rogers, 1981). Moreover, £ changes in p h y s i c a l c h a r a c t e r i s t i c s may r e s u l t in an a l t e r e d body image and a change in the e x p e c t a t i o n s of o t h e r s . The a b i l i t y to t h i n k in a b s t r a c t terms, to r e a s o n , and to p l a n ahead ( K e a t i n g , 1980) may be at v a r i a n c e with o t h e r s ' or one's own e x p e c t a t i o n s . Changes in i n t e r p e r s o n a l r e l a t i o n s h i p s , combined with a d e v e l o p i n g h e t e r o s e x u a l i n t e r e s t , an i n c r e a s e in the importance of p e e r s , and a s t r i v i n g f o r e mancipation from p a r e n t s , produces t e n s i o n ( P e t e r s e n & S p i g a , 1982, p. 519). Environmental and a c t i v i t y changes e x p e r i e n c e d when a d o l e s c e n t s move i n t o h i g h s c h o o l <LeBou, 1976); and r o l e expansion (Greenberg & V a l l e t u t t i , 1980) as a d d i t i o n a l p r i v i l e g e s and r e s p o n s i b i l i t i e s are g r a n t e d , may be f u r t h e r s o u r c e s of s t r e s s . Compounding the s t r e s s of developmental change i s a l i m i t e d e x p e r i e n t i a l background. In s i t u a t i o n s where t h e r e has been l i t t l e p r e p a r a t i o n , such as d r i v i n g , i n t e r p e r s o n a l r e l a t i o n s h i p s , or substance abuse, d e f i c i t s in s k i l l and judgment may r e s u l t in f e e l i n g s of inadequacy, decreased e f f i c a c y , and s t r e s s ( P e t e r s e n & S p i g a , 198£, p. 525). L i m i t e d e x p e r i e n c e may a l s o a f f e c t the a b i l i t y to manage s t r e s s . T h e o r i s t s debate whether a d o l e s c e n c e i s a p e r i o d of "storm and s t r e s s " and whether c o n f l i c t and t u r m o i l are a n e c e s s a r y and normal p a r t of a d o l e s c e n t development (Coleman, 1978; O f f e r , Ostrov & Howard, 1981; R o l l , 1980; R u t t e r , Graham, ChadwicK & Y u l e , 1974; S t a n t o n , 1974). S o c i e t a l a m b i g u i t i e s , such as f u t u r e o c c u p a t i o n a l c h o i c e s and l i m i t e d o p p o r t u n i t i e s f o r employment, are s t r e s s - p r o d u c i n g . Moreover, a d o l e s c e n t development a l s o o c c u r s in i n t e r a c t i o n with a s o c i e t y i t s e l f t h a t i s undergoing a c c e l e r a t i n g t e c h n o l o g i c a l and s o c i a l change. These changes themselves c o n t r i b u t e to s t r e s s ( T o f f l e r , 1974). A d o l e s c e n t s ' p e r s p e c t i v e s p e r t a i n i n g to t h e i r needs and concerns have been sought (Erne, MaisiaK & Goodale, 1979; House, Durfee & Bryan, 1979; L e v i n e , 1981; Smith, 1980) as have t h e i r p e r s p e c t i v e s of h e a l t h and i l l n e s s (Benjamin & F i n k , 1876; 3 BrunswicK 1969; BrunsuicK 1980; P a r c e l , Nader & Meyer, 1977; Ra d i u s , D i l l m a n , BecKer, RosenstocK & Horvath, 1880; 5-ternl ieb & Munan, 1972; WalKer et a l . , 1982). These s t u d i e s i n d i c a t e a d o l e s c e n t s are concerned about t h e i r s e l v e s , t h e i r emotions, and t h e i r h e a l t h (Benjamin & FinK 1976; House et a l . , 1979; L e v i n e , 1981; P a r c e l et a l . , 1977). Such concerns as "headaches," "p r e s s u r e s to do t h i n g s , " "emotional c o n c e r n s , " and "Knots in my stomach" are f r e q u e n t l y e x p r e s s e d . Two f r e q u e n t l y i d e n t i f i e d problems the a d o l e s c e n t would 1iKe s o l v e d are "nervousness" and " f e e l i n g s of d e p r e s s i o n and sadness" ( P a r c e l et a l . , 1977; S t e r n l i e b & Munan, 1972). These concerns and problems are s i m i l a r to the a d u l t s ' s u b j e c t i v e f e e l i n g s of being s t r e s s e d which are i d e n t i f i e d in the l i t e r a t u r e ( S e l y e , 1976, P P . 176-178). The s p e c i f i c a l l y a d o l e s c e n t view of s t r e s s , however, i s not Known. H e a l t h i n f o r m a t i o n i s i d e n t i f i e d as an a d o l e s c e n t need by r e s e a r c h e r s (Benjamin & F i n K , 1976; Radius et a l . , 1980; WalKer et a l . , 1982) and by a d o l e s c e n t s ( P a r c e l et a l . , 1977," S t e r n l e i b & Munan, 1972). It i s only with the a c q u i s i t i o n of a p p r o p r i a t e h e a l t h i n f o r m a t i o n t h a t sound d e c i s i o n s c o n c e r n i n g p e r s o n a l r e s p o n s i b i l i t y and se1f-management may be made. The more Knowledge one has c o n c e r n i n g h e a l t h , the more a b l e one w i l l be to make r e s p o n s i b l e d e c i s i o n s ( S h i r r e f f s , 1978) and engage in e f f e c t i v e h e a l t h b e h a v i o r s (Cummings, BecKer & M a i r e , 1980). With the a b i l i t y to maKe d e c i s i o n s , e f f i c a c y may be enhanced and thus b r i n g about g r e a t e r s e l f - e s t e e m . L i f e s t y l i n g and s t r e s s management are h e a l t h c o n c e p t s . Teaching youth about l i f e s t y l i n g and s t r e s s management may produce p o s i t i v e b e h a v i o r a l change. T h i s i s confirmed in s t u d i e s by B i e n e r ( 1 8 7 5 ) , who found a r e d u c t i o n in the use of a l c o h o l and tobacco by a d o l e s c e n t boys r e c e i v i n g h e a l t h e d u c a t i o n ; Evans and Raines ( 1 9 8 2 ) , who found programs to be e f f e c t i v e in the p r e v e n t i o n of smoKing; and E l i t z u r ( 1 9 7 6 ) , who taught r e l a x a t i o n to a d o l e s c e n t s with b e h a v i o r a l d i s t u r b a n c e s and o b t a i n e d p o s i t i v e 4 r e s u l t s . R i c h a r d s o n , Beal1 and Jessup <1983> noted e f f e c t i v e s t r e s s management b e h a v i o r s were used by high s c h o o l s t u d e n t s f o r f i v e ueeKs f o l l o w i n g the c o n c l u s i o n of a u n i t on s t r e s s management. T r a i n i n g a d o l e s c e n t s in s t r e s s management may have s i m i l a r p o s i t i v e r e s u l t s . The f i r s t s t e p to s t r e s s management i s r e c o g n i t i o n or se1f-awareness <J. D. Adams, 1980; H a r t l , 1985, p. 257; S u t t e r l e y , 1979). Statement of the Problem The p e r c e p t i o n s a d o l e s c e n t s have towards s t r e s s are c u r r e n t l y unknown. Ye t , in order to i n t e r v e n e e f f e c t i v e l y and to f a c i l i t a t e s t r e s s management with y o u t h , nurses must Know a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s . What are the v a r i a b l e s which a d o l e s c e n t s p e r c e i v e as the c a u s e s , symptoms, r e s p o n s e s , and outcomes of t h e i r s t r e s s ? Do t h e i r responses d i f f e r based on s e l e c t e d demographic v a r i a b l e s ? Do a d o l e s c e n t s p e r c e i v e a r e l a t i o n s h i p between s t r e s s and i l l n e s s ? Purpose of the Study The purpose of t h i s study i s to d e s c r i b e h e a l t h y a d o l e s c e n t s ' p e r c e p t i o n of s t r e s s . The s p e c f i c o b j e c t i v e s ares 1. to d e s c r i b e h e a l t h y a d o l e s c e n t s ' p e r c e p t i o n s of the c a u s e s , symptoms, responses and outcomes of t h e i r s t r e s s . 2. to d e s c r i b e h e a l t h y a d o l e s c e n t s ' p e r c e p t i o n s of the c a u s e s , symptoms, responses and outcomes of t h e i r s t r e s s based on sex, age, and e x p e r i e n c e in s t r e s s management c l a s s . 3. to d e s c r i b e h e a l t h y a d o l e s c e n t s ' p e r c e p t i o n s of the r e l a t i o n s h i p between s t r e s s and i l l n e s s . 5 T h e o r e t i c a l FrameuorK Nur s i n g taxes d i r e c t i o n i n u n d e r s t a n d i n g b e h a v i o r from t h a t branch of psychology Known as phenomenology or p e r c e p t u a l psychology <Combs & Snygg, 1359; Combs, R i c h a r d s & R i c h a r d s , 1976; C. Rogers, 1951). P e r c e p t u a l psychology i s congruent with n u r s i n g p h i l o s o p h i e s in viewing man h o l i s t i c a l l y and u n i q u e l y and in s e e i n g man as worthy of v a l u e and r e s p e c t < H i t t , 1971, pp. 54-55). ft b a s i c premise in n u r s i n g p r a c t i c e i s to understand the p e r s p e c t i v e s of the i n d i v i d u a l because b e h a v i o r i s i n f l u e n c e d by some v a r i a b l e s which are meaningful o n l y to the i n d i v i d u a l (Roy, 1974; Neuman, 1982). The n u r s i n g concern f o r the i n d i v i d u a l ' s p e r c e p t i o n i s complementary to the study of s t r e s s which i s d e r i v e d from a d a p t a t i o n t h e o r y . Man's a d a p t a t i o n to h i s environment i s c e n t r a l to the development of a number of n u r s i n g models (Byrne & Thompson, 1978; Neuman, 1982; Roy, 1974). T h i s n u r s i n g study c o n s i d e r e d s e l e c t e d elements of the t h e o r i e s of both p e r c e p t u a l psychology and a d a p t a t i o n . The major t e n e t of p e r c e p t u a l psychology i s t h a t one behaves in response to what one p e r c e i v e s . A c c o r d i n g to p e r c e p t u a l p s y c h o l o g i s t s , p e r c e p t i o n i s how one sees o n e s e l f in r e l a t i o n to a p a r t i c u l a r s i t u a t i o n ; i t i s the i n t e g r a t i o n of Phenomena through the senses i n t o the p e r c e p t u a l f i e l d , the c e n t e r of which i s the s e l f . The p e r c e p t u a l f i e l d i s d e f i n e d as the sum t o t a l of p e r c e p t i o n s at the moment of behaving (Combs, R i c h a r d s & R i c h a r d s 1976, p. 2 2 ) . The pr o c e s s of p e r c e p t i o n i s s e l e c t i v e and i s based on p h y s i c a l , s o c i a l , and p s y c h o l o g i c a l needs. P e r c e p t i o n s may be at d i f f e r e n t l e v e l s of awareness and are l e a r n e d . They are a f f e c t e d by the p h y s i c a l s t a t e of the organism, t i m e , e x p e r i e n c e , and the s e l f (Combs 1971, p. 119). Given these parameters, t h e r e i s an i n s a t i a b l e need f o r the maintenance and enhancement of the s e l f ; growth i s the 6 development of the s e l f . Guided by these t e n e t s , the p e r c e p t i o n s of an i n d i v i d u a l are sought to determine the need, mode, and e f f e c t i v e n e s s of n u r s i n g i n t e r v e n t i o n . Wu <1973>, in d e s c r i b i n g the b e h a v i o r a l a s p e c t s of i l l n e s s , makes the f o l l o w i n g statement: How the i n d i v i d u a l e x p e r i e n c e s h i s [ s t r e s s ] i s the important determinant of h i s b e h a v i o r and as such becomes cont e n t f o r n u r s i n g . When the i n d i v i d u a l ' s p e r c e p t i o n of h i s [ s t r e s s 1 i s incongruent with the o b j e c t i v e d a t a g i v e n to us e f f o r t s may be d i r e c t e d , when a p p r o p r i a t e , toward changing h i s p e r c e p t i o n so t h a t i t i s more c o n s i s t e n t with r e a l i t y ( p . 3 1 ) . Wu's remarks are a p p l i c a b l e to t h i s study because both the b e h a v i o r a l a s p e c t s of i l l n e s s , as d e f i n e d by Wu , and s t r e s s , as d e f i n e d i n t h i s s t u d y , are s i m i l a r s u b j e c t i v e s t a t e s i d e n t i f y i n g dL±s_-ease. The task i s to reduce the d i s p a r i t y between the p e r c e p t i o n s of the nurse and those of the i n d i v i d u a l . With a background of s c i e n t i f i c n u r s i n g knowledge and c l i n i c a l e x p e r i e n c e , the nurse may have a d i f f e r e n t p e r s p e c t i v e than the i n d i v i d u a l ( S t e e l e , 1981, p.465; Neuman, 1982, p.18). The f o c u s of the nurse's i n t e r v e n t i o n i s concern f o r man's a d a p t a t i o n to h i s env ironment. A d a p t a t i o n t h e o r y addresses the t r a n s a c t i v e p r o c e s s between p e o p l e , t h e i r l i f e s i t u a t i o n s ( M e c h a n i c , 1976a), and the environment. Change i s c o n s i d e r e d c o n s t a n t and i n h e r e n t in a d a p t a t i o n (Oubos, 1865, p. x v i i i ; Goosen & Bush, 1982, p. 20); h e a l t h and d i s e a s e s t a t e s are synonymous with the succ e s s or f a i l u r e e x p e r i e n c e d by the i n d i v i d u a l in e f f o r t s to respond a d a p t i v e l y to environ m e n t a l c h a l l e n g e s (Dubos, 1965, p. x v i i i ) . A l s o , c e n t r a l to a d a p t a t i o n t h e o r y i s the n o t i o n of t b io -psycho -soc io 3 h o m e o s t a s i s , or m a i n t a i n i n g e q u i l i b r i u m (Dubos, 1965, p. 256; M a r g e t t s , 1975; S e l y e , 1976, p. 13). Man l i v e s in a dynamic s t a t e in i n t e r a c t i o n with the environment and i s c o n f r o n t e d by s t i m u l i in h i s quest f o r growth and s u r v i v a l . He adapts with change to m a i n t a i n e q u i l i b r i u m ( M a r g e t t s 1975). Man 7 responds to h i s environment with h i s a b i l i t y to choose between a l t e r n a t i v e s and to d e c i d e upon a course of a c t i o n . Furthermore, h i s responses s e r v e to f u l f i l l the need f o r s e l f - a c t u a l i z a t i o n which i s the development of the s e l f (Dubos, 1965, p. x v i i i - x i x ) . These responses are a f f e c t e d by the p e r c e p t i o n the i n d i v i d u a l has of the s i t u a t i o n <Dubos, 1965, p. £64; Roy, 1974, p. 137). When the input of s t i m u l i i s e x c e s s i v e or i n s u f f i c i e n t , d i s e q u i l i b r i u m o c c u r s with r e s u l t i n g s t r e s s <Margetts, 1975). The s i t u a t i o n i s p e r c e i v e d as t h r e a t e n i n g or harmful ( L a z a r u s , 1966) and the responses one u s u a l l y maKes are no longer u s e f u l ( H o l r o y d & L a z a r u s , 1982, p. 123). It i s t h i s s t r e s s s t a t e which i s of concern in t h i s s t u d y . S t r e s s i s c o n s i d e r e d a broad c o n s t r u c t c o n s i s t i n g of s e v e r a l components under which a number of more p r e c i s e l y d e f i n e d v a r i a b l e s may be i d e n t i f i e d ( E l l i o t t & E i s d o r f e r , 1982; L a z a r u s , 1966; Mason, 1975a). The components of s t r e s s are diagrammed in F i g u r e 1. F i g u r e 1. Diagram of s t r e s s components. How one views and i n t e r a c t s with a s i t u a t i o n i n f l u e n c e s the s t r e s s e x p e r i e n c e ( H i n K l e , 1958; L a z a r u s , 1966; Hyman & Woog, 1982). The causes of s t r e s s , or s t r e s s o r s , are s i t u a t i o n s i n i t i a t i n g the s t r e s s s t a t e or d i s e q u i l i b r i u m . These are n o r m a l l y o c c u r r i n g l i f e events which are p e r c e i v e d as b e i n g harmful or t h r e a t e n i n g ( L a z a r u s , 1966) and cause change in normal r e a c t ion( symptom) *. response cause « outcome 8 f u n c t i o n i n g . They may be r e a l or imagined, d e s i r a b l e or u n d e s i r a b l e . With d i s e q u i l i b r i u m , a r e a c t i o n o c c u r s which may r e s u l t in p s y c h o l o g i c a l , p h y s i o l o g i c a l , or b e h a v i o r a l m a n i f e s t a t i o n s . S e l y e < 1976, p. 1) d e s c r i b e d t h i s as a " n o n - s p e c i f i c response of the body to any demand." The symptoms are the s e l f - r e p o r t s of the r e a c t i o n . Knowledge, a f a c e t of p e r c e p t i o n , i n f l u e n c e s the symptoms e x p e r i e n c e d , the i n t e r p r e t a t i o n of the symptoms ( S c h a c h t e r & S i n g e r , 1964?, and the l a b e l l i n g of the symptoms (Mec h a n i c , 1972). In o r d e r to r e g a i n e q u i l i b r i u m , man responds or copes by employing p a r t i c u l a r b e h a v i o r s and r e s o u r c e s which s e r v e to m i n i m i z e , r e d u c e , or i n c o r p o r a t e the r e a l or imagined t h r e a t ( L a z a r u s , 1966; P e a r l in & S c h o o l e r , 1978; Ziemer, 1982). These responses are determined by what one p e r c e i v e s are a v a i l a b l e r e s o u r c e s and what one p e r c e i v e s c a p a b l e of doing ( L a z a r u s , 1966). Based on the premise t h a t t h e r e i s a n o n - s p e c i f i c b o d i l y r e a c t i o n to s t r e s s , the outcome may be an a l t e r e d s t a t e in w e l l - b e i n g or i l l n e s s . F u r t h ermore, the outcome may be i n f l u e n c e d by what the i n d i v i d u a l b e l i e v e s (Simonton, Matthew-Simonton & C r e i g h t o n , 1978) and how t h a t outcome i s d e f i n e d ( M e c h a n i c , 1972). The i l l n e s s outcome i s presumed to be more l i K e l y , but not n e c e s s a r y , with p r o l o n g e d , c h r o n i c , s e v e r e , or accumulated s t r e s s ( B i e 1 i a u s K a s , 1982; E l l i o t t & E i s d o r f e r , 1982; S e l y e , 1976). The s t a t e of r e g a i n e d e q u i l i b r i u m i s a d a p t a t i o n ( L a z a r u s , 1966; S e l y e , 1976). S t r e s s and a d a p t a t i o n are e s s e n t i a l f o r l i f e and growth. C h a l l e n g e s and t h r e a t s a l l o w f o r mastery in man's s t r i v i n g f o r s e 1 f - a c t u a l i z a t i o n . However, the amount of s t r e s s t h a t i s o p t i m a l , or the amount t h a t may be t o l e r a t e d without d e l e t e r i o u s e f f e c t s i s d i f f e r e n t f o r each person (Jasmin & T r y g s t a d , 1979, P.48; S e l y e , 1974). S t r e s s cannot be avoided t o t a l l y , nor can i t be overcome. R a t h e r , i t must be managed to reduce the n e g a t i v e e f f e c t s and to promote the p o s i t i v e e f f e c t s . 9 A major determinant of s t r e s s and a f o c a l p o i n t f o r i t s management i s the i n d i v i d u a l ' s p e r c e p t i o n or Knowledge. Knowledge about s t r e s s may i n f l u e n c e how one views and i n t e r a c t s with s t r e s s f u l s i t u a t i o n s which, in t u r n , w i l l a f f e c t the e x p e r i e n c e of s t r e s s (Meichenbaum & Cameron, 1983, p. 118>. D e f i n i t i o n of Terms P e r c e p t i o n : those a t t i t u d e s , b e l i e f s and Knowledge h e l d by the i n d i v i d u a l in r e l a t i o n to a p a r t i c u l a r s i t u a t i o n . The o p e r a t i o n a l d e f i n i t i o n i s : t h a t p e r c e p t i o n or those p e r c e p t i o n s i n d i c a t e d by the i n d i v i d u a l ' s responses on the q u e s t i o n n a i r e or in the i n t e r v i e w schedu1e. A d o l e s c e n t : an i n d i v i d u a l age 14 to 19 with no i d e n t i f i e d major h e a l t h problem. D i s e q u i l i b r i u m : the dynamic s t a t e in which t h e r e i s a change in normal or usual f u n c t i o n i n g f o r the i n d i v i d u a l and i s p e r c e i v e d as t h r e a t e n i n g , harmful or u p s e t t i n g ( L a z a r u s , 1366). Cause: the i n i t i a t i n g or p r e c i p i t a t i n g e v e n t , p e r c e i v e d as t h r e a t e n i n g or harmful which causes change or d i s e q u i l i b r i u m . It may be p l e a s a n t or u n p l e a s a n t ; i t may be r e a l or imagined ( L a z a r u s , 1966). The o p e r a t i o n a l d e f i n i t i o n i s : t h a t cause or those causes i n d i c a t e d by the i n d i v i d u a l ' s responses on the q u e s t i o n n a i r e or in the i n t e r v i e w s c h e d u l e . R e a c t i o n : the n o n - s p e c i f i c b o d i l y response which o c c u r s with d i s e q u i l i b r i u m ( S e l y e , 1976). 10 Symptom: t h a t e f f e c t e x p e r i e n c e d by the i n d i v i d u a l which occu r s with r e a c t i o n . The o p e r a t i o n a l d e f i n i t i o n i s : t h a t symptom or those symptoms i n d i c a t e d by the i n d i v i d u a l ' s responses on the q u e s t i o n n a i r e or in the i n t e r v i e w s c h e d u l e . Response i t h a t method used by an i n d i v i d u a l to e l i m i n a t e , minimize or i n c o r p o r a t e the p e r c e i v e d t h r e a t ( L a z a r u s , 1966). The o p e r a t i o n a l d e f i n i t i o n i s : t h a t response or those responses i n d i c a t e d by the i n d i v i d u a l ' s answers on the q u e s t i o n n a i r e or in the i n t e r v i e w s c h e d u l e . Outcome the s t a t e of h e a l t h as d e f i n e d by the i n d i v i d u a l . The o p e r a t i o n a l d e f i n i t i o n i s : t h a t outcome or those outcomes i n d i c a t e d by the i n d i v i d u a l ' s responses on the q u e s t i o n n a i r e or in the i n t e r v i e w schedu1e . Age : the c h r o n o l o g i c a l age a t t a i n e d at the l a s t b i r t h d a y as i n d i c a t e d by the i n d i v i d u a l ' s response on the q u e s t i o n n a i r e . Gradei the l a s t grade completed in s c h o o l as i n d i c a t e d by the i n d i v i d u a l ' s response on the q u e s t i o n n a i r e . E x p e r i e n c e in s t r e s s management: the s e l f - r e p o r t of a t t e n d i n g at l e a s t one i n s t r u c t i o n a l p e r i o d in which the t o p i c of i n s t r u c t i o n was s t r e s s . A d a p t a t i o n : the dynamic s t a t e in which the i n d i v i d u a l has a d j u s t e d to change which r e s u l t s in system 11 b a l a n c e , h o m e o s t a s i s , or e q u i l i b r i u m . The s i t u a t i o n i s no l o n g e r p e r c e i v e d by the i n d i v i d u a l as t h r e a t e n i n g , h a r m f u l , or u p s e t t i n g . fissumptions It uas assumed t h a t every a d o l e s c e n t e x p e r i e n c e s s t r e s s . It Mas assumed t h a t an a d o l e s c e n t uses responses in o r d e r to reduce the d i s e q u i l i b r i u m . It was assumed the respondent would answer a c c u r a t e l y to the best of h i s a b i l i t y . It was assumed the goal of s t r e s s management c l a s s i s a r e d u c t i o n in p e r c e i v e d s t r e s s . L i m i t a t i o n s of the Study The age d i f f e r e n c e between the r e s e a r c h e r and the a d o l e s c e n t s may have been a l i m i t a t i o n . The a d o l e s c e n t may have been r e l u c t a n t to communicate openly with an a d u l t . There are no o b j e c t i v e measures of p e r c e p t i o n s . There was complete dependence on the r e s p o n d e n t s ' a c c u r a t e r e p o r t i n g of the i r p e r c e p t ions . A b i l i t y to g e n e r a l i z e r e s u l t s of the study beyond the sample i s l i m i t e d based on the n o n - p r o b a b i 1 i t y , convenience s e l e c t i o n of the sample. O r g a n i z a t i o n of the Study Chapter One addresses the problem and purpose of t h i s s t u d y . The t h e o r e t i c a l o r g a n i z a t i o n , based on s e l e c t e d t h e o r i e s of a d a p t a t i o n and p e r c e p t u a l psychology i s o u t l i n e d . The d e f i n i t i o n s , assumptions, and l i m i t a t i o n s of the study are s t a t e d and i t s o r g a n i z a t i o n i s o u t l i n e d . 12 Chapter Two reviews the l i t e r a t u r e with r e f e r e n c e to f a c t o r s i n f l u e n c i n g p e r c e p t i o n and an h i s t o r i c a l development of the s t r e s s c o n c e p t . S t u d i e s r e l a t e d to the c a u s e s , symptoms, r e s p o n s e s , and outcomes of s t r e s s f o r the a d u l t and f o r the the a d o l e s c e n t are c i t e d . Chapter Three d e s c r i b e s the methodology. The r e s e a r c h d e s i g n , sample s e l e c t i o n , q u e s t i o n n a i r e development, p i l o t s t u d y , d a t a c o l l e c t i o n , and d a t a a n a l y s i s are o u t l i n e d . The r e s u l t s of d a t a c o l l e c t i o n and a n a l y s i s are p r e s e n t e d and d i s c u s s e d in Chapter Four. The responses to the q u e s t i o n n a i r e , the sample, and an overview of the s t r e s s t o p i c are o u t l i n e d , i n c l u d i n g the r e l a t i o n s h i p a d o l e s c e n t s p e r c e i v e between s t r e s s and i l l n e s s . Both open-response and c1osed-response q u e s t i o n s are c o n s i d e r e d in the d i s c u s s i o n of the c a u s e s , symptoms, r e s p o n s e s , and outcomes of s t r e s s . The s t r e s s components are then f u r t h e r a n a l y z e d on the b a s i s of p a r t i c i p a n t s ' sex and age. The summary, c o n c l u s i o n s , and i m p l i c a t i o n s of t h i s study are p r e s e n t e d in Chapter F i v e . Recommendations f o r f u r t h e r r e s e a r c h are s t a t e d . 13 CHAPTER I I Review of the L i t e r a t u r e L i t e r a t u r e p e r t i n e n t to a d o l e s c e n t s ' p e r c e p t i o n of s t r e s s i s reviewed i n t h i s c h a p t e r . F a c t o r s t h a t i n f l u e n c e p e r c e p t i o n and the h i s t o r i c a l development of the s t r e s s concept are a l s o o u t l i n e d . The c a u s e s , symptoms, r e s p o n s e s , and outcomes of s t r e s s are c o n s i d e r e d from both the a d u l t and a d o l e s c e n t p e r s p e c t i v e . Factors Influencing Perception In o r d e r to understand a d o l e s c e n t s ' views of s t r e s s , i t i s nece s s a r y to c o n s i d e r the ways in which t h i n g s or events are p e r c e i v e d . Things or events appear as c o n c r e t e o b j e c t s r a t h e r than as forms, q u a l i t i e s , or dimensions in the human mind ( A l l p o r t , 1955, p. 104). F u r t h e r , these c o n c r e t e o b j e c t s r e p r e s e n t meaning to the i n d i v i d u a l . F a c t o r s s p e c i f i c to the i n d i v i d u a l i n f l u e n c e yJiajL i s p e r c e i v e d and the r e a d i n e s s with which t h i n g s are p e r c e i v e d ( A l l p o r t , 1955, p. 104; Combs, 1971, p. 114; Combs, R i c h a r d s & R i c h a r d s , 1976). Four v a r i a b l e s , as o u t l i n e d by Combs ( 1 9 7 1 ) , have been s e l e c t e d f o r c o n s i d e r a t i o n . These are the p h y s i c a l s t a t e of the i n d i v i d u a l , e x p e r i e n c e , t i m e , and the s e l f . The f i r s t t h r e e are common to most p s y c h o l o g i c a l t h e o r i e s <Combs, 1971, p. 119), wh i l e the f o u r t h i s a p p r o p r i a t e to the study of a d o l e s c e n t s . S t a t e of the Ind iv i d u a l The s t a t e of an i n d i v i d u a l ' s h e a l t h determines the i n t e r e s t l e v e l , the foc u s of a t t e n t i o n , and the energy a v a i l a b l e to the i n d i v i d u a l to seeK f u r t h e r p e r s p e c t i v e s (Combs, R i c h a r d s & R i c h a r d s , 1976, p. 8 0 ) . Adequate f u n c t i o n i n g of the sensory 14 apparatus and the nervous system i s n e c e s s a r y to the p e r c e p t u a l p r o c e s s . C o n v e r s e l y , s t a t e s or substances which a f f e c t t h i s system, such as i l l n e s s or d r u g s , a l t e r the p e r c e p t u a l p r o c e s s . F u r t h e r , g e n e r a l body s t r u c t u r e r e f l e c t s the p h y s i c a l s t a t e and i s the v i s i b l e a s p e c t of the s e l f . How the body i s viewed and v a l u e d c o n t r i b u t e s to s e 1 f - c o n c e p t . Furthermore, g e n e t i c s a f f e c t b e h a v i o r a l r e a c t i o n s and responses which, in t u r n , i n f l u e n c e p e r c e p t ion . Exper ience Another f a c t o r i n f l u e n c i n g p e r c e p t i o n i s e x p e r i e n c e i t s e l f . E x p e r i e n c e s may be of two t y p e s : d i r e c t or i n d i r e c t , and communication i s the l i n k a g e between the two. Communication makes i n d i r e c t e x p e r i e n c e s p o s s i b l e . That which i s p e r c e i v e d tends to be expected and l e a r n e d as a r e s u l t of past e x p e r i e n c e s (Combs, R i c h a r d s & R i c h a r d s , 1976, pp. 96-98), w h i l e some e x p e r i e n c e s become c o n s t a n t and s e r v e as a r e f e r e n c e f o r new s t i m u l i . These c o n s t a n t s are maintained in the c u l t u r e or s u b c u l t u r e , the f a m i l y , and through s i g n i f i c a n t o t h e r s (Combs, R i c h a r d s & R i c h a r d s , 1976, PP. 109-123). Time E x p e r i e n c e has time parameters and these a f f e c t i n d i v i d u a l p e r c e p t i o n . Time r e f l e c t s the o p p o r t u n i t y a v a i l a b l e f o r p e r c e i v i n g and i n f l u e n c e s p e r c e p t i o n . Age of the i n d i v i d u a l i s one f a c e t of time; r e p e t i t i o n and d u r a t i o n of an event are another ( A l l p o r t , 1955, p. 65>. Moreover, as new p e r c e p t i o n s are embedded in p r e v i o u s e x p e r i e n c e s w i t h i n the p e r c e p t u a l f i e l d , d i f f e r e n t i a t i o n s are n e c e s s a r y i f new p e r c e p t i o n s are to o c c u r . Time i s r e q u i r e d t o make these d i f f e r e n t i a t i o n s (Combs, R i c h a r d s & R i c h a r d s , 1976, p. 127). 15 The Self F i n a l l y , i t i s important in c o n s i d e r i n g the a d o l e s c e n t s ' p e r c e p t i o n s to i n c l u d e the concept of the s e l f . The p e r c e i v e d s e l f , the "me," or phenomenal s e l f i s d e s c r i b e d by Uiyl ie (1974) as : ...an o r g a n i z e d c o n f i g u r a t i o n of p e r c e p t i o n s of the s e l f u h i c h are a d m i s s i b l e to auareness. It i s composed of such elements as the p e r c e p t i o n s of one's c h a r a c t e r i s t i c s and a b i l i t i e s ; the p r e c e p t s and concepts of the s e l f in r e l a t i o n to o t h e r s and to the environment; the v a l u e q u a l i t i e s which are p e r c e i v e d as a s s o c i a t e d with e x p e r i e n c e and o b j e c t s ; and g o a l s and i d e a l s which are p e r c e i v e d as having p o s i t i v e or n e g a t i v e v a l e n c e ( p . 9 ) . The p e r c e i v e d or phenomenal s e l f i s l e a r n e d and a r i s e s out of e x p e r i e n c e s and i n t e r a c t i o n s with o t h e r p e o p l e . The way one sees o n e s e l f s e l e c t i v e l y i n f l u e n c e s p e r c e p t i o n (Combs, R i c h a r d s and Ri c h a r d s 1976, p. 184). The s e l f r e s i s t s change. T h e r e f o r e , t h r e a t s to the s e l f r e s u l t in a narrowing of the p e r c e p t u a l f i e l d and b e h a v i o r i s l i K e l y to be made r i g i d and d e f e n s i v e (Combs, R i c h a r d s and R i c h a r d s , 1976, p. 252). In C. Roger's (1951) view, s t r e s s r e s u l t s when the s e l f i s t h r e a t e n e d . The maintenance and enhancement of the s e l f i s the prime o b j e c t i v e in human f u n c t i o n i n g and i s r e f e r r e d to as " s e l f - a c t u a l i z a t i o n " ( M a s l o u , 1976), "being and becoming" ( C . Rogers, 1951), or " s t r i v i n g f o r p e r s o n a l adequacy" (Combs, R i c h a r d s & R i c h a r d s , 1976, p. 57). The i n d i v i d u a l ' s need at the moment i s b a s i c to p e r c e p t i o n . A c c o r d i n g to Maslou ( 1970) b a s i c needs are o r g a n i z e d in the f o l l o w i n g h i e r a r c h i c a l o r d e r : 16 1. P h y s i o l o g i c a l n e e d s - - f o o d , water, oxygen S. S a f e t y needs — s e c u r i t y , s t a b i l i t y , freedom from f e a r 3. Be 1ongingness and love n e e d s - - a f f e c t i o n a t e r e l a t i o n s h i p s with people and the f e e l i n g t h a t one belongs i n some s o c i a l c o n t e x t 4. S e l f - E s t e e m needs--achievement, adequacy, mastery, r e c o g n i t i o n , importance 5. S e 1 f - A c t u a l i z a t i o n n e e d s - - s e l f - f u 1 f i 1 l m e n t , to a c t u a l i z e one's p o t e n t i a l , to become e v e r y t h i n g t h a t one i s cap a b l e of becoming (Mas low, 1970, pp. 35-58> Combs, R i c h a r d s and R i c h a r d s ( 1976> on the other hand, address needs in a more g l o b a l f a s h i o n and m a i n t a i n t h a t s t r i v i n g f o r p e r s o n a l adequacy i s the b a s i c human need from b i r t h to d e a t h : ...each person seeks not merely the maintenance of a s e l f , but the development of an adequate s e l f - - a s e l f c a p a b l e of d e a l i n g e f f e c t i v e l y and e f f i c i e n t l y with the e x i g e n c i e s of l i f e , both now and in the f u t u r e . To a c h i e v e t h i s se1f-adequacy r e q u i r e s of each person t h a t they seeK not on l y t o m a i n t a i n h i s e x i s t i n g o r g a n i z a t i o n , but a l s o t h a t he b u i l d up and maxe more adequate the s e l f of which he i s aware <pp. 56-57>. Th i s s t r i v i n g f o r p e r s o n a l adequacy or enhancement of the s e l f i s s i g n i f i c a n t d u r i n g the a d o l e s c e n t l i f e s t a g e . Adolescence i s a developmental p e r i o d , c r i t i c a l to the development of the s e l f . P s y c h o s o c i a l l i t e r a t u r e proposes developmental tasKs or g o a l s to be accomplished by the a d o l e s c e n t . These i n c l u d e : - A c h i e v i n g a s e l f - i d e n t i t y , a sexual i d e n t i t y , and a c c e p t i n g one's s e l f - A c h i e v i n g new and more mature r e l a t i o n s with peers of both sexes - A c h i e v i n g independence of p a r e n t s and o t h e r a d u l t s with f o r m a t i o n of interdependent r e l a t i o n s h i p s with p a r e n t s - P r e p a r i n g and a c h i e v i n g f o r s e l f - s u f f i c i e n t r o l e in soc i e t y 1 7 - P r e p a r i n g f o r marriage and f a m i l y l i f e - A c q u i r i n g a s e t of v a l u e s and an e t h i c system as a guide to b e h a v i o r - D e v e l o p i n g f u r t h e r c o g n i t i v e a b i l i t i e s , to t h i n k a b s t r a c t l y , to p l a n ahead <Havighurst, 1 3 5 3 ; Nelms, 1 9 8 1 ; Rabichou & S k l a n s k y , 1 9 8 0 , P P . 1 6 - 1 7 ) In a d d i t i o n , these t a s k s are i n c l u s i v e of the s t r i v i n g to develop a sense of p e r s o n a l adequacy. H i s t o r i c a l Development of the S t r e s s Concept The s t r e s s concept has developed s p o r a d i c a l l y and in a fragmented manner. Cu r r e n t i n t e r e s t in the concept stems from the a s s o c i a t i o n between s t r e s s and i l l n e s s which arose from a n e c d o t a l r e p o r t s of i l l n e s s e s t h a t seemed to occur d u r i n g p e r i o d s of major l i f e changes ( B i e 1 i a s u s k a s , 1 9 8 2 , p. 6 ) . I n i t i a l work i s a t t r i b u t e d to Meyer ( L i e f , 1 9 4 8 ) who, in 1 9 1 9 , developed a l i f e c h a r t of p a t i e n t s ' s o c i a l , p e r s o n a l and b i o l o g i c a l h i s t o r i e s and observed t h a t p s y c h i a t r i c and p h y s i c a l d i s o r d e r s f r e q u e n t l y f o l l o w e d a c l u s t e r of p e r s o n a l and s o c i a l changes. S e l y e ( 1 9 7 6 ) f u r t h e r developed the id e a of homeostasis and the f i g h t - f l i g h t mechanism with h i s use of the concept " s t r e s s , " which he d e f i n e d as a "general n o n - s p e c i f i c [ b i o l o g i c a l ] response of the body to any demand." He e l a b o r a t e d f u r t h e r in the t h r e e stage General A d a p t a t i o n Syndrome a stage of a l a r m , a stage of r e s i s t a n c e , and a f i n a l s tage of e x h a u s t i o n . In the f i e l d of psychosomatic m e d i c i n e , Alexander ( 1 9 5 0 ) and Dunbar ( 1 9 5 5 ) r e l a t e d s p e c i f i c u n r e s o l v e d p s y c h o l o g i c a l c o n f l i c t s to p a r t i c u l a r d i s e a s e s such as asthma or u l c e r a t i v e c o l i t i s . At t h a t time the mind and body were c o n s i d e r e d s e p a r a t e . More 18 r e c e n t l y , however, man has come to be viewed as a g e n e r a l system with mind-body i n t e r r e l a t e d n e s s ( L e i g h , 1982, p. 735). D i s e a s e may r e s u l t -from a p a r t i c u l a r organ weakness as man responds to the demands of the environment, a c c o r d i n g to the c u r r e n t paradigm. Wolff (1953) and H i n K l e ( H i n K l e , 1958; H i n K l e , 1974; H i n K l e & W o l f f , 1957) r e c o g n i z e d the impact of d a i l y l i f e o c c u r r e n c e s on h e a l t h . In t h e i r paradigm, i l l n e s s s u s c e p t i b i l i t y was r e l a t e d to the i n d i v i d u a l ' s r e l a t i o n s h i p to the environment. How the s i t u a t i o n was p e r c e i v e d by the i n d i v i d u a l was a more important determinant of h e a l t h or i l l n e s s than the a c t u a l l i f e s i t u a t i o n s exper ienced . Caplan (1964) viewed s t r e s s as a s t i m u l u s and d e s c r i b e d a simple stimu1 us-response approach in which man r e a c t s to s t r e s s f u l s i t u a t i o n s with l e a r n e d c o p i n g mechanisms. Lazarus (1966) developed an i n t e r a c t i o n a l approach to s t r e s s and emphasized the importance of c o g n i t i v e a p p r a i s a l and p e r c e p t i o n . A c c o r d i n g to him, s t r e s s r e s u l t s when t h e r e i s a p e r c e i v e d d i s c r e p a n c y between the responses r e q u i r e d and the responses a v a i l a b l e to the i n d i v i d u a l . He c o n s i d e r e d t h a t the i n d i v i d u a l ' s p s y c h o l o g i c a l e f f e c t i v e n e s s determined the s t r e s s outcome ( R o s k i e s & L a z a r u s , 1988). Holmes and Rahe (1967) began the worK of i d e n t i f y i n g and q u a n t i f y i n g l i f e events which cause s t r e s s and were thought to i n f l u e n c e h e a l t h changes. Other i n v e s t i g a t o r s have a l s o used v a r i o u s s c a l e s and methods l i n k i n g l i f e change events to i l l n e s s ( B ramwell, Masuda, Wagner & Holmes, 1975; C o d d i n g t o n , 1972a; V o l i c e r , 1977). Y e t , a simple l i n e a r l i n k between l i f e change events and i l l n e s s has not been e s t a b l i s h e d ; environmental and i n d i v i d u a l v a r i a b l e s are a l s o i n f l u e n t i a l (Mason, 1975a, 1975b; M i l l e r , 1981; RabKin & S t r e u n i n g , 1976). In c o n t r a s t to these s t u d i e s l i n k i n g l i f e events t o i l l n e s s , Antonevsky (1979) advocated s t u d y i n g why people s t a y h e a l t h y as opposed to g e t t i n g s i c k . Those f a c t o r s which f a c i l i t a t e people 19 c o p i n g with a d v e r s i t i e s s h o u l d be i n v e s t i g a t e d , he m a i n t a i n e d . Ye t , r e l a t i v e l y l i t t l e worK has addressed the i s s u e of c o p i n g f o r the h e a l t h y p o p u l a t i o n . It i s c l a i m e d , "Coping and s t r e s s are but tuo f a c e s of the same c o i n and any model of s t r e s s must a l s o be viewed as a model of c o p i n g " <RosKies & L a z a r u s , 1980, p. 4 5 ) . In summary, the l i t e r a t u r e r e f l e c t s the i n c r e a s i n g c o m p l e x i t y of the s t r e s s c o n c e p t . It has been d e f i n e d as a s t i m u l u s , a r e s p o n s e , or a combination of b o t h . There i s no g e n e r a l consensus on a d e f i n i t i o n of s t r e s s , nor i s t h e r e an e x p l a n a t o r y model (Cox, 1978; E l l i o t t & E i s d o r f e r , 1982). S t u d i e s f a i l to account f o r the c o m p l e x i t y of s t r e s s ( E l l i o t t & E i s d o r f e r , 1982; Hyman & Uioog, 1982; RabKin & S t r u e n i n g , 1976). It may be c o n c l u d e d from an e x t e n s i v e review of r e s e a r c h ( E l l i o t t & E i s d o r f e r , 1982) t h a t s t r e s s i s a complex c o n s t r u c t with many i n f l u e n c i n g v a r i a b l e s . To quote B i e l i a u s K a s ( 1 9 8 2 ) : In g e n e r a l , c u r r e n t r e s e a r c h s u g g ests t h a t the s t r e s s response i s not a simple b i o l o g i c a l response to n o n s p e c i f i c s t r e s s o r s but r a t h e r a complex, i n t e r r e l a t e d p r o c e s s i n c l u d i n g the o c c u r r e n c e of a s t r e s s o r , how i t i s seen p s y c h o l o g i c a l l y by the organism, under what c i r c u m s t a n c e s the s t r e s s o r o c c u r s , how the organism c h a r a c t e r i s t i c a l l y r e a c t s , and what the r e s o u r c e s are t h a t the organism has a v a i l a b l e f o r d e a l i n g with the s t r e s s o r . The concept of a g e n e r a l s t r e s s r e a c t i o n may be v i a b l e , but o n l y i f we assume t h a t i t r e p r e s e n t s the sum of a g r e a t many p s y c h o l o g i c a l and p h y s i o l o g i c a l f a c t o r s r a t h e r than a s p e c i f i c a l l - o r - n o n e response to the o c c u r r e n c e of a s t r e s s i n g event (pp. 5-6). There are many unanswered q u e s t i o n s about s t r e s s ( E l l i o t t & E i s d o r f e r , 1982; Goldberg & B r e z n i t z , 1982) and most of the s t u d i e s have i n v o l v e d a d u l t s . Because c u r r e n t s t r e s s t h e o r y i s based on r e s e a r c h with a d u l t s , i t i s important the l i t e r a t u r e p e r t a i n i n g to the a d u l t be reviewed when c o n s i d e r i n g s t r e s s in r e l a t i o n to the a d o l e s c e n t . However, s t r e s s from a developmental p o i n t of view, has not been w e l l r e s e a r c h e d ( R u t t e r , 1981). 20 Causes of Stress Research P e r t a i n i n g to the A d u l t Causes of s t r e s s are equated u i t h l i f e change e v e n t s . These events have been s t u d i e d e x t e n s i v e l y , based on the assumption t h a t they uere d i r e c t l y r e l a t e d to i l l n e s s . Change Mas equated u i t h s t r e s s . I d e n t i f i c a t i o n of the causes of s t r e s s stems from the uorK of Holmes and Rahe <1S67) and t h e i r c o l l e a g u e s . Over 5000 p a t i e n t s uere asKed to i d e n t i f y events which o c c u r r e d b e f o r e the onset of i l l n e s s e s . The 43 items i d e n t i f i e d uere n o r m a l l y o c c u r r i n g changes in the p e r s o n a l , s o c i a l , f a m i l i a l , o c c u p a t i o n a l , and f i n a n c i a l spheres which r e q u i r e d an adjustment on the p a r t of the i n d i v i d u a l . Many of the events were s o c i a l l y d e s i r a b l e and r e f l e c t e d the American v a l u e system such as m a r r i a g e , e d u c a t i o n , o c c u p a t i o n , and economics. Others were u n d e s i r a b l e such as a j a i l t erm, p e r s o n a l i n j u r y , or being f i r e d from worK. Numerous m o d i f i c a t i o n s of t h i s l i s t have been made. L i s t s have been developed in a s i m i l a r f a s h i o n and s t u d i e s done of d i f f e r e n t groups in s p e c i f i c s i t u a t i o n s such as a t h l e t e s ( B r a m u e l l , Masuda, Wagner & Holmes, 1975), h o s p i t a l p a t i e n t s ( V o l i c e r , 1977), p s y c h i a t r i c p a t i e n t s <PayKel, 1974), r a c i a l and e t h n i c groups <Holmes & Masuda, 1974, p. 5 6 ) , and c h i l d r e n ( C o d d i n g t o n , 1972b). Each l i s t of events i s d i f f e r e n t . The events address major upheavals such as death of a parent or spouse (Holmes & Rahe, 1967), items r e l a t e d to a s p e c i f i c s i t u a t i o n such as h o s p i t a l i z a t i o n , i n f r e q u e n t events such as C h r i s t m a s , or more f r e q u e n t d a i l y o c c u r r e n c e s such as f a m i l y arguments or changes in uorK times ( C o c h r a n e , 1973; L a z a r u s , 1981). A l l events i n v o l v e an element of change and maKe demands on the i n d i v i d u a l to a c h i e v e adaptat i o n . L i f e events u h i c h impact d i f f e r e n t l y on i n d i v i d u a l s have been 21 compared a c c o r d i n g to frequency and ranK o r d e r or an a s s i g n e d u e i g h t e d s c o r e to address i n t e n s i t y or d u r a t i o n of the e v e n t . S c a l e s have been developed to q u a n t i f y the amount of change or impact of l i f e s t r e s s . These have been s c o r e d by summing the f r e q u e n c i e s of e v e n t s , adding u e i g h t e d s c o r e s , or doing m u l t i - d i m e n s i o n a l s c a l i n g of i n f l u e n c i n g f a c t o r s . In summary, the causes of a d u l t s t r e s s are s p e c i f i c f o r d i f f e r e n t groups and d i f f e r e n t s i t u a t i o n s . Dimensions of the s t r e s s o r s may be a d d r e s s e d . Comparison of one l i s t of s t r e s s o r s to another i s t h e r e f o r e d i f f i c u l t . Although an i n c l u s i v e l i s t of s t r e s s o r s uould seem not f e a s i b l e , t h e r e are some causes of s t r e s s which are common to many groups and s i t u a t i o n s . Research P e r t a i n i n g to the A d o l e s c e n t A d o l e s c e n t l i f e change events have a l s o been s t u d i e d f o r the purpose of q u a n t i f y i n g s t r e s s and i d e n t i f y i n g p o t e n t i a l s t r e s s o r s . Because p e r c e p t i o n v a r i e s u i t h age and p h y s i c a l s t a t e , t h i s r e v i e u of a d o l e s c e n t l i f e events c o n s i d e r s l i s t e d items t h a t o r i g i n a t e d u i t h a d o l e s c e n t s and those t h a t o r i g i n a t e d u i t h a d u l t s . A d o l e s c e n t s ' s e l f - r e p o r t s of items u h i c h cause them s t r e s s uere used to develop the 31-item A d o l e s c e n t L i f e Change Event S c a l e CALCES) d e s c r i b e d by Y e a u o r t h , YorK, Hussey, Ingle and Gooduin <1980). The events most f r e q u e n t l y e x p e r i e n c e d uere " h a s s l i n g u i t h b r o t h e r or s i s t e r " <87JO, "making neu f r i e n d s " ( 8 4 X ) , and " h a s s l i n g u i t h p a r e n t s " <75X). Items u h i c h uere g i v e n h i g h e r w e i g h t i n g s , a l t h o u g h not n e c e s s a r i l y e x p e r i e n c e d , uere those r e l a t e d to death or s e p a r a t i o n in the f a m i l y and c l o s e f r i e n d s , f a m i l y problems such as " f a m i l y member g e t t i n g very s i c K " or " f a m i l y member having t r o u b l e u i t h d r i n k i n g , " and those r e l a t e d to f a i l u r e s in s c h o o l . Seventy-one p e r c e n t of the respondents suggested a d d i t i o n a l items, most of u h i c h uere e l a b o r a t i o n s of those a l r e a d y i n c l u d e d . Items u h i c h d i f f e r e d , such as " g e t t i n g 22 pregnant," "screwing g i r l s , " " s t e a l i n g , " and " g e t t i n g beat up," were r e l a t e d t o sex and v i o l e n c e . A m o d i f i e d v e r s i o n of the ALCES with 38 items, has been used to study the i n f l u e n c e of socio-economic s t a t u s , s e x , and age on the change events <Mendez, Yeaworth, YorK & Goodwin, 1980>. Those who had e x p e r i e n c e d an e v e n t , such as " g e t t i n g i n t o drugs or a l c o h o l , " " f a i l i n g a s u b j e c t in s c h o o l , " or " g e t t i n g a r r e s t e d by p o l i c e , " r a t e d i t l e s s s t r e s s f u l than those who had not e x p e r i e n c e d the e v e n t . Females r e p o r t e d more events and a g r e a t e r w e i g h t i n g f o r events than males. N i n t h grade s t u d e n t s r a t e d more items as b e i n g s t r e s s f u l . Age was not a s i g n i f i c a n t v a r i a b l e , a l t h o u g h t h e r e was a t r e n d f o r the number of events e x p e r i e n c e d to i n c r e a s e with age. JacKson <1982) a l s o used a m o d i f i e d ALCES to study the r e l a t i o n s h i p of l i f e change events to i l l n e s s in h i gh s c h o o l s t u d e n t s . Those items most f r e q u e n t l y e x p e r i e n c e d a c r o s s a l l age l e v e l s were "making new f r i e n d s " < 87>0 and "breaking up with g i r l f r i e n d or b o y f r i e n d " < 46JO. In comparing l i f e change events by grade, items a s s o c i a t e d with s c h o o l were found more f r e q u e n t l y at the e n t r a n c e to h i g h s c h o o l . In l a t e r g r a d e s , items such as " i n c r e a s e d or worse arguments with p a r e n t s , " " f i n a n c i a l money problems," " s t a r t i n g a j o b , " and " i n c r e a s e in p r e s s u r e of having too many a c t i v i t i e s and not enough time" were more f r e q u e n t . Less f r e q u e n t was " g e t t i n g grounded." In the a n a l y s i s of l i f e change events by s e x , females r e p o r t e d more l i f e change events and these c e n t e r e d on "problems with s i z e " <42JO, " c l o s e g i r l f r i e n d g e t t i n g p r egnant" <24JO, " i n c r e a s e d or worse arguments with p a r e n t s " < 49JO, and "major assignments due f o r c l a s s e s " < 65JO . Males r e p o r t e d " s t a r t i n g a j o b " < 5350 and " g e t t i n g acne" < 35'A> more f r e q u e n t l y than f e m a l e s . Events r e l a t e d to i n t e r p e r s o n a l r e l a t i o n s were r e p o r t e d more f r e q u e n t l y by g i r l s in n i n t h and t e n t h g r a d e s . B r i t i s h s t u d i e s of a d o l e s c e n t l i f e change events have a l s o 23 been i d e n t i f i e d . A m o d i f i e d v e r s i o n of the ALCES uas a d m i n i s t e r e d to h i g h s c h o o l s t u d e n t s at the end p o i n t of t h e i r s e n i o r s c h o o l y e a r s . Common sou r c e s of s t r e s s c i t e d uere items r e l a t e d to s c h o o l , the f a m i l y , and s e p a r a t i o n or l o s s (Dobson, 1980). Over 66'A of s t u d e n t s c o n s i d e r e d b e i n g a s t u d e n t caused them extreme or a l o t of s t r e s s . S i m i l a r l y , in a study of male high s c h o o l s t u d e n t s in the e a r l i e r s e n i o r y e a r s (Dobson 1983, p. 351) s t r e s s uas a s s o c i a t e d u i t h study and examination problems, as u e l l as " l e t t i n g doun p a r e n t s " and u o r r i e s about t h e i r own g e n e r a l h e a l t h as common s t r e s s o r s . In comparing h e a l t h y to unhealthy s u b j e c t s , Tyerman and Humphrey <1983) c o n t r a s t e d p s y c h i a t r i c p a t i e n t s u i t h a matched c o n t r o l group of h e a l t h y a d o l e s c e n t s in the i n v e s t i g a t i o n of l i f e s t r e s s , u s i n g a s c a l e developed by the a u t h o r s . I n f o r m a t i o n on the s c a l e uas not i n c l u d e d in t h e i r r e p o r t , houever. The most f r e q u e n t l y i d e n t i f i e d items by the c o n t r o l and p a t i e n t groups uere "examinations" and "change to neu s c h o o l " u h i c h uere s i m i l a r to those c i t e d in the Dobson s t u d i e s . When items uere t o t a l l e d , the p a t i e n t group had a t h r e e - f o l d f r e q u e n c y of items as compared to the c o n t r o l group. As u e l l as these l i s t items o r i g i n a t i n g u i t h a d o l e s c e n t s , l i s t s have been developed by u s i n g items t h a t o r i g i n a t e d u i t h a d u l t s . T h i s approach uas used by Coddington (1972a). To q u a n t i f y s t r e s s , Coddington (1972a) had p r o f e s s i o n a l s i d e n t i f y the causes of s t r e s s f o r c h i l d r e n and a d o l e s c e n t s . Four s c a l e s uere developed f o r the d i f f e r e n t ages i n v o l v e d . Coddington then surveyed h e a l t h y c h i l d r e n and found l i f e change event s c o r e s i n c r e a s e d u i t h advancing age and t h i s a g e - r e l a t e d curve uas analogous to the grouth c u r v e . He found the most f r e q u e n t l y e x p e r i e n c e d items uere "break-up u i t h b o y / g i r l f r i e n d , " " i n c r e a s e in number of arguments u i t h p a r e n t s , " "beginning high s c h o o l , " and "beginning to d a t e . " In an attempt to develop a more i n c l u s i v e l i s t o f p o t e n t i a l 24 s t r e s s o r s . Palmer <19S1) had a d o l e s c e n t s respond to a 108 item i n v e n t o r y which o r i g i n a t e d with p r o f e s s i o n a l s . Study r e s u l t s were p r e s e n t e d as frequency of "most s t r e s s f u l " or " l e a s t s t r e s s f u l . " Trends in d a t a were not i n d i c a t e d . Items i d e n t i f i e d as p o t e n t i a l l y most s t r e s s f u l were "death of p a r e n t " and "death of f r i e n d . " E i g h t events were noted more f r e q u e n t l y by f e m a l e s . "Developing good r e l a t i o n s h i p s with a d u l t s o t h e r than p a r e n t s " was c o n s i d e r e d p o t e n t i a l l y more s t r e s s f u l f o r males than f e m a l e s . Moreover, ranK o r d e r of events d i f f e r e d f o r g i r l s and boys, but the m a j o r i t y of events in the top or bottom 10% were s i m i l a r . ft f u r t h e r 36 items were suggested in open-ended r e s p o n s e s . BurKe and Weir <1978) examined l i f e s t r e s s items, s o c i a l s u p p o r t , and p h y s i c a l and emotional w e l l - b e i n g in male and female a d o l e s c e n t s . L i f e s t r e s s items were grouped in seven c a t e g o r i e s . Females r e p o r t e d s i g n i f i c a n t l y g r e a t e r l i f e s t r e s s in the f o u r c a t e g o r i e s l a b e l l e d "peer a c c e p t a n c e , " " i s o l a t i o n , " " d i f f i c u l t i e s with p a r e n t s , " and " r e l a t i o n s h i p s with o p p o s i t e sex." The d i f f e r e n c e s in responses were e x p l a i n e d on the b a s i s of a d i f f e r e n c e in s o c i a l i z a t i o n e x p e r i e n c e s . The p e r s p e c t i v e s of a d o l e s c e n t s with c h r o n i c i l l n e s s may a l s o d i f f e r from those of h e a l t h y a d o l e s c e n t s . In another s t u d y , c h i l d r e n and a d o l e s c e n t s with d i a b e t e s were asked to l i s t and weight items which caused them s t r e s s <Kosub & Kosub, 19827. Those items most f r e q u e n t l y i d e n t i f i e d were "arguments with p a r e n t s , " "nonacceptance by p e e r s , " "having a c l o s e f r i e n d d i e , " " f e a r of a u t h o r i t y f i g u r e s , " and " r e l a t i o n s with o p p o s i t e sex." Some responses were s p e c i f i c to the d i s e a s e , but o t h e r s would be a p p l i c a b l e to h e a l t h y c h i l d r e n . The items r e l a t e d to i l l n e s s concerned i n t e r f e r e n c e with or a t h r e a t to a d o l e s c e n t developmental t a s k s such as the s t r u g g l e f o r independence, the e s t a b l i s h m e n t of i d e n t i t y , and the development and maintenance of peer and h e t e r o s e x u a l r e l a t i o n s h i p s . To c o n t r a s t t h e s e responses with those of h e a l t h y i n d i v i d u a l s , the items were compared to 25 Coddington's s c a l e s . There uas a s i g n i f i c a n t c o r r e l a t i o n betueen Coddington's rank order s c a l e and the d i a b e t i c s ' rank order of s t r e s s . However, Coddington's s c a l e accounted f o r only 6 6 X of the rank order items. The authors suggested Coddington's s c a l e might not be r e p r e s e n t a t i v e of d i a b e t i c a d o l e s c e n t s ' perceptions of s t r e s s nor of s t r e s s in the normal adolescent. N e v e r t h e l e s s , the r e s u l t s d i d support the contention that adolescents have a unique p e r s p e c t i v e and options must o r i g i n a t e u i t h them to be representat i v e . Summary S t r e s s o r s or causes of s t r e s s have been 1 inked to 1 i f e change events and have been s t u d i e d e x t e n s i v e l y , as have t h e i r l i n k s u i t h i l l n e s s in a d u l t s . These s t r e s s o r s vary among d i f f e r e n t groups and d i f f e r e n t s i t u a t i o n s . Adolescent s t r e s s o r s , as deri v e d from the p e r s p e c t i v e s of adolescents and p r o f e s s i o n a l s , uere s t u d i e d u i t h the i n t e n t i o n of q u a n t i f y i n g s t r e s s or i d e n t i f y i n g p o t e n t i a l s t r e s s o r s . The causes i d e n t i f i e d r e f l e c t the environment, developmental t a s k s , and a c t i v i t i e s of the age group. School has been i d e n t i f i e d as a major source of s t r e s s . R e l a t i o n s h i p s u i t h peers, p a r e n t s , f a m i l y and members of the opposite sex have been f r e q u e n t l y i d e n t i f i e d as common sources of s t r e s s , uhereas described d i f f e r e n c e s based on age, grade, and sex vary. G i r l s uere noted to rep o r t more causes of s t r e s s . Symptoms of Stress Research P e r t a i n i n g to the A d u l t The symptoms, or se1f-percept ions of s t r e s s , are a complex i n t e r t u i n i n g of emotions and p h y s i o l o g i c a l a c t i v i t y i n v o l v i n g the immune, e n d o c r i n e , and autonomic nervous systems. P a r r i n o <1979) c l a i m s the emotions, or " f e e l i n g " s t a t e s , are the symptoms of m a l a d a p t a t i o n or s t r e s s . These f e e l i n g s t a t e s i n c l u d e b e h a v i o r a l , a f f e c t i v e , and p h y s i o l o g i c a l m a n i f e s t a t i o n s <Cox, 1978, p. £ 5 ) . There are i n h e r e n t d i f f i c u l t i e s in s t u d y i n g the symptoms of s t r e s s s i n c e the a t t r i b u t i o n of symptoms i s shaped by change in body f u n c t i o n i n g , the c o g n i t i v e d e f i n i t i o n about what i s happening, and the i n d i v i d u a l t o l e r a n c e f o r s t r e s s ( M e c h a n i c , 1983, P P . 596-598). What the i n d i v i d u a l f e e l s i s i n f e r r e d from v e r b a l and w r i t t e n r e p o r t s or from appearance and b e h a v i o r . As a r e s u l t , t h e r e i s concern f o r s t a n d a r d i z a t i o n of language l a b e l s . Each person tends to a p p r a i s e neu b o d i l y e x p e r i e n c e s a g a i n s t p r i o r l e a r n i n g and e x p e r i e n c e (Mechanic, 1983, p. 591). Moreover, c o g n i t i v e development ( L e v e n t h a l , 1979, p.13) and s o c i a l l e a r n i n g i n f l u e n c e the symptoms and the v o c a b u l a r i e s people use to d e f i n e t h e i r c o m p l a i n t s (Mechanic, 197£). The s t r e s s e x p e r i e n c e i s an emotional one. There i s no one emotion l a b e l l e d " s t r e s s . " R a ther, s t r e s s encompasses v a r i o u s emotions such as anger, d e p r e s s i o n , f e a r and a n x i e t y ( P a r r i n o , 1979, p. £ 8 5 ) . T h e o r i e s of emotion, such as those by James Lange, Cannon and S c h a c h t e r , s e r v e to e x p l a i n the s t r e s s e x p e r i e n c e and r e l a t e the v i s c e r a l a r o u s a l , and the autonomic and c e n t r a l nervous system a c t i v i t y (Cox, 1978, P P . 31-37). S c h a c h t e r (1964; Sch a c h t e r & S i n g e r , 196£) has c l a i m e d emotions a r i s e from the i n t e g r a t i o n of c o g n i t i o n of the s i t u a t i o n and autonomic a r o u s a l . The i n d i v i d u a l ' s c o g n i t i o n s on past and p r e s e n t l y a v a i l a b l e i n f o r m a t i o n g i v e d i r e c t i o n to l a b e l l i n g emotions, he c l a i m s . F u r t h e r , these l a b e l s i n f l u e n c e hou emotion w i l l be e x p e r i e n c e d and hou one u i l l r espond. P h y s i o l o g i c a l a c t i v i t y i s r e l a t e d to the s t r e s s emotion. S e l y e (1976) d e s c r i b e d a g e n e r a l p a t t e r n of r e a c t i o n in the t h r e e stage General A d a p t a t i o n Syndrome. The t h r e e s t a g e s a r e : alarm, r e s i s t a n c e , and e x h a u s t i o n . During the a l a r m s t a g e , t h e r e i s an 27 i n i t i a l a c t i v a t i o n of defense u i t h an i n c r e a s e i n sympathetic-adrenomedu11ary a c t i v i t y as a r e s u l t of s t i m u l a t i o n by the hypothalamus. With c o n t i n u e d a c t i v a t i o n t h e r e i s r e l e a s e of t r o p i c hormones by the a n t e r i o r p i t u i t a r y and an i n c r e a s e in a d r e n o c o r t i c a l a c t i v i t y . The t h y r o i d g l and i s s t i m u l a t e d and a d e p r e s s i o n of the thymus and lymphatic system o c c u r s u i t h i n the immune system. During the st a g e of r e s i s t a n c e , the organism s t r i v e s f o r r e s o l u t i o n and f o r a d a p t a t i o n . With s u s t a i n e d s t r e s s , t h e r e i s c o n t i n u e d a c t i v a t i o n of a l l the p r o c e s s e s . T h i s may r e s u l t in body s t r u c t u r a l change. With c h r o n i c s e v e r e s t r e s s , the f i n a l s t a g e , e x h a u s t i o n , may occur and may end in deat h . I n d i v i d u a l response v a r i a t i o n i n p h y s i o l o g i c a l s t r e s s r e a c t i o n s have been s t u d i e d . P h y s i o l o g i c a l s t r e s s r e a c t i o n s d i f f e r in males and females <Col ins & FranKenhaeuser, 1978). Males have been found to s e c r e t e more a d r e n a l i n i n t h e i r response to s t r e s s , i n d i c a t i n g a g r e a t e r sympathetic-adrenomedu11ary response <Cox, 1978, p. 65). D i f f e r e n c e s u i t h age have a l s o been suggested ( P e t e r s e n & S p i g a , 1982). P h y s i o l o g i c a l l y , an i n d i v i d u a l tends to respond in a s i m i l a r f a s h i o n to d i f f e r e n t s t r e s s o r s (Lacey & Lacey, 1858), houever, each i n d i v i d u a l may respond d i f f e r e n t l y to the same s t r e s s o r . It has been proposed t h a t i n d i v i d u a l v a r i a t i o n s in the p h y s i o l o g i c a l r e a c t i o n s are l a r g e l y determined by the i n t e r f a c e of the p s y c h o l o g i c a l f a c t o r s in s t r e s s (Cox, 1978, p. 7; L a z a r u s , 1966). Awareness of p h y s i o l o g i c a l a c t i v i t y r e l a t e d to emotion has a l s o been s t u d i e d . It has been suggested i n c r e a s e d p h y s i o l o g i c a l a c t i v i t y i s a s s o c i a t e d u i t h an i n c r e a s e d auareness of symptoms ( S h i e l d s & S t e r n , 1979) and t h a t f a c t o r s r e l a t e d to the i n d i v i d u a l i n f l u e n c e the symptoms. Furthermore, males and females a l s o d i f f e r in t h e i r s t r e s s symptoms. For example, in a study of p h y s i o l o g i c a l symptoms, males r e p o r t e d more "sweating palms" than females ( S t e r n & H i g g i n s , 1969). Females uere r e p o r t e d to i d e n t i f y more symptoms of s t r e s s than males ( S t e r n & H i g g i n s , 28 1869) as as s e s s e d u s i n g the Somatic P e r c e p t i o n Q u e s t i o n n a i r e u h i c h measures p h y s i o l o g i c a l symptoms. Mechanic <1976b) found females r e p o r t e d more symptoms of i l l n e s s and d i s t r e s s than males in h i s study of h e a l t h c o m p l a i n t s . Sex d i f f e r e n c e s in r e a c t i o n s to p a i n and i l l n e s s have been found to be apparent by grade f o u r and i n c r e a s e with age (Leu i s . Leu i s , Lorimer & Palmer, 1977; Mechanic, 1983, P . 594). With i n c r e a s i n g age. S t e r n and H i g g i n s (1969) found c o l l e g e s t u d e n t s and t h e i r s i b l i n g s r e p o r t e d a h i g h e r i n c i d e n c e of symptoms on the Somatic P e r c e p t i o n Q u e s t i o n n a i r e . C u l t u r e ( S h i e l d s & S t e r n , 1979; Z b o r o u s K i , 1977) and s i m i l a r i t y t o pa r e n t ' s s e l f - r e p o r t s of p e r c e p t i o n s ( S t e r n & H i g g i n s , 1969) a l s o i n f l u e n c e p e r c e i v e d somatic r e a c t i o n s to s t r e s s . One study addressed the p e r c e i v e d symptoms of s t r e s s to i n c l u d e b e h a v i o r a l , a f f e c t i v e , and p h y s i o l o g i c a l m a n i f e s t a t i o n s . Humphrey and E v e r l y (1980) examined p e r c e i v e d s t r e s s r e a c t i o n s in c o l l e g e s t u d e n t s u s i n g an a n x i e t y s c a l e . From f a c t o r a n a l y s i s , s t a t i s t i c a l l y independent f a c t o r s uere found f o r each sex. The g r e a t e s t d i f f e r e n c e s uere noted in the g a s t r o i n t e s t i n a l s e n s i t i v i t y r e p o r t e d by males and the n e g a t i v e a f f e c t i v e r e a c t i o n r e p o r t e d by fe m a l e s . Both sexes r e p o r t e d items in the a c t i v e m u s c u l o s k e l e t a l and c a r d i o v a s c u l a r g r o u p i n g s , a l t h o u g h the i n d i v i d u a l items each sex r e p o r t e d uere not s i m i l a r . To a s s e s s the p e r c e p t i o n of t h i s i n t e r p l a y of emotions, e n d o c r i n e and autonomic nervous system a c t i v i t y , numerous s t r e s s i n v e n t o r i e s have been developed f o r a d u l t s . They vary in l e n g t h . S e l y e (1976, P P . 173-177) i d e n t i f i e d a l i s t of 31 se1f-observab1e s i g n s of s t r e s s . Examples of such q u e s t i o n n a i r e s are the " S i g n a l of S t r e s s " ( J . D. Adams, 1980, p. 174) and the "Symptoms of S t r e s s Q u e s t i o n n a i r e " ( C o o p e r , 1980, pp. 164-165). Some s t r e s s i n v e n t o r i e s , such as the Psychosomatic S t r e s s T e n s i o n R e l a x a t i o n Inventory ( W a l l a c e , 1980, p. 253) and the Somatic P e r c e p t i o n Q u e s t i o n n a i r e ( S h i e l d s & S t e r n , 1979), have been e m p i r i c a l l y t e s t e d . Some are more i n c l u s i v e than o t h e r s . They may address 29 p e o p l e s ' a f f e c t i v e f e e l i n g s , what people f e e l 1 iKe d o i n g , and what they f e e l happens to t h e i r body. The s t r e s s symptoms, t h e n , as s t u d i e d p r i m a r i l y in a d u l t s , are a mixture of emotions and p h y s i o l o g i c a l a c t i v i t y ; are i n f l u e n c e d by l e a r n i n g ; and are e videnced as b e h a v i o r a l , a f f e c t i v e , and p h y s i o l o g i c a l m a n i f e s t a t i o n s . Research Pertaining to the Adolescent A lacK of r e s e a r c h i n f o r m a t i o n p e r t a i n i n g to a d o l e s c e n t s ' symptoms of s t r e s s i s noted in review of the l i t e r a t u r e . F urthermore, t h e r e are few s e l f - r e p o r t s of emotional e x p e r i e n c e from a developmental p e r s p e c t i v e ( S h i e l d s & S t e r n , 1979, p. 104). In one s t u d y , a m o d i f i e d v e r s i o n of the Somatic P e r c e p t i o n Q u e s t i o n n a i r e was used with g i r l s and boys age 7 to 10 who were asKed to r e p o r t t h e i r p h y s i o l o g i c a l r e a c t i o n s to a s t o r y . The most f r e q u e n t l y r e p o r t e d symptoms were " i n c r e a s e d h e a r t r a t e " ( 8 7 % ) , " r e s t l e s s n e s s " <77JO, and "awareness of h e a r t a c t i v i t y " <77>0. There were no s i g n i f i c a n t d i f f e r e n c e s in responses between boys and g i r l s or between i n d i v i d u a l s of d i f f e r e n t ages. Furthermore, no i n v e n t o r i e s which address the symptoms of s t r e s s e x p e r i e n c e d by the a d o l e s c e n t have been i d e n t i f i e d and i n v e s t i g a t i o n of the s e l f - r e p o r t s of a d o l e s c e n t s t r e s s r e a c t i o n s are not Known. The lacK of Knowledge and lacK of i n v e s t i g a t i o n of a d o l e s c e n t s t r e s s symptoms, t h u s , warrants e x p l o r a t i o n . Summary. The p r e s e n t Knowledge c o n c e r n i n g s t r e s s symptoms i s d e r i v e d p r i m a r i l y from s t u d i e s with a d u l t s . These s t u d i e s i n d i c a t e the symptoms of s t r e s s are an emotional e x p e r i e n c e a t t r i b u t e d to a l t e r a t i o n in p h y s i o l o g i c a l a c t i v i t y , i n d i v i d u a l t o l e r a n c e f o r s t r e s s , and c o g n i t i v e d e f i n i t i o n s of the s i t u a t i o n . These 30 symptoms may be m a n i f e s t e d as b e h a v i o r a l , a f f e c t i v e and P h y s i o l o g i c a l f e e l i n g s t a t e s . For a d u l t s , d i f f e r e n c e s in symptoms are noted based on age and sex. More symptoms are r e p o r t e d by f e m a l e s , the frequency of d i f f e r e n t symptoms v a r i e s f o r each sex, and the number of symptoms r e p o r t e d i n c r e a s e s with age. S e l f - r e p o r t s of s t r e s s r e a c t i o n s by the a d o l e s c e n t are not i d e n t i f i e d , nor are i n v e n t o r i e s of s t r e s s symptoms s p e c i f i c f o r the a d o l e s c e n t i d e n t i f i e d . I n v e s t i g a t i o n of s t r e s s symptoms f o r the a d o l e s c e n t i s warranted. Responses to S t r e s s Research P e r t a i n i n g to the A d u l t S t r e s s responses to 1 i f e - t h r e a t e n i n g s i t u a t i o n s and major upheavals have been d e s c r i b e d . The s t u d i e s have been of such events as near drowning ( J a n i s , 1971), undergoing s u r g e r y (Jan i s , 1958), a d j u s t i n g to permanent d i s a b i l i t y (Adams & Lindeman 1974; Shontz 1975;), or i l l n e s s (Cohen and L a z a r u s , 1979; G a r f i e l d , 1979) and e n t e r i n g c o l l e g e ( S i l b e r , Hamburg, C o e l h o , Murphy, Rosenberg & P e r l i n , 1961; C o e l h o , Hamburg & Murphy, 1963). However, s t u d i e s of w e l l i n d i v i d u a l s with s e l f - r e p o r t s of responses to the s t r e s s of d a i l y l i v i n g are few. As responses are i n f l u e n t i a l in the s t r e s s e x p e r i e n c e and outcome, t h e r e i s need f o r a d d i t i o n a l r e s e a r c h . In the p r e s e n t s t u d y , responses or copin g are s u b d i v i d e d i n t o b e h a v i o r s and a v a i l a b l e r e s o u r c e s . B e h a v i o r s are the s p e c i f i c a c t i o n s employed to r e d u c e , a v o i d or manage the s t r e s s f u l s i t u a t i o n . Resources are f a c t o r s a v a i l a b l e to people as they develop t h e i r c o p i n g r e p e r t o i r e . Response b e h a v i o r s . Response b e h a v i o r s have been c a t e g o r i z e d a c c o r d i n g to t h e i r 31 primary f o c u s : the problem, the emotion, and the c o g n i t i v e a p p r a i s a l (Moos & B i l l i n g s , 1982). Problem-focused c o p i n g s e r v e s to f i n d a s o l u t i o n to a d i f f i c u l t y and e n t a i l s d i r e c t a c t i o n in r e l a t i o n to a s i t u a t i o n such as s e e k i n g i n f o r m a t i o n , a d v i c e , or h e l p ; d e v e l o p i n g a l t e r n a t i v e r e u a r d s ; or changing a c t i v i t i e s . E motion-focused c o p i n g s e r v e s to r e g u l a t e the emotional upheaval through the c o n t r o l and d i s c h a r g e of f e e l i n g s or r e s i g n e d a c c e p t a n c e . C o g n i t i v e a p p r a i s a l - f o c u s e d c o p i n g s e r v e s to a f f e c t the p e r c e p t i o n of the event by a t t e m p t i n g to d e f i n e the meaning, cause, or s o l u t i o n to problems; drawing upon past e x p e r i e n c e s ; or m e n t a l l y r e h e a r s i n g a c t i o n s and consequences of s i t u a t i o n s . These s t r e s s response b e h a v i o r s have been s t u d i e d in u e l l p o p u l a t i o n s . S e l f - r e p o r t s of c o p i n g b e h a v i o r s have been i d e n t i f i e d by samples w i t h i n the community ( B i l l i n g s & Moos, 1981; FolKman & L a z a r u s , 1980; P e a r l in & S c h o o l e r , 1978). Except f o r the P e a r l in and S c h o o l e r s t u d y , q u e s t i o n items f o r these s t u d i e s uere d e r i v e d from the l i t e r a t u r e c o n c e r n i n g c r i s i s s i t u a t i o n s or pathology as opposed to normal, everyday events (Moos & B i l l i n g s , 1932). Q u e s t i o n s f o r the P e a r l in & S c h o o l e r study uere developed from e x p l o r a t o r y i n t e r v i e w s u i t h a u e l l community sample. In a d d r e s s i n g a p a r t i c u l a r p o p u l a t i o n . S i d l e , Moos, Adams and Cady (1969) developed a 10 item c o p i n g s t r a t e g y s c a l e by a s k i n g c o l l e g e s t u d e n t s hou they uould respond to d e s c r i p t i o n s of s t r e s s f u l s i t u a t i o n s . The items on the s c a l e uere found to be d i s c r e t e and the responses of boys and g i r l s d i f f e r e d f o r f i v e out of ten s t r a t e g i e s . Females uere found to seek a d d i t i o n a l i n f o r m a t i o n , t a l k u i t h o t h e r s , become i n v o l v e d in o t h e r a c t i v i t i e s and reduce t e n s i o n more than males. Males uere more prepared to accept the u o r s t . There uere no s i g n i f i c a n t d i f f e r e n c e s based on age. In another s t u d y , r e p o r t e d by Ziemer ( 1 9 8 2 ) , 61 c o l l e g e s t u d e n t s uere asked uhat they d i d uhen c o n f r o n t e d u i t h a s t r e s s f u l e vent. T h i r t y - t u o of the respondents s t a t e d t h a t " t a l k i n g to someone" uas the p r e f e r r e d b e h a v i o r , seventeen c l a i m e d "doing 32 something e l s e , " s i x t e e n s t a t e d " e a t , " and t h i r t e e n r e p l i e d they "engage in p h y s i c a l a c t i v i t y . " The p a r t i c i p a n t s i d e n t i f i e d from 1 to 5 b e h a v i o r s with an average of 2.3 each. Many items l i s t e d were s i m i l a r to those noted on the S i d l e s c a l e . Furthermore, in a comparative study of c o p i n g methods in h e a l t h y i n d i v i d u a l s and those with mental i l l n e s s . B e l l < 197?> d i f f e r e n t i a t e d between long term and s h o r t term c o p i n g . Those respondents with mental i l l n e s s used more s h o r t term c o p i n g . The s t r e s s response b e h a v i o r s may be summarized in terms of the o u t l i n e d c a t e g o r i e s . FolKman and Lazarus < 1980) found i n d i v i d u a l s tend to use b e h a v i o r s s e r v i n g problem s o l v i n g and emotion c o n t r o l with each s t r e s s f u l e v e n t , and t h e s e b e h a v i o r s may be complementary to each o t h e r <Cohen & L a z a r u s , 1983). Persons who are more l i k e l y to use c o g n i t i v e s t r a t e g i e s and l e s s l i k e l y to a v o i d s i t u a t i o n s , show b e t t e r a d a p t a t i o n outcomes ( B e l l , 1977; Moos & B i l l i n g s , 1982). There i s a c e r t a i n d u r a b i l i t y to p a t t e r n s of responses (Hamburg, E l l i o t t & P a r r o n , 1882, p. 77; Moos & B i l l i n g s , 1982, P . 220; S i d l e et a l . , 1969, p. 230) and a d d i t i o n a l responses may be c u m u l a t i v e in t h e i r e f f e c t . P e a r l in and S c h o o l e r < 1978) suggest i t i s not the p a r t i c u l a r c o p i n g b e h a v i o r but the v a r i e t y of c o p i n g s k i l l s used which l e a d to s u c c e s s f u l c o p i n g . Response resources! Resources which i n f l u e n c e the s t r e s s response are i d e n t i f i e d . These may be p e r s o n a l , s o c i a l , or m a t e r i a l v a r i a b l e s . Some are amenable to m a n i p u l a t i o n and some may be enhanced as p a r t of the s t r e s s r e s p o n s e . S e v e r a l e n d u r i n g t r a i t s have been a s s o c i a t e d with e f f e c t i v e c o p i n g . ft p e r s o n a l i t y v a r i a b l e which Kobasa <1979; Kobasa, Maddi & Kahn, 1982) c a l l e d " h a r d i n e s s " has been l i n k e d to b u f f e r i n g the d e l e t e r i o u s e f f e c t s of s t r e s s . It i s comprised of commitment, which i s a sense of meaningfulness and a d e s i r e to get i n v o l v e d ; c o n t r o l , which i s to f e e l and a c t as i f one can i n f l u e n c e e v e n t s ; 33 and c h a l l e n g e , u h i c h i s the view t h a t change i s a c h a l l e n g e and needed f o r g r o u t h . AntonevsKy <1979) c a l l e d a t t e n t i o n to "a sense of coherence," u h i c h r e f e r s to the e x t e n t a person f e e l s c o n f i d e n t t h a t h i s i n t e r n a l and e x t e r n a l environments are p r e d i c t a b l e and t h i n g s u i l l uorK o u t . Another p e r s o n a l i t y t r a i t . Type A B e h a v i o r , may be viewed in an ambivalent manner. It i s c h a r a c t e r i z e d by compu1siveness, c o m p e t i t i v e n e s s , and a c o m p e l l i n g sense of time urgency. In one sense, i t i s a uay of c o p i n g u i t h s o c i e t a l v a l u e s of achievement and the uorK e t h i c , but in a n o t h e r , i t has been 1inKed to h e a r t d i s e a s e (Friedman & Rosenman, 1978). Good p h y s i c a l c o n d i t i o n a s s o c i a t e d u i t h h e a l t h p r a c t i c e s such as s u f f i c i e n t s l e e p , ue11-balanced n u t r i t i o n , and p h y s i c a l e x e r c i s e i s a b u f f e r f o r the d e l e t e r i o u s e f f e c t s of s t r e s s r e a c t i o n s . With p h y s i c a l e x e r c i s e , p r o d u c t s of the s t r e s s r e a c t i o n are u t i l i z e d . There i s a decrease in a n x i e t y and a r e s u l t i n g i n c r e a s e in s e l f - e s t e e m . An improved f i t n e s s l e v e l leads to g r e a t e r t o l e r a n c e of s t r e s s ( E v e r l y & R o s e n f e l d 1981, pp. 159-161>. F a c t o r s r e l a t e d to the s e l f - c o n c e p t are i d e n t i f i e d as c o p i n g r e s o u r c e s . Bandura <1977) fo c u s e d on the n o t i o n of s e 1 f - e f f i c a c y , the b e l i e f t h a t one can s u c c e s s f u l l y accomplish a ta s K . He noted s e l f - e f f i c a c y i s n e c e s s a r y f o r a c t i v e e f f o r t s to manage a tasK and i s f a c i l i t a t e d by s u c c e s s f u l c o p i n g . Persons u i t h h i g h e r s e 1 f - e f f i c a c y are more a c t i v e and p e r s i s t e n t in t h e i r e f f o r t s to handle s t r e s s , w h i l e those with lower l e v e l s a v o i d s i t u a t i o n s or are more p a s s i v e in t h e i r r e s p o n s e . R e l a t e d to s e 1 f - e f f i c a c y i s a p r e d i c t a b i l i t y and a degree of p e r c e i v e d c o n t r o l over a s i t u a t i o n ( S e l i g m a n , 1975). Without c o n t r o l , " l e a r n e d h e l p l e s s n e s s " may r e s u l t . T h i s o c c u r s uhen a person b e l i e v e s they have no e f f e c t on a s i t u a t i o n and cease any e f f o r t . P e a r l in and S c h o o l e r < 1978) c o n s i d e r e d c o n t r o l as they i d e n t i f i e d r e s o u r c e s r e l a t e d to s u c c e s s f u l c o p i n g . These r e s o u r c e s u e r e : freedom from s e l f - d e n i g r a t i o n or d e r o g a t o r y thoughts about o n e s e l f , p o s i t i v e 34 se 1 f-esteem, and a sense of c o n t r o l f o r o n e s e l f and the s i t u a t i o n . These p e r s o n a l r e s o u r c e s were c l a i m e d to be more important f o r s u c c e s s f u l s t r e s s management than d i r e c t a c t i o n in s i t u a t i o n s where t h e r e i s l i t t l e o p p o r t u n i t y f o r d i r e c t c o n t r o l . S o c i a l s u p p o r t , s o c i a l p a r t i c i p a t i o n , and s o c i a l p o s i t i o n have been i d e n t i f i e d as i n f l u e n t i a l in s t r e s s r e d u c t i o n <Caplan, 1974; Cobb, 1976; RabKin & S t r u e n i n g , 1976). The a v a i l a b i l i t y of a r e l i a b l e s o c i a l s u p p ort network i s a f a c t o r in m i t i g a t i n g the e f f e c t s of s t r e s s ( L i e b e r m a n , 1982). S o c i a l s u p p o r t i s d e f i n e d as e n d u r i n g i n t e r p e r s o n a l t i e s to a group s h a r i n g s i m i l a r s t a t u s and v a l u e s <Caplan, 1974). These support systems promote mastery of d i f f i c u l t e x p e r i e n c e s by p r o v i d i n g a b u f f e r a g a i n s t the e f f e c t s of s t r e s s , o f f e r i n g d i r e c t i o n and g u i d a n c e , i d e n t i f y i n g p e r s o n a l and community r e s o u r c e s , and p r o v i d i n g feedback about b e h a v i o r (Hamburg, E l l i o t t & P a r r o n , 1982, pp. 297-300). In s o c i a l i n t e r a c t i o n , the r o l e s one assumes may be a r e s o u r c e or a hindrance in managing s t r e s s . RabKin and S t r e u n i n g < 1976) i d e n t i f i e d t h r e e impairments in the s o c i a l system which may exacerbate s t r e s s . These impairments ares s o c i a l i s o l a t i o n , c h a r a c t e r i z e d by l i v i n g and f u n c t i o n i n g a l o n e ; s o c i a l m a r g i n a l i t y , which i s membership in a low s t a t u s or a n u m e r i c a l m i n o r i t y group; and s t a t u s i n c o n s i s t e n c y , c h a r a c t e r i z e d by m a i n t a i n i n g two or more r o l e s which are i n c o m p a t i b l e . Resources can a f f e c t the p e r c e p t i o n of a s i t u a t i o n as w e l l as the s e l e c t i o n of c o p i n g b e h a v i o r s . P r e v i o u s s u c c e s s at c o p i n g tends to f a c i l i t a t e s u c c e s s f u l c o p i n g (Hamburg, E l l i o t t and Parron 1982, pp. 77-78; Monat & L a z a r u s , 1977, p. 213) and mastery i s thought to b r i n g improved s k i l l s and i n c r e a s e d s e l f - e s t e e m . Phenomeno1ogical s t u d i e s r e l a t e d to c o p i n g r e s o u r c e s in a d u l t s were not i d e n t i f i e d . 35 Research P e r t a i n i n g to the A d o l e s c e n t In a major phenomeno1ogical study of the a d o l e s c e n t s e l f . O f f e r , Ostrov and Houard (1381) i n c l u d e d a 10 item c o p i n g s c a l e u h i c h addressed p s y c h o p a t h o l o g y , mastery, and adjustment. A d o l e s c e n t s d i d not generate the items f o r t h i s s c a l e . Healthy a d o l e s c e n t s uere found to see themselves u i t h o u t major problems. D i f f e r e n c e s uere noted with age and sex. O i r l s r e p o r t e d more empathetic f e e l i n g s and more attachment to r e l a t i v e s and f r i e n d s than boys. Younger g i r l s e xpressed more concerns r e l a t e d to t h e i r s e l f - c o n c e p t s . L o n g i t u d i n a l s t u d i e s have addressed p a t t e r n s of c o p i n g and a d a p t a t i o n in a d o l e s c e n c e . S p e c i f i c b e h a v i o r s have not been a d d r e s s e d . In a study of c h i l d r e n and a d o l e s c e n t s , M o r i a r t y and Toussieng (1976) d e s c r i b e d f o u r g e n e r a l c o p i n g s t y l e s . These s t y l e s ranged on a continuum betueen those the i n d i v i d u a l h o l d s as e s t a b l i s h e d v a l u e s and those uhere change uas sought. These s t y l e s tend to remain c o n s i s t e n t throughout c h i l d h o o d and a d o l e s c e n c e . v a i l l a n t (1977) s t u d i e d c o p i n g s t y l e s based on the use of defense mechanisms as a d o l e s c e n t s p r o g r e s s to a d u l t h o o d . He i d e n t i f i e d f o u r l e v e l s c o n s i d e r e d deve1opmental1y p r o g r e s s i v e . From a l o n g i t u d i n a l study of middle c l a s s f a m i l i e s . Murphy and M o r i a r t y (1976) d e s c r i b e d c o n d i t i o n s u h i c h c o n t r i b u t e d to c o p i n g such as o p p o r t u n i t i e s to e x p l o r e , s u p p o r t , and the d e f i n i t i o n of c l e a r l i m i t s . F urthermore, s t r e s s uas seen as a c h a l l e n g e u h i c h s t i m u l a t e d f u r t h e r energy and a l s o p r o v i d e d an " i n o c u l a t i o n " e f f e c t u i t h a r e s u l t i n g a b i l i t y to cope. Murphy and M o r i a r t y advocated l o o k i n g f o r an optimal l e v e l of s t r e s s f o r the development of e f f e c t i v e c o p i n g p a t t e r n s ( p . 351). Coping b e h a v i o r s used by the c h i l d and youth u i t h c h r o n i c i l l n e s s or d i s a b i l i t y have been d e s c r i b e d , based on o b s e r v a t i o n s by h e a l t h p r o f e s s i o n a l s . The d e s c r i p t i o n s uere p a r t i c u l a r to managing the d i s e a s e ( M a t t s s o n , 1972; S t e e l e , 1971) and a number 36 of b e h a v i o r s i n v o l v e d the use of defense mechanisms ( D a n i e l , 1377; M a t t s s o n , 1972). Moos and Tsu (1977) i d e n t i f i e d major a d a p t i v e t a s k s and s k i l l s f o r those with i l l n e s s . Some uere r e l a t e d to i l l n e s s and some uere more g e n e r a l , r e l e v a n t to d i f f e r e n t t ypes of s t r e s s . These g e n e r a l t a s k s uere to p r e s e r v e a r e a s o n a b l e emotional b a l a n c e , to m a i n t a i n a s a t i s f a c t o r y s e l f - i m a g e and r e l a t i o n s h i p s with f a m i l y and f r i e n d s , and to prepare f o r an u n c e r t a i n f u t u r e . These are s i m i l a r to the a d o l e s c e n t developmental t a s k s i d e n t i f i e d by H a v i g h u r s t (1958?. The c o p i n g s k i l l s i d e n t i f i e d are complementary to the c o p i n g b e h a v i o r c a t e g o r i e s d e s c r i b e d f o r the a d u l t (Moos & B i l l i n g s , 1982). These u e r e : m i n i m i z i n g the s e r i o u s n e s s of i l l n e s s and m e n t a l l y r e h e a r s i n g in the c o g n i t i v e a p p r a i s a l - f o c u s e d c a t e g o r y ; s e e k i n g r e l e v a n t i n f o r m a t i o n , s e t t i n g c o n c r e t e g o a l s and l e a r n i n g s p e c i f i c s k i l l s r e l a t e d to the problem in the problem-focused c a t e g o r y ; and r e q u e s t i n g r e a s s u r a n c e and emotional support in the emotion-focused c a t e g o r y . The e f f e c t s of e x p e r i e n c e and time with c h r o n i c i l l n e s s are e x e m p l i f i e d in s t u d i e s by Z e l t z e r , K e l l e r m a n , E l l e n b e r g , Dash and R i g l e r (1988; K e l l e r m a n , Z e l t z e r , E l l e n b e r g , Dash & R i g l e r , 1980), Kosub and C e r r e t o (1981) and B e d e l l , G i o r d a n i . Amour, Tavormina and B o l l (1977). A n x i e t y was r e l a t e d to l i f e s t r e s s f o r h e a l t h y y o u t h , but not in those with c h r o n i c d i s e a s e . The youth with c h r o n i c i l l n e s s have l e a r n e d to l i v e u i t h v a r y i n g degrees of d i s r u p t i o n , and have developed adequate c o p i n g mechanisms and heightened s t r e s s t o l e r a n c e which uould support the c o n t e n t i o n of Murphy and M o r i a r t y (1976) t h a t e x p e r i e n c e with s t r e s s p r o v i d e s an i n c r e a s e d a b i l i t y to cope. S t u d i e s to i d e n t i f y a d o l e s c e n t s ' s e l f - r e p o r t s of s t r e s s responses have not been undertaken. 37 Summary Pr e s e n t s t r e s s t h e o r y i n d i c a t e s a v a r i e t y of response b e h a v i o r s and r e s o u r c e s r e l a t e to s u c c e s s f u l c o p i n g . B e h a v i o r s r e l a t e d to a d a p t i v e outcomes are the use of a v a r i e t y of s k i l l s , the use of c o g n i t i v e and problem-focused s t r a t e g i e s as opposed to a v o i d a n c e , and the use of a combination of s t r a t e g i e s . Response r e s o u r c e s i n f l u e n t i a l in c o p i n g ares p e r s o n a l i t y t r a i t s of h a r d i n e s s and a sense of coherence; s e l f - f a c t o r s such as s e 1 f - e f f i c a c y , p o s i t i v e s e l f - e s t e e m , and freedom from s e 1 f - d e p r e c a t i o n ; l o c u s of c o n t r o l ; s o c i a l support and s o c i a l p o s i t i o n ; and good p h y s i c a l c o n d i t i o n a r i s i n g from s u f f i c i e n t s l e e p , r e g u l a r e x e r c i s e , and good n u t r i t i o n . L o n g i t u d i n a l s t u d i e s and s t u d i e s of s i c K a d o l e s c e n t s have addressed g e n e r a l p a t t e r n s of b e h a v i o r s in a d o l e s c e n t c o p i n g . It i s noted t h a t e x p e r i e n c e u i t h s t r e s s may r e s u l t in more adequate c o p i n g or i n c r e a s e d t o l e r a n c e f o r s t r e s s . S t u d i e s t h a t concern s p e c i f i c s e l f - r e p o r t s of s t r e s s r esponses f o r the h e a l t h y a d o l e s c e n t are l a c k i n g . Outcomes of S t r e s s Research P e r t a i n i n g to the A d u l t S t r e s s has been l i n k e d u i t h d i s e a s e p r e d i s p o s i t i o n , p r e c i p i t a t i o n , c o u r s e , and outcome ( E l l i o t t & E i s d o r f e r , 1982) but the e v i d e n c e f o r a cause and e f f e c t r e l a t i o n s h i p i s not c o n c l u s i v e . Houever, i t can be c oncluded i n d i v i d u a l s uho e x p e r i e n c e i n t e n s e , c h r o n i c , or a uide range of s t r e s s f u l events are at an i n c r e a s e d r i s k of d e v e l o p i n g a p h y s i c a l or mental d i s o r d e r ( E l l i o t t & E i s d o r f e r , 1982; D. A. Hamburg, 1982, p. x i x ) . The c a u s e s , r e a c t i o n s , and responses of s t r e s s have been s t u d i e d in r e l a t i o n to outcome. In s p i t e of many v a r i a b l e s , a 38 c o n s i s t e n t , a l t h o u g h not c o n v i n c i n g l y s t r o n g , r e l a t i o n s h i p has been found r e l a t i n g l i f e change events to i l l n e s s (Hyman & Woog, 1982). The r e a c t i o n s to s t r e s s a l t e r the f u n c t i o n i n g of the e n d o c r i n e , autonomic, and immune systems which may f a c i l i t a t e the onset of d i s e a s e <Zegans, 1982, p. 150). C o p i n g , moreover, may a f f e c t the p r e c i p i t a t i o n of i l l n e s s and maintenance of d i s e a s e by i n f l u e n c i n g the f r e q u e n c y , i n t e n s i t y , and p a t t e r n i n g of the p h y s i o l o g i c a l s t r e s s r e a c t i o n s . D i s e a s e may be p r e c i p i t a t e d or m a i n t a i n e d uhen an i n d i v i d u a l choses i n j u r i o u s agents such as a l c o h o l or tobacco as a s t r e s s response and thus m a i n t a i n a p h y s i o l o g i c a l r e a c t i o n . D i s e a s e may a l s o be m a i n t a i n e d as p h y s i o l o g i c a l symptoms or i l l n e s s b e h a v i o r s are used to cope. Hou an i n d i v i d u a l copes with i l l n e s s can i n f l u e n c e the course of t h a t i l l n e s s and i t s outcome ( H o l r o y d & Lazarus 1882, p. 2 6 ) . For a d u l t s , i d e n t i f i e d outcomes of s t r e s s have been major i l l n e s s e s such as h y p e r t e n s i o n , p e p t i c u l c e r s , c o r o n a r y a r t e r y d i s e a s e , asthma, a l c o h o l i s m , and d i a b e t e s ; mental i l l n e s s e s such as d e p r e s s i o n , n e u r o s i s , s c h i z o p h r e n i a , and s u i c i d e < B i e l i a u s K a s , 1982; Cox, 1978; E l l i o t t & E i s d o r f e r , 1982); c o m p l i c a t i o n s of pregnancy ( N u c h o l l s , C a s s e l & K a p l a n , 1972); o b e s i t y (Dobson, 1983, p. 243); minor i l l n e s s e s such as " c o l d s , " stomach aches, and c o l d s o r e s ( C a s s i d y 1972; E l l i o t t & E i s d o r f e r , 1982); and a c c i d e n t s such as a t h l e t i c i n j u r i e s < Br annuel 1, Masuda, Wagner & Holmes, 1975). S t r e s s has a l s o been i m p l i c a t e d in t u b e r c u l o s i s , asthma, c a n c e r , rheumatoid a r t h r i t i s , and h y p e r t h y r o i d i s m < B i e l i a u s K a s , 1982). Research P e r t a i n i n g to the A d o l e s c e n t L i f e changes f o r c o l l e g e freshmen (Marx, G a r r i t y & Bowers, 1975) and f o r the a d o l e s c e n t <CIine & Chosey, 1972; J a c k s o n , 1982) have a l s o been r e l a t e d to h e a l t h change. Those a d o l e s c e n t s who uere found to be pregnant at a f a m i l y p l a n n i n g c l i n i c had both a 39 g r e a t e r w e i g h t i n g and a g r e a t e r frequency of l i f e change events than non-pregnant g i r l s ( R o b b i n s , 1981). Coddington ( 1979) r e p o r t e d more l i f e change in pregnant a d o l e s c e n t s than in a c o n t r o l groups the pregnant g i r l s e x p e r i e n c e d s i g n i f i c a n t l y more t h r e a t e n e d or a c t u a l l o s s of f a m i l y members as compared to the c o n t r o l group. A t h l e t e s in c o l l e g e uere found to have an i n c r e a s e d r a t e of i n j u r y u i t h more l i f e change ( B r a m u e l l et a l . , 1975). S t r e s s f u l l i f e e v e n t s , a s s o c i a t e d u i t h l e s s p e r c e i v e d s u p p o r t , uere more o f t e n r e p o r t e d by o u t p a t i e n t p s y c h i a t r i c p a t i e n t s than by a c o r r e s p o n d i n g c o n t r o l group <Tyerman & Humphrey, 1983). F u r t h e r , in a p r o s p e c t i v e s t u d y , an i n c r e a s e in u p s e t t i n g events uas found in f a m i l i e s of c h i l d r e n and a d o l e s c e n t s uho developed upper r e s p i r a t o r y i n f e c t i o n s and s t r e p t o c o c c a l i n f e c t i o n s ( H a g g e r t y , 1880; Meyer & Haggerty, 1962). Compared to h e a l t h y i n d i v i d u a l s , more f r e q u e n t and more s e r i o u s l i f e events o c c u r r e d u i t h i n a year of h o s p i t a l i z a t i o n f o r c h i l d r e n and youth on a g e n e r a l p e d i a t r i c s , s u r g i c a l , and p s y c h i a t r i c s e r v i c e ( H e i s e l , Ream, R a i t z , Rappaport & Co d d i n g t o n , 1973). W i t h i n a year of more f r e q u e n t and more s e r i o u s l i f e e v e n t s , c h r o n i c d i s e a s e s have been r e p o r t e d to occur such as rheumatoid a r t h r i t i s ( H e i s e l , 1972), leuKemias and lymphomas (Greene & M i l l e r , 1958; Jacobs & C h a r l e s , 1980), and d i a b e t e s ( S t e i n & C h a r l e s , 1871). The outcomes of s t r e s s f o r the i l l a d o l e s c e n t p r e s e n t a v a r y i n g impact. Hudgen (1974) found a r e l a t i o n s h i p betueen l i f e change events and d e p r e s s i v e i l l n e s s in h i s study of m e d i c a l l y i l l a d o l e s c e n t s . He c l a i m e d , houever, t h a t f a m i l y h i s t o r y of p s y c h i a t r i c i l l n e s s and c h r o n i c i t y and s e v e r i t y a s s o c i a t e d u i t h the medical d i a g n o s i s uere the i n f l u e n t i a l f o r c e s in the p r e c i p i t a t i o n of d e p r e s s i o n . Higher l i f e change s c o r e s have been found to be c o r r e l a t e d u i t h a decrease in s e l f - c o n c e p t and an e x a c e r b a t i o n of the symptoms of c h r o n i c d i s e a s e i n c h i l d r e n and youth ( B e d e l l et a l . , 1977; Kosub & C e r r e t o , 1981). 40 Summary In review of the l i t e r a t u r e c o n c e r n i n g outcomes of s t r e s s i t may be concluded t h a t a c o n s i s t e n t , a l t h o u g h not s t r o n g , r e l a t i o n s h i p i s found r e l a t i n g s t r e s s to i l l n e s s . ft v a r i e t y of s t r e s s outcomes have been i d e n t i f i e d which a f f e c t mental, s o c i a l , and p h y s i c a l f u n c t i o n i n g . They vary in s e v e r i t y from " c o l d s " to c o r o n a r y d i s e a s e . S t r e s s outcomes f o r a d o l e s c e n t s are comparable to those of the a d u l t and are a s s o c i a t e d with h e a l t h problems. Pregnancy, c h r o n i c i l l n e s s , p s y c h i a t r i c problems, s t r e p t o c o c c a l i n f e c t i o n s , and a c c i d e n t s are examples of outcomes noted f o r the ado 1escent. Summary of the L i t e r a t u r e Review L i t e r a t u r e has been reviewed which p e r t a i n s to a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s . The p h y s i c a l s t a t e , t i m e , e x p e r i e n c e , and the s e l f are d e s c r i b e d as s e l e c t e d f a c t o r s t h a t i n f l u e n c e p e r c e p t i o n . The development of the s t r e s s concept r e v e a l s a concern f o r c o n s t r u c t v a l i d i t y and c r i t i c i s m of the c o m p l e x i t y of the s t r e s s concept in r e s e a r c h . Much of the l i t e r a t u r e c o n c e r n i n g the c a u s e s , symptoms, r e s p o n s e s , and outcomes of s t r e s s r e l a t e s to a d u l t s , r a t h e r than to a d o l e s c e n t s . Moreover, s i n c e age and e x p e r i e n c e a f f e c t p e r c e p t i o n , which in t u r n i n f l u e n c e s the s t r e s s e x p e r i e n c e , t h e r e may be l i t t l e c o r r e l a t i o n between the r e s u l t s of r e s e a r c h devoted to a d u l t s and the needs of a d o l e s c e n t s . S t r e s s causes or l i f e change events vary with d i f f e r e n t groups in d i f f e r e n t s i t u a t i o n s . For a d o l e s c e n t s , the causes of s t r e s s r e l a t e t o s c h o o l , i n t e r p e r s o n a l r e l a t i o n s h i p s , and t h e i r s e l v e s . Reported d i f f e r e n c e s in causes based on age or grade and sex v a r y . It was g e n e r a l l y noted t h a t g i r l s r e p o r t more causes of s t r e s s than boys. The symptoms of s t r e s s are m a n i f e s t e d as b e h a v i o r a l , a f f e c t i v e , and p h y s i o l o g i c a l f e e l i n g s t a t e s . In a d u l t s , symptoms 41 vary a c c o r d i n g to sex and i n c r e a s e u i t h age. As d e s c r i b e d f o r a d u l t s , s u c c e s s f u l c o p i n g or response to s t r e s s i s r e l a t e d to u s i n g a v a r i e t y and combination of b e h a v i o r s , r a t h e r than u s i n g a s i n g l e s t r a t e g y ; and to u s i n g problem s o l v i n g and c o g n i t i v e b e h a v i o r s , r a t h e r than u s i n g avoidance or escape s t r a t e g i e s . Response r e s o u r c e s u h i c h a i d in the management of s t r e s s i n c l u d e the p e r s o n a l i t y t r a i t of h a r d i n e s s , p o s i t i v e s e l f - e s t e e m , s o c i a l s u p p o r t , and good p h y s i c a l c o n d i t i o n . E x p e r i e n c e u i t h s t r e s s r e s u l t s in i n c r e a s e d t o l e r a n c e f o r s t r e s s . The outcome of p r o l o n g e d , s e v e r e , or accumulated s t r e s s has a d e l e t e r i o u s e f f e c t on h e a l t h and a f f e c t s m e n t a l , s o c i a l and p h y s i c a l f u n c t i o n i n g . A review of the l i t e r a t u r e p e r t a i n i n g to a d o l e s c e n t s ' p e r c e p t i o n of s t r e s s has r e v e a l e d areas uhere f u r t h e r i n v e s t i g a t i o n i s j u s t i f i e d . There have been many s t u d i e s r e l a t e d to s t r e s s , but t h e r e are r e l a t i v e l y feu c o n c e r n i n g the h e a l t h y a d o l e s c e n t and s t r e s s . A d o l e s c e n t s ' p e r c e p t i o n s of a s i n g l e s t r e s s component, the c a u s e s , have been sought, but u i t h the i n t e n t i o n of measuring s t r e s s or i d e n t i f y i n g p o t e n t i a l s t r e s s o r s . Houever, h e a l t h y a d o l e s c e n t s p e r c e p t i o n s of the c a u s e s , symptoms, r e s p o n s e s , and outcomes of t h e i r s t r e s s have not been i d e n t i f i e d . The methodology and r e s e a r c h d e s i g n s e l e c t e d f o r t h i s i n v e s t i g a t i o n i s d e s c r i b e d in the f o l l o w i n g c h a p t e r . 42 CHAPTER III Methodo 1ogy A d e s c r i p t i v e survey d e s i g n was s e l e c t e d f o r t h i s e x p l o r a t o r y study of a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s . A s e 1 f - a d m i n i s t e r e d q u e s t i o n n a i r e uas developed as a p a r t of t h i s study and a p i l o t study uas conducted t o t e s t the q u e s t i o n n a i r e and t o r e f i n e the r e s e a r c h methodology. T h i s c h a p t e r d e s c r i b e s the study methodology i n the f o l l o u i n g s e c t i o n s : s u b j e c t s , q u e s t i o n n a i r e development, p i l o t s t u d y , d a t a c o l l e c t i o n , and d a t a a n a l y s i s . Subjects Populat ion The s u b j e c t s uere s e l e c t e d from group program p a r t i c i p a n t s in the Young Men's C h r i s t i a n A s s o c i a t i o n (Y.M.C.A.) of G r e a t e r Vancouver. The Y.M.C.A. i s a community agency u h i c h o p e r a t e s f a c i l i t i e s and o f f e r s a v a r i e t y of programs f o r a l l ages in the m e t r o p o l i t a n a r e a . It i s assumed those uho j o i n a ccept the p h i l o s o p h y of the o r g a n i z a t i o n u h i c h i s summarized in the statement of purpose: "The Y.M.C.A. i s a u o r l d u i d e f e l l o w s h i p d e d i c a t e d to the growth of persons i n s p i r i t , mind and body i n a sense of r e s p o n s i b i l i t y to each other and the human community." Membersh ip i s open to a l l . G r e a t e r Vancouver Y.M.C.A. S t a t i s t i c s of 1982 i n d i c a t e t h e r e uere 5,655 p a r t i c i p a n t s , of both s e x e s , ages 13 to 17, i n v o l v e d in s o c i a l , e d u c a t i o n a l , r e c r e a t i o n a l , and p h y s i c a l e d u c a t i o n a c t i v i t i e s . Many of the p a r t i c i p a n t s uere i n v o l v e d in 1 or more of an i d e n t i f i e d 72 youth group programs. Youth programs in the Y.M.C.A. tend to be sea s o n a l and co r r e s p o n d to the s c h o o l y e a r . During the summer months, outdoor r e c r e a t i o n i s a major a c t i v i t y 43 u i t h emphasis on l e a d e r s h i p development and uorK e x p e r i e n c e . Sample A convenience n o n - p r o b a b i 1 i t y sample uas s e l e c t e d from youth i n v o l v e d in Y.M.C.A. outdoor r e c r e a t i o n group programs d u r i n g August, 1983. T u e n t y - f i v e to 50 p a r t i c i p a n t s uere r e q u i r e d to conduct an e x p l o r a t o r y study of t h i s n ature ( D a v i s , 1971, p.3; Sudman, 1976, p.87>. There uere 77 i n d i v i d u a l s in thes e outdoor r e c r e a t i o n groups but not a l l met the c r i t e r i a f o r p a r t i c i p a t i o n in the s t u d y . There uere 47 i n d i v i d u a l s uho uere e l i g i b l e f o r p a r t i c i p a t i o n and 1 e l i g i b l e i n d i v i d u a l uas not a v a i l a b l e at the times of da t a c o l l e c t i o n . Q u e s t i o n n a i r e s uere c o l l e c t e d from 46 (N=46> i n d i v i d u a l s . C r i t e r i a f o r P a r t i c i p a t i o n I n d i v i d u a l s uho v o l u n t a r i l y p a r t i c i p a t e d in t h i s study met the f o l l o w i n g c r i t e r i a : 1. uere 14 t o 18 years of age, 2. had no Known major h e a l t h problem, 3. s i g n e d a consent form ( s e e Appendix A f o r the l e t t e r of e x p l a n a t i o n and c o n s e n t ) i n d i c a t i n g t h e i r u n d e r s t a n d i n g and w i l l i n g n e s s to p a r t i c i p a t e i n the s t u d y , and, i f under the age of 19, o b t a i n e d the s i g n e d consent of t h e i r parent or g u a r d i a n , 4. uere a b l e to understand v e r b a l and w r i t t e n E n g l i s h , and 5. had not p r e v i o u s l y p a r t i c i p a t e d in t h i s s t u d y . S e l e c t i o n Procedure The i n v e s t i g a t o r met u i t h each small group of i n d i v i d u a l s and e x p l a i n e d the purpose and format of the s t u d y . I n d i v i d u a l s uere r e q u e s t e d to p a r t i c i p a t e . F u l l d i s c l o s u r e of the n e c e s s a r y 44 c r i t e r i a and the nature of p a r t i c i p a t i o n uas made. L e t t e r s of e x p l a n a t i o n and consent uere d i s t r i b u t e d and an e x p l a n a t i o n made as to t h e i r purpose. These l e t t e r s uere to be r e t u r n e d at the next group meeting. Fit subsequent group meetings, i n d i v i d u a l s uere reminded to r e t u r n the consent form. Ethical Considerations C o n s i d e r a t i o n f o r e t h i c s and the p r o t e c t i o n of human r i g h t s uas done in the f o l l o w i n g way: 1. The app r o v a l of the U n i v e r s i t y of B r i t i s h Columbia S c r e e n i n g Committee f o r Research I n v o l v i n g Human S u b j e c t s uas o b t a i n e d b e f o r e commencing with the s t u d y . 2. The app r o v a l of the p a r t i c i p a t i n g agency was r e q u e s t e d ( see Appendix B f o r the l e t t e r of r e q u e s t ) and o b t a i n e d ( s e e Appendix C f o r the agency c o n s e n t ) . 3. I n d i v i d u a l s uere informed v e r b a l l y and in w r i t i n g about the p r o j e c t , and s i g n e d consent forms uere o b t a i n e d . I n d i v i d u a l s uere assured they may choose or r e f u s e to p a r t i c i p a t e without a f f e c t i n g t h e i r p a r t i c i p a t i o n in the Y.M.C.A. in any way. 4. Youth under age 19 uere r e q u i r e d to o b t a i n s i g n e d p a r e n t a l c o n s e n t . The r e s e a r c h e r uas a v a i l a b l e by phone t o d i s c u s s the p r o j e c t . 5. The q u e s t i o n n a i r e responses were anonymous. 6. Data uere reviewed by the r e s e a r c h e r , and c o n s u l t a n t s . 7. Raw dat a were d e s t r o y e d at the c o m p l e t i o n of the s t u d y . Q u e s t i o n n a i r e Development A q u e s t i o n n a i r e uas developed t h a t uould gather d a t a to answer the r e s e a r c h q u e s t i o n s . In d e v e l o p i n g the q u e s t i o n n a i r e , the p r o c e s s , c o n t e n t , and format f o r the t o o l were a d d r e s s e d . 4 5 Process ft d r a f t q u e s t i o n n a i r e was prepared from d e t a i l s o b t a i n e d from i n t e r v i e w s u i t h a d o l e s c e n t s , r e v i e u of the l i t e r a t u r e , and in f o r m a l d i s c u s s i o n s u i t h p r o f e s s i o n a l s uho uorK u i t h a d o l e s c e n t s . The q u e s t i o n n a i r e uas c r i t i c a l l y r e v i e u e d f o r a m b i g u i t y , c o n t e n t , o r g a n i z a t i o n , and c l a r i t y by: t h e s i s committee members, an expert in s t r e s s management f o r a d o l e s c e n t s , an e x p e r t i n n u r s i n g c a r e of a d o l e s c e n t s , and youth c o n s i d e r e d r e p r e s e n t a t i v e of the study sample <see Appendix D f o r r e v i e u comments to the q u e s t i o n n a i r e ) . The d r a f t q u e s t i o n n a i r e uas p r e t e s t e d u i t h a r e p r e s e n t a t i v e group of seven a d o l e s c e n t s . Based on the r e v i e u and p r e t e s t , the t o o l uas r e v i s e d . There uas f u r t h e r t e s t i n g of the t o o l in the p i l o t study . F i n a l l y , the q u e s t i o n n a i r e uas preceded f o r computer t a b u l a t i o n in c o n s u l t a t i o n u i t h a computer c o n s u l t a n t <C. L a i , p e r s o n a l communication, June, 1983). Content For t h i s e x p l o r a t o r y s t u d y , the q u e s t i o n n a i r e uas designed to i n c l u d e c o n t e n t about the g e n e r a l t o p i c of s t r e s s , the r e s e a r c h q u e s t i o n s , demographic d a t a , and r e s p o n d e n t s ' r e a c t i o n s to the q u e s t i o n n a i r e . ft c h e c k l i s t uas used to ensure a ba l a n c e d d i s t r i b u t i o n of q u e s t i o n s by con t e n t a r e a . D e r i v a t i o n of the ge n e r a l t o p i c c o n t e n t and the o p t i o n s f o r each of the s t r e s s components stemmed from the i n t e r v i e u s u i t h y o u t h , the r e v i e u of the l i t e r a t u r e , and d i s c u s s i o n s u i t h p r o f e s s i o n a l s uho uorK u i t h ado 1 e s c e nts. Because of the e x p l o r a t o r y nature of the s t u d y , the s u b j e c t uas i n t r o d u c e d u i t h g e n e r a l t o p i c q u e s t i o n s . These q u e s t i o n s addressed uhether s t r e s s i s a c o n c e r n , manageable, and r e l a t e d to h e a l t h . Respondents uere asKed to r a t e t h e i r p r e s e n t s t r e s s l e v e l 4 6 and i n d i c a t e hou t h i s compared to t h a t of t h e i r p e e r s . In a d d i t i o n , respondents uere asKed i f they gained new ideas about s t r e s s management by c o m p l e t i n g the q u e s t i o n n a i r e . C o n s t r u c t i o n of each r e s e a r c h q u e s t i o n uas guided by the t h e o r e t i c a l frameuorK of t h i s study and uas p r e s e n t e d in open-response and c1 o s e d - r e s p o n s e q u e s t i o n format. S e l e c t i o n of the demographic d a t a f o r i n c l u s i o n on the q u e s t i o n n a i r e uas a l s o guided by the t h e o r e t i c a l frameuorK. Because causes of s t r e s s r e l a t e d to s c h o o l uere c i t e d in the l i t e r a t u r e as being f r e q u e n t l y i d e n t i f i e d , grade in s c h o o l and l e v e l of academic achievement uere a l s o inc1uded . Questions c o n c e r n i n g the p e r c e i v e d l e v e l of u n e a s i n e s s uere an i n d i r e c t measure of response v a l i d i t y <Sudman & Bradburn, 1 9 8 2 , P. 8 4 ) . P a r t i c i p a n t s uere asked to r e c a l l s t r e s s causes u h i c h o c c u r r e d only d u r i n g the l a s t y e a r . Format The q u e s t i o n n a i r e uas o r g a n i z e d to f a c i l i t a t e response and e l i m i n a t e b i a s . I n s t r u c t i o n s and c l a r i f i c a t i o n on the d e f i n i t i o n of s t r e s s preceded the t o p i c e n q u i r y . O r g a n i z a t i o n uas from ge n e r a l t o s p e c i f i c and i n c l u d e d both open-ended and closed-ended responses f o r the r e s e a r c h q u e s t i o n s . The p r o v i s i o n f o r open-ended response a l l o u e d f l e x i b i l i t y in e x p l o r a t o r y d e s c r i p t i v e r e s e a r c h d e s i g n f o r o p t i o n s u h i c h may not have been i n c l u s i v e < S e l l t i z , Urightsman & Cook, 1 8 7 6 , pp. 3 1 5 - 3 1 6 ) . The p r o v i s i o n f o r c 1 o s e d - r e s p o n s e q u e s t i o n s minimized the r i s k of u n d e r - r e p o r t i n g m a t e r i a l u h i c h i s not a l u a y s s a l i e n t (Sudman & Bradburn, 1 9 8 H , p. 5 8 ) , f a c i l i t a t e d ease in response and t a b u l a t i o n ( P o l i t & Hungler, 1 9 7 8 , p. 3 2 8 ) , and a c h i e v e d u n i f o r m i t y in the q u e s t i o n s t i m u l u s ( K e r l i n g e r , 1 9 7 3 , p. 4 8 7 ) . Demographic da t a uas c o n s i d e r e d e a s i e s t to ansuer and uas t h e r e f o r e , p l a c e d at the end. The q u e s t i o n n a i r e uas designed to 4 7 be completed in a p p r o x i m a t e l y 20 minutes tim e . P i l o t Study To r e f i n e the planned methodology and to determine the instrument u t i l i t y , a p i l o t study uas conducted u i t h a s m a l l sample < bt= 11 > of r e p r e s e n t a t i v e a d o l e s c e n t s . Those uho v o l u n t e e r e d f i r s t uere draun from Y.M.C.A. outdoor r e c r e a t i o n groups. The p r o c e s s f o r c o n d u c t i n g the p i l o t study uas the same as t h a t d e s c r i b e d f o r dat a c o l l e c t i o n and d a t a a n a l y s i s . Data c o l l e c t i o n f o r the p i l o t study uas completed in one day. Response o p t i o n s uere added and s e v e r a l minor r e v i s i o n s uere made in the q u e s t i o n n a i r e f o l l o w i n g the p i l o t s t u d y . A copy of the r e s u l t i n g q u e s t i o n n a i r e used in d a t a c o l l e c t i o n i s i n c l u d e d <see Appendix E>. Data Collection Data uas c o l l e c t e d i n a group s i t u a t i o n . Because some a d o l e s c e n t s might be s e l f - c o n s c i o u s and s e n s i t i v e e x p r e s s i n g p e r s o n a l o p i n i o n s and f a c t s , the a d m i n i s t r a t i o n of a q u e s t i o n n a i r e in a group s i t u a t i o n p r o v i d e d f o r peer s u p p o r t , p e r m i t t e d a common e x p l a n a t i o n of d i r e c t i o n s and ansuers to p a r t i c i p a n t s ' q u e s t i o n s , and o f f e r e d anonymity. The methodology of a d m i n i s t r a t i o n uas c o n s i d e r e d to y i e l d a h i g h e r response r a t e and l e s s i n h e r e n t b i a s (Sudman & Bradburn, 1982). Data uas c o l l e c t e d d u r i n g the p e r i o d August 16 to August 28, 1983, at a time of convenience f o r the group. The s e 1 f - a d m i n i s t e r e d q u e s t i o n n a i r e and ne c e s s a r y u r i t i n g t o o l s uere d i s t r i b u t e d by the i n v e s t i g a t o r . The p a r t i c i p a n t s uere asKed not to communicate u i t h one a n o t h e r , and not to u r i t e t h e i r names on the q u e s t i o n n a i r e . The q u e s t i o n n a i r e uas r e v i e u e d u i t h the group 48 and n e c e s s a r y c l a r i f i c a t i o n s made. The i n v e s t i g a t o r uas a v a i l a b l e to ansuer q u e s t i o n s u h i l e the respondents uere c o m p l e t i n g the q u e s t i o n n a i r e . Upon c o m p l e t i o n , q u e s t i o n n a i r e s uere c o l l e c t e d and p a r t i c i p a n t s t o l d hou they might o b t a i n the f o r t h c o m i n g study r e s u I t s . E l i g i b l e p a r t i c i p a n t s uere g i v e n t h r e e o p p o r t u n i t i e s to complete the q u e s t i o n n a i r e . No p r o v i s i o n uas made to i n v o l v e those uho uere absent a l l t h r e e days. Data Analysis Answers to the open-response q u e s t i o n s uere grouped a c c o r d i n g to c o n t e n t by tuo i n d i v i d u a l s e x p e r i e n c e d in working u i t h a d o l e s c e n t s and i n t e r r a t e r r e l i a b i l i t y uas determined f o r t h i s p r o c e s s ( P o l i t & Hu n g l e r , 1978, p. 431). The c o n t e n t c a t e g o r i e s uere d e r i v e d from a r e v i e u of the l i t e r a t u r e and rau d a t a . These groupings uere compared to the c o r r e s p o n d i n g c1osed-response q u e s t i o n s i n d i s c u s s i o n of the d a t a . Data from the c1osed-response q u e s t i o n s uas a n a l y z e d through the a i d of the S t a t i s t i c a l Package f o r the S o c i a l S c i e n c e s : V e r s i o n 9 (under MTS) computer program ( L a i , 1983). D e s c r i p t i v e s t a t i s t i c s uere used to p r e s e n t the d a t a . The percentage frequency s c o r e s uere based on the number of o b t a i n e d r e s p o n s e s . The s t r e s s component o p t i o n s uere c r o s s t a b u l a t e d u i t h the s e l e c t e d demographic v a r i a b l e s and comparative a n a l y s i s o b t a i n e d by C h i Square A n a l y s i s . C o n f i d e n c e i n t e r v a l s f o r p r o p o r t i o n s , c a l c u l a t e d by the i n v e s t i g a t o r , uere used to v e r i f y the s t a t i s t i c a l s i g n i f i c a n c e i d e n t i f i e d by Chi Square A n a l y s i s . A 95X c o n f i d e n c e l e v e l uas s e l e c t e d as being a c c e p t a b l e f o r t h i s s t u d y . R e l i a b i l i t y f o r the l i s t of o p t i o n s f o r each s t r e s s component uas assess e d u s i n g Cronbach's Alpha ( K e r l i n g e r , 1973, p. 452). 49 Summary of the Methodology Survey methodology uas s e l e c t e d f o r t h i s e x p l o r a t o r y study and a s e 1 f - a d m i n i s t e r e d q u e s t i o n n a i r e uas developed and used to c o l l e c t d a t a in a group s i t u a t i o n . The convenience sample uas s e l e c t e d from y o u t h , ages 14 to 19, i n v o l v e d in group programs u i t h the Y.M.C.ft. T h i s study c o n s i s t e d of s e v e r a l s t a g e s : the s e l e c t i o n of the sample, development of the q u e s t i o n n a i r e , P i l o t - s t u d y , c o l l e c t i o n of d a t a , and a n a l y s i s of d a t a . The r e s u l t s of d a t a c o l l e c t i o n and a n a l y s i s are p r e s e n t e d and d i s c u s s e d in Chapter Four. 58 CHAPTER IV Study R e s u l t s and D i s c u s s i o n The p e r c e p t i o n s a d o l e s c e n t s have of s t r e s s are p r e s e n t e d in t h i s c h a p t e r u i t h a d e s c r i p t i o n of the sample and a summary of the responses about the q u e s t i o n n a i r e . The p e r c e p t i o n s a d o l e s c e n t s have of the r e l a t i o n s h i p betueen s t r e s s and i l l n e s s are i n c l u d e d in the r e s u l t s f o r the g e n e r a l t o p i c . In a d d i t i o n , r e s u l t s f o r the open-response and c1osed-response q u e s t i o n s are d i s c u s s e d u i t h r e f e r e n c e to each s t r e s s component. The c 1 osed-response o p t i o n s are f u r t h e r c o n s i d e r e d u i t h a d e s c r i p t i o n of the sample subgroups based on respondent's sex and age. Because of the sample c h a r a c t e r i s t i c s , the r e p o r t e d frequency s c o r e s are p r e s e n t e d as a d j u s t e d p e r c e n t a g e s . S i g n i f i c a n t f i n d i n g s are r e p o r t e d . For t h i s e x p l o r a t o r y s t u d y , t r e n d s in data are a l s o p r e s e n t e d to r e v e a l p o s s i b l e v a r i a t i o n s u h i c h may e x i s t . It s h o u l d be noted at the o u t s e t , houever, i t i s p o s s i b l e these v a r i a t i o n s o c c u r r e d by chance. Description of the Sample F o r t y - s i x <ti=46) a d o l e s c e n t s responded to the q u e s t i o n n a i r e . One q u e s t i o n n a i r e uas r e t u r n e d m i s s i n g the demographic d a t a . T h e r e f o r e , a sample of f o r t y - f i v e <n_=45> i s d e s c r i b e d based on age, sex, and e x p e r i e n c e in s t r e s s management t r a i n i n g . The respondents uere boys and g i r l s uho ranged in age from 14 to 19 y e a r s . T h e i r mean age uas 16.04 years u i t h a s t a n d a r d d e v i a t i o n of 1.35. Both the median and the mode uere 16 y e a r s . Table 1 d e s c r i b e s the sample by age and sex. More than t u i c e as many boys <n_=31) as g i r l s <o_=14) responded to the q u e s t i o n n a i r e . 51 Tab 1e 1 Description of Respondents: flge by sex <N=45> Age in years 14 15 16 17 18 19 T o t a l Males 2 9 11 6 1 2 31 Females 3 3 2 3 2 1 14 T o t a l 5 12 13 9 3 3 45 The l a s t s c h o o l grade completed by the p a r t i c i p a n t s ranged from Grade 8 to f i r s t year p o s t - s e c o n d a r y e d u c a t i o n ( r e f e r r e d to as Grade 13 in t h i s s t u d y ) . The mean and median uas Grade 10. The mode uas Grade 9 and the s t a n d a r d d e v i a t i o n uas 1.31. The d e s c r i p t i o n of the sample based on grade and sex i s p r e s e n t e d in Table 2. T h i r t e e n <29JO of the respondents r e p o r t e d they uere in the upper achievement l e v e l of t h e i r c l a s s e s , 2 6 <59X> uere in the middle l e v e l , and 4 < 9 J O uere i n the l o u e r l e v e l . T able 2 Description of Respondents' Grade by Sex (N=45? Grade in s c h o o l 8 9 10 11 12 13 T o t a l Males 0 9 11 6 2 2 31 Females 1 5 2 3 2 2 14 T o t a l 1 14 13 8 4 4 4 5 52 P a r t i c i p a t i o n in a s t r e s s management c l a s s uas r e p o r t e d by 4 O'S.) r e s p o n d e n t s : tuo boys, age 16; one g i r l , age 15; and one boy, age 17. Because of the s m a l l number u i t h s t r e s s management c l a s s e x p e r i e n c e , comparative s t a t i s t i c a l a n a l y s i s i s not meaningful and u i l l be excluded from the r e s u l t s of t h i s s t u d y . The number uho p a r t i c i p a t e d in a s t r e s s management c l a s s may r e f l e c t the s t a t u s of s t r e s s management e d u c a t i o n in the s c h o o l s . Responses to the Questionnaire A l l d i s t r i b u t e d q u e s t i o n n a i r e s uere r e t u r n e d . The response r a t e f o r both open-response and c 1 osed-response q u e s t i o n s uas 39'A. Of the ten q u e s t i o n s i d e n t i f i e d as d i f f i c u l t by one or more p a r t i c i p a n t s , nine uere open-response format u h i l e one uas c1osed-response f o r m a t . Respondents r a t e d t h e i r f e e l i n g s about each of the s t r e s s component q u e s t i o n s . The average s c o r e f o r each component uas in the " s l i g h t l y uneasy" c a t e g o r y , a l t h o u g h f i v e boys each r a t e d a d i f f e r e n t q u e s t i o n as b e i n g " p e r s o n a l . " These responses support the r a t i o n a l e f o r the r e s e a r c h d e s i g n as d e s c r i b e d in Chapter Three. S i x < 14X> respondents c l a i m e d a d e f i n i t i o n f o r s t r e s s d i f f e r e n t from t h a t s t a t e d on the q u e s t i o n n a i r e u h i c h uas "p l e a s a n t or u n p l e a s a n t s i t u a t i o n s , e v e n t s , or o c c u r r e n c e s u h i c h cause change in your normal f u n c t i o n i n g . " P a r t i c i p a n t s a s s o c i a t e d s t r e s s u i t h p r e s s u r e and u n p l e a s a n t n e s s o n l y ; they d i d not a s s o c i a t e i t u i t h p l e a s a n t n e s s and change. As s t a t e d in the l i t e r a t u r e <Cox, 1S78, P P . l-25>, t h e r e i s no consensus on a d e f i n i t i o n of s t r e s s . The r e l i a b i l i t y f o r the c l o s e d r esponses ranged from Cronbach's A l p h a .73 to Alpha .85. The i n t e r r a t e r r e l i a b i l i t y f o r the c ontent g r o u p i n g of the open-response items uas .78. The r e l i a b i l i t y s c o r e f o r each s t r e s s component uas a s s e s s e d u s i n g 53 r e s p o n s e s , Alpha .73; and outcomes. Alpha .73. An a c c e p t a b l e l e v e l of r e l i a b i l i t y uas found to be p r e s e n t . E i g h t i n d i v i d u a l s (18%) i n d i c a t e d they gained neu ideas about s t r e s s management by co m p l e t i n g the q u e s t i o n n a i r e . T h e i r i d e a s , such as problem s o l v i n g , t a l k i n g , or r e l a x i n g , uere r e l a t e d t o the causes and management of s t r e s s . T h e i r comments i n c l u d e d "to s i t back and look at uhy I have s t r e s s " and "to look more c a r e f u l l y uhen l o t s of s t r e s s accumulates." It may be assumed these youth uere r e c e p t i v e to neu i d e a s . A d o l e s c e n t P e r c e p t i o n s of the S t r e s s T o p i c S t r e s s uas i d e n t i f i e d as a concern by 26 (56%) of the re s p o n d e n t s . G i r l s <64%) responded to t h i s item more f r e q u e n t l y than boys ( 5 2 % ) . The m a j o r i t y of p a r t i c i p a n t s p e r c e i v e d s t r e s s as i n c r e a s i n g u i t h accumulated events ( 9 1 % ) , v a r y i n g u i t h time ( 9 3 % ) , being manageable ( 7 8 % ) , and r e l a t e d to h e a l t h ( 8 5 % ) . G i r l s responded a f f i r m a t i v e l y to these items more f r e q u e n t l y than boys. A l l of the g i r l s (100%) p e r c e i v e d s t r e s s as r e l a t e d to h e a l t h . The response frequency f o r the items "being manageable" and " r e l a t e d to h e a l t h " i n c r e a s e d u i t h age f o r both sexes. In ansuer to the q u e s t i o n about the e f f e c t s of prol o n g e d or accumulated s t r e s s on h e a l t h , respondents r e p l i e d u i t h such comments as "high blood p r e s s u r e , " " t h i n k i t uould ueaken ones h e a l t h , " "get d e p r e s s e d , not 100% w i l l i n g to f u n c t i o n p r o p e r l y , " and "you get s i c k , you f e e l l e t h a r g i c and don't uant to do a n y t h i n g , e v e r y t h i n g i s t e r r i b l e . " Seven i n d i v i d u a l s (15%) e i t h e r d i d not ansuer or responded "don't know" to the q u e s t i o n . S t r e s s uas p e r c e i v e d as having a n e g a t i v e e f f e c t on h e a l t h by the m a j o r i t y (85%) of r e s p o n d e n t s . It appears t h a t most of the p a r t i c i p a n t s understood the r e l a t i o n s h i p betueen s t r e s s and h e a l t h because they d e s c r i b e d the e f f e c t s of s t r e s s on h e a l t h . The m a j o r i t y of r e s p o n d e n t s , moreover, c o n s i d e r e d s t r e s s manageable and uere knowledgeable of 5 4 the g e n e r a l t o p i c . T h e i r Knowledge and u n d e r s t a n d i n g uas e v i d e n t , even though they had not had s t r e s s management t r a i n i n g . The po p u l a r l i t e r a t u r e , the media, or the e x p e r i e n c e s of s i g n i f i c a n t o t h e r s may have p r o v i d e d t h i s i n f o r m a t i o n . T u e n t y - f i v e i n d i v i d u a l s <56JO r e p o r t e d having had e x p e r i e n c e u i t h accumulated s t r e s s . Because of d i f f e r e n t l e v e l s of au a r e n e s s , i t i s p o s s i b l e those uho d i d not respond uere not auare of accumulated s t r e s s , houever. P a r t i c i p a n t s uere asKed to r a t e t h e i r p r e s e n t s t r e s s l e v e l on a 10 p o i n t s c a l e . The mean l e v e l of s t r e s s uas 3.87. When the mean r a t i n g s uere compared f o r boys and g i r l s , the s t r e s s l e v e l of the g i r l s uas 5.57, n e a r l y t u i c e as high as the boys' l e v e l of 2.81. As noted in the l i t e r a t u r e , g i r l s tend to r a t e a l l events as more s t r e s s f u l ( Mendez et a l . , 1982), r e p o r t more s t r e s s (BurKe & Weir, 1978), and i d e n t i f y more symptoms of s t r e s s ( S h i e l d s & S t e r n , 1979; S t e r n & H i g g i n s , 1968) than boys. T h i s d i f f e r e n c e betueen the sexes may be r e l a t e d to d i f f e r e n c e s in t h e i r g e n e t i c c o n s t i t u t i o n , t h e i r past e x p e r i e n c e s , or t h e i r r e a c t i o n to p r e s e n t s i t u a t i o n s . The mean l e v e l of s t r e s s uas r a t e d h i g h e r by t h o s e , ages 17 to 19 <4.20) as compared to t h o s e , ages 14 to 16 <3.63). When d i v i d e d i n t o t h r e e age groups, i n d i v i d u a l s r e p o r t e d s t r e s s l e v e l s u h i c h i n c r e a s e d u i t h age. T h i s d i f f e r e n c e may be r e l a t e d to e x p e r i e n c e u i t h i n c r e a s e d a c t i v i t i e s , g r e a t e r demands, and more change. It may a l s o be r e l a t e d to p e r c e p t u a l f a c t o r s a s s o c i a t e d u i t h a broadened e x p e r i e n c e and i n c r e a s e d r e c o g n i t i o n of b o d i l y symptoms u h i c h i n c r e a s e u i t h age ( S h i e l d s & S t e r n , 1979). Peers are important to the a d o l e s c e n t and may s e r v e as a r e f e r e n c e p o i n t . Fourteen respondents (305O r a t e d themselves as having more s t r e s s ; 18 ( 3 9 X ) , the same; and 14 (30%) r a t e d themselves as having l e s s s t r e s s than t h e i r p e e r s . T h i s may be an i n d i r e c t measure of t h e i r s t r e s s l e v e l and c o n c e r n . In a study by P a r c e l e t a l . <1977), uhere a d o l e s c e n t s compared p e r c e p t i o n s of t h e i r oun h e a l t h to t h a t of t h e i r p e e r s , SB'S, of a d o l e s c e n t s 5 5 c o n s i d e r e d themselves h e a l t h i e r , 61% r e p o r t e d having the same h e a l t h , and 11% c o n s i d e r e d themselves l e s s h e a l t h y than t h e i r p e e r s . Unl iKe the p e r c e p t i o n s of h e a l t h noted in the P a r c e l et a l . s t u d y , a l a r g e r p r o p o r t i o n of respondents in the p r e s e n t s t u d y , p e r c e i v e d themselves as having more or l e s s s t r e s s than t h e i r p e e r s . S i n c e h e a l t h and s t r e s s are r e l a t e d , t h i s may i n d i c a t e s t r e s s i s of g r e a t e r concern to them than h e a l t h . A d o l e s c e n t P e r c e p t i o n s of the Causes of S t r e s s I n f o r m a t i o n on a d o l e s c e n t s ' p e r c e p t i o n s of the causes of s t r e s s uas d e r i v e d from tuo q u e s t i o n f o r m a t s , open-response and c1osed-response. The responses to these tuo q u e s t i o n formats are p r e s e n t e d and d i s c u s s e d f o r the t o t a l sample. D e s c r i p t i o n of the c1osed-responses i s made based on the respondent's sex and age. D e s c r i p t i o n of T o t a l Sample Open-ended r e s p o n s e s . The l i s t of items generated in response to the q u e s t i o n , "What causes you s t r e s s ? " uere grouped a c c o r d i n g to c o n t e n t <see Appendix F f o r the open-ended responses to causes of s t r e s s : f r e q u e n c i e s and c a t e g o r i e s ) . The c a t e g o r i e s , t a b u l a t i o n , and c o n t e n t summary f o r the open responses to causes of s t r e s s are p r e s e n t e d in Table 3. The most f r e q u e n t l y l i s t e d items uere r e l a t e d to uorK, s c h o o l and p e e r s . I n t e r p e r s o n a l r e l a t i o n s h i p s uere a concern i d e n t i f i e d in the Family and Peers c a t e g o r i e s . Items r e l a t e d to the P a r e n t s c a t e g o r y uere r e c o r d e d s e p a r a t e l y . Houever, thes e items uould be a p p r o p r i a t e in e i t h e r the Family or A u t h o r i t y F i g u r e s c a t e g o r y . The f r e q u e n c y of responses in the Emotions c a t e g o r y i s equal to t h a t in each of the P a r e n t s , F a m i l y , S e l f - C o n c e p t , A u t h o r i t y , L o s s , and Time D e a d l i n e s c a t e g o r i e s . 56 Table 3 Causes Pf S t r e s s : C a t e g o r i e s , T a b u l a t i o n and Con-tent Summar v( N=46 > Category A c t u a l f r e q u e n c y 3 Content summary UiorK 36 j o b , performance, t a s K s , uorK load Peers 34 i n t e r p e r s o n a l r e l a t i o n s h i p s , i n c l u s i o n , peer p r e s s u r e , s e x u a l i t y Schoo1 33 s c h o o l , s t u d y i n g , performance, tasKs Fami1y 10 f a m i l y members, arguments, m a r i t a l prob1 ems Parent s 10 p a r e n t s , parent p r e s s u r e Author i t y f i g u r e s 10 being p e r s o n a l l y in t r o u b l e , a s s o c i a t e d u i t h a u t h o r i t y , urong-doing Se1f-concept 10 body image, s e l f e x p e c t a t i o n s . "put-douns" Time dead 1ines 10 d e a d l i n e s , time p r e s s u r e Loss 10 l o s t p e r s o n a l a r t i c l e s , d e a t h , i l l n e s s , i n j u r y Emot ions 10 a f f e c t i v e s t a t e s such as sad moments, depress ion , nervousness Change 9 doing something neu, not Knowing uhat to do, problem F inane i a i 7 money problems Cars 5 car t r o u b l e , t r a v e l l i n g , d r i v i n g , t r a f f i c S i t u a t i o n < spec i f i c > 5 a l c o h o l , d r u g s , n o i s e , b eing Kept in darK Compet i t ion 3 w i n / l o s e s i t u a t i o n s i n c l u d i n g s p o r t s , games Other 3 headaches, monthly p e r i o d s , f a t i g u e More than 1 response may be 1 i s t e d by each respondent 57 Closed-ended items. Responses to the same q u e s t i o n , expressed in a d i f f e r e n t f o r m a t , were o b t a i n e d in the c1osed-response items. P a r t i c i p a n t s i d e n t i f i e d s p e c i f i c items from a s e l e c t i o n of s t r e s s - c a u s i n g o p t i o n s . The causes of s t r e s s are d i s p l a y e d in Table 4 in ranK order of f r e q u e n c y . The response frequency ranged from 7Y. f o r "pregnancy" to 89% f o r "school uorK, t e s t s . " The items most f r e q u e n t l y r a t e d uere those r e l a t e d to s c h o o l , time p r e s s u r e s , peer r e l a t i o n s , and p a r e n t s . Another cause of s t r e s s i n v o l v e d the s e l f - c o n c e p t as e v i d e n c e d in the items " p e r s o n a l l y f e e l i n g put-douns," "problems u i t h s i z e , appearance," and " c l o t h e s . " The items "parents g e t t i n g on bacK," " t r o u b l e u i t h t e a c h e r / p r i n c i p a l , " and " h a s s l e s u i t h the law" may be grouped under A u t h o r i t y . Those items p e r t a i n i n g to l o s s and major u p h e a v a l , such as "death of a p a r e n t " <11X> or "death of a c l o s e f r i e n d or r e l a t i v e " <28X), uere i d e n t i f i e d l e s s f r e q u e n t l y . The i n d i v i d u a l s in the sample had l i K e l y not yet e x p e r i e n c e d these traumas. D i s c u s s i o n . The responses to both q u e s t i o n formats support the impact of s c h o o l as a major s o u r c e of s t r e s s , a r e s u l t a l s o i d e n t i f i e d by Tyerman and Humphrey (1882) and Dobson <1988; 1983). Even though d a t a f o r the p r e s e n t study uere c o l l e c t e d at the end of the summer v a c a t i o n , schoo1-re 1ated items are prominent, perhaps because s c h o o l was b e i n g a n t i c i p a t e d . School a c t i v i t y f o r a d o l e s c e n t s i n v o l v e s the g r e a t e r p a r t of t h e i r year and s e r v e s to meet many of t h e i r i d e n t i f i e d developmental t a s K s . WorK/1eadership was the a d o l e s c e n t s ' major a c t i v i t y and, because s t r e s s o c c u r s as people i n t e r a c t u i t h t h e i r environment, i t was expected uorK items uould a l s o be dominant. T h i s e x p e c t a t i o n i s supported by the frequency of r esponses in the UlorK c a t e g o r y , even though UtorK had only t h r e e more responses than S c h o o l . In the l i s t of o p t i o n s , schoo1-re 1ated items uere most f r e q u e n t l y i d e n t i f i e d , u i t h f e u e r items r e l a t e d to uorK. The c1osed-response l i s t was l i K e l y not comp1ete. 58 Table 4 Causes of S t r e s s : Frequency in Rank Order <N=46) A c t u a l A d j u s t e d * %> Cause frequency f r e q u e n c y SchooluorK , t e s t s 41 89 P r e s s u r e to do t h i n g s u i t h i n time frame 37 80 R e l a t i o n s h i p s u i t h o p p o s i t e sex 38 70 L i v i n g up to p a r e n t s ' e x p e c t a t i o n s 33 70 Pa r e n t s " g e t t i n g on back" 31 67 P r e s s u r e s from f r i e n d s 29 63 P e r s o n a l l y f e e l i n g "put-douns" 29 63 S t a r t i n g a neu job 28 61 Team p r e s s u r e s to u i n in s p o r t s 23 50 Problems u i t h s i z e , appearance 20 43 C l o t h e s 20 44 Tr o u b l e u i t h t e a c h e r / p r i n c i p a l 20 43 R o u t i n e s , same o l d t h i n g 19 41 H a s s l e s u i t h the 1 au 18 33 Loss of a pet 18 39 P a r e n t / r e l a t i v e very s i c k 18 39 F a i l i n g a s u b j e c t 16 36 H a s s l e s u i t h b r o t h e r / s i s t e r 13 28 Death of c l o s e f r i e n d or r e l a t i v e 13 28 Changing s c h o o l 13 28 Wrecking the car 12 26 Problems u i t h acne 12 26 Badly s i c k or hu r t 10 22 Parent l o s i n g j ob 10 22 Pa r e n t s d i v o r c e d or s e p a r a t e d 10 22 F l u n k i n g a grade 9 20 L o s i n g a job 7 15 F i n i s h i n g s c h o o l 7 15 G e t t i n g , m a i n t a i n i n g a car 6 13 Fam i l y member d r i n k i n g 6 13 Death of parent 5 11 Pregnancy 3 7 59 I n t e r p e r s o n a l r e l a t i o n s h i p s with p a r e n t s , s i b l i n g s , and p e e r s , i n c l u d i n g those u i t h the o p p o s i t e s e x , uere i d e n t i f i e d as causes of s t r e s s , a r e s u l t s i m i l a r l y noted in the l i t e r a t u r e <Coddington, 1973b; JacKson, 1982; Kosub & Kosub, 1982; Yeauorth et a l . , 1980>. Concerns r e l a t e d to the s e 1 f - c o n c e p t , i d e n t i f i e d as s t r e s s o r s , uere a l s o noted in the l i t e r a t u r e <JacKson, 1982) and r e f l e c t the d e v e l o p i n g s e l f . As the s e l f - c o n c e p t i s determined by r e f l e c t i o n i n i n t e r a c t i o n u i t h o t h e r s ( W y l i e , 1974, p. 9 ) , i n t e r p e r s o n a l r e l a t i o n s h i p s are of utmost importance to the ado 1escent. " L i v i n g up to p a r e n t s ' e x p e c t a t i o n s " i s s i m i l a r to the item " l e t t i n g p a r e n t s doun," i d e n t i f i e d as a f r e q u e n t s o u r c e of s t r e s s in the Dobson study <1983, p. 351). T h i s may be a r e f l e c t i o n of the e x p e c t a t i o n one has of o n e s e l f . It may a l s o r e l a t e to the r e f l e c t i v e s e l f - c o n c e p t as d e s c r i b e d p r e v i o u s l y . Family c a t e g o r y items in the open-ended responses r e l a t e to the l i s t of o p t i o n s u h i c h i n c l u d e "parents g e t t i n g on back," " h a s s l e s u i t h b r o t h e r / s i s t e r , " and "parents d i v o r c e d or s e p a r a t e d . " The r e s u l t s i n d i c a t e the s t r u g g l e f o r independence and f o r some, perhaps, a concern f o r the f u t u r e and t h e i r oun p o s s i b l e m a r ried l i f e . Tuo items, "parents g e t t i n g on bacK" and " h a s s l i n g u i t h b r o t h e r / s i s t e r , " have a l s o been noted as f r e q u e n t l y i d e n t i f i e d s t r e s s o r s by Mendez et a l . < 1980). Those items u h i c h concern the u e l l - b e i n g of o t h e r s , such as " p a r e n t / r e l a t i v e very s i c K , " uere noted more f r e q u e n t l y than uere the items a p p l i c a b l e to the a d o l e s c e n t s ' oun s t a t e of w e l l - b e i n g , such as "badly s i c K or h u r t . " T h i s r e s u l t uas s i m i l a r l y noted by Yeauorth et a l . <1980). Compared to a d u l t s , the respondents are l i K e l y to have had l i m i t e d p e r s o n a l e x p e r i e n c e u i t h i l l n e s s or i n j u r y . T h e r e f o r e , they are more l i K e l y to r e a c t to d i f f i c u l t i e s e x p e r i e n c e d by s i g n i f i c a n t a d u l t s than they are t o r e a c t to d i f f i c u l t i e s they might e x p e r i e n c e t h e m s e l v e s . The r e s u l t s f o r items r e l a t e d to a u t h o r i t y f i g u r e s are s i m i l a r to those f o r the " f e a r of a u t h o r i t y f i g u r e s " noted by 60 Kosub and Kosub (1982). The r e s u l t s may r e f l e c t the a d o l e s c e n t ta s k t o develop a code of e t h i c s and moral s t a n d a r d s and to become independent. Time p r e s s u r e , d e a d l i n e s , change, and f i n a n c i a l items are c o n s i s t e n t u i t h s o c i e t a l s t r e s s and are common to many of the l i f e change event i n v e n t o r i e s . These items, as u e l l as those c o n c e r n i n g c a r s , a l c o h o l , and d r u g s , are i n d i c a t i v e of the expanding r o l e and i n c r e a s i n g r e s p o n s i b i l i t y of the a d o l e s c e n t u i t h concomitant s t r e s s . S e l y e (1974) c l a i m e d t h e r e i s an optimum l e v e l of s t r e s s d e s i r a b l e f o r each i n d i v i d u a l . F o r t y - o n e p e r c e n t of the respondents i d e n t i f i e d " r o u t i n e s , same o l d t h i n g " as being a cause of s t r e s s . For these r e s p o n d e n t s , i t i s p o s s i b l e t h e i r l i f e e x p e r i e n c e uas not p r o v i d i n g s u f f i c i e n t change and s t i m u l a t i o n . The l i s t i n g of emotions, i n the open-response items, as a cause of s t r e s s i s s i m i l a r to the i d e n t i f i c a t i o n of emotions as a h e a l t h or p e r s o n a l concern by the a d o l e s c e n t d e s c r i b e d in the l i t e r a t u r e ( P a r c e l et a l . , 1977; S t e r n l i e b & Munan, 1972). When s c h o o l and uorK items are e x c l u d e d , those items most f r e q u e n t l y i d e n t i f i e d r e f l e c t the d e v e l o p i n g s e l f and the developmental t a s k s of the a d o l e s c e n t p e r i o d . These f i n d i n g s c o r r e s p o n d to the premise t h a t s t r e s s o c c u r s uhen the s e l f i s t h r e a t e n e d ( C . Rogers, 1951). The items a l s o r e f l e c t the e x p e r i e n c e of the a d o l e s c e n t and t h e i r age or time f o r opportun i t i e s . D e s c r i p t i o n of Subgroups Based on Demographic V a r i a b l e s Sex. To f u r t h e r d e s c r i b e the a d o l e s c e n t p e r c e p t i o n s of the s t r e s s c a u s e s , comparisons of boys' and g i r l s ' p e r c e p t i o n s uere made. Frequency s c o r e s f o r s e l e c t e d causes of s t r e s s by sex are d i s p l a y e d in Table 5. The summary of Chi Square A n a l y s i s f o r these causes of s t r e s s by sex i s p r e s e n t e d in Table 6. 61 Tabl e 5 S e l e c t e d Causes of S t r e s s : Frequency bv Sex a d j u s t e d frequency* Y.~> Cause of s t r e s s Males 0_=31 Females n.= 14 Frequency h i g h e r f o r males S t a r t i n g a new job 64 050 Team p r e s s u r e s to win in s p o r t 55 36 Tro u b l e with t e a c h e r / p r i n c i p a l 58 21 H a s s l e s with the law 45 21 F a i l i n g a s u b j e c t 40 21 Wrecking the car 33 14 Parent l o s i n g j ob 29 7 F l u n k i n g a grade 26 7 L o s i n g a job 19 7 Frequency h i g h e r f o r f e ma1e s R e l a t i o n s h i p s with o p p o s i t e sex 55 100 ** Parent s " g e t t i n g on back" 53 86 P e r s o n a l l y f e e l i n g "put downs" 58 78 L i v i n g up to p a r e n t s ' e x p e c t a t i o n s 64 78 C l o t h e s 37 57 H a s s l i n g with b r o t h e r / s i s t e r 19 50 P a r e n t / r e l a t i v e very s i c k 32 50 Pregnancy 0 21 * S i g n i f i c a n c e u s i n g C h i Square A n a l y s i s : * p_< .05. ** p_<.01. 62 Table 6 Summary of Chi Square A n a l y s i s : S e l e c t e d Causes bv Sex <N=45) Cause of s t r e s s S t a r t i n g a neu job Team p r e s s u r e s to u i n in s p o r t s T r o u b l e with t e a c h e r / p r i n c i p a l H a s s l e s u i t h the 1 au F a i l i n g a s u b j e c t Wrecking the c a r Parent l o s i n g job F l u n k i n g a grade L o s i n g a job R e l a t i o n s h i p s u i t h o p p o s i t e sex Pare n t s " g e t t i n g on back" P e r s o n a l l y f e e l i n g put douns L i v i n g up to p a r e n t s ' e x p e c t a t i o n s C l o t h e s H a s s l i n g u i t h b r o t h e r / s i s t e r P a r e n t / r e l a t i v e very s i c k Pregnancy Chi Square Degrees of freedom 0.35 1 0.75 1 2.47 1 1.41 1 0.75 l a 0.92 l a 1.56 l a 1.09 l a 0.36 l a 7. 19 l a 2. 19 l a 0.99 l a 0.35 l a 0.90 1 3.04 l a 0.65 1 4.09 1 a Note t C h i Square uas c a l c u l a t e d u s i n g Yates C o r r e c t i o n . a Chi Square uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * p_< . 05. * * p_< . 01 . 63 One item, " r e l a t i o n s h i p s u i t h the o p p o s i t e sex" uas i d e n t i f i e d s i g n i f i c a n t l y more f r e q u e n t l y by g i r l s than boys when compared u s i n g both Chi Square A n a l y s i s and c o n f i d e n c e i n t e r v a l comparisons, p.<.05. T h i s r e s u l t uas s i m i l a r to t h a t r e p o r t e d by BurKe and Weir <1979>. Another item, "pregnancy" uas a l s o i d e n t i f i e d more f r e q u e n t l y by g i r l s than boys. Although C h i Square A n a l y s i s r e v e a l e d the d i f f e r e n c e in s c o r e s to be s i g n i f i c a n t , a comparison of c o n f i d e n c e i n t e r v a l s r e v e a l e d the r e s u l t s to be i n s i g n i f i c a n t at p.<.05. With the tasK of d e v e l o p i n g a sexual i d e n t i t y and h e t e r o s e x u a l r e l a t i o n s h i p s , a d o l e s c e n t s of both sexes may be s e x u a l l y a c t i v e . S i n c e both sexes s h o u l d be concerned u i t h the consequences of t h e i r a c t i v i t y , i t i s of concern t h a t o n l y g i r l s i d e n t i f i e d pregnancy as a cause of s t r e s s . It i s p o s s i b l e the female respondents to t h i s item uere d a t i n g o l d e r boys uho uere not i n v o l v e d in t h i s s t u d y . An examination of d a t a r e v e a l s t r e n d s u h i c h i n d i c a t e t h a t boys i d e n t i f i e d s t r e s s o r s p e r t a i n i n g to a j o b , s c h o o l , c a r s , and a u t h o r i t y f i g u r e s more f r e q u e n t l y than g i r l s , uhereas g i r l s i d e n t i f i e d s t r e s s o r s p e r t a i n i n g to the f a m i l y , i n t e r p e r s o n a l r e l a t i o n s h i p s , and the s e l f more f r e q u e n t l y than boys. P o s s i b l e reasons f o r the v a r i a t i o n s in responses between boys and g i r l s may be based on e x p e r i e n c e or g e n e t i c c o n s t i t u t i o n . The s o c i a l i z a t i o n p a t t e r n s may be d i f f e r e n t f o r i n d i v i d u a l s r a i s e d in t r a d i t i o n a l male or female r o l e s . However, i t i s p r o b a b l e t h a t some i n d i v i d u a l s have e x p e r i e n c e d a b i s e x u a l o r i e n t a t i o n in c h i l d h o o d . For the a d o l e s c e n t , with the developmental tasKs of a c h i e v i n g a sexual i d e n t i t y and assuming a sexual r o l e , those items u h i c h may be i d e n t i f i e d u i t h a p a r t i c u l a r sex r o l e may a l s o be s o u r c e s of s t r e s s . At a d o l e s c e n c e , the s o c i e t a l and f a m i l i a l e x p e c t a t i o n s f o r females may be c o n t r a d i c t o r y and r e s u l t in a d i f f u s i o n of i d e n t i t y u i t h concomitant u n c e r t a i n t i e s and lacK of 64 c o n t r o l . C o n s e q u e n t l y , females may looK to r e l a t i o n s h i p s u i t h o t h e r s f o r t h e i r s e 1 f - d e f i n i t i o n . Males, c o n v e r s e l y , may not have the same ambiguity in d e f i n i t i o n of the s e l f and thus can become c o m p e t i t i v e , a g g r e s s i v e and independent. Another p o s s i b l e reason f o r the v a r i a t i o n s i n responses betueen the sexes may a r i s e from t h e i r i n h e r e n t b i o l o g i c a l d i f f e r e n c e s . There uas l i t t l e d i f f e r e n c e betueen g i r l s (39%) and boys <38JO in the mean t o t a l percentage f r e q u e n c i e s f o r a l l causes of s t r e s s . Although g i r l s and boys responded d i f f e r e n t l y t o d i f f e r e n t items, the number of items each i d e n t i f i e d uas very s i m i l a r . T h i s f i n d i n g s tands in c o n t r a s t to those of Mendez et a l . < 1986) and JacKson < 1982) uho found g i r l s r e p o r t e d more events than boys. D i f f e r e n c e s in the l i s t of o p t i o n s or in each sample may account f o r the d i s c r e p a n c i e s betueen study f i n d i n g s . Age . A d o l e s e n t s ' p e r c e p t i o n s of s t r e s s causes uere a l s o compared based on the respondent's age. The frequency of s e l e c t e d causes of s t r e s s by age i s summarized in Table 7. The summary of C h i Square A n a l y s i s f o r the s e l e c t e d causes of s t r e s s by age i s pr e s e n t e d in Table 8. 65 Tabl e 7 S e l e c t e d Causes of S t r e s s ; Frequency bv Age A d j u s t e d Frequency Age: 14-15 16-17 18-19 Cause of s t r e s s 11=17 0_=2£ 0_=6 Frequency i n c r e a s e u i t h age P r e s s u r e s to do t h i n g s u i t h i n time frame 71 82 100 F i n i s h i n g s c h o o l 6 14 50 * Pregnancy 6 8 17 Frequency decrease u i t h age P e r s o n a l l y f e e l i n g "put douns" 71 68 33 P r e s s u r e s from f r i e n d s 71 64 33 Team p r e s s u r e s to u i n in s p o r t s 65 45 17 Loss of pet 53 36 0 T r o u b l e u i t h t e a c h e r / p r i n c i p a l 47 45 17 P a r e n t / r e l a t i v e very s i c K 47 36 17 H a s s l e s u i t h 1au 47 36 17 H a s s l i n g u i t h b r o t h e r / s i s t e r 47 23 0 F a i l i n g a s u b j e c t 44 32 17 L o s i n g a job 23 14 0 Problems u i t h acne 29 27 0 Frequency h i g h e r at a p a r t i c u l a r age S t a r t i n g a job 53 73 33 Wrecking the car 18 41 0 S i g n i f i c a n c e u s i n g C hi Square A n a l y s i s : * E.< .85. 66 Tabl e 8 Summary o-f Chi Square A n a l y s i s : S e l e c t e d Causes of S t r e s s by Age <N=45> Cause of s t r e s s C h i Square Degrees of freedom P r e s s u r e to do t h i n g s w i t h i n time 2.49 2 F i n i s h i n g s c h o o l , g r a d u a t i n g 6.69 2 * Pregnancy 2.39 2 P e r s o n a l l y f e e l i n g put downs 2.95 2 P r e s s u r e s from f r i e n d s 2.65 2 Team p r e s s u r e s to u i n in s p o r t s 4.30 2 Loss of pet 5.32 2 Tro u b l e u i t h t e a c h e r / p r i n c i p a l 1.86 2 P a r e n t / r e l a t i v e very s i c K 1 .78 2 H a s s l e s u i t h the 1au 1.78 2 H a s s l i n g u i t h b r o t h e r / s i s t e r 5.58 2 F a i l i n g a s u b j e c t 1 .53 2 Problems u i t h acne 2.26 2 L o s i n g a job 1 .99 2 S t a r t ing a job 3.62 2 Wrecking the c a r 4.90 2 Note: Chi Square uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * p_< . 05. There uere no s i g n i f i c a n t d i f f e r e n c e s f o r responses based on age. " F i n i s h i n g s c h o o l " uas noted most f r e q u e n t l y by the o l d e r age group. Although s t a t i s t i c a l l y s i g n i f i c a n t u s i n g C h i Square A n a l y s i s , t h i s d i f f e r e n c e uas not s i g n i f i c a n t u s i n g c o n f i d e n c e i n t e r v a l s , p_<.05. T h i s s t r e s s o r uas i d e n t i f i e d by 100% of the 18 67 year o l d s , a f a c t u h i c h i s to be expected u i t h s c h o o l g r a d u a t e s . Trends in d i f f e r e n c e s , based on age are i n d i c a t e d . S t r e s s o r s u h i c h i n c r e a s e d u i t h age uere " f i n i s h i n g s c h o o l , " "pregnancy," and "pressures to do t h i n g s u i t h i n a g i v e n time frame." These s t r e s s o r s r e f l e c t the a c t i v i t i e s of the age group u i t h i t s p a r t i c u l a r developmental t a s K s : p r e p a r i n g f o r an o c c u p a t i o n , d e v e l o p i n g a sexual i d e n t i t y , and i n c r e a s i n g auareness and a b i l i t y to p l a n ahead. The frequency f o r "pressure to do t h i n g s u i t h i n a g i v e n time frame" uas a l s o noted by Jackson <1982) and may r e f l e c t i n c r e a s i n g a c t i v i t i e s and o p p o r t u n i t i e s , u i t h consequent demands, t h a t occur u i t h m a t u r i t y . S t r e s s o r s u h i c h decreased u i t h age uere r e l a t e d to a u t h o r i t y f i g u r e s , f a m i l y r e l a t i o n s h i p s , s c h o o l , and peer p r e s s u r e and r e f l e c t the developmental t a s k s of a c h i e v i n g independence, p r e p a r i n g f o r an o c c u p a t i o n , d e v e l o p i n g peer r e l a t i o n s h i p s , and a c h i e v i n g a s e 1 f - i d e n t i t y . Decrease in c o m p e t i t i o n such as "team p r e s s u r e s to u i n in s p o r t s , " as u e l l , may r e f l e c t a more se c u r e sense of s e l f t h a t i s not as v u l n e r a b l e to i n f l u e n c e s from o t h e r s . S e v e r a l items shou a h i g h e r response frequency by a p a r t i c u l a r age group. " S t a r t i n g a neu j o b " and " u r e c k i n g the c a r " uere r e p o r t e d as s t r e s s o r s more f r e q u e n t l y by 16 and 17 year o l d s than by the other age groups. Lack of e x p e r i e n c e , a s s o c i a t e d u i t h an i n c r e a s e d r e s p o n s i b i l i t y , i s s t r e s s - p r o d u c i n g . With e x p e r i e n c e , u o r k i n g and d r i v i n g a car become l e s s s t r e s s f u l . S i m i l a r p a t t e r n s uere noted uhen the responses uere r e l a t e d to grade in s c h o o l . The items r e l a t e d to s c h o o l , "changing s c h o o l , " "school uork, t e s t s , " " f l u n k i n g a grade," and " f a i l i n g a s u b j e c t " uere r a t e d most f r e q u e n t l y by respondents in Grade 9 and uere r e p o r t e d u i t h d e c r e a s i n g f r e q u e n c y in s u c c e e d i n g g r a d e s . Houever , the frequency of schoo1-re 1ated s t r e s s o r s i n c r e a s e d a gain f o r s t u d e n t s in Grade 13. S i m i l a r i l y , an i n c r e a s e in s t r e s s uas noted at the e n t r a n c e to high s c h o o l by LeBou <1976) and Jackson < 1982) and may be r e l a t e d to a change in a c t i v i t y format and 68 e x p e c t a t i o n s u i t h high s c h o o l e n t r a n c e . "Trouble u i t h t e a c h e r / p r i n c i p a l " uas r e p o r t e d most f r e q u e n t l y by respondents in Grade 10 and uas a l s o noted in the l i t e r a t u r e <JacKson, 1882; Mendez et a l . , 1830). The s t r u g g l e f o r independence and autonomy may reach a climax at ages 15 to 16 <B. Hamburg, 1974) and r e s u l t in f r u s t r a t i o n uhen thwarted by those in a u t h o r i t y . The mean percentage frequency of a l l r e p o r t e d causes of s t r e s s decreased u i t h age from 46% f o r i n d i v i d u a l s ages 14 to 16, to 37% f o r i n d i v i d u a l s ages 17 to 19. These r e s u l t s are in o p p o s i t i o n to those r e p o r t e d by Mendez et a l . C1980), uho noted the number of s t r e s s o r s i n c r e a s e d u i t h age. Perhaps the c o n f l i c t in r e s u l t s lends support to Maccoby's t h e s i s (1983) t h a t t h e r e i s no l i n e a r i n c r e a s e or decrease in v u l n e r a b i l i t y to s t r e s s u i t h age; t h e r e i s only change. The v a r i a t i o n in study r e s u l t s may a l s o be due to the d i f f e r e n t q u e s t i o n n a i r e s used in each s t u d y . Sex and age. A d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s causes uere f u r t h e r compared on the b a s i s of sex and age. Table 9 r e p o r t s the p a t t e r n s f o r s e l e c t e d causes of s t r e s s c o n s i d e r e d by sex and by age. The summary of Chi Square A n a l y s i s f o r these s e l e c t e d causes of s t r e s s by sex and by age i s d i s p l a y e d in Table 10. The d e s c r i p t i o n of response p a t t e r n s f o r sex and age may be f u r t h e r e l a b o r a t e d . Trends are e v i d e n t . Although both sexes at an o l d e r age i d e n t i f i e d " f i n i s h i n g s c h o o l " as a cause of s t r e s s , the g i r l s i d e n t i f i e d t h i s item more f r e q u e n t l y . T h i s d i f f e r e n c e uas s t a t i s t i c a l l y s i g n i f i c a n t u s i n g Chi Square A n a l y s i s , but uas not s i g n i f i c a n t u s i n g c o n f i d e n c e i n t e r v a l comparisons, p_< .05. Compared to boys, g i r l s may be l e s s g o a l - o r i e n t e d in s e e k i n g a job and may e x p e r i e n c e more ambivalence about t h e i r f u t u r e . F urthermore, the d e t a i l s of the g r a d u a t i o n event such as t h e i r d a t e , c l o t h e s , and p a r t i c u l a r a c t i v i t i e s may be of g r e a t e r i n t e r e s t to g i r l s , than boys. 63 Table 9 S e l e c t e d Causes of S t r e s s : Frequency bv Sex and bv flae A d j u s t e d frequency < Y.) Male Female Age: 14-16 Cause of s t r e s s n_=22 17-19 D_=9 14-16 D_=8 17-D_=l 19 B Frequency i n c r e a s e d u i t h age P r e s s u r e s to do t h i n g s u i t h i n time frame 73 89 75 100 F i n i s h i n g s c h o o l 9 22 0 50 * Frequency decreased with age P r e s s u r e s from f r i e n d s 73 33 75 17 L i v i n g up to p a r e n t s ' e x p e c t a t i o n s 68 55 87 67 Team p r e s s u r e s to win in s p o r t 59 44 50 17 P e r s o n a l l y f e e l i n g put douns 59 55 87 67 T r o u b l e u i t h t e a c h e r / p r i n c i p a l 59 33 25 17 F a i l i n g a s u b j e c t 48 22 25 17 Loss of pet 45 33 39 17 H a s s l e s u i t h b r o t h e r / s i s t e r 27 0 75 17 ** Frequency d i s s i m i l a r i t i e s P a r e n t / r e l a t i v e very s i c K 32 33 62 33 Pregnancy 0 0 0 50 *** S i g n i f i c a n c e u s i n g C h i Square A n a l y s i s : *p_< .05. **&_<.01. ***£_< .001 . 70 Table 10 Summary of Chi Square Analysis' s e l e c t e d causes of s t r e s s by Sex and bv Age ( N=45> Cause of s t r e s s P r e s s u r e s to do t h i n g s u i t h i n time frame F i n i s h i n g s c h o o l , g r a d u a t i n g P r e s s u r e s from f r i e n d s L i v i n g up to p a r e n t s ' e x p e c t a t i o n s Team p r e s s u r e s to u i n in s p o r t s P e r s o n a l l y f e e l i n g put douns T r o u b l e with t e a c h e r / p r i n c i p a l F a i l i n g a s u b j e c t Loss of a pet H a s s l e s u i t h b r o t h e r / s i s t e r P a r e n t / r e l a t i v e very s i c K Pregnancy Chi Square Degrees of freedom 2.80 3 7.90 3 * 5. 16 3 2.06 3 3.48 3 2.45 3 5.44 3 3.38 3 1 .76 3 12.40 3 ** 2.54 3 20.88 3 *** Note; C h i Square uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * P_<.05. ** p_<.01. *** p_<.001. Younger g i r l s i d e n t i f i e d " p a r e n t / r e l a t i v e very s i c K " and "h a s s l e s u i t h b r o t h e r / s i s t e r " more f r e q u e n t l y than boys or o l d e r g i r l s . T h i s d i f f e r e n c e in the l a t t e r item uas s t a t i s t i c a l l y s i g n i f i c a n t u s i n g both C h i Square A n a l y s i s and c o n f i d e n c e i n t e r v a l s , e_<.05. Compared to o t h e r groups, younger g i r l s may be more s e n s i t i v e to f a m i l y members than oth e r persons a r e , and hence f e e l more f r u s t r a t i o n from s i b l i n g s and more concern uhen a parent or r e l a t i v e i s s i c K . G i r l s may a l s o be more s e n s i t i v e to the 71 remarks of o t h e r s , p a r t i c u l a r l y those of f a m i l y members, and at a younger age, are more v u l n e r a b l e to c o n f l i c t s with s i b l i n g s . "Pregnancy" f o r o l d e r g i r l s uas s i g n i f i c a n t u s i n g C h i Square A n a l y s i s but uas not s i g n i f i c a n t u s i n g c o n f i d e n c e i n t e r v a l c omparisons, p_<.05. "Pregnancy" uas not i d e n t i f i e d by younger g i r l s as a cause of s t r e s s . It i s p o s s i b l e younger g i r l s had no reason f o r concern about pregnancy, or perhaps t h e i r Knowledge concern ing pregnancy uas inadequate. Summary In summary, the most f r e q u e n t causes of s t r e s s i d e n t i f i e d by p a r t i c i p a n t s uere schoo1-re 1ated items. S t r e s s o r s p e r t a i n i n g to uorK uere a l s o f r e q u e n t l y l i s t e d and both s c h o o l and uorK r e f l e c t the a c t i v i t i e s in the environment. Other i d e n t i f i e d s t r e s s o r s r e l a t e to f a m i l y , a u t h o r i t y f i g u r e s , i n t e r p e r s o n a l r e l a t i o n s h i p s , p e r s o n a l l y f e e l i n g "put douns," and p r e s s u r e from f r i e n d s . These s t r e s s o r s r e f l e c t the d e v e l o p i n g s e l f . Comparisons of a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s causes based on r e s p o n d e n t s ' age and sex r e v e a l e d s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s f o r tuo items. " R e l a t i o n s h i p s u i t h the o p p o s i t e sex" uas i d e n t i f i e d more f r e q u e n t l y by g i r l s and " h a s s l e s u i t h b r o t h e r / s i s t e r " uas i d e n t i f i e d more f r e q u e n t l y by younger g i r l s than by o l d e r g i r l s or any boys. Although not s i g n i f i c a n t , a t r e n d in d i f f e r e n c e s in responses based on the sex and age of the p a r t i c i p a n t s i s appa r e n t . The frequency of s t r e s s o r s c o n c e r n i n g the f a m i l y , a u t h o r i t y f i g u r e s , p r e s s u r e s from f r i e n d s , and the s e l f decreased u i t h age, r e f l e c t i n g i n c r e a s e d f a c i l i t y u i t h developmental t a s k s and a maturing s e l f . With i n c r e a s e in age, houever, the p r e s s u r e of time uas more f r e q u e n t , r e f l e c t i n g i n c r e a s e d o p p o r t u n i t i e s , r e s p o n s i b i l i t i e s , and demands. When sex of the p a r t i c i p a n t uas c o n s i d e r e d , response p a t t e r n s uere a l s o found. There was l i t t l e d i f f e r e n c e between boys and g i r l s in the mean f r e q u e n c i e s f o r 72 causes of s t r e s s . However, t h e r e uere d i f f e r e n c e s in the i n d i v i d u a l items u h i c h each more f r e q u e n t l y i d e n t i f i e d . G i r l s i d e n t i f i e d items r e l a t e d to the f a m i l y , the s e l f , r e l a t i o n s h i p s , and pregnancy as s t r e s s o r s more f r e q u e n t l y than boys, uhereas boys i d e n t i f i e d p r e s s u r e s in team s p o r t s , s c h o o l , j o b - r e l a t e d c o n c e r n s , and a u t h o r i t y f i g u r e s as s t r e s s o r s more f r e q u e n t l y than g i r l s . Younger g i r l s i d e n t i f i e d the item " p a r e n t / r e l a t i v e very s icK " more f r e q u e n t l y than the o t h e r subgroups, uhereas o l d e r g i r l s i d e n t i f i e d "pregnancy" more f r e q u e n t l y than the o t h e r subgroups. The average number of causes of s t r e s s decreased u i t h age. Moreover, s e v e r a l items uere r e p o r t e d more f r e q u e n t l y at a p a r t i c u l a r age, r e f l e c t i n g the a d o l e s c e n t ' s a c t i v i t i e s . S c h o o l - r e l a t e d items uere most f r e q u e n t l y noted by those in Grade 9. A d o l e s c e n t P e r c e p t i o n s of the Symptoms of S t r e s s Information on uhat a d o l e s c e n t s p e r c e i v e as the symptoms of s t r e s s uas d e r i v e d from open-ended and closed-ended q u e s t i o n s . The responses to these tuo q u e s t i o n formats are p r e s e n t e d and d i s c u s s e d f o r the t o t a l sample. F u r t h e r c o n s i d e r a t i o n i s g i v e n the ansuers to the c1osed-response q u e s t i o n s based on the sex and age of the r e s p o n d e n t s . Description of Total Sample Qpen-ended responses. The symptoms l i s t e d in response to the open-ended q u e s t i o n uere c a t e g o r i z e d a c c o r d i n g to c o n t e n t , counted, and r e c o r d e d <see Appendix G f o r the open-ended responses to symptoms of s t r e s s ! f r equency and c a t e g o r i e s ) . Table 11 c o n t a i n s the c a t e g o r i e s , t a b u l a t i o n and c o n t e n t summary to the open-ended responses f o r the symptoms of s t r e s s . 73 Tab 1e 11 Symptoms of S t r e s s ; C a t e g o r i e s . T a b u l a t i o n and Content Summary <N=46? Category A c t u a l f r e q u e n c y 3 Content summary Phys io1og i c a l 5S b o d i l y symptoms such as h e a r t pounding, s w e a t i n g , tense muse 1es B e h a v i o r a l SB f e e l i n g s r e l a t e d to a c t i o n s , such as " f e e l 1iKe h i t t i n g " A f f e c t ive 2£ emotional f e e l i n g s such as sadness , depress ion a More than 1 response may be 1 i s t e d by each respondent P h y s i o l o g i c a l c a t e g o r y symptoms such as "tense muscles," "nervous," "jump e a s i l y , " and headaches" uere l i s t e d most f r e q u e n t l y . Less f r e q u e n t l y i d e n t i f i e d items uere in the B e h a v i o r a l c a t e g o r y , such as "s h o r t temper" and "bad mood." Items in the A f f e c t i v e c a t e g o r y such as " f e e l i n g d e p r e s s e d " or " i r r i t a b l e " uere l e a s t f r e q u e n t l y l i s t e d . Closed-ended responses. S t r e s s symptoms, i d e n t i f i e d from a l i s t of o p t i o n s , r e v e a l e d a range of f r e q u e n c i e s from 5% f o r "frequent need to go pee" to 83% f o r " i r r i t a b i l i t y or d e p r e s s i o n . " The s t r e s s symptoms in ranK order of frequency are l i s t e d i n Table IS. 74 Table 12 Symptoms of S t r e s s ' Frequency in RanK Order <N=46? A c t u a l A d j u s t e d ( X ) Symptom of s t r e s s frequency f r e q u e n c y I r r i t a b i l i t y or d e p r e s s i o n 38 83 F e e l a g g r e s s i v e , 1iKe h i t t i n g something 36 82 F e e l i n g of wanting to be a l o n e , not t a l K 35 80 Pounding of h e a r t 33 75 Being u p t i g h t 34 74 Sweat ing 27 63 Stomach u p s e t . . . d i a r r h e a , c o n s t i p a t i o n 26 59 I n a b i l i t y to c o n c e n t r a t e 26 59 Constant f a t i g u e or r e s t l e s s n e s s 25 57 Insomnia, d i f f i c u l t y s l e e p i n g 25 57 Headaches 23 52 C r a v i n g to eat or l o s s of a p p e t i t e 23 52 Shaking l e g s , t r e m b l i n g , nervous 21 48 Being a f r a i d 21 46 I n a b i l i t y to laugh openly 20 45 Dryness of t h r o a t and mouth 17 38 Urge to c r y 16 37 F e e l i m p u l s i v e 15 35 Indec i s ion 15 33 Overpowering urge to run or hide 12 27 Weakness or d i z z i n e s s 9 20 S t u t t e r i n g , speech d i s t u r b a n c e 8 18 Nightmares 7 15 Frequent need to "go pee" 2 5 75 The g r e a t e r p r o p o r t i o n of items i d e n t i f i e d by the m a j o r i t y of respondents were p h y s i o l o g i c a l or symptoms of body s t a t e s . These i n c l u d e d "pounding of h e a r t , " "sweating," "stomach u p s e t . . . d i a r r h e a , c o n s t i p a t i o n , " "headaches," or " c r a v i n g to eat or l o s s of a p p e t i t e . " " F e e l i n g of wanting to be a l o n e " was noted by 35 <S0%) of the p a r t i c i p a n t s . Another f r e q u e n t l y i d e n t i f i e d symptom was " f e e l a g g r e s s i v e , 1iKe h i t t i n g something" <8S%). "Constant f a t i g u e or r e s t l e s s n e s s " was i d e n t i f i e d by 57% of the r e s p o n d e n t s , as was "insomnia, d i f f i c u l t y s l e e p i n g . " D i s c u s s ion. The c o n t e n t from the open-response and c1osed-response items y i e l d e d s i m i l a r i n f o r m a t i o n . P h y s i o l o g i c a l symptoms uere i d e n t i f i e d most f r e q u e n t l y ; a f f e c t i v e symptoms were i d e n t i f i e d l e a s t f r e q u e n t l y . The c o n t e n t in the open-response items c o r r e s p o n d s to the most f r e q u e n t l y i d e n t i f i e d c1osed-response o p t i o n s , " i r r i t a b i l i t y or d e p r e s s i o n , " " f e e l a g g r e s s i v e , 1iKe h i t t i n g something," and " f e e l i n g of wanting to be a l o n e , not t a l K . " Houever, the sp o n t a n e o u s l y l i s t e d items uere noted l e s s f r e q u e n t l y than the c o r r e s p o n d i n g c1osed-response items. A d o l e s c e n t s may not be a b l e to v e r b a l i z e t h e i r symptoms as r e a d i l y as they can r e c o g n i z e them. Furthermore, they may not be auare of t h e i r oun symptoms. "Pounding of h e a r t " uas i d e n t i f i e d by 75% of the p a r t i c i p a n t s and may c o r r e s p o n d to the c a r d i o v a s c u l a r g rouping noted in the Humphrey and E v e r l y study <1880). As u e l l , t h i s item uas the most f r e q u e n t l y r e c o g n i z e d autonomic s t r e s s response by c h i l d r e n , ages seven to t e n , in a study by S h i e l d s and S t e r n <1979). A high frequency of r e s t l e s s n e s s uas a l s o noted in the same study u h i c h may c o r r e s p o n d to r e s t l e s s n e s s , in the item "constant f a t i g u e or r e s t l e s s n e s s . " These items are i n d i c a t i v e of the a r o u s a l s t a t e in the s t r e s s r e a c t i o n <Selye, 1874). 76 It i s worth n o t i n g t h a t some symptoms such as " f e e l i n g of wanting to be a l o n e , not t a l K , " " f e e l a g g r e s s i v e , 1iKe h i t t i n g something," or those noted as "short temper, bad mood," i f c a r r i e d f o r t h i n t o b e h a v i o r s may not be conducive to managing s t r e s s and may be f u r t h e r s t r e s s - p r o d u c i n g . It i s not Known i f t h e r e i s a r e l a t i o n s h i p between the symptoms and the responses to s t r e s s . S e v e r a l premises are suggested to e x p l a i n these r e s u l t s . Based on t h e i r lacK of e x p e r i e n c e , a d o l e s c e n t s may lacK Knowledge about emotions and thus not be a b l e to v e r b a l i z e t h e i r e x p e r i e n c e s . The p h y s i o l o g i c a l symptoms are l e s s s u b j e c t i v e and may be e a s i e r to i d e n t i f y . With a l i m i t e d e x p e r i e n t i a l background, a d o l e s c e n t s may not understand t h e i r own emotions. Some may be r e l u c t a n t to admit f e e l i n g s t a t e s because of imposing s o c i a l norms and c u l t u r a l e x p e c t a t i o n s . D e s c r i p t i o n of Subgroups Based on Demographic V a r i a b l e s Sex. To f u r t h e r d e s c r i b e the a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s symptoms, comparisons uere made of subgroups based on the respondent's sex. Table 13 p r e s e n t s s e l e c t e d symptoms of s t r e s s by sex . The summary of Chi Square A n a l y s i s f o r the s e l e c t e d symptoms of s t r e s s by sex i s d i s p l a y e d i n Table 14. A s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e betueen boys and g i r l s was i d e n t i f i e d with r e s p e c t to tuo items, u s i n g both C h i Square A n a l y s i s and c o n f i d e n c e i n t e r v a l comparisons, P_< .85. G i r l s r e p o r t e d the items " c r a v i n g to eat or l o s s of a p p e t i t e " and "urge to c r y " more f r e q u e n t l y than boys. Perhaps g i r l s are p h y s i c a l l y more s u b j e c t to a p p e t i t e d i s t u r b a n c e than boys u h i c h i s suggested by the h i g h e r p r o p o r t i o n of a n o r e x i a found in females ( M a r l o n , 1977, p. 884). It may be s o c i a l l y more a c c e p t a b l e f o r g i r l s to admit the symptom "urge to c r y " . 77 Table 13 S e l e c t e d Svmp-toms of S t r e s s : Frequency bv Sex A d j u s t e d Frequency* JO Symptom of s t r e s s Males 0_=31 Females n_=14 Frequency h i g h e r f o r mal es Pounding of h e a r t 80 61 Sueat ing 65 54 Sha k i n g , t r e m b l i n g 50 39 Frequency h i g h e r f o r females I r r i t a b i l i t y or d e p r e s s i o n 77 93 Being u p t i g h t 68 36 F e e l i n g of u a n t i n g to be a l o n e , not t a l k 77 85 C r a v i n g to eat or l o s s of a p p e t i t e 40 85 * Urge to c r y £4 69 * Headaches 43 63 Being a f r a i d 39 64 I n a b i l i t y to laugh 43 54 Indec i s ion 26 50 S i g n i f i c a n c e u s i n g C h i Square A n a l y s i s : * p_< .05. Furthermore, t r e n d s in d a t a uere e v i d e n t . Those symptoms r e p o r t e d more f r e q u e n t l y by boys uere p h y s i o l o g i c a l such as "heart pounding," " s u e a t i n g , " and " s h a k i n g , t r e m b l i n g . " F e e l i n g s t a t e s such as " i r r i t a b i l i t y or d e p r e s s i o n , " "being u p t i g h t , " and " f e e l i n g of u a n t i n g to be a l o n e " uere more r e a d i l y i d e n t i f i e d by g i r l s . I n t e r e s t i n g l y , Humphrey and E v e r l y <1980) a l s o found c o l l e g e g i r l s r e p o r t e d more a f f e c t i v e symptoms, uhereas males r e p o r t e d more p h y s i c a l symptoms such as g a s t r o - i n t e s t i n a l u p s e t s . 78 The item " i n d e c i s i o n , " r e p o r t e d more f r e q u e n t l y by g i r l s , may r e f l e c t the ambivalence f e l t in response to u n c l e a r r o l e e x p e c t a t i o n s . Table 14 Summary of Chi Square ftnalvsiss S e l e c t e d Symptoms of S t r e s s bv Sex <N=45> Symptom of s t r e s s Pounding of h e a r t Sweating Shaking l e g s , t r e m b l i n g I r r i t a b i l i t y or d e p r e s s i o n Being u p t i g h t F e e l i n g of u a n t i n g to be alone C r a v i n g to eat or l o s s of a p p e t i t e Urge to c r y Headaches Being a f r a i d I n a b i l i t y to laugh openly Indec i s ion Chi Square Degrees of freedom 0.80 l a 0. 14 l a 0. 13 1 0.68 l a 0.81 l a 0.03 l a 5.57 1 * 5.94 l a * 1.51 1 1.61 1 0.09 1 1 .57 l a Note; C h i Square uas c a l c u l a t e d u s i n g Yates C o r r e c t i o n . a Chi Square uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * P_< . 05. 79 A g r e a t e r number of symptoms uere more f r e q u e n t l y i d e n t i f i e d by g i r l s than by boys, a r e s u l t a l s o noted in the l i t e r a t u r e <BurKe & Weir, 1878; Mechanic, 1976b; S t e r n & H i g g i n s , 1969). Perhaps g e n e t i c c o n s t i t u t i o n accounts f o r g i r l s r e a c t i n g to s t r e s s d i f f e r e n t l y than boys. Perhaps g i r l s may be more i n t e r e s t e d in h e a l t h and be more s e n s i t i v e to symptoms, uhereas boys may c o n s i d e r i t unmanly to be u o r r i e d about f e e l i n g and b o d i l y s t a t e s , ft d i f f e r e n c e in c h i l d r e a r i n g p a t t e r n s may a l s o c o n t r i b u t e to the d i f f e r e n c e s in p e r c e i v e d symptoms. As suggested by Mechanic < 197S; 1976a; 1976b), g i r l s may be g i v e n more r e c o g n i t i o n f o r c o m p l a i n t s and thus l e a r n to r e c o g n i z e symptoms more r e a d i l y than boys. C o n v e r s e l y , boys may l e a r n to ignore f e e l i n g s t a t e s or may be r e l u c t a n t to admit them. Thus, i t may be s o c i a l l y more a c c e p t a b l e f o r g i r l s to admit "being a f r a i d " or having the "urge to c r y " than i t i s f o r boys. P h y s i o l o g i c a l symptoms may be more a c c e p t a b l e f o r boys than f o r g i r l s . The i n c i d e n c e of h e a l t h problems i d e n t i f i e d as being d e r i v e d from s t r e s s , such as u l c e r s or coronary d i s e a s e , are o f t e n a s s o c i a t e d u i t h p r e s t i g i o u s p o s i t i o n s or hard uorK. The symptoms a s s o c i a t e d u i t h these c o n d i t i o n s , such as g a s t r o - i n t e s t i n a l c o m p l a i n t s , h e a r t a c t i v i t y or s u e a t i n g , may be more r e a d i l y acknowledged by boys. Age. A d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s symptoms uere a l s o compared based on the age of the r e s p o n d e n t s . Ta b l e 15 d i s p l a y s s e l e c t e d symptoms of s t r e s s by age. 80 Table 15 S e l e c t e d Symptoms o-f S t r e s s : Frequency by flae A d j u s t e d f r e q u e n c y <.'/.') Age: 14-15 16-17 18-19 Symptom of s t r e s s D_=16 o_=21 Q_=6 Frequency t r e n d to i n c r e a s e u i t h age Fat i g u e / r e s t l e s s n e s s 50 62 67 Frequency t r e n d to decrease u i t h age F e e l i n g of wanting to be alone 87 76 67 Insomn i a 75 57 20 C r a v i n g to eat or l o s s of appet i t e 62 52 33 Being a f r a i d 59 45 17 Indec i s ion 41 32 17 Urge to run or hide 31 3 3 a 0 Frequency h i g h e r at a p a r t icu1ar age Heart pounding 50 90 83 Sweat ing 40 76 67 Stomach upset 58 76 17 I n a b i l i t y to c o n c e n t r a t e 53 68 50 Shaking t r e m b l i n g 37 62 17 I n a b i l i t y to laugh 44 52 23 a Th i s i n c r e a s e in s c o r e may be accounted f o r by the percentage s c o r e c a l c u l a t e d u i t h a sma l l sample s i z e . S i g n i f i c a n c e u s i n g Chi Square A n a l y s i s : * P_<.05. 81 Tab l e 16 d i s p l a y s the summary of Chi Square A n a l y s i s f o r the s e l e c t e d symptoms of s t r e s s by age. There uere no s i g n i f i c a n t d i f f e r e n c e s in s t r e s s symptoms based on age. "Heart pounding" uas i d e n t i f i e d l e s s f r e q u e n t l y by 14 and 15 year o l d s and "stomach u p s e t " uas i d e n t i f i e d l e s s f r e q u e n t l y by 18 and 18 year o l d s . The d i f f e r e n c e s in responses f o r these tuo items uere s t a t i s t i c a l l y s i g n i f i c a n t u s i n g C h i Square A n a l y s i s but uere not s i g n i f i c a n t u s i n g c o n f i d e n c e i n t e r v a l comparison, P_<.05. Table 16 Summary Of C h i Square A n a l y s i s : S e l e c t e d Symptoms of S t r e s s bv <=>qe <N=45) Symptom of s t r e s s Fat i g u e / r e s t l e s s n e s s F e e l i n g of u a n t i n g to be alone Insomn i a C r a v i n g to eat or l o s s of a p p e t i t e Being a f r a i d Indec i s ion Urge to run or h i d e Heart pounding Sueat ing Stomach upset I n a b i l i t y to c o n c e n t r a t e S h a k i n g , t r e m b l i n g I n a b i l i t y to laugh Chi Square Degrees of freedom 0.74 2 1.35 2 4.88 2 1.51 2 3. 18 2 1 .24 2 2.72 2 8.11 2 * 4.33 2 7.43 2 * 1 .22 2 4.67 2 0.76 2 Note: C h i Square uas c a l c u l a t e d u s i n g l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * E _ < . 0 5 . 82 Trends in d a t a may be noted. The response frequency f o r one item, " f a t i g u e and r e s t l e s s n e s s " i n c r e a s e d u i t h age. C o n v e r s e l y , the response frequency f o r "insomnia" decreased u i t h age. The combination of time p r e s s u r e s and the p o s s i b i l i t y of g r e a t e r o p p o r t u n i t i e s , r e s p o n s i b i l i t i e s , and demands may overextend the c a p a b i l i t i e s of the i n d i v i d u a l , r e s u l t i n g in f a t i g u e and r e s t l e s s n e s s . A number of o t h e r symptoms such as " f e e l i n g of u a n t i n g to be a l o n e , " "being a f r a i d , " " i n d e c i s i o n , " and "urge to run or h i d e , " decreased u i t h age and these may r e f l e c t an i n c r e a s e in m a t u r i t y and e x p e r i e n c e . The item c o n c e r n i n g a p p e t i t e , " c r a v i n g to eat or l o s s of a p p e t i t e " may r e f l e c t the importance of food d u r i n g the e a r l y a d o l e s c e n t grouth p e r i o d . "Heart pounding," " s u e a t i n g , " and " i n a b i l i t y to c o n c e n t r a t e " uere r e p o r t e d most f r e q u e n t l y by 16 and 17 year o l d s , r e g a r d l e s s of the d i r e c t i o n a l t r e n d f o r f r e q u e n c i e s . The 16 and 17 year o l d s a l s o i n d i c a t e d the h i g h e s t mean percentage frequency <53%) f o r a l l symptoms. Perhaps i t i s d u r i n g t h i s p e r i o d t h a t i n d i v i d u a l s become auare of b o d i l y symptoms and, u i t h t h e i r i n c r e a s e d c o g n i t i v e f u n c t i o n i n g ( K e a t i n g , 1980), can l a b e l and r e l a t e to s i t u a t i o n s or concepts such as s t r e s s . It i s a l s o p o s s i b l e , changes in hormone l e v e l s a f f e c t the p h y s i o l o g i c a l r e a c t i o n to s t r e s s to a g r e a t e r degree at these ages than at o t h e r s . Sex a n d a g e • The comparisons betueen r e s p o n d e n t s ' p e r c e p t i o n s of s t r e s s symptoms based on sex and age are f u r t h e r e l a b o r a t e d . Table 17 r e p o r t s the freq u e n c y of s e l e c t e d symptoms of s t r e s s by sex and by age. The summary of C h i Square A n a l y s i s f o r these s e l e c t e d s t r e s s symptoms by sex and by age i s d i s p l a y e d in Table 18. There uere no s i g n i f i c a n t d i f f e r e n c e s in the subgroups based on age and sex. Although the item, "dryness in mouth" uas i d e n t i f i e d by the m a j o r i t y of younger boys and the m a j o r i t y of o l d e r g i r l s , i t uas 83 not i d e n t i f i e d by any o l d e r boys. T h i s d i f f e r e n c e showed s t a t i s t i c a l s i g n i f i c a n c e u s i n g C h i Square A n a l y s i s , but uas not s i g n i f i c a n t u s i n g c o n f i d e n c e i n t e r v a l comparisons, P_<.05. Tab 1e 17 S e l e c t e d Symptoms of S t r e s s : Frequency bv Sex and bv Age A d j u s t e d frequency* JO Males Females 14-16 17-18 14-16 17-19 Symptom of s t r e s s n_=22 o_=9 o_=8 n_=G Frequency t r e n d to i n c r e a s e u i t h age F a t i g u e , r e s t l e s s n e s s 52 56 43 100 Heart pounding 71 100 57 67 Sueat ing 60 78 29 83 Be ing upt igh t 64 78 75 100 Frequency t r e n d to d ecrease u i t h age F e e l i n g of u a n t i n g to be alone 86 56 86 77 Being a f r a i d 41 33 75 50 Insomn i a 62 50 71 50 I n a b i l i t y to laugh 52 22 57 50 Sh a k i n g , t r e m b l i n g 57 33 43 33 Stomach upset 62 41 71 50 Frequency d i s s i m i l a r i t i e s Dryness in mouth 52 0 29 67 Indec i s ion 32 11 50 50 S i g n i f i c a n c e u s i n g Chi Square A n a l y s i s : p_< .05. 84 Table 18 Summary of Chi Square A n a l y s i s : S e l e c t e d Symptoms of S t r e s s bv Sex and by ftqe <N=45? Symptom of s t r e s s Chi Square Degrees of freedom F a t i g u e , r e s t l e s s n e s s 5.3© 3 Heart pounding 4 . 4 8 3 Sueat ing 5.46 3 Being u p t i g h t 3.34 3 F e e l i n g of u a n t i n g to be alone 3.8S 3 Being a f r a i d 3.54 3 Insomn i a 0 .93 3 I n a b i l i t y to laugh a . 77 3 S h a k i n g , t r e m b l i n g a . 04 3 Stomach upset 1.49 3 Dryness in mouth 9 . 5 3 3 * Indec i s ion 3 .77 3 Note: C h i Square A n a l y s i s uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * P_< . 0 5 . Summary P h y s i o l o g i c a l symptoms such as "heart pounding" and "stomach u p s e t " uere the most f r e q u e n t l y i d e n t i f i e d s t r e s s symptoms by p a r t i c i p a n t s in t h i s s t u d y . A f f e c t i v e and b e h a v i o r a l symptoms uere noted l e s s f r e q u e n t l y . F r e q u e n t l y chosen items uere " i r r i t a b i l i t y or d e p r e s s i o n , " " f e e l a g g r e s s i v e , l i k e h i t t i n g 85 some-thing," and " f e e l i n g of wanting to be a l o n e , not t a l K . " When r e p o r t e d symptoms uere compared based on respondents ' sex and age, t h e r e uere s i g n i f i c a n t d i f f e r e n c e s in responses f o r the items "urge to c r y " and " c r a v i n g to eat or l o s s of a p p e t i t e . " These uere r e p o r t e d more f r e q u e n t l y by g i r l s . A tendency to d i f f e r e n c e s in responses based on p a r t i c i p a n t s ' sex and age may be noted. G i r l s r e p o r t e d a g r e a t e r mean frequency of symptoms. G i r l s r e p o r t e d more a f f e c t i v e symptoms; boys r e p o r t e d more p h y s i o l o g i c a l symptoms. These r e s u l t s may be a t t r i b u t e d to e x p e r i e n c e and s o c i a l l e a r n i n g . There uas a t r e n d f o r the fre q u e n c y f o r " f a t i g u e , r e s t l e s s n e s s , " "heart pounding," " s u e a t i n g , " and "being u p t i g h t " to i n c r e a s e u i t h age. Houever, t h e r e uas a t r e n d f o r the frequency of " f e e l i n g of u a n t i n g to be a l o n e , " "being a f r a i d , " " i n d e c i s i o n , " "insomnia," "stomach u p s e t , " and " i n a b i l i t y to l a u g h " to decrease u i t h age. I n d i v i d u a l s uho uere ages 16 to 17 r e p o r t e d a g r e a t e r mean percentage f r e q u e n c y f o r symptoms. The e x p e r i e n c e background of the respondent may account f o r these t r e n d s . A p o s s i b l e r e l a t i o n s h i p of s t r e s s symptoms to s t r e s s responses uas q u e r i e d . A d o l e s c e n t P e r c e p t i o n s of the Responses to S t r e s s Responses to s t r e s s are both b e h a v i o r s and r e s o u r c e s u h i c h a f f e c t the management of s t r e s s . B e h a v i o r a l responses are the a c t i o n s employed to r e d u c e , a v o i d , or manage s t r e s s ; r e s o u r c e responses are the a v a i l a b l e a i d s u h i c h f a c i l i t a t e the management of s t r e s s . A d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s response b e h a v i o r s and r e s o u r c e s , as d e r i v e d from open-response and c1osed-response q u e s t i o n f o r m a t s , are p r e s e n t e d and d i s c u s s e d f o r the t o t a l sample. The d a t a are f u r t h e r d e s c r i b e d based on r e s p o n d e n t s ' age and sex . 86 D e s c r i p t i o n of T o t a l Sample Open-ended r e s p o n s e s . The open-ended q u e s t i o n s u h i c h addressed uhat a d o l e s c e n t s do and uhat h e l p s them manage s t r e s s y i e l d e d s i m i l a r c o n t e n t i n f o r m a t i o n . The ansuers uere grouped and counted (see Appendix H f o r the open-ended ansuers to s t r e s s r e s p o n s e s : f r e q u e n c i e s and c a t e g o r i e s ) . The c a t e g o r i e s , t a b u l a t i o n , and con t e n t summary f o r the responses to s t r e s s are p r e s e n t e d in Table 13. The most f r e q u e n t l y l i s t e d response items uere r e l a t e d to R e l a x a t i o n Techniques c a t e g o r y such as " s i t " or " l i e down," " t r y to mellow o u t , " or " r e l a x . " N e g a t ive h e a l t h b e h a v i o r s such as " d r i n K i n g , " "smoKing," or "smoKing m i l d d r u g s " uere a l s o i n c l u d e d . "Using s o c i a l s u p p o r t " and "having s o c i a l support a v a i l a b l e " uere f r e q u e n t l y l i s t e d as s t r e s s r e s p o n s e s . The most f r e q u e n t l y l i s t e d s o u rces of s o c i a l s u p p ort uere " f r i e n d s . " Less f r e q u e n t l y l i s t e d items uere r e l a t e d to Escape c a t e g o r y such as "being a l o n e " or "stop t h i n k i n g about i t . " "Music", " l i s t e n i n g to music," "other n o i s e s , " or " p l a y i n g g u i t a r " accounted f o r the m a j o r i t y of the items in the c a t e g o r y . Music and D i v e r s i o n a r y A c t i v i t i e s . P h y s i c a l A c t i v i t y items, " p l a y i n g hockey," " j o g g i n g , " " h i t my p i l l o w , " "do something r e a l l y p h y s i c a l , " "get v i o l e n t , " or "get madder than s t i n k " uere l i s t e d l e s s f r e q u e n t l y than R e l a x a t i o n T e c h n i q u e s , S o c i a l S u p p o r t , or Music and D i v e r s i o n a r y A c t i v i t i e s items. Although some items in the C o g n i t i v e T h i n k i n g c a t e g o r y uere s i m i l a r to those in Problem S o l v i n g , d i f f e r e n t i a t i o n uas based on s p e c i f i c i t y of a problem f o r the Problem S o l v i n g c a t e g o r y items . Respondents uere asked to i d e n t i f y f a c t o r s t h a t make managing s t r e s s d i f f i c u l t . A n suers, such as "personal f r u s t r a t i o n s , " "too many a c t i v i t i e s , " and " f i n d i n g no s o l u t i o n s , " uere s i m i l a r to those 1 i s t e d as the causes of s t r e s s and i n c l u d e d items r e l a t e d to i n t e r p e r s o n a l problems, added e x t e r n a l p r e s s u r e s , peer p r e s s u r e , and l o s s . 87 Table 19 Responses -to S t r e s s ; C a t e g o r i e s . T a b u l a t i o n and Content Summary  <N=46) A c t u a l Category f r e q u e n c y 3 Content summary R e l a x a t i o n t e c h n i q u e s 47 S o c i a l s u p port 35 Music and d i v e r s i o n a r y £3 act iv i t i e s P h y s i c a l a c t i v i t y 15 C o g n i t i v e / t h i n K i n g 14 Escape 14 Problem s o l v i n g 9 Symptoms 3 Other 1 r e l a x a t i o n , s i t or l i e down smoKe, d r i n K , m e d i t a t e , s l e e p t a l K to f r i e n d , p a r e n t s , f a m i l y , pets P l a y i n g or l i s t e n i n g to music, doing hobby, r e a d i n g p h y s i c a l a c t i v i t i e s as j o g g i n g , w a l k i n g , s p o r t s v e n t i n g a g g r e s s i o n t h i n k , worry, c o v e r i n g i t up and Keeping i t i n s i d e b e h a v i o r s used to a v o i d the s i t u a t i o n as stop t h i n k i n g about i t , b e i n g a l o n e , get drunK a s s e s s i n g , a n a l y z i n g , p l a n n i n g to f i n d s o l u t i o n sweat, f e e l t i c k e d o f f , f e e l d i s o r i e n t e d p e r s o n a l problem a More than 1 answer may be l i s t e d by each r e s p o n d e n t . 88 Closed-ended responses. P a r t i c i p a n t s s e l e c t e d b e h a v i o r s used in response to s t r e s s from a l i s t of o p t i o n s . T a b l e 20 r e p o r t s the i d e n t i f i e d response b e h a v i o r s to s t r e s s in ranK o r d e r frequency . Table 20 Response Behaviors to Stress' Frequency in RanK Order <N=46? A c t u a l A d j u s t e d <%> Response b e h a v i o r to s t r e s s f requency frequency Try to f i g u r e out uhat the problem i s 40 87 Play music, read or other a c t i v i t y 34 74 Involve s e l f in something e l s e do u e l l 32 71 Do a t h l e t i c a c t i v i t i e s "hard" 30 67 TalK to someone 28 61 Remove s e l f from s i t u a t i o n 27 61 P l a y team s p o r t s " r e a l mean" 24 52 Try not to t h i n K about s i t u a t i o n 24 52 • u e l l or " s t e u " about problem 20 43 DrinK a l c o h o l , smoKe 17 37 Eat f o r s a t i s f a c t i o n 1 1 24 D r i v e f a s t , squeal t i r e s , make smoKe 11 24 "Act o u t " 10 23 Use medicines 5 1 1 Use r e l a x a t i o n t e c h n i q u e s such as Yoga, T.M. or p r o g r e s s i v e muscle r e l a x a t i o n 1 2 39 The i d e n t i f i e d response r e s o u r c e s ranged in frequency from 2% f o r "use r e l a x a t i o n t e c h n i q u e s such as Yoga, T.M. or p r o g r e s s i v e muscle r e l a x a t i o n " to 87% f o r " t r y to f i g u r e out what the problem i s . " Items r e l a t e d to a t h l e t i c a c t i v i t y , d i v e r s i o n a r y a c t i v i t i e s , t a l k i n g to someone, and removing s e l f or thought from a s i t u a t i o n uere i d e n t i f i e d by over h a l f the p a r t i c i p a n t s . S e v e r a l items, "drink a l c o h o l , smoke," "use m e d i c i n e s , " " d r i v e f a s t , s queal t i r e s , make smoke," and "eat f o r s a t i s f a c t i o n " uere i d e n t i f i e d by at l e a s t 24% of the a d o l e s c e n t s as a uay of copin g u i t h s t r e s s and are c o n s i d e r e d n e g a t i v e h e a l t h b e h a v i o r s . "Act o u t " uas i d e n t i f i e d by n e a r l y one q u a r t e r of the r e s p o n d e n t s . "Use r e l a x a t i o n t e c h n i q u e s . . . " uas i d e n t i f i e d by only one p a r t i c i p a n t . P a r t i c i p a n t s a l s o s e l e c t e d response r e s o u r c e s u h i c h they f i n d h e l p f u l in managing s t r e s s from a l i s t of o p t i o n s . T a b l e 21 p r e s e n t s the response r e s o u r c e s f o r s t r e s s in rank o r d e r f r e q u e n c y . The i d e n t i f i e d response r e s o u r c e s ranged in frequency from 65% to 97%. The most f r e q u e n t l y i d e n t i f i e d items uere r e l a t e d to the s e l f , i n c l u d i n g " f e e l good about s e l f " <97%), and "have c o n f i d e n c e in s e l f " <91%). " G e t t i n g enough s l e e p " <93%> uas a l s o f r e q u e n t l y i d e n t i f i e d . Other items r e l a t e d to h e a l t h h a b i t s , such as " g e t t i n g r e g u l a r e x e r c i s e " <70%) and " e a t i n g a u e l 1 - b a l a n c e d d i e t " <67%), uere not r a t e d as f r e q u e n t l y . "Being a b l e to a n t i c i p a t e uhat u i l l happen" uas i d e n t i f i e d l e a s t f r e q u e n t l y . D i s c u s s ion • D i f f e r e n c e s are noted in the r e s u l t s betueen the open-response and c1osed-response q u e s t i o n s . In the open-response q u e s t i o n s , the most f r e q u e n t l y l i s t e d items uere in the R e l a x a t i o n Techniques c a t e g o r y . Houever, "use r e l a x a t i o n t e c h n i q u e s such as Yoga, T.M. or p r o g r e s s i v e muscle r e l a x a t i o n " uas the l e a s t f r e q u e n t l y i d e n t i f i e d o p t i o n from the l i s t of c1osed-response items. Those items s p o n t a n e o u s l y l i s t e d i n c l u d e d a v a r i e t y of b e h a v i o r s such as " s i t " or " l i e down," "meditate," 90 Table £1 Response Resources for Stress' Frequency in RanK Order <N=46) Ac t u a l A d j u s t e d < %) Response r e s o u r c e f o r s t r e s s frequency f r e q u e n c y F e e l i n g good about s e l f 44 97 Having time f o r s e l f 44 97 G e t t i n g enough s l e e p 43 93 Having c o n f i d e n c e in s e l f 42 91 Having c l o s e f r i e n d in uhom can c o n f i d e 33 85 Having a say or c o n t r o l i n s i t u a t i o n 36 78 P r e v i o u s l y e x p e r i e n c i n g a s i m i l a r s i t u a t ion and manag ing 36 78 Being a b l e to say "no" u i t h o u t f e e l i n g g u i l t y 36 78 Having broad range of i n t e r e s t s and being accomplished in some 35 76 G e t t i n g r e g u l a r p h y s i c a l e x e r c i s e 32 70 E a t i n g ue11-balanced d i e t 31 67 Being a b l e to a n t i c i p a t e uhat u i l l happen 30 65 "smoke," or " d r i n K , " uhereas the c h o i c e in the l i s t of o p t i o n s may have been p e r c e i v e d as being s p e c i f i c to the examples i n c l u d e d "...such as Yoga, T.M. or p r o g r e s s i v e muscle r e l a x a t i o n . " Some s t r e s s r e s p o n s e s , such as d r i n k i n g , smoKing c i g a r e t t e s or m i l d drugs and e a t i n g , are n e g a t i v e h e a l t h b e h a v i o r s . These s t r e s s response b e h a v i o r s are a l s o d e s c r i b e d in the l i t e r a t u r e p e r t a i n i n g to the a d u l t <Oobson, 1383; Ziemer, 1982) and although these responses may r e l i e v e s t r e s s , they may, in t u r n , cause f u r t h e r s t r e s s . "Drive f a s t , squeal t i r e s , make smoke" may be a s s o c i a t e d u i t h the high p r o p o r t i o n of t r a f f i c a c c i d e n t s in young d r i v e r s . There i s a need to s u b s t i t u t e b e h a v i o r s more conducive 31 to h e a l t h , a c c e p t a b l e to the a d o l e s c e n t , and more e f f e c t i v e in the management of s t r e s s . Problem s o l v i n g was the most f r e q u e n t l y chosen o p t i o n but the o p t i o n l e a s t f r e q u e n t l y l i s t e d . A d o l e s c e n t s may not c o n s i d e r i t a d i r e c t response to s t r e s s . It a l s o may not be at a l e v e l of awareness t h a t i s e a s i l y r e c a l l e d , a l t h o u g h i t can be r e c o g n i z e d . The high f r e q u e n c y f o r t h i s item i s supported in the f i n d i n g s of FolKman and Lazarus ( 1 9 3 0 ) , who noted problem s o l v i n g as a major response to s t r e s s f o r a d u l t s . The r e s u l t s f o r p h y s i c a l a c t i v i t y may a l s o be e x p l a i n e d as a lacK of awareness. Although c l o s e d - e n d e d items, "do a t h l e t i c a c t i v i t i e s h a r d " and "play team s p o r t s r e a l mean," uere i d e n t i f i e d by the m a j o r i t y of the r e s p o n d e n t s , o n l y 15 comments uere l i s t e d r e l a t i n g to p h y s i c a l a c t i v i t y in the open-ended r e s p o n s e s . In a d d i t i o n , p h y s i c a l a c t i v i t y uas one of the l e s s f r e q u e n t l y i d e n t i f i e d response r e s o u r c e s . Escape c a t e g o r y items uere l i s t e d more f r e q u e n t l y than Problem S o l v i n g i n the open-ended items. As noted in the l i t e r a t u r e , more a d a p t i v e outcomes have been r e p o r t e d f o r a d u l t s by those uho use l e s s avoidance and more problem s o l v i n g b e h a v i o r s ( B e l l , 1977; Moos & B i l l i n g s , 1982). Is t h i s premise supported f o r the a d o l e s c e n t ? Or does escape/avoidance b e h a v i o r r e s u l t in more a d a p t i v e outcome uhen e x p e r i e n c e i s l a c k i n g ? "Act o u t , " i d e n t i f i e d as a s t r e s s response b e h a v i o r , may mean im p u l s i v e or d e l i b e r a t e m i s b e h a v i o r and may not be the most a p p r o p r i a t e response to s t r e s s . In f a c t , i t may p r e c i p i t a t e f u r t h e r s t r e s s . Houever, the p r e c i s e meaning i s open to i n t e r p r e t a t i o n . "Music" or "other n o i s e , " as a major d i v e r s i o n a r y a c t i v i t y , i s not n e c e s s a r i l y a b e h a v i o r t y p i c a l l y a d o l e s c e n t . Music may serve as a f o c a l p o i n t f o r r e l a x a t i o n but may a l s o be i n d i c a t i v e of a s u b t l e s t r e s s f u l s i t u a t i o n f o r the a d o l e s c e n t . Seeking and having a v a i l a b l e s o c i a l support from f r i e n d s and 92 f a m i l y uas i d e n t i f i e d f r e q u e n t l y as a s t r e s s management re s p o n s e . The importance of s o c i a l support i s a l s o d e s c r i b e d in the l i t e r a t u r e <Caplan, 1 9 7 4 ; Lieberman, 1 9 8 2 ; S i d l e et a l . , 1 9 6 9 ; Tyerman & Humphrey, 1 9 8 3 ; Ziemer, 1 9 8 2 ) . However, comments r e l a t e d to i n t e r p e r s o n a l r e l a t i o n s h i p s such as "people not u n d e r s t a n d i n g uhy or t h a t I'm under s t r e s s , " " h a s s l i n g , " or "bugging" u i t h "no time on my oun" suggest t h e r e are parameters to s o c i a l s u p p o r t . Perhaps the s t r e n g t h in s o c i a l support i s hawing persons a v a i l a b l e to whom one may c a l l . There a l s o may be a time p e r i o d or sequence f o r most advantageous s o c i a l s u p p o r t . With the s t r u g g l e f o r autonomy, a d o l e s c e n t s may b e n e f i t from the o p p o r t u n i t y to t r y to s o l v e problems on t h e i r oun. What are the parameters to s o c i a l support and to problem s o l v i n g f o r the ado 1 e s c e n t ? The study r e s u l t s have been r e l a t e d to the l i t e r a t u r e c o n c e r n i n g a d u l t c o p i n g b e h a v i o r s . Does the same p a t t e r n e x i s t f o r the a d o l e s c e n t ? If i t can be presumed t h a t a p e r c e i v e d s t r e s s l e v e l i s an i n d i c a t i o n of a d a p t a t i o n , i s t h e r e a r e l a t i o n s h i p betueen the i d e n t i f i e d response b e h a v i o r v a r i a b l e s and p e r c e i v e d s t r e s s l e v e l ? A s s o c i a t e d u i t h the response b e h a v i o r s are the response r e s o u r c e s . The r e s o u r c e s i d e n t i f i e d by a d o l e s c e n t s c o r r e s p o n d to the r e s o u r c e s d e s c r i b e d in the l i t e r a t u r e f o r s u c c e s s f u l c o p i n g in a d u l t s : p o s i t i v e s e l f - e s t e e m < P e a r l i n & S c h o o l e r , 1 9 7 8 ; a sense of coherence <AntonevsKy, 1 8 7 9 ) , p r e v i o u s e x p e r i e n c e <Monat & L a z a r u s , 1 9 7 7 , p. 2 1 3 ) , good h e a l t h h a b i t s <Everly & R o s e n f e l d , 1 9 8 1 , P P . 1 5 9 - 1 6 1 ) , and s o c i a l support <Caplan, 1 9 7 4 ; Cobb, 1 9 7 6 ) . Houever, the l i s t of o p t i o n s does not d i s c r i m i n a t e those items u h i c h are not r e s o u r c e s . A d d i t i o n a l items in the l i s t of o p t i o n s may remedy t h i s s i t u a t i o n . The l e a s t f r e q u e n t l y i d e n t i f i e d item, "being a b l e to a n t i c i p a t e uhat u i l l happen," may r e f l e c t the e x p e r i e n t i a l background of the a d o l e s c e n t uho i s c o n s t a n t l y e x p e r i e n c i n g neu 33 s i t u a t i o n s . With l i m i t e d e x p e r i e n c e in b e i n g a b l e to a n t i c i p a t e , the a d o l e s c e n t may not r e c o g n i z e t h i s as a response r e s o u r c e . The most f r e q u e n t l y i d e n t i f i e d r e s o u r c e s p e r t a i n to the s e l f , " f e e l i n g good about s e l f , " "having time f o r s e l f , " "having c o n f i d e n c e in s e l f . " These may r e f l e c t the impact of the d e v e l o p i n g s e l f and the importance of the s e l f - c o n c e p t at ado 1escence. " G e t t i n g enough s l e e p " uas the most f r e q u e n t l y i d e n t i f i e d h e a l t h h a b i t item and may be r e l a t e d to the cause of s t r e s s , "time p r e s s u r e s , " or to the symptom of s t r e s s , " f a t i g u e , r e s t l e s s n e s s . " F urthermore, u i t h t h e i r r a p i d grouth and expanding s o c i a l s p h e r e , both of u h i c h are f a t i g u e - p r o d u c i n g , a d o l e s c e n t s may be expected to r e c o g n i z e s l e e p as a r e s o u r c e . These v a r i a b l e s are i d e n t i f i e d as s t r e s s response r e s o u r c e s by a d o l e s c e n t s , but hou do a d o l e s c e n t s p e r c e i v e these r e s o u r c e s being f a c i l i t a t e d ? Are some more condu c i v e to s t r e s s management than o t h e r s f o r the a d o l e s c e n t ? D e s c r i p t i o n of Subgroups Based on Demographic V a r i a b l e s Sex . A d o l e s c e n t s ' p e r c e p t i o n s of response b e h a v i o r s and response r e s o u r c e s uere f u r t h e r d e s c r i b e d by comparing the responses of subgroups based on the respondent's sex. Response b e h a v i o r s to s t r e s s uere compared betueen boys and g i r l s . In the p r e s e n t a n a l y s i s , t h e r e uas no s i g n i f i c a n t d i f f e r e n c e i n response b e h a v i o r s p e r c e i v e d by e i t h e r sex. Table S2 d i s p l a y s s e l e c t e d response b e h a v i o r s by sex and the summary of Chi Square A n a l y s i s f o r s e l e c t e d response b e h a v i o r s to s t r e s s by sex i s p r e s e n t e d in Table S3. 94 Table 22 S e l e c t e d Response B e h a v i o r s to S t r e s s ; Frequency bv Sex Ad j u s t e d f r e q u e n c y <%> Males Females Response b e h a v i o r to s t r e s s n_=31 n_=14 Frequency h i g h e r f o r males Try to f i g u r e out uhat problem i s 93 71 Do a t h l e t i c a c t i v i t i e s hard 74 50 P l a y team s p o r t s r e a l mean 58 36 D u e l l or s t e u about problem 45 36 Act out in some uay 31 7 Frequency h i g h e r f o r females Remove s e l f from s i t u a t i o n 55 64 DrinK a l c o h o l , smoKe 35 43 Use med i c ines 7 14 D i f f e r e n c e s in the d a t a are noted as t r e n d s . Items u h i c h boys i d e n t i f i e d more f r e q u e n t l y than g i r l s , such as "play team s p o r t s r e a l mean," " t r y to f i g u r e out uhat the problem i s , " and "act o u t , " are a c t i v e approaches to managing a s i t u a t i o n . G i r l s , in c o n t r a s t , r e v e a l e d a more p a s s i v e approach in t h e i r response b e h a v i o r s u i t h more f r e q u e n t c h o i c e of the o p t i o n s "remove s e l f f rom s i t u a t i o n , " "drinK a l c o h o l , smoKe," and "use m e d i c i n e s . " Using a c t i v e approaches and problem s o l v i n g r a t h e r than avoidance s t r a t e g i e s i s suggested to r e s u l t in more a d a p t i v e outcomes f o r a d u l t s < B e l l , 1977; Moos & B i l l i n g s , 1982). Items c o n s i d e r e d to be long term c o p i n g such as " t r y to f i g u r e out uhat the problem i s " or " p a r t i c i p a t i n g in a t h l e t i c s " a l s o l e a d to more a d a p t i v e 95 Table 23 Summary of Chi Square A n a l y s i s ! S e l e c t e d Response Behauinrs -to  S t r e s s by Sex (N=45> Response b e h a v i o r f o r s t r e s s C h i Square Degrees of freedom Try to f i g u r e out uhat problem i s Do a t h l e t i c a c t i v i t i e s hard Play team s p o r t s r e a l mean D u e l l or s t e u about problem Act out in some uay Remove s e l f from s i t u a t i o n DrinK a l c o h o l , smoKe Use medicines 2.39 1.5? 1.93 0.07 1.33 0.07 0.02 0.06 i a Note: C h i Square uas c a l c u l a t e d u s i n g Yates c o r r e c t i o n . a Chi Square A n a l y s i s uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . c o p i n g in a d u l t s . These b e h a v i o r s uere r e p o r t e d more f r e q u e n t l y by boys. The s h o r t term methods such as "dr inK a l c o h o l , smoKe," "use m e d i c i n e s , " or "remove s e l f from the s i t u a t i o n " are l e s s e f f e c t i v e ( B e l l , 1977) and are r e p o r t e d more f r e q u e n t l y by g i r l s . The mean of the percentage frequency s c o r e s f o r response b e h a v i o r s uas 47% f o r boys and 42% f o r g i r l s . A d o l e s c e n t s ' p e r c e i v e d response r e s o u r c e s to s t r e s s a l s o uere compared betueen boys and g i r l s . Table 24 d i s p l a y s s e l e c t e d response r e s o u r c e s by sex. Table 25 p r e s e n t s the summary of Chi Square A n a l y s i s f o r the s e l e c t e d response r e s o u r c e s by sex. Boys r e p o r t e d "being a b l e to 36 Table 24 S e l e c t e d Response Resources f o r S t r e s s : Frequency bv Sex A d j u s t e d < '/."> frequency Males Females Response r e s o u r c e f o r s t r e s s rj_=31 D_=14 Frequency h i g h e r f o r males F e e l i n g good about s e l f 100 86 Having c o n f i d e n c e in s e l f 93 86 Having p r e v i o u s e x p e r i e n c e and managing 84 64 Having broad range of i n t e r e s t s and accomplishments 81 64 Being able to a n t i c i p a t e what w i l l happen 81 36 # Frequency h i g h e r frequency f o r females Having time f o r s e l f 83 100 Having f r i e n d to c o n f i d e in 81 83 G e t t i n g r e g u l a r e x e r c i s e 68 78 E a t i n g u e l l b a l a n c e d d i e t 64 71 S i g n i f i c a n c e u s i n g Chi Square A n a l y s i s : *p_<.0i. a n t i c i p a t e what u i l l happen," more f r e q u e n t l y than g i r l s . The d i f f e r e n c e uas s t a t i s t i c a l l y s i g n i f i c a n t u s i n g both Chi Square and c o n f i d e n c e i n t e r v a l comparisons, g_<.05. Boys may be more autonomous and v i e u c o n t r o l as a response r e s o u r c e to a g r e a t e r e x t e n t than g i r l s . F urthermore, t h i s item p e r t a i n s to l o c u s of c o n t r o l u h i c h has been r e l a t e d to s u c c e s s f u l c o p i n g in a d u l t s <Kobasa, 1978; P e a r l in & S c h o o l e r , 1978; Seligman, 1975). With the tasK to a c h i e v e autonomy d u r i n g a d o l e s c e n c e , i t may be s p e c u l a t e d t h i s r e l a t i o n s h i p i s a l s o t r u e f o r a d o l e s c e n t s . 97 Table 25 Summary of Chi Square A n a l y s i s ; Selected Response Resources by Sex CN=45) Response r e s o u r c e f o r s t r e s s C h i Square Degrees of freedom F e e l i n g good about s e l f 1.88 1 Having c o n f i d e n c e in s e l f 0.88 1 Having p r e v i o u s e x p e r i e n c e and manag ing 1.16 1 Having broad range of i n t e r e s t s and accomplishments 0.65 1 Being a b l e to a n t i c i p a t e uhat w i l l happen 6.86 1 * Having time f o r s e l f 0.04 1 Having f r i e n d to c o n f i d e in 0.36 1 G e t t i n g r e g u l a r e x e r c i s e 0.15 1 E a t i n g u e l l b a l a nced d i e t 0.01 1 Note; Chi Square uas c a l c u l a t e d u s i n g Yates C o r r e c t i o n . C h i Square uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * P_< . 01 . V a r i a t i o n s in the ansuers of boys and g i r l s may be noted f o r response r e s o u r c e s . Those items u h i c h boys r a t e d more f r e q u e n t l y than g i r l s r e l a t e to the s e l f , such as " f e e l i n g good about s e l f " or "having c o n f i d e n c e in s e l f , " and to e x p e r i e n c e such as "having p r e v i o u s e x p e r i e n c e and managing." G i r l s more f r e q u e n t l y i d e n t i f i e d "having time f o r s e l f , " "a f r i e n d to c o n f i d e i n , " and v a r i a b l e s r e l a t e d to good h e a l t h h a b i t s . The mean response 98 r e s o u r c e s c o r e f o r boys uas 83% and f o r g i r l s , 76%. To e x p l a i n •these d i f f e r e n c e s , g i r l s may be more concerned and a b l e to f i n d s u p p o rt in o t h e r s . T h i s i s r e p o r t e d in s t u d i e s by O f f e r , O s t r o v , and Houard (1881) uho found g i r l s i n d i c a t e d more empathetic f e e l i n g s and more attachment to r e l a t i v e s and f r i e n d s than d i d boys. Another v a r i a t i o n , g i r l s i d e n t i f i e d " g e t t i n g r e g u l a r p h y s i c a l e x e r c i s e " and " e a t i n g u e l l b a l a nced d i e t " more f r e q u e n t l y than boys. They are r e p o r t e d to note a g r e a t e r frequency of h e a l t h concerns than boys in a survey of a d o l e s c e n t v i e u s on h e a l t h (Radius e t a l . , 1880). D i f f e r e n c e s in s o c i a l i z a t i o n e x p e r i e n c e s f o r each sex may account f o r these v a r i a t i o n s . Age -Response b e h a v i o r s uere compared on the b a s i s of the respondent's age. S e l e c t e d response b e h a v i o r s by age are d i s p l a y e d in Table 86. Table £7 p r e s e n t s the summary of Chi Square A n a l y s i s f o r s e l e c t e d response b e h a v i o r s by age. "Remove s e l f from s i t u a t i o n , " uas noted more f r e q u e n t l y by the 14 to 15 year o l d s than by other age groups. T h i s d i f f e r e n c e uas s t a t i s t i c a l l y s i g n i f i c a n t u s i n g both C h i Square A n a l y s i s and c o n f i d e n c e i n t e r v a l approaches, P_<.05. T h i s avoidance may be predominant f o r the younger age group because of t h e i r lack' of e x p e r i e n c e and immature s e l f . It i s not known whether t h i s b e h a v i o r p a t t e r n r e s u l t s in f e u e r a d a p t i v e outcomes, as r e p o r t e d f o r a d u l t s (Moos & B i l l i n g s , 198£). Tuo o t h e r items, " t a l k to someone" and " d r i v e f a s t , squeal t i r e s , make smoke," uere r e p o r t e d most f r e q u e n t l y by 16 to 17 year o l d s . The d i f f e r e n c e s uere s t a t i s t i c a l l y s i g n i f i c a n t u s i n g C h i Square A n a l y s i s but uere not s i g n i f i c a n t u s i n g c o n f i d e n c e i n t e r v a l comparisons, p_<.05. 99 Table £6 S e l e c t e d Response B e h a v i o r s to S t r e s s ; Frequency bv flae <N=45) Adj u s t e d <%> frequency Age : 14-15 16-17 18- 18 Response b e h a v i o r s f o r s t r e s s 11=17 D_=££ 0_=i 6 Frequency t r e n d to decrease u i t h age Remove s e l f from s i t u a t i o n 83 45 17 ** Try not to thinK about s i t u a t i o n 59 54 33 DrinK a l c o h o l , smoKe 47 41 0 Eat f o r s a t i s f a c t i o n 35 18 17 Act out 31 £3 0 Frequency h i g h e r at a p a r t i c u l a r - age Try to f i g u r e out uhat the problem i s 76 95 83 TalK to someone 53 77 17 * Involve s e l f in something e l s e do u e l l 71 76 67 Do a t h l e t i c a c t i v i t i e s hard 65 73 50 Dr ive f a s t , squeal t i r e s , maKe smoke 6 41 17 * S i g n i f i c a n c e u s i n g Chi Square A n a l y s i s : * p<.05 ##p_< . 001 . Frequency p a t t e r n s f o r the p e r c e i v e d response b e h a v i o r s may be o b s e r v e d . No items shoued a t r e n d to i n c r e a s e in frequency u i t h age. Items u h i c h shoued a t r e n d to decrease u i t h age are r e l a t e d to avoidance b e h a v i o r s , such as "remove s e l f from s i t u a t i o n " and " t r y not to thinK about s i t u a t i o n , " and a c t i n g out b e h a v i o r s . "Act o u t " may be r e l a t e d to im p u l s i v e b e h a v i o r and immaturity. With m a t u r i t y , t h e r e i s i n c r e a s e d ego s t r e n g t h and i n c r e a s e d s o c i a l i z a t i o n e x p e r i e n c e u h i c h r e s u l t s in g r e a t e r impulse c o n t r o l ( L a z a r u s , 1366, pp. 230-231). 100 Table 27 Summary of Chi Square A n a l y s i s : S e l e c t e d Response B e h a v i o r s to S t r e s s bv Age <N=45) Response b e h a v i o r -for s t r e s s Chi Square Degrees of freedom Remove s e l f from s i t u a t i o n 1 1. 39 2 ** Try not to thinK about s i t u a t i o n 1. 18 2 DrinK a l c o h o l , smoKe 4. 36 2 Eat f o r s a t i s f a c t i o n 1. 75 2 Act out 2. 09 2 Try to f i g u r e out what problem i s 3. 06 2 TalK to someone 7. 78 2 * Involve s e l f in something e l s e 0. 28 2 Do a t h l e t i c a c t i v i t i e s hard 1 . 14 2 D r i v e f a s t , squeal t i r e s , make smoke 6. 60 2 * Note: Chi Square A n a l y s i s uas c a l c u l a t e d u s i n g l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * p_< .05. ** p_< .01 . Negative h e a l t h b e h a v i o r s such as "drink a l c o h o l , smoke," "eat f o r s a t i s f a c t i o n , " and "use m e d i c i n e s " a l s o decreased u i t h age. It may be, u i t h time and e x p e r i e n c e , those response b e h a v i o r s u h i c h are found to be i n e f f e c t i v e are no longer used. Those items most f r e q u e n t l y r e p o r t e d by the 16 to 17 year o l d s may r e f l e c t the a c t i v i t i e s and p h y s i c a l s t a t e of t h i s age group. Hormonal l e v e l s tend to be h i g h e s t at mid-ado 1escence and may account f o r a g g r e s s i v e b e h a v i o r s <B. Hamburg, 1874, pp. 107-108>. Furthermore, i t i s p o s s i b l e u i t h c o g n i t i v e development 101 t h e r e i s an i n c r e a s e d awareness of response b e h a v i o r s at these ages . The i d e n t i f i e d response r e s o u r c e s uere compared on the b a s i s of the respondent's age. S e l e c t e d response r e s o u r c e s by age are d i s p l a y e d in Table S3. Table 23 S e l e c t e d Response Resources f o r S t r e s s ; Frequency by flge A d j u s t e d (%> frequency Response r e s o u r c e f o r s t r e s s Age: 14-15 n=17 16 a. -1? =22 18-18 D_=6 Frequency t r e n d to i n c r e a s e u i t h age Having time f o r s e l f 83 100 100 Having broad range of i n t e r e s t and accomplishments 71 77 83 Frequency t r e n d to decrease u i t h age Having c o n f i d e n c e in s e l f 100 81 67* F e e l i n g good about s e l f 100 100 67** Having c o n t r o l in s i t u a t i o n 88 73 67 Having p r e v i o u s e x p e r i e n c e and managing 82 77 67 Frequency h i g h e r at a p a r t i c u l a r age G e t t i n g enough s l e e p 34 95 83 Having f r i e n d to c o n f i d e in 76 35 67 Being a b l e to say no u i t h o u t f e e l i n g g u i l t y 71 86 67 S i g n i f i c a n c e u s i n g Chi Square A n a l y s i s : * P_<,05. ** p_<.01. 108 The summary of Chi Square A n a l y s i s f o r s e l e c t e d response r e s o u r c e s by age is p r e s e n t e d in Table £9. There uere no s i g n i f i c a n t d i f f e r e n c e s betueen the age groups f o r response r e s o u r c e s . The d i f f e r e n c e s f o r tuo items, "having c o n f i d e n c e in s e l f " and " f e e l i n g good about s e l f " uere s t a t i s t i c a l l y s i g n i f i c a n t u s i n g C h i Square A n a l y s i s but uere not s i g n i f i c a n t uhen compared u s i n g c o n f i d e n c e i n t e r v a l s , P_<05. Table 29 Summary of Chi Square A n a l y s i s ; S e l e c t e d Response Resources f o r S t r e s s bv Age <N=45> Response r e s o u r c e f o r s t r e s s Chi Square Degrees of freedom Having time f o r s e l f 3 .45 Having broad range of i n t e r e s t s and accomplishments 0 .46 Having c o n f i d e n c e in s e l f 6 . 0 9 F e e l i n g good about s e l f 13.60 Having c o n t r o l in s i t u a t i o n 1.83 Having p r e v i o u s e x p e r i e n c e and managing 0 .64 G e t t i n g enough s l e e p 1.14 Having f r i e n d to c o n f i d e in 4 . 3 0 Being able to say no without f e e l i n g g u i l t y 1.87 2 2 * 2 ** 2 2 2 2 Note; C h i Square was c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * e_< . 0 5 . ** e_< . 0 1 . 103 Although not s i g n i f i c a n t d i f f e r e n c e s , t r e n d s in da t a may be noted. "Hawing c o n f i d e n c e in s e l f " and " f e e l i n g good about s e l f , " r e p o r t e d more f r e q u e n t l y at a younger age, are perhaps a r e f l e c t i o n of a f r a g i l e , more v u l n e r a b l e s e l f . Those r e s o u r c e items r e p o r t e d more f r e q u e n t l y at an o l d e r age may i n d i c a t e the s t r u g g l e f o r s e l f - a c t u a l i z a t i o n . Those items r e p o r t e d more f r e q u e n t l y by 16 to 17 year o l d s may r e f l e c t p h y s i c a l demands at a time of growth, the d e v e l o p i n g s o c i a l sphere, an awareness of the walue of s o c i a l s u p p o r t , and a l e s s v u l n e r a b l e s e l f . Sex and age. F u r t h e r comparison of a d o l e s c e n t s ' p e r c e p t i o n s of response b e h a v i o r s uere made by sex and by age. S e l e c t e d response b e h a v i o r s as compared by sex and by age are d i s p l a y e d in Table 30. Table 31 p r e s e n t s the summary of C h i Square A n a l y s i s f o r these s e l e c t e d response b e h a v i o r s by sex and by age. There uere no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s betueen the subgroups. The item, "act o u t " uas i d e n t i f i e d by younger boys and o l d e r g i r l s but not by e i t h e r o l d e r boys or younger g i r l s . T h i s shoued s t a t i s t i c a l s i g n i f i c a n c e u s i n g Chi Square A n a l y s i s but when compared u s i n g c o n f i d e n c e i n t e r v a l s , p_<.05, uas not s i g n i f i c a n t . Trends in answers are e v i d e n t . Two items i n c r e a s e d with age f o r both s e x e s , " t r y to f i g u r e out what the problem i s " and " t r y not to thinK about s i t u a t i o n . " Problem s o l v i n g and c o g n i t i v e management of s t r e s s i s d e s c r i b e d in the l i t e r a t u r e as being complementary <Cohen & L a z a r u s , 1983> and both s e r v e to f a c i l i t a t e the management of s t r e s s f o r a d u l t s (FolKman & L a z a r u s , 1980; Moos & B i l l i n g s , 188S). With age and e x p e r i e n c e , i n d i v i d u a l s may be b e t t e r a b l e to i d e n t i f y b e h a v i o r s which are conducive to s t r e s s management. A g a i n , frequency r e s u l t s which show a t r e n d f o r a p a r t i c u l a r group such as "play music, read or o t h e r a c t i v i t y " f o r o l d e r boys may r e f l e c t the a c t i v i t i e s of t h a t group. 104 Tabl e 30 Selected Response Behaviors to stress' Frequency bv Sex and by Age A d j u s t e d < '/."> frequency Males Females Age: 14-16 17-19 14-16 17-19 Response b e h a v i o r s to s t r e s s rj_=22 n_=9 rj_=3 CL=6 Frequency t r e n d to i n c r e a s e u i t h age Try to f i g u r e out uhat problem i s 91 100 62 83 Try not to thinK about s i t u a t i o n 50 56 50 67 Frequency t r e n d to decrease u i t h age Do a t h l e t i c a c t i v i t i e s hard 77 67 62 33 Play team s p o r t s r e a l mean 64 44 37 33 TalK to someone 64 56 62 50 Remove s e l f from s i t u a t i o n 64 33 75 50 DrinK a l c o h o l , smoKe 41 22 50 33 Eat f o r s a t i s f a c t i o n 32 1 1 37 0 Use medicines 9 0 £5 0 Frequency d i s s i m i l a r i t i e s D r i v e f a s t , squeal t i r e s maKe smoKe 32 1 1 12 33 Play music, read or other a c t i v i t y 64 100 75 12 Act out 43 0 0 17 * S i g n i f i c a n c e u s i n g Chi Square A n a l y s i s : *e_<.05. 105 Table 31 Summary Of Chj Square Analysis' S e l e c t e d Response B e h a v i o r s to Stress by Sex and by Age <N=45> Response b e h a v i o r to s t r e s s C h i Square Degrees of freedom Try to f i g u r e out uhat problem i s 5. 83 3 Try not to th i n K about s i t u a t i o n 0. 58 3 Do a t h l e t i c a c t i v i t i e s hard 4. 18 3 Play team s p o r t s r e a l mean 2. 83 3 TalK to someone 0. 4? 3 Remove s e l f from s i t u a t i o n 3. 63 3 DrinK a l c o h o l , smoKe 1 . 58 3 Eat f o r s a t i s f a c t i o n 4. 13 3 Use med i c i n e s 3. 85 3 Play music, read or o t h e r a c t i v i t y 4. 48 3 D r i v e f a s t , s queal t i r e s , maKe smoKe 2. 33 3 Act out 3. 51 3 * Note: C h i Square uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * p_< .85. As u e l l as the response b e h a v i o r s , f u r t h e r comparisons of the p e r c e i v e d response r e s o u r c e s by sex and by age uere made. S e l e c t e d response r e s o u r c e s c o n s i d e r e d by sex and by age are pr e s e n t e d i n Table 32. The summary of Chi Square A n a l y s i s f o r these s e l e c t e d response r e s o u r c e s by sex and by age i s d i s p l a y e d in Table 33. There uere no s i g n i f i c a n t d i f f e r e n c e s between these subgroups. Older g i r l s i d e n t i f i e d the items "being a b l e to a n t i c i p a t e uhat u i l l happen" and " f e e l i n g good about s e l f " l e s s f r e q u e n t l y than o t h e r subgroups. These d i f f e r e n c e s uere 106 s t a t i s t i c a l l y s i g n i f i c a n t u s i n g Chi Square A n a l y s i s but uere not s i g n i f i c a n t u s i n g c o n f i d e n c e i n t e r v a l comparisons, p_<.05. Perhaps o l d e r g i r l s have a more secure f e e l i n g about t h e m s e l v e s . Table 32 S e l e c t e d Response Resources f o r S t r e s s ; Frequency bv Sex and bv  Age A d j u s t e d <.'/.> frequency Males Females Age s 14-16 17-19 14-16 17-Response r e s o u r c e s f o r s t r e s s n_=22 D_=9 D_=3 D_=6 Frequency t r e n d to i n c r e a s e u i t h age Having broad range of i n t e r e s t s and accomplishments 77 88 62 67 Frequency t r e n d to d e crease u i t h age G e t t i n g enough s l e e p 95 88 100 83 Having c o n f i d e n c e in s e l f 95 33 100 67 Having p r e v i o u s e x p e r i e n c e and manag ing 36 78 75 50 Having c o n t r o l in s i t u a t i o n 32 78 75 67 Having f r i e n d to c o n f i d e in 82 78 100 83 Being a b l e to a n t i c i p a t e uhat w i l l happen 82 78 50 17 Frequency d i s s i m i l a r i t i e s F e e l i n g good about s e l f 100 100 100 68 * S i g n i f i c a n c e u s i n g Chi Square A n a l y s i s : * p_<.Bl. 107 Table 33 Summary of Chi Square A n a l y s i s  Sex and by Age (N=45J S e l e c t e d Response Resources by Response r e s o u r c e f o r s t r e s s Chi Square Degrees of freedom Having broad range of i n t e r e s t s and accomplishments G e t t i n g enough s l e e p Having c o n f i d e n c e in s e l f Having p r e v i o u s e x p e r i e n c e and manag ing Having c o n t r o l in s i t u a t i o n Having f r i e n d to c o n f i d e in Being a b l e to a n t i c i p a t e uhat u i11 happen F e e l i n g good about s e l f 1.30 1 .38 5.77 3.65 0.67 1 .90 10.52 13.60 3 3 3 3 3 3 3 * 3 # Note: Chi Square uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * e_< . 01. Summary Ad o l e s c e n t respondents r e p o r t e d a v a r i e t y of response behav i o r s and r e s o u r c e s f o r s t r e s s . The r e p o r t e d response b e h a v i o r s i n c l u d e d problem s o l v i n g and t h i n k i n g , u s i n g s o c i a l s u p p o r t , doing a t h l e t i c a c t i v i t i e s , u s i n g a v a r i e t y of r e l a x a t i o n t e c h n i q u e s , and e s c a p i n g from the s i t u a t i o n . Music as a d i v e r s i o n a r y a c t i v i t y uas r e p o r t e d f r e q u e n t l y . The d i s c r e p a n c i e s in f r e q u e n c i e s f o r the open and closed-ended format ansuers may be a t t r i b u t e d to v a r i a t i o n s in l e v e l s of awareness. Negative h e a l t h 108 b e h a v i o r s uere a l s o noted as a response to s t r e s s . S t r e s s response r e s o u r c e s u h i c h the a d o l e s c e n t r e p o r t e d as h e l p f u l uere s o c i a l s u p p o r t , f a c t o r s r e l a t e d to the s e l f , c o n t r o l , e x p e r i e n c e , and good h e a l t h h a b i t s . These response r e s o u r c e s c o r r e s p o n d to those noted in the l i t e r a t u r e f o r a d u l t s ( C a p l a n , 1874; E v e r l y & R o s e n f e l d , 1881; Hamburg, E l l i o t t & P a r r o n , 1882, PP. 77-78; Kobasa, 1373; P e a r l in & S c h o o l e r , 1978). S i g n i f i c a n t d i f f e r e n c e s , e_<.05, uere noted f o r two items uhen a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s responses uere compared based on sex and age. Boys i d e n t i f i e d c o n t r o l as a r e s o u r c e more f r e q u e n t l y in the item "being a b l e to a n t i c i p a t e uhat u i l l happen." The 14 to 15 year o l d s i d e n t i f i e d avoidance/escape as a b e h a v i o r more f r e q u e n t l y in the item "remove s e l f from s i t u a t i o n . " As u e l l , t r e n d s u h i c h i n d i c a t e d i f f e r e n c e s based on age and sex uere noted. Boys i d e n t i f i e d a more a c t i v e , long term approach to managing s t r e s s , uhereas g i r l s i d e n t i f i e d more s h o r t term, p a s s i v e approaches. A l s o , boys i d e n t i f i e d r e s o u r c e s c o n c e r n i n g the s e l f - c o n c e p t and l o c u s of c o n t r o l more f r e q u e n t l y than g i r l s , whereas g i r l s i d e n t i f i e d f a c t o r s r e l a t e d to good h e a l t h h a b i t s and "having a f r i e n d to c o n f i d e i n " more f r e q u e n t l y than boys. A g e - r e l a t e d t r e n d s uere a l s o noted. With an i n c r e a s e in age, problem s o l v i n g i n c r e a s e d but avoidance b e h a v i o r s , n e g a t i v e h e a l t h b e h a v i o r s , and " a c t i n g o u t " d e c r e a s e d . The r e s o u r c e s u h i c h v a r i e d u i t h age uere r e l a t e d to the s e l f , l o c u s of c o n t r o l and p r e v i o u s e x p e r i e n c e . P r e v i o u s e x p e r i e n c e uas i d e n t i f i e d l e s s f r e q u e n t l y by the o l d e r age group as uas " f e e l i n g good about s e l f " by the o l d e r g i r l s . S e v e r a l response b e h a v i o r s and r e s o u r c e s uere more f r e q u e n t at ages 16 to 17. D i f f e r e n c e s uere e x p l a i n e d in terms of the a d o l e s c e n t ' s e x p e r i e n c e and t h e i r maturing s e l f . It i s q u e r i e d whether p a t t e r n s of response r e s o u r c e s and b e h a v i o r s f o r the a d o l e s c e n t c o r r e s p o n d to the p a t t e r n s d e s c r i b e d of a d a p t i v e outcomes f o r the a d u l t . 109 A d o l e s c e n t P e r c e p t i o n s of the Outcomes of S t r e s s Information on uhat a d o l e s c e n t s p e r c e i v e as the outcomes of s t r e s s uas d e r i v e d from tuo q u e s t i o n f o r m a t s , open-response and c1osed-response. The responses to these tuo formats are p r e s e n t e d and d i s c u s s e d f o r the t o t a l sample. F u r t h e r d e s c r i p t i o n of the ansuers from the c1osed-response q u e s t i o n s i s p r e s e n t e d based on the respondent's sex and age. D e s c r i p t i o n of T o t a l Sample Open-ended r e s p o n s e s . The ansuers to the open-ended q u e s t i o n s about uhat a d o l e s c e n t s p e r c e i v e are outcomes of s t r e s s uere grouped in f o u r c a t e g o r i e s by c o n t e n t and counted <See Appendix I f o r the open-ended responses to outcomes of s t r e s s ! f requency and c a t e g o r i e s ) . Table 34 p r e s e n t s the c a t e g o r i e s , t a b u l a t i o n and content summary f o r the outcomes of s t r e s s . The m a j o r i t y of s t r e s s outcomes noted by p a r t i c i p a n t s i n v o l v e d n e g a t i v e e f f e c t s on h e a l t h . General statements about h e a l t h uere made such as " h e a l t h goes d o u n h i l l , " "shortened l i f e span," or "burnt o u t . " A l s o , more s p e c i f i c statements uere made i d e n t i f y i n g s p e c i f i c d i s e a s e c o n d i t i o n s such as "heart a t t a c k , " " u l c e r , " or " h y p e r t e n s i o n . " A p o s i t i v e outcome to s t r e s s uas i d e n t i f i e d in one item, "become s t r o n g and muscular." Mental h e a l t h c o n d i t i o n s such as " b r a i n damage," " i n s a n i t y , " and " p o s s i b l e nervous breaKdoun" uere not l i s t e d as f r e q u e n t l y . F i v e respondents s p o n t a n e o u s l y l i s t e d "don't Knou" or "doesn't a f f e c t h e a l t h . " One r e s p o n s e , r e l a t e d to s o c i a l r e l a t i o n s h i p s , uas l i s t e d as "don't l i k e a n y t h i n g or anyone." 110 Table 34 Outcomes of S t r e s s : C a t e g o r i e s . T a b u l a t i o n and Content Summary <N=4e> Category A c t u a l •frequency 3 Content summary Phys i c a l 46 r e l a t e d to b o d i l y h e a l t h , s p e c i f i c c o n d i t i o n s , f a t i g u e , b e h a v i o r s Mental 10 depress ion , nervousness , insan i t y Don 't Know 5 statement t h a t doesn't Know or t h a t doesn't a f f e c t h e a l t h Soc i a i 1 r e l a t e d to i n t e r p e r s o n a l r e l a t i o n s h i p s and a t t i t u d e s i n v o l v i n g o t h e r s a More than 1 answer may be 1 i s t e d by each respondent Closed-ended responses. Respondents i d e n t i f i e d what they p e r c e i v e d as outcomes to s t r e s s from a l i s t of o p t i o n s . Table 35 d i s p l a y s the outcomes of s t r e s s p r e s e n t e d i n ranK order f r e q u e n c y . The answers i d e n t i f y i n g the outcomes of s t r e s s ranged in frequency from 13% f o r a l l e r g i e s to 76% f o r " a l c o h o l i s m or drug abuse." Nine of the t h i r t e e n items uere i d e n t i f i e d by over h a l f of the re s p o n d e n t s . Those items r a t e d l e s s f r e q u e n t l y were "asthma" and " a l l e r g i e s . " 1 1 1 Table 3 5 Outcomes of Stress: Frequency in Rank Order <N = 4 6 > A c t u a l A d j u s t e d ( X) Outcome of s t r e s s frequency frequency A l c o h o l ism, drug abuse 3 5 7 6 Headaches 3 4 7 4 Stomach u l c e r s 3 3 7 2 H y p e r t e n s i o n ( h i g h blood p r e s s u r e ) 3 2 7 0 Heart a t t a c k 3 1 6 7 Mental i l l n e s s ( f r e a k o u t ) 3 0 6 5 Lack of c a r i n g about s e l f and o t h e r s 2 3 6 3 Depress ion 2 8 6 1 Acc i d e n t s 2 6 5 7 Colds 2 1 4 6 S p o r t s i n j u r i e s 1 3 2 8 Asthma 1 0 2 2 A l 1 erg i e s 6 1 3 D i s c u s s ion . The p a r t i c i p a n t s in t h i s study g e n e r a l l y p e r c e i v e d the outcomes of s t r e s s to have a n e g a t i v e e f f e c t on h e a l t h . Although they l i s t e d many g e n e r a l statements c o n c e r n i n g h e a l t h as s t r e s s outcomes in the open-response q u e s t i o n format, they uere a b l e to i d e n t i f y the m a j o r i t y of spec i f i c statements c o n c e r n i n g h e a l t h in the c1 o s e d - r e s p o n s e format a n s u e r s . The s t r e s s outcome most f r e q u e n t l y i d e n t i f i e d uas " a l c o h o l i s m or drug abuse." T h i s h e a l t h problem i s a d i r e c t consequence of b e h a v i o r and i t may be the a d o l e s c e n t p a r t i c i p a n t s viewed t h i s as a r e s u l t of maladaptive c o p i n g , a commonly h e l d i d e a . A d o l e s c e n t s 1 12 may be more aware of the r e s u l t s of substance abuse because of t h e i r exposure t o , and dec i s ion-maKing about, a l c o h o l or drugs. The items u h i c h uere i d e n t i f i e d l e s s f r e q u e n t l y , "asthma" and " a l l e r g i e s , " are p r o b a b l y l e s s commonly understood as r e l a t e d to s t r e s s . These items a f f e c t the immune system and the p a r t i c i p a n t s may not have the Knowledge to understand these c o n d i t i o n s . They a l s o may not be auare of the r e l a t i o n s h i p of asthma and a l l e r g i e s to s t r e s s . A d o l e s c e n t s are more l i K e l y to e x p e r i e n c e " a c c i d e n t s , " " c o l d s , " " s p o r t s i n j u r i e s , " a l l e r g i e s , " and perhaps "asthma" than they are to e x p e r i e n c e "heart a t t a c K , " "stomach u l c e r s , " or " h y p e r t e n s i o n . " Those items they are more l i K e l y to e x p e r i e n c e , uere l e s s f r e q u e n t l y i d e n t i f i e d , perhaps because they lacK Knowledge about these outcomes. Furthermore, these outcomes are p r o b a b l y not commonly Known as r e l a t e d to s t r e s s as are " h y p e r t e n s i o n , " "heart a t t a c K , " and "stomach u l c e r s . " A d o l e s c e n t s a l s o may be r e l u c t a n t to acknowledge h e a l t h problems do o c c u r . T h i s may r e f l e c t the d e v e l o p i n g , v u l n e r a b l e s e l f u h i c h i s s e n s i t i v e to d i s c r e p a n c i e s in s e l f e x p e c t a t i o n s . I m p e r f e c t i o n s in the body image, such as occur u i t h h e a l t h problems, r e f l e c t the s e l f . " D e p r e s s i o n , " "mental i l l n e s s , " or "lacK of c a r i n g about s e l f and o t h e r s " as a s t r e s s outcome uas i d e n t i f i e d by 61% to 65% of the r e s p o n d e n t s . Auareness of items r e l a t e d to mental h e a l t h might be expected c o n s i d e r i n g the r a t e of a d o l e s c e n t s u i c i d e . C o n v e r s e l y , a d o l e s c e n t s may have d i f f i c u l t y acKnou1edging t h i s item i f they p e r c e i v e a stigma a s s o c i a t e d u i t h mental i l l n e s s . They a l s o may not Knou the ansuer. 113 D e s c r i p t i o n of Subgroups Based on Demographic V a r i a b l e s Sex . A d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s outcomes uere compared based on the respondent's sex. Table 36 p r e s e n t s s e l e c t e d outcomes of s t r e s s by sex. The summary of Chi Square A n a l y s i s f o r s e l e c t e d outcomes of s t r e s s by sex i s d i s p l a y e d in T a b l e 37. There uere no s i g n i f i c a n t d i f f e r e n c e s based on sex. Table 36 S e l e c t e d Outcomes of S t r e s s : Frequency bv Sex A d j u s t e d < '/.) frequency Males Females Outcome of s t r e s s D_=31 D_=14 Higher frequency f o r males Hypertens ion 71 64 Me n t a l i l l n e s s 68 57 Acc i d e n t s 61 43 S p o r t s i n j u r i e s 35 14 Frequency h i g h e r f o r females A l c o h o l i s m or drug abuse 74 79 Headaches 71 79 U l c e r s 68 78 Heart a t t a c k 64 71 Asthma 16 36 A l 1 e r g i e s 10 21 1 14 Table 37 Summary of Chi Square A n a l y s i s : S e l e c t e d Outcomes o-f S t r e s s bv Sex <N=45? Outcome of s t r e s s C h i Square Degrees of freedom Hypertens ion 0. ,01 l a Mental i l l n e s s 0. . IS l a flee i d e n t s 0, .69 1 S p o r t s i n j u r i e s 1, ,20 l a A l c o h o l ism, drug abuse 0. .00 l a Headaches 0. ,03 l a U l c e r s 0, . 15 l a Heart a t t a c k 0. ,01 l a Asthma 1, . 16 l a Al1 erg ies 0. ,36 l a Note: Chi Square uas c a l c u l a t e d u s i n g Yates c o r r e c t i o n . a Chi Square uas c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . Although not s i g n i f i c a n t , t r e n d s in d a t a r e v e a l some d i f f e r e n c e s based on sex. Compared to g i r l s , boys i d e n t i f i e d more s p o r t s i n j u r i e s and a c c i d e n t s as outcomes of s t r e s s . T h i s may r e f l e c t t h e i r a c t i v i t i e s and e x p e r i e n c e . There uas a n e g l i g i b l e d i f f e r e n c e in f o u r of the outcomes u h i c h g i r l s p e r c e i v e d more f r e q u e n t l y than boys. G i r l s i d e n t i f i e d the items "asthma" and " a l l e r g i e s " more than t u i c e as f r e q u e n t l y as boys. G i r l s may be more s e n s i t i v e and Knowledgeable about h e a l t h than boys. They may a l s o be more s e n s i t i v e to o t h e r s and t h u s , more auare of o t h e r s ' problems. Perhaps the e x p e r i e n t i a l bacKground of the respondents c o n t r i b u t e s to t h i s Knowledge. 1 15 F u r t hermore, the mean percentage frequency s c o r e f o r a l l s t r e s s outcomes r e p o r t e d uas 55% f o r g i r l s as compared to 54% f o r boys . ftqe , A d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s outcomes uere a l s o compared based on the respondent's age. T a b l e 38 o u t l i n e s the frequency p a t t e r n s f o r s e l e c t e d outcomes of s t r e s s based on age. Table 38 S e l e c t e d Outcomes of S t r e s s : Frequency by Age A d j u s t e d <%> frequency Age: 14-15 16-17 18-18 Outcome of s t r e s s n_= 17 rj_=2£ n_=6 Frequency t r e n d to i n c r e a s e u i t h age A l c o h o l i s m or drug abuse 71 73 100 Headaches 71 73 83 Heart attacK 65 6 4 a 83 Acc i d e n t s 4 1 64 67 Asthma 12 27 33 Frequency d i s s i m i l a r i t i e s LacK of c a r i n g about s e l f or o t h e r s 59 73 50 S p o r t s i n j u r i e s 41 3 67 Mental i l l n e s s 53 73 67 a T h i s decrease in s c o r e may be accounted f o r by the percentage s c o r e c a l c u l a t e d u i t h a s m a l l sample s i z e . S i g n i f i c a n c e u s i n g C h i Square A n a l y s i s : * P_<.01. 1 16 The summary of Chi Square A n a l y s i s f o r these s e l e c t e d outcomes of s t r e s s by age i s p r e s e n t e d in Table 39. There uere no s i g n i f i c a n t d i f f e r e n c e s i n the r e p o r t e d outcomes based on age. The 16 to 17 year o l d s i d e n t i f i e d " s p o r t s i n j u r i e s " as a s t r e s s outcome l e s s f r e q u e n t l y than the ot h e r age groups. T h i s d i f f e r e n c e uas s t a t i s t i c a l l y s i g n i f i c a n t u s i n g C h i Square A n a l y s i s but uas not s i g n i f i c a n t uhen c o n f i d e n c e i n t e r v a l s uere compared, P_<.85. Moreover, u i t h age and e x p e r i e n c e , i t uas expected t h i s item uould i n c r e a s e u i t h age. Table 33 Summary of C h i Square A n a l y s i s ; S e l e c t e d Outcomes of S t r e s s bv Age <N=45? Outcome of s t r e s s Chi Square Degrees of freedom A l c o h o l i s m , drug abuse 2.26 2 Headaches 0.38 2 Heart a t t a c K 0.87 2 Acc i d e n t s 2.30 2 Asthma 1 .83 2 LacK of c a r i n g about s e l f 1.44 2 Spo r t s i n j u r i e s 9.61 2 * Mental i l l n e s s 1 .65 2 Note; Chi Square was c a l c u l a t e d u i t h l e s s than the expected c e l l f r e q u e n c i e s u h i c h r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * p_< . 01. 11? Trends i n d a t a may be noted. No items decreased u i t h age. Houever, f i v e items uere r e p o r t e d more f r e q u e n t l y u i t h i n c r e a s e d age. It uas expected t h a t u i t h the broadened e x p e r i e n c e background a s s o c i a t e d u i t h i n c r e a s e d age, i n d i v i d u a l s uould Knou more outcomes. The study r e s u l t s s u p p ort t h i s e x p e c t a t i o n . The items r e p o r t e d more f r e q u e n t l y by 16 and 17 year o l d s may co r r e s p o n d to o t h e r s t r e s s component items r e p o r t e d more f r e q u e n t l y at these ages. F u r t h e r study may r e v e a l a r e l a t i o n s h i p betueen components. The mean percentage frequency of a l l s t r e s s outcomes i n c r e a s e d u i t h age from 52% f o r 14 to 15 year o l d s to 62% f o r 18 to 18 year o l d s . With e x p e r i e n c e and t i m e , i n d i v i d u a l s knou more outcomes of s t r e s s . Sex and age. A d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s outcomes uere f u r t h e r compared on the b a s i s of both sex and age. S e l e c t e d outcomes of s t r e s s are c o n s i d e r e d by sex and by age as p r e s e n t e d in Table 40. Table 41 d i s p l a y s the summary of Chi Square A n a l y s i s f o r s e l e c t e d outcomes of s t r e s s by sex and by age. There uere no s i g n i f i c a n t d i f f e r e n c e s betueen subgroups. Younger boys responded to the item "asthma" l e s s f r e q u e n t l y than o t h e r groups. T h i s d i f f e r e n c e uas s i g n i f i c a n t u s i n g C h i Square A n a l y s i s but uas not s i g n i f i c a n t uhen c o n f i d e n c e i n t e r v a l s uere compared, e_<.05. 1 18 T a b l e 40 S e l e c t e d Outcomes of S i i - e s s ! Frequency bv Sex bv flae A d j u s t e d <y.) frequency Males Females Age: 14-16 17-13 14-16 17-18 Outcome of s t r e s s n_=22 n_=8 n_=8 n_=6 Frequency t r e n d to i n c r e a s e u i t h age A l c o h o l i s m or drug abuse 73 78 62 100 U l c e r s 64 78 75 83 Mental I l l n e s s 64 78 50 67 Acc i d e n t s 58 67 25 67 Heart a t t a c k 58 78 62 83 S p o r t s i n j u r i e s 32 44 12 17 Frequency d i s s i m i l a r i t i e s Headaches 68 78 67 67 Asthma 4 44 37 33 S i g n i f i c a n c e u s i n g Chi Square A n a l y s i s : e.< .05. 1 19 Table 41 Summary of Chi Square Final vs i s : S e l e c t e d Outcomes of S t r e s s bv Sex bv ftqe <N=45? Outcome of s t r e s s C h i Square Degrees of freedom A l c o h o l ism, drug abuse S.80 3 U l c e r s 1 .S9 3 Mental i l l n e s s 1.45 3 Acc i d e n t s 3.89 3 Heart a t t a c K 1.88 3 S p o r t s i n j u r i e s S.63 3 Headaches 1.35 3 Asthma 8.06 3 * Note: C h i Square was c a l c u l a t e d with l e s s than the expected c e l l f r e q u e n c i e s which r e s u l t s in an o p t i m i s t i c s i g n i f i c a n c e v a l u e . * P<.05. Summary The p a r t i c i p a n t s in t h i s study p e r c e i v e d the outcomes of s t r e s s to have a n e g a t i v e e f f e c t on h e a l t h and the m a j o r i t y of s p e c i f i c outcomes l i s t e d uere i d e n t i f i e d by the m a j o r i t y of re s p o n d e n t s . " A l c o h o l i s m or drug abuse" uas the most f r e q u e n t l y i d e n t i f i e d outcome. The l e s s f r e q u e n t l y i d e n t i f i e d outcomes uere those u h i c h are more l i K e l y to occur in t h i s age group, such as " c o l d s , " " s p o r t s i n j u r i e s , " " a l l e r g i e s , " and " a c c i d e n t s . " There uere no s i g n i f i c a n t d i f f e r e n c e s in the a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s outcomes based on sex and age. Trends in dat a r e v e a l l i t t l e d i f f e r e n c e in the frequency s c o r e s between g i r l s and boys. Some items uere i d e n t i f i e d more f r e q u e n t l y u i t h i n c r e a s i n g age. "Sports i n j u r i e s " uas i d e n t i f i e d l e s s f r e q u e n t l y by the 16 to 17 year o l d s . 120 Summary o f Study R e s u l t s and D i s c u s s i o n Q u e s t i o n n a i r e s uere c o l l e c t e d -from 46 r e s p o n d e n t s , c o n s i s t i n g of 31 boys and 14 g i r l s , ages 14 to 13 y e a r s , uho had completed Grade 8 to Grade 13. Four respondents had e x p e r i e n c e in s t r e s s management c l a s s . The response r a t e f o r the q u e s t i o n n a i r e uas 99%. Assessed r e l i a b i l i t y uas c o n s i d e r e d r e a s o n a b l e . The m a j o r i t y of respondents p e r c e i v e d s t r e s s as a concern (56%) and as having a n e g a t i v e e f f e c t on h e a l t h . I n d i v i d u a l s in the subgroups uho r a t e d t h e i r oun s t r e s s l e v e l h i g h e r than t h e i r subgroup c o u n t e r p a r t s uere g i r l s and 1? to IS year o l d s of both sexes. E i g h t <18%) of the respondents i n d i c a t e d they gained neu ideas about s t r e s s management by co m p l e t i n g the q u e s t i o n n a i r e . The i d e n t i f i e d causes of s t r e s s r e f l e c t the a c t i v i t i e s in the environment and r e l a t e to s c h o o l and uork. Other i d e n t i f i e d causes r e l a t e to f a m i l y , a u t h o r i t y f i g u r e s , p e r s o n a l s e n s i t i v i t y , i n t e r p e r s o n a l r e l a t i o n s h i p s , time d e a d l i n e s , and p r e s s u r e from f r i e n d s . S i g n i f i c a n t d i f f e r e n c e s betueen the subgroups, based on age and sex, uere noted f o r the items " r e l a t i o n s h i p u i t h the o p p o s i t e sex," r e p o r t e d more f r e q u e n t l y by g i r l s , and " h a s s l e s u i t h b r o t h e r / s i s t e r , " r e p o r t e d more f r e q u e n t l y by younger g i r l s . Trends in d a t a i n d i c a t e t h a t g i r l s i d e n t i f i e d pregnancy as a s t r e s s o r more f r e q u e n t l y than boys, uhereas boys i d e n t i f i e d p r e s s u r e s in team s p o r t s , j ob c o n c e r n s , and a u t h o r i t y f i g u r e s more f r e q u e n t l y than g i r l s . Moreover, u i t h an i n c r e a s e in age, s t r e s s o r s r e l a t e d to the developmental t a s k s d e c r e a s e d , but those r e l a t e d to time p r e s s u r e s i n c r e a s e d . The s t r e s s symptoms most f r e q u e n t l y i d e n t i f i e d uere p h y s i o l o g i c a l symptoms. A f f e c t i v e symptoms uere the l e a s t f r e q u e n t l y i d e n t i f i e d . There uere s i g n i f i c a n t d i f f e r e n c e s betueen the sexes f o r "urge to c r y " and " c r a v i n g to eat or l o s s of a p p e t i t e , " r e p o r t e d more f r e q u e n t l y by g i r l s . Trends i n d a t a 121 i n d i c a t e t h a t g i r l s p e r c e i v e d a g r e a t e r mean frequency of symptoms and i d e n t i f i e d more a f f e c t i v e symptoms than boys. Boys p e r c e i v e d more p h y s i o l o g i c a l symptoms. U i t h an i n c r e a s e i n the age of the p a r t i c i p a n t , the frequency of " f a t i g u e , r e s t l e s s n e s s " , "heart pounding", "sweating" and "being u p t i g h t " i n c r e a s e d , uhereas "being a f r a i d " and " f e e l i n g of u a n t i n g to be a l o n e " d e c r e a s e d . I n d i v i d u a l s ages 16 to 17 r e p o r t e d a g r e a t e r mean percentage frequency of symptoms. The r e l a t i o n s h i p of s t r e s s symptoms to s t r e s s responses uas q u e r i e d . The response b e h a v i o r s r e p o r t e d i n c l u d e d problem s o l v i n g , u s i n g s o c i a l s u p p o r t , doing a t h l e t i c a c t i v i t i e s , u s i n g r e l a x a t i o n t e c h n i q u e s , e s c a p i n g from the s i t u a t i o n , as u e l l as responses c o n s i d e r e d n e g a t i v e b e h a v i o r s . The i d e n t i f i e d response r e s o u r c e s uere s i m i l a r to those c i t e d in the l i t e r a t u r e and i n c l u d e d those r e l a t e d to the s e l f , l o c u s of c o n t r o l and having p r e v i o u s e x p e r i e n c e . S i g n i f i c a n t d i f f e r e n c e s uere noted betueen the age and sex subgroups f o r tuo items. Boys i d e n t i f i e d c o n t r o l as a response r e s o u r c e more f r e q u e n t l y than g i r l s . The 14 to 15 year o l d s i d e n t i f i e d avoidance/escape more f r e q u e n t l y than the o t h e r age groups. Trends in da t a i n d i c a t e t h a t boys i d e n t i f i e d a c t i v e , long term response b e h a v i o r s and r e s o u r c e s r e l a t e d to the s e l f and lo c u s of c o n t r o l more f r e q u e n t l y than g i r l s . G i r l s i d e n t i f i e d items r e l a t e d to good h e a l t h h a b i t s and s o c i a l s u p p ort more f r e q u e n t l y than d i d boys. Moreover, u i t h an i n c r e a s e in age, escape b e h a v i o r s , " a c t i n g o u t , " and n e g a t i v e h e a l t h b e h a v i o r s uere r e p o r t e d l e s s f r e q u e n t l y . In a d d i t i o n , 16 to 17 year o l d s i d e n t i f i e d some s t r e s s response items more f r e q u e n t l y . It uas q u e r i e d whether p a t t e r n s of c o p i n g f o r the a d o l e s c e n t c o r r e s p o n d to those d e s c r i b e d f o r the a d u l t . The m a j o r i t y of s p e c i f i c s t r e s s outcomes l i s t e d uere noted by the m a j o r i t y of the r e s p o n d e n t s . " A l c o h o l i s m or drug abuse" uas the most f r e q u e n t l y i d e n t i f i e d item. H e a l t h problems t h a t are more l i K e l y to occur u i t h the a d o l e s c e n t age group uere l e s s 128 •frequently i d e n t i f i e d as s t r e s s outcomes. There uere no s i g n i f i c a n t d i f f e r e n c e s in r e p o r t e d s t r e s s outcomes uhen compared, based on sex and age. With an i n c r e a s e in age of the r e s p o n d e n t , t h e r e uas a tendency f o r r e p o r t e d outcomes to i n c r e a s e . These r e s u l t s uere e x p l a i n e d on the b a s i s of v a r i a b l e s u h i c h i n f l u e n c e p e r c e p t i o n : t i m e , e x p e r i e n c e , p h y s i c a l s t a t e and the s e l f . From these r e s u l t s , the s t a t e d c o n c l u s i o n s and i m p l i c a t i o n s are p r e s e n t e d in the next c h a p t e r f o l l o w i n g a b r i e f summary. Recommendations f o r f u r t h e r r e s e a r c h are o u t l i n e d . 123 CHAPTER V Summary, C o n c l u s i o n s , I m p l i c a t i o n s and Recommendations T h i s l a s t c h a p t e r p r e s e n t s the summary and c o n c l u s i o n s d e r i v e d from the r e s e a r c h s t u d y . It a l s o o u t l i n e s i m p l i c a t i o n s and recommendations f o r f u r t h e r r e s e a r c h . Summary and C o n c l u s i o n s T h i s study uas des i g n e d to e x p l o r e and d e s c r i b e the h e a l t h y a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s . What do h e a l t h y a d o l e s c e n t s p e r c e i v e as the c a u s e s , symptoms, r e s p o n s e s , and outcomes of t h e i r s t r e s s ? Do t h e i r p e r c e p t i o n s vary based on t h e i r s ex, age, or an e x p e r i e n c e in s t r e s s management c l a s s ? What do they p e r c e i v e as the r e l a t i o n s h i p betueen s t r e s s and i l l n e s s ? The t h e o r e t i c a l frameuorK f o r t h i s n u r s i n g study uas d e r i v e d from s e l e c t e d elements of p e r c e p t u a l psychology and a d a p t a t i o n t h e o r y . A s t r e s s model, composed of c a u s e s , symptoms, r e s p o n s e s , and outcomes uas used to address c o n s t r u c t v a l i d i t y . A q u e s t i o n n a i r e , c o n s i s t i n g of open-response and c1osed-response q u e s t i o n s , uas developed from i n t e r v i e u s u i t h y o u t h s , c o n s u l t a t i o n u i t h h e a l t h p r o f e s s i o n a l s , and a r e v i e u of the l i t e r a t u r e . The t o o l uas p r e t e s t e d and a p i l o t study uas conducted to r e f i n e the r e s e a r c h d e s i g n and to f u r t h e r t e s t the t o o l . Q u e s t i o n n a i r e s uere d i s t r i b u t e d to a convenience sample of 46 boys and g i r l s , ages 14 to 19, in Y.M.C.A. youth group programs. Because only f o u r p a r t i c i p a n t s r e p o r t e d an e x p e r i e n c e u i t h s t r e s s management c l a s s , t h i s v a r i a b l e uas not c o n s i d e r e d f o r f u r t h e r a n a l y s i s . Open-ended responses uere grouped and t a b u l a t e d by content 124 and c1osed-response items a n a l y z e d through the S t a t i s t i c a l Package f o r the S o c i a l S c i e n c e s : V e r s i o n 9 (under MTS) computer program. D e s c r i p t i v e s t a t i s t i c s uere used to p r e s e n t the d a t a . Because of the e x p l o r a t o r y n a t u r e of the s t u d y , t r e n d s in da t a uere n o t e d , as u e l l as s t a t i s t i c a l l y s i g n i f i c a n t f i n d i n g s d e r i v e d from C h i Square A n a l y s i s and c o n f i d e n c e i n t e r v a l comparisons at p_< .05. The r e s u l t s and c o n c l u s i o n s from the a n a l y s i s are as f o l l o w s : 1. The m a j o r i t y of a d o l e s c e n t respondents v i e u s t r e s s as a t o p i c of c o n c e r n . Furthermore, they see i t as being manageable and as r e l a t e d to h e a l t h . The p a r t i c i p a n t s ' i n t e r e s t and v i e u s on the s t r e s s t o p i c are supported in r e l a t e d h e a l t h l i t e r a t u r e (Benjamin & F i n K , 1976; House et a l . , 1979; S t e r n l i e b & Munan, 1972). However, s t r e s s may be a t o p i c of more r e l e v a n c e and more meaning to them than h e a l t h . Because they are h e a l t h y , they are more l i K e l y to e x p e r i e n c e s t r e s s , a v a r i a t i o n in a d a p t a t i o n , than they are to e x p e r i e n c e d_is_ease, a v a r i a t i o n in h e a l t h . 2. Most h e a l t h y a d o l e s c e n t p a r t i c i p a n t s p e r c e i v e the f a c t t h a t c o n t i n u e d , accumulated or extreme s t r e s s u i l l have a n e g a t i v e e f f e c t on t h e i r h e a l t h . Moreover, they are a b l e to d e s c r i b e i t s general e f f e c t s . P a r t i c i p a n t s l e s s f r e q u e n t l y noted i t s soec i f i c e f f e c t s and some respondents (1550 d i d not Know any of i t s e f f e c t s . It may be concluded t h a t p a r t i c i p a n t s have a g e n e r a l Knowledge of the r e l a t i o n s h i p of s t r e s s to h e a l t h , but may lacK s p e c i f i c Knowledge of t h i s r e l a t i o n s h i p . Without e x p e r i e n c e in s t r e s s management c l a s s , i t i s p o s s i b l e the s o u r c e s of t h e i r u n d e r s t a n d i n g come from popul a r l i t e r a t u r e , the media, or s i g n i f i c a n t o t h e r s . 3. Major causes of s t r e s s p e r c e i v e d by a d o l e s c e n t respondents r e l a t e to s c h o o l and worK, the s e l f , i n t e r p e r s o n a l r e l a t i o n s h i p s , f a m i l y , a u t h o r i t y f i g u r e s , time d e a d l i n e s , r o u t i n e s , and emotions. 125 School was i d e n t i f i e d as a f r e q u e n t s t r e s s o r in s t u d i e s by Dobson <1980; 1983, p. 351) and Tyerman and Humphrey (1882). School/worK are major a c t i v i t i e s f o r a d o l e s c e n t s and these causes of s t r e s s r e f l e c t t h e i r i n t e r a c t i o n with the environment. S t r e s s o r s a s s o c i a t e d with the s e l f and i n t e r p e r s o n a l r e l a t i o n s h i p s with the o p p o s i t e sex, p a r e n t s , s i b l i n g s , and peers are s i m i l a r to r e s u l t s r e p o r t e d in the l i t e r a t u r e ( C o d d i n g t o n , 1972b; JacKson, 1982; Yeaworth et a l . , 1980) and r e l a t e t o the d e v e l o p i n g s e l f - c o n c e p t u h i c h i s determined in r e f l e c t i o n , d u r i n g i n t e r a c t i o n with o t h e r s . Causes of s t r e s s r e l a t e d to f a m i l y and a u t h o r i t y f i g u r e s , r e f l e c t the s t r u g g l e f o r independence. Time p r e s s u r e s uere r e p o r t e d more f r e q u e n t l y with age, a r e s u l t a l s o noted by JacKson ( 1 9 8 2 ) , and are a s s o c i a t e d u i t h i n c r e a s i n g r e s p o n s i b i l i t y and u i d e n i n g s o c i a l and a c t i v i t y s p h e r e s . C o n v e r s e l y , " r o u t i n e s , same o l d t h i n g " uas noted as being a cause of s t r e s s by 41% of the r e s p o n d e n t s . T h i s r e s u l t suggests these i n d i v i d u a l s d i d not have enough change, a f a c t o r S e l y e ( 1974) r e l a t e d to s t r e s s . Emotions as a cause of s t r e s s i s c o r r o b o r a t e d by f i n d i n g s in the l i t e r a t u r e . F u r t h ermore, many of the causes of s t r e s s r e f l e c t the environment, the a c t i v i t i e s , and the s t r u g g l e f o r m a t u r i t y and a d e v e l o p i n g s e l f . Those f a c t o r s u h i c h i n t e r f e r e u i t h the d e v e l o p i n g s e l f produce s t r e s s <C. Rogers, 1951). 4. The m a j o r i t y of s t r e s s symptoms r e c o g n i z e d by these a d o l e s c e n t s are p h y s i o l o g i c a l such as "heart pounding." The b e h a v i o r a l or a f f e c t i v e f e e l i n g s t a t e s are noted l e s s f r e q u e n t l y . A s i m i l a r f i n d i n g i s r e p o r t e d u i t h c o l l e g e s t u d e n t s (Humphrey & E v e r l y , 1980). Because s t r e s s symptoms are l e a r n e d (Mechanic, 1972) and a d o l e s c e n t s have a l i m i t e d e x p e r i e n t i a l and Knouledge base, b e h a v i o r a l and a f f e c t i v e symptoms may not a l u a y s be r e c o g n i z e d . A d o l e s c e n t s may not r e l a t e t h e i r f e e l i n g s to a p a r t i c u l a r s i t u a t i o n or be a b l e to express t h e i r f e e l i n g s in v e r b a l terms. P h y s i o l o g i c a l symptoms may be c o n s i d e r e d l e s s s u b j e c t i v e and t h u s . 126 e a s i e r to d e s c r i b e . The s i n g l e item i d e n t i f i e d most f r e q u e n t l y uas " i r r i t a b i l i t y or d e p r e s s i o n . " B e h a v i o r a l symptoms such as " f e e l a g g r e s s i v e , 1iKe h i t t i n g something," or " f e e l 1 iKe u a n t i n g to be a l o n e , not t a l K " uere i d e n t i f i e d . It i s not Known uhether these a d o l e s c e n t s behave in response to the uay they f e e l . 5. A d o l e s c e n t respondents p e r c e i v e a v a r i e t y of b e h a v i o r s they use in response to s t r e s s . These i n c l u d e : p r o b l e m - s o l v i n g , u s i n g r e l a x a t i o n , p a r t i c i p a t i n g in p h y s i c a l a c t i v i t y , e s c a p i n g , " a c t i n g o u t , " and s e e k i n g s o c i a l s u p p o r t . More escape b e h a v i o r s than p r o b l e m - s o l v i n g b e h a v i o r s uere noted in the open-response items. With t h e i r l i m i t e d e x p e r i e n c e , a d o l e s c e n t s may not be Knowledgeable of more d i r e c t approaches to managing s t r e s s . As u e l l , " a c t i n g o u t " may be c o n s i d e r e d an immature b e h a v i o r and use of t h i s response may r e s u l t in decreased s e l f - e s t e e m and f u r t h e r s t r e s s . Negative h e a l t h b e h a v i o r s such as "smoKing," " d r i n K i n g , " or " d r i v i n g f a s t , " a l s o uere p e r c e i v e d as response b e h a v i o r s . A d o l e s c e n t s may l e a r n to use these b e h a v i o r s from ro1e-mode 1ing o t h e r s ' b e h a v i o r s or from examples d i s p l a y e d through media. However, these b e h a v i o r s may not be conducive to s t r e s s management and may a l s o cause f u r t h e r s t r e s s . D i f f e r e n c e s in the f r e q u e n c i e s of the s p o n t a n e o u s l y l i s t e d items and the chosen items on the q u e s t i o n n a i r e uere noted. LacK of auareness may account f o r the d i s c r e p a n c i e s . P a t t e r n s of s t r e s s response b e h a v i o r s u h i c h are conducive to a d a p t i v e outcomes are d e s c r i b e d f o r a d u l t s ( B e l l , 1977; Moos & B i l l i n g s , 1982; P e a r l in & S c h o o l e r , 1978). It i s not Known whether the same b e h a v i o r p a t t e r n s by a d o l e s c e n t s y i e l d s i m i l a r r e s u l t s . 6. The a d o l e s c e n t respondents p e r c e i v e the s t r e s s response r e s o u r c e s to be s o c i a l s u p p o r t , p o s i t i v e s e l f - e s t e e m , sense of c o n t r o l over s e l f and s i t u a t i o n , and p r e v i o u s e x p e r i e n c e . These 127 are s i m i l a r to the response r e s o u r c e s f o r a d u l t s d e s c r i b e d in the l i t e r a t u r e (Bandura, 1977; C a p l a n , 1974; Hamburg, E l l i o t t & P a r r o n , 1982, pp. 77-78; Kobasa, 1979; P e a r l in & S c h o o l e r , 1978). Although i d e n t i f i e d from the l i s t of o p t i o n s , these items uere not p e r c e i v e d s p o n t a n e o u s l y u h i c h may suggest a lacK of a u a r e n e s s . Items r e l a t e d to the s e l f uere noted most f r e q u e n t l y u h i c h r e f l e c t s the impact of the d e v e l o p i n g s e l f and the importance of the s e l f - c o n c e p t at a d o l e s c e n c e . Although c i t e d as r e s o u r c e s to manage the e f f e c t s of the s t r e s s r e a c t i o n <Everly & R o s e n f e l d , 1981, P P . 159-161), p h y s i c a l e x e r c i s e and good n u t r i t i o n uere among the l e a s t f r e q u e n t l y noted r e s o u r c e s . A d o l e s c e n t s may la c k s p e c i f i c Knowledge about the s t r e s s r e a c t i o n and the i n f l u e n c e of these response r e s o u r c e s . "Being a b l e to a n t i c i p a t e uhat u i l l happen" uas a l s o l e s s f r e q u e n t l y i d e n t i f i e d . A lacK of e x p e r i e n c e may account f o r t h i s r e s u l t . 7. The a d o l e s c e n t respondents p e r c e i v e the outcomes of s t r e s s to be a n e g a t i v e e f f e c t on h e a l t h . Although they d e s c r i b e d a g e n e r a l e f f e c t , they i d e n t i f i e d s p e c i f i c c o n d i t i o n s as " a l c o h o l i s m , drug abuse," "headaches," "stomach u l c e r s , " " h y p e r t e n s i o n , " "heart a t t a c K , " and "mental i l l n e s s . " Those c o n d i t i o n s u h i c h they might be more l i K e l y to e x p e r i e n c e , " a l l e r g i e s , " "asthma," " s p o r t s i n j u r i e s , " and " c o l d s " uere i d e n t i f i e d l e s s f r e q u e n t l y . These items are p r o b a b l y l e s s understood as s t r e s s - r e 1ated than are "stomach u l c e r s , " " h y p e r t e n s i o n , " or "heart a t t a c K . " The r e s u l t s suggest a d o l e s c e n t s do not Knou these h e a l t h c o n d i t i o n s may be s t r e s s outcomes. 8. These a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s vary u i t h sex. S i g n i f i c a n t d i f f e r e n c e s , p_<.05, betueen the sexes uere noted f o r f o u r items. G i r l s i d e n t i f i e d " r e l a t i o n s h i p s u i t h the o p p o s i t e sex" as a cause, and "urge to c r y " and " c r a v i n g to eat or l o s s of a p p e t i t e " as symptoms, more f r e q u e n t l y than boys, uhereas boys 128 i d e n t i f i e d "being a b l e to a n t i c i p a t e uhat u i l l happen" as a r e s o u r c e response more f r e q u e n t l y than g i r l s . Trends u h i c h i n d i c a t e d i f f e r e n c e s in the p e r c e p t i o n s of s t r e s s , based on sex, are i n d i c a t e d . Boys tended to more f r e q u e n t l y p e r c e i v e s t r e s s causes r e l a t e d to a j o b , s c h o o l , c a r s and a u t h o r i t y f i g u r e s ; r e c o g n i z e d s t r e s s u i t h p h y s i o l o g i c a l symptoms as "heart pounding;" r e p o r t e d u s i n g more long term a c t i v e , approaches to manage s t r e s s ; and p e r c e i v e d l o c u s of c o n t r o l , p o s i t i v e s e l f - e s t e e m and s e l f - c o n f i d e n c e as response r e s o u r c e s f o r s t r e s s . G i r l s tended to more f r e q u e n t l y p e r c e i v e causes of s t r e s s a s s o c i a t e d u i t h the f a m i l y , i n t e r p e r s o n a l r e l a t i o n s h i p s and the s e l f ; p e r c e i v e d more s t r e s s symptoms and more a f f e c t i v e symptoms; r e p o r t e d u s i n g more s h o r t term, p a s s i v e approaches to manage s t r e s s and p e r c e i v e d having f r i e n d s , time f o r s e l f , and good h e a l t h h a b i t s as response r e s o u r c e s . As u e l l , g i r l s p e r c e i v e d a h i g h e r mean s t r e s s l e v e l than boys, a r e s u l t a l s o noted in the l i t e r a t u r e < BurKe & Weir, 1378," Mendez et a l . , 1980). S o c i a l and l e a r n i n g e x p e r i e n c e s and g e n e t i c c o n s t i t u t i o n of the respondents may account f o r the r e p o r t e d d i f f e r e n c e s betueen the sexes in p e r c e p t i o n s of s t r e s s . 8. The a d o l e s c e n t s ' p e r c e p t i o n s of s t r e s s vary u i t h age and u i t h sex by age. The group, ages 14 to 15, r e p o r t e d the response b e h a v i o r "remove s e l f from s i t u a t i o n " s i g n i f i c a n t l y more f r e q u e n t l y than the other tuo age groups. When age and sex uere p a r t i t i o n e d o u t , younger g i r l s noted " h a s s l e s u i t h b r o t h e r / s i s t e r " s i g n i f i c a n t l y more f r e q u e n t l y than o l d e r g i r l s or any boys. Trends in the d a t a suggest d i f f e r e n c e s in the p e r c e p t i o n s of s t r e s s based on age. With i n c r e a s e in age the f o l l o w i n g uere noted. P e r c e i v e d l e v e l of s t r e s s i n c r e a s e d u i t h age. S t r e s s causes r e l a t i n g to the s e l f , f a m i l y , a u t h o r i t y f i g u r e s , and peer p r e s s u r e uere p e r c e i v e d l e s s f r e q u e n t l y but those r e l a t i n g to time 123 p r e s s u r e s , pregnancy, and f i n i s h i n g s c h o o l uere noted more f r e q u e n t l y . Symptoms, such as "uanting to be a l o n e , " "being a f r a i d , " and "urge to run or h i d e , " decreased in freq u e n c y u i t h age, but " f a t i g u e or r e s t l e s s n e s s " and p h y s i c a l symptoms such as "heart pounding" i n c r e a s e d . Immature b e h a v i o r , avoidance b e h a v i o r s and n e g a t i v e h e a l t h b e h a v i o r s tended to decrease u i t h age. As u e l l , r e s o u r c e s a s s o c i a t e d u i t h l o c u s of c o n t r o l , having p r e v i o u s e x p e r i e n c e , and the s e l f uere p e r c e i v e d l e s s f r e q u e n t l y u i t h i n c r e a s i n g age. More s t r e s s outcomes uere noted by the o l d e r age groups. The e x p e r i e n c e s , the d e v e l o p i n g s e l f , and the p h y s i c a l grouth of the a d o l e s c e n t e x p l a i n these t r e n d s . There uas a tendency f o r i n d i v i d u a l s , ages 16 to 17, to p e r c e i v e more causes of s t r e s s a s s o c i a t e d u i t h t h e i r a c t i v i t i e s , more symptoms, more response b e h a v i o r s , and more response r e s o u r c e s than o t h e r age groups. T h e i r i n c r e a s e in r e s p o n s i b i l i t i e s , i n c r e a s e in c o g n i t i v e a b i l i t i e s , change in p h y s i c a l s t a t e and e x p e r i e n c e may account f o r these r e s u l t s . P a t t e r n s in p e r c e p t i o n s of s t r e s s based on grade in sc h o o l uere s i m i l a r to those f o r age, u i t h tuo e x c e p t i o n s . I n d i v i d u a l s in Grade 9 and in Grade 13 p e r c e i v e d s t r e s s causes r e l a t e d to sc h o o l more f r e q u e n t l y than those in o t h e r grades. T h i s r e s u l t may be a t t r i b u t e d to a change in sc h o o l format. 10. Although the intended use of the t o o l uas to c o l l e c t d a t a c o n c e r n i n g a d o l e s c e n t p e r c e p t i o n s of s t r e s s , 18% of the a d o l e s c e n t respondents p e r c e i v e d they gained neu ideas about s t r e s s management by comp l e t i n g the q u e s t i o n n a i r e . It may be assumed these i n d i v i d u a l s l a c k e d Knowledge about s t r e s s and uere r e c e p t i v e to neu i d e a s . The a b i l i t y to g e n e r a l i z e the r e s u l t s beyond t h i s study i s l i m i t e d . It i s p o s s i b l e t h a t a d o l e s c e n t s i n v o l v e d in Y.M.C.A. group programs have a unique s e t of c h a r a c t e r i s t i c s u h i c h may 130 i n f l u e n c e t h e i r p e r c e p t i o n of s t r e s s . Furthermore, the convenience s e l e c t i o n and sma l l s i z e of the sample are f a c t o r s u h i c h l i m i t the a b i l i t y t o g e n e r a l i z e . It i s p o s s i b l e only p a r t i c i p a n t s uho uere i n t e r e s t e d in the s t r e s s t o p i c v o l u n t e e r e d f o r p a r t i c i p a t i o n . Data c o l l e c t i o n tooK p l a c e at the end of the summer uhen worK a c t i v i t i e s uere c o n c l u d i n g and s c h o o l uas pending. T h i s t i m i n g may have i n f l u e n c e d the r e s u l t s . I n d i v i d u a l f a c t o r s such as f a t i g u e , as u e l l as the nature of the a c t i v i t i e s , or of the environment might have a l s o i n f l u e n c e d the st u d y . On the other hand, because the Y.M.C.A. programs tend to be s e a s o n a l , and p a r t i c i p a n t s in the Y.M.C.A. are i n v o l v e d throughout the y e a r , t h i s sample may be s i m i l a r to ot h e r Vancouver Y.M.C.A. youth groups. The study f i n d i n g s may be a p p l i c a b l e to youth p a r t i c i p a t i n g in Vancouver Y.M.C.A. group programs. I m p l i c a t ions The f a c i l i t a t i o n of h e a l t h y s t r e s s management p a t t e r n s at a d o l e s c e n c e , b e f o r e poor h a b i t s are i n g r a i n e d and d i f f i c u l t t o change, uould seem uorthy of the nurse's e f f o r t . To f u r t h e r support t h i s p r e m i s e , s t r e s s uas i d e n t i f i e d as a concern by the m a j o r i t y of the p a r t i c i p a n t s . Because an i n i t i a l s t e p to s t r e s s management i s r e c o g n i t i o n or s e l f - a w a r e n e s s < H a r t l , 1332), and a b a s i s f o r i n f l u e n c i n g b e h a v i o r i s an un d e r s t a n d i n g of the i n d i v i d u a l ' s p e r s p e c t i v e , the nurse must a p p r e c i a t e the a d o l e s c e n t v i e u s of s t r e s s . Knowledge of the c a u s e s , symptoms, r e s p o n s e s , and outcomes of s t r e s s may guide the nurse in a s s i s t i n g the i n d i v i d u a l to manage s t r e s s . To g i v e d i r e c t i o n in t h i s q u e s t , the model of s t r e s s , i n c l u d i n g the q u e s t i o n n a i r e method, as used i n t h i s s t u d y , has p r a c t i c a l i m p l i c a t i o n s . The f o u r s t r e s s components s t u d i e d p r o v i d e a frameuorK f o r a s s e s s i n g , p l a n n i n g , i n t e r v e n i n g , and e v a l u a t i n g n u r s i n g c a r e . Each component may be c o n s i d e r e d a p o i n t 131 of i n t e r v e n t i o n . Knowledge o-f the p a t t e r n of v a r i a b l e s f o r each component w i l l help the nurse more e a s i l y i d e n t i f y those uho are "at r i s K " and to a s s i s t a d o l e s c e n t s manage t h e i r s t r e s s more e f f e c t i v e l y . As u e l l , the q u e s t i o n n a i r e method may be an a i d in a s s e s s i n g and expanding an i n d i v i d u a l ' s s e 1 f - a u a r e n e s s of s t r e s s , and as a t o o l in e v a l u a t i n g u n d e r s t a n d i n g . T h i s p r e l i m i n a r y study i n d i c a t e s those v a r i a b l e s a d o l e s c e n t s f r e q u e n t l y p e r c e i v e as the causes of s t r e s s , the symptoms u i t h u h i c h they r e c o g n i z e t h e i r s t r e s s , hou they r e s p o n d , f a c t o r s t h a t h e l p them manage and the outcomes they b e l i e v e are r e l a t e d to s t r e s s . It f u r t h e r i n d i c a t e s a t r e n d f o r the v a r i a b l e s to d i f f e r based on sex and age. While t h i s study has i d e n t i f i e d some p a t t e r n s and t r e n d s , f u r t h e r i n v e s t i g a t i o n i s needed. Other demographic v a r i a b l e s , such as c u l t u r e or i l l n e s s may produce o t h e r response p a t t e r n s . F u r t hermore, u h i l e the v a r i a b l e , e x p e r i e n c e in a s t r e s s management c l a s s c o u l d not be i n v e s t i g a t e d in t h i s s t u d y , the responses of the a d o l e s c e n t s i n d i c a t e a lacK of auareness of s t r e s s and, f o r some i n d i v i d u a l s , a d e s i r e to Knou more . To f u r t h e r expand t h i s i n f o r m a t i o n u i l l be u s e f u l to nurses and o t h e r h e a l t h p r o f e s s i o n a l s as they i d e n t i f y p o t e n t i a l areas of c o n c e r n , as they r e c o g n i z e i n d i v i d u a l s who are in need of a s s i s t a n c e , and as they h e l p i n d i v i d u a l s r e c o g n i z e t h e i r oun s t r e s s . D i f f e r e n t groups may d i f f e r in the Kind of i n f o r m a t i o n they need . Many of the s t r e s s component v a r i a b l e s i d e n t i f i e d by the a d o l e s c e n t s are s i m i l a r to those d e s c r i b e d in the l i t e r a t u r e f o r a d u l t s . It i s not Known i f the v a r i a b l e s and p a t t e r n s of these v a r i a b l e s i n f l u e n c e a d a p t i v e outcomes f o r the a d o l e s c e n t in the same uay as d e s c r i b e d f o r the a d u l t . The r e l a t i o n s h i p of v a r i a b l e s i s q u e s t i o n a b l e . F u r t h e r study i s u a r r a n t e d . The r e s u l t s of t h i s p r e l i m i n a r y study g i v e d i r e c t i o n f o r a l a r g e r survey u h i c h might s u b s t a n t i a t e the p r e s e n t study r e s u l t s . 132 Recommendations f o r F u r t h e r Research Recommendations f o r f u r t h e r r e s e a r c h are as f o l l o w s : 1. Conduct a l a r g e r survey of h e a l t h y a d o l e s c e n t s , u s i n g a s i m i l a r r e s e a r c h d e s i g n u i t h a t t e n t i o n to p r o b a b i l i t y sampling a f t e r the t o o l used in t h i s study i s m o d i f i e d and p r e t e s t e d . To modify the t e s t i n s t r u m e n t , i t i s suggested t h a t one! a. D e l e t e the open-ended q u e s t i o n s to f a c i l i t a t e d a t a a n a l y s i s and i n c o r p o r a t e the more f r e q u e n t l y i d e n t i f i e d o p t i o n s from the open-response q u e s t i o n s in the l i s t s of c1osed-response q u e s t i o n s . ftn o p t i o n , " o t h e r , " to be completed by the r e s p o n d e n t , may be added t o each 1 i s t to address inc1 us iveness . b. R e c o n s i d e r q u e s t i o n s u h i c h are r e p e t i t i v e and exclude them from the q u e s t i o n n a i r e . For example: b i r t h d a t e i n f o r m a t i o n i s a d u p l i c a t i o n of age and may be d e l e t e d . C o n s i d e r a d d i t i o n a l q u e s t i o n s f o r i n c l u s i o n . For example: a q u e s t i o n about t i m i n g of entrance to high s c h o o l may be added to f u r t h e r e x p l o r e items r e l a t e d to s c h o o l . c. D i v i d e those items u h i c h are combined in an o p t i o n such as " f a t i g u e , r e s t l e s s n e s s " or "dr inK a l c o h o l , smok'e" i n t o d i s c r e t e v a r i a b l e s such as " f a t i g u e , " " r e s t l e s s n e s s , " "drinK a l c o h o l , " and "smoKe." T h i s u i l l f a c i l i t a t e d i s c r i m i n a t i o n . d. Change the response o p t i o n s f o r the l i s t s from "yes, no, don't Knou" to a r a t i n g s c a l e so t h a t o r d i n a l / i n t e r v a l d a t a may be c o l l e c t e d . e. Expand the l i s t of o p t i o n s f o r s t r e s s response r e s o u r c e s to f a c i l i t a t e d i s c r i m i n a t i o n . F u r t h e r expand the l i s t u i t h more d e t a i l d e r i v e d from r e v i e u of the l i t e r a t u r e and from a d d i t i o n a l i n t e r v i e w s u i t h a d o l e s c e n t s . 133 S. I n i t i a t e a s i m i l a r study u i t h a d i f f e r e n t sample to a s s e s s response d i f f e r e n c e s based on o t h e r demographic v a r i a b l e s , such as c u l t u r e or i l l n e s s . These v a r i a b l e s are suggested by the t h e o r e t i c a l frameuorK as f a c t o r s u h i c h i n f l u e n c e p e r c e p t i o n . 3. I n v e s t i g a t e the r e l a t i o n s h i p of s t r e s s components to s p e c i f i c s t r e s s f u l s i t u a t i o n s . For example: respondents may be asked to v o l u n t e e r i n f o r m a t i o n about u h i c h s i t u a t i o n s cause them s t r e s s , hou they uould r e c o g n i z e t h e i r s t r e s s in t h a t s i t u a t i o n , u h i c h responses they might employ, and u h i c h outcome they uould e x p e c t . Data may be c o l l e c t e d u s i n g i n t e r v i e u s , or an open-ended response q u e s t i o n n a i r e . 4. I n v e s t i g a t e the r e l a t i o n s h i p betueen s p e c i f i c v a r i a b l e s and a component such as the use of a p a r t i c u l a r response b e h a v i o r in r e l a t i o n to outcome. As u e l l , i n v e s t i g a t e the r e l a t i o n s h i p betueen p a t t e r n s of v a r i a b l e s and a component such as the use of avoidance/escape b e h a v i o r s and outcome. 5. Conduct q u a l i t a t i v e s t u d i e s , u s i n g i n t e r v i e u s , to p r o v i d e f u r t h e r in-depth i n v e s t i g a t i o n of each s t r e s s component, such as s t r e s s symptoms or s t r e s s r e s p o n s e s , f o r example: copi n g b e h a v i o r s as a s t r e s s component. Conduct f u r t h e r in-depth i n v e s t i g a t i o n of a p a r t i c u l a r v a r i a b l e , f o r example: s c h o o l as a s t r e s s cause, f e e l i n g upset as a s t r e s s symptom, p r o b l e m - s o l v i n g , s o c i a l s u p p o r t , or r e l a x a t i o n as s t r e s s r e s p o n s e s . 6. F u r t h e r develop the q u e s t i o n n a i r e as an assessment t o o l f o r s t r e s s management. T h i s uould i n c l u d e development of s c a l e s f o r each s t r e s s component l i s t and a t t e n d i n g f u r t h e r to v a l i d i t y and re 1iab i 1 i t y . 7. F u r t h e r develop the q u e s t i o n n a i r e f o r use as an a i d to 134 c o u n s e l i n g by changing the response o p t i o n s to a r a t i n g system, d e l e t i n g q u e s t i o n s about the s e n s i t i v i t y to the q u e s t i o n n a i r e , and d e v e l o p i n g a s c o r i n g system s u i t a b l e f o r s e 1 f - a d m i n i s t r a t i o n . 8. Use the q u e s t i o n n a i r e to compare p e r c e p t i o n s of s t r e s s b e f o r e and a f t e r s t r e s s management t r a i n i n g to f u r t h e r t e s t and r e f i n e the instrument. 9. Employ a p r e t e s t and p o s t t e s t study to a s s e s s neu u n d e r s t a n d i n g about s t r e s s gained from c o m p l e t i n g the q u e s t i o n n a i r e , a r e s u l t u h i c h uas suggested to occur in the p r e s e n t s t u d y . The i n f o r m a t i o n d e r i v e d from t h i s study u i l l expand the Knowledge and u n d e r s t a n d i n g of hou the h e a l t h y a d o l e s c e n t p e r c e i v e s s t r e s s , i t s c a u s e s , symptoms, r e s p o n s e s , and outcomes. Houever, f u r t h e r i n v e s t i g a t i o n of the t o p i c i s u a r r a n t e d . With g r e a t e r Knowledge, nurses and o t h e r h e a l t h p r o f e s s i o n a l s may be able to more e f f e c t i v e l y f a c i l i t a t e s t r e s s management f o r a d o l e s c e n t s . T h i s , in t u r n , uould promote the enhancement of h e a l t h y l i f e s t y l i n g p a t t e r n s f o r youth. 135 References Adams, J . D. (1880). Understanding and managing s t r e s s ; A norKbpgK in changing l i f e s t y l e s . San Diego! U n i v e r s i t y Assoc i a t e s . Adams, J . E. & Lindeman, E. (1374). Coping u i t h l o n g - t e r m d i s a b i l i t y . In G. V. Coelho, D. A. Hamburg, & J . E. Adams ( E d s . ) . Coping and a d a p t a t i o n ( P P . 127-138). Neu YorK' B a s i c B O O K S . Adams, J . F. <Ed. ) . ( 1 376). Understanding a d o l e s c e n c e ! C u r r e n t deve1OPmentS in a d o l e s c e n t psychology ( 3 r d e d . ) . Boston: A l l y n and Bacon. A d e l s o n , J . ( E d . ) . (1380). 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L i f e s t r e s s , f a m i l y support and a d o l e s c e n t d i s t u r b a n c e . J o u r n a l of A d o l e s c e n c e , 6_, 1-12. U n i t e d S t a t e s Department of H e a l t h E d u c a t i o n & W e l f a r e . (1979). Healthy people <DHEW Pub. No. PHS 78-1232). Washington, DC: u. S. Government P r i n t i n g O f f i c e . V a i l l a n t , G. < 1977). Adaptat ion to 1 i f e . Boston: L i t t l e , Broun & Co. V o l i c e r , B. J . <1977). P a t i e n t ' s p e r c e p t i o n s of s t r e s s f u l events a s s o c i a t e d u i t h h o s p i t a l i z a t i o n . N ursing R e s e a r c h , £3_, 235-238. Walker, D. K. , C r o s s , A. W. , Heyman, P. W., Ruch-Ross, H. , Benson, P., & T u t h i l l , J . W. G. <1372). Comparisons betueen i n n e r - c i t y and p r i v a t e s c h o o l a d o l e s c e n t s ' p e r c e p t i o n s of h e a l t h problems. J o u r n a l of A d o l e s c e n t H e a l t h Care, 3_, 82-90. W a l l a c e , J . M. (1980). B e h a v i o r a l h e a l t h change through t e n s i o n c o n t r o l l e a r n i n g in a d u l t e d u c a t i o n c l a s s e s . In F. J . McGuigan & W. E. Sime < Eds. ) . S t r e s s and t e n s i o n c o n t r o l <PP . 242-261). Neu York: Plenum P r e s s . W o l f f , H. G. <1953). S t r e s s and d i s e a s e . S p r i n g f i e l d , IL: C h a r l e s C. Thomas. Wu , R. < 1973>. Be h a v i o r and i l l n e s s . Engleuood C l i f f s , NJ: Prent i c e - H a l 1. W y l i e , R. C. < 1374). The s e 1 f - c o n c e p t . Vol 1. A r e v i e u of m e t h o d o l o g i c a l c o n s i d e r a t i o n s and measuring i n s t r u m e n t s . L i n c o l n : U n i v e r s i t y of Nebraska P r e s s . Y e a u o r t h , R. C , York, J . , Hussey, M. A., I n g l e , M. E., & Gooduin, T. <1380). The development of an a d o l e s c e n t l i f e change event s c a l e . Adolescence . 13., 31-93. 149 Z b o r o u s K i , M. <1977>. D i f f e r e n c e s and s i m i l a r i t i e s . In ft. Monat & R. Lazarus ( E d s . ). S t r e s s and c o p i n g ; ftn anthology (pp. 95-107). Neu YorK: Columbia U n i v e r s i t y P r e s s . Zegans, L. S. (1382). S t r e s s and the development of somatic d i s o r d e r s . In L. Goldberger & S. B r e z n i t z ( E d s . ) , Handbook of s t r e s s : Theoret i c a l and c l i n c a l a s p e c t s ( P P . 134-152). Neu YorK: The Free P r e s s . Z e l t z e r , L., K e l l e r m a n , J . , E l l e n b e r g , L., Dash, J . , & R i g l e r , D. (1980). P s y c h o l o g i c e f f e c t s of i l l n e s s in a d o l e s c e n c e I I : Impact of i l l n e s s in ado 1 e s c e n t s — c r u c i a l i s s u e s and c o p i n g s t y l e s . J o u r n a l of P e d i a t r i c s . 9_Z, 132-138. Ziemer, M. M. (1382). Coping b e h a v i o r : ft response to s t r e s s . T O P i c s in Cl in i c a l Nurs ing , 4.(2), 4-12. 150 Appendix As L e t t e r of E x p l a n a t i o n and Consent t 152 Appendix B: Request to Agency Appendix Cs Agency Consent 156 Appendix Ds Revieu Comments to Q u e s t i o n n a i r e D r a f t 159 Appendix E: Sample Q u e s t i o n n a i r e 160 VIEWS ON STRESS T h i s survey i s about how people f e e l , t h i n k , and respond to s t r e s s f u l s i t u a t i o n s . You may f i n d the t o p i c i n t e r e s t i n g . Completion of the q u e s t i o n n a i r e w i l l take a p p r o x i m a t e l y 2 0 minutes of your time. THIS INFORMATION IS CONFIDENTIAL Your responses to t h i s q u e s t i o n n a i r e a re c o n f i d e n t i a l and you w i l l not be i d e n t i f i e d p e r s o n a l l y . You may r e f u s e to p a r t i c i p a t e o r withdraw from the study w i t h o u t a f f e c t i n g your p a r t i c i p a t i o n i n the Y.M.C.A. group i n any way. Completion of the q u e s t i o n n a i r e w i l l i n d i c a t e your w i l l i n g n e s s to p a r t i c i p a t e i n the study. P l e a s e answer each q u e s t i o n . Complete each one b e f o r e going on to the next. Be as t r u t h f u l as you can. THERE ARE NO RIGHT OR WRONG ANSWERS. A POINT OF CLARIFICATION: For purposes of t h i s study, " s t r e s s " means s i t u a t i o n s , e v e n t s ,  o r o c c u r r e n c e s which cause change i n your normal f u n c t i o n i n g . These s i t u a t i o n s may be p l e a s a n t o r unpleasant or both. Our r e a c t i o n s to these s i t u a t i o n s cause us to f e e l " s t r e s s e d " . Would you d e f i n e " s t r e s s " any d i f f e r e n t l y ? Yes . No I f y e s, how? NOTE: In the subsequent pages, the content i n the r i g h t hand column i s coded f o r computer t a b u l a t i o n . P l e a s e do not w r i t e i n t h i s a r e a . 161 S t r e s s i s o f t e n a t o p i c one does not c o n s i d e r ; perhaps because of l a c k of knowledge or l a c k of awareness or perhaps because i t i s n ' t an important t o p i c . P l e a s e check you answer to the f o l l o w i n g q u e s t i o n s . 1. Is s t r e s s a t o p i c of c o n c e r n f o r you? Yes. No 2. In your o p i n i o n , do you t h i n k you can do a n y t h i n g about s t r e s s ? Yes No Don't Know 3. Do you t h i n k p rolonged s t r e s s or accumulated s t r e s s i s r e l a t e d to i l l h e a l t h ? Yes No Don 11 Know P l e a s e answer the f o l l o w i n g q u e s t i o n s as b r i e f l y and s p e c i f i c a l l y as you c a i The causes of s t r e s s are d i f f e r e n t f o r each person. 4. What causes s t r e s s f o r you? L i s t as many s i t u a t i o n s or events as you can. 10 19 11 20 12 21 5. B e g i n n i n g w i t h number 1 as the most s t r e s s f u l , number the items l i s t e d above i n o r d e r of p r i o r i t y . 6. How can you t e l l t hat you are under s t r e s s ? 7. The f o l l o w i n g i s a l i s t of n a t u r a l l y o c c u r r i n g events which may cause s t r e s s . F or each item i n d i c a t e i n the a p p r o p r i a t e column whether the item has been a cause of s t r e s s f o r you w i t h i n the past y e a r . I f you have not e x p e r i e n c e d the item, you may not know the answer. YES NO DON'T KNOW a. • death of parent b. l o s s of a pet c. changing s c h o o l d. s t a r t i n g a new j o b e. f i n i s h i n g s c h o o l ( g r a d u a t i n g ) f . p a r e n t s " g e t t i n g on back" g. p r e s s u r e s to do t h i n g s w i t h i n a g i v e n time frame h. s c h o o l work, t e s t s i . d e a t h of c l o s e f r i e n d o r r e l a t i v e j . h a s s l e s w i t h the law k. b a d l y h u r t / s i c k 1. team p r e s s u r e s to win i n s p o r t s m. p a r e n t / r e l a t i v e v e r y s i c k n. r e l a t i o n s h i p s w i t h o p p o s i t e sex o. f l u n k i n g a grade p. r o u t i n e s - "same o l d t h i n g " q. p r e s s u r e s from your f r i e n d s r . l o s i n g a job s. p e r s o n a l l y f e e l i n g "put downs" t . h a s s l i n g w i t h b r o t h e r / s i s t e r u. t r o u b l e w i t h t e a c h e r / p r i n c i p a l v. pregnancy w , wrecking the c a r x. f a i l i n g a s u b j e c t y. parent l o s i n g job l e a 13 22 14 23 15 24 16 25 17 26 18 27 19 28 20 29 21 30 22 31 23 32 24 33 25 34 26 35 27 36 28 37 29 38 • 30 39 • 31 40 -32 41 -33 42 -34 43 -35 44 -36 45 -37 46 -163 YES NO- DON'T KNOW z. g e t t i n g and m a i n t a i n i n g a car aa. f a m i l y member d r i n k i n g bb. problems w i t h s i z e , appearance c c . problems w i t h acne dd. c l o t h e s ee. parents d i v o r c e d / s e p a r a t e d f f . l i v i n g up to parents e x p e c t a t i o n s 38 47 39 48 40 49 41 50 42 51 43 52 44 53 3. Would you be more l i k e l y to f e e l more s t r e s s e d i f a number of these events o c c u r r e d ' together? Yes No Don't Know 9. Are there sometimes when such n a t u r a l l y o c c u r r i n g events g i v e you more s t r e s s at one time than at o t h e r times? Yes Mo Don' t Know 10. What do you u s u a l l y do when you .are f e e l i n g s t r e s s e d ? 45 54 46 55 11. Compared to o t h e r persons your age, do you t h i n k you e x p e r i e n c e more r e a c t i o n to s t r e s s , l e s s r e a c t i o n to s t r e s s or the same amount of r e a c t i o n to s t r e s s as o t h e r s ? More r e a c t i o n 47 56 Same r e a c t i o n Less r e a c t i o n 164 We are not always aware of how we r e a c t to s i t u a t i o n s . P l e a s e check the a p p r o p r i a t e box f o r those items which d e s c r i b e your e x p e r i e n c e . 12. When you are f e e l i n g s t r e s s e d , what do you f e e l l i k e doing? YES XO DON'T KNOW a. overpowering urge to run or h i d e b. urge to c r y c. f e e l i n g a g g r e s s i v e , f e e l l i k e • h i t t i n g something d. c r a v i n g to eat or l o s s o f a p p e t i t e e. i n a b i l i t y to laugh openly o r h o n e s t l y f . s t u t t e r i n g or o t h e r speech d i s t u r b a n c e g. f e e l i n g of wanting to be al o n e , not t a l k to anyone h. f e e l i n g i m p u l s i v e _ _ _ _ i . o t h e r 48 57 49 58 50 59 51 60 52 61 53 62 54 63 55 64 56 65 13. In s t r e s s f u l s i t u a t i o n s , what k i n d s of t h i n g s happen co your body? YES ' NO DON'T KNOW a. dryness of t h r o a t and mouth b. pounding of h e a r t c. shaking l e g s , t r e m b l i n g , nervous d. insomnia, d i f f i c u l t y s l e e p i n g e. c o n s t a n t f a t i g u e or r e s t l e s s n e s s f. f r e q u e n t need to "go pee" g. sweating h. headaches i . stomach ups e t , q u e a s i n e s s , " b u t t e r f l i e s " i n stomach, d i a r r h e a , c o n s t i p a t i o n 57 66 58 67 59 68 60 69 61 70 62 71 63 72 64 73 65 74 ot h e r 66 75 14. When you are i n a s t r e s s f u l s i r u a t i o n , what kind s of t h i n g s do you f e e l ' YES NO DON'T KNOW a. 165 ( c a r d 2) g e n e r a l i r r i t a b i l i t y or d e p r e s s i o n b. i n a b i l i t y to make d e c i s i o n s c. i n a b i l i t y to c o n c e n t r a t e or to complete a task b e f o r e going on to another d. nightmares e. f e e l i n g s of u n r e a l i t y , weakness or d i z z i n e s s f. f e e l i n g of being a f r a i d though don't know what you are a f r a i d of g. f e e l i n g of bei n g "keyed up" or " u p t i g h t " h. o t h e r 15. P l e a s e i n d i c a t e whether o r not you do each of the f o l l o w i n g a c t i v i t i e s when you are f e e l i n g s t r e s s e d . YES NO DON'T KNOW a. p l a y music, read, or do o t h e r d i v e r s i o n a r y a c t i v i t y b. p l a y team s p o r t s " r e a l mean" c. do a t h l e t i c a c t i v i t i e s " h a r d " such as j o g g i n g , weight l i f t i n g d. t a l k to someone e. t r y not to t h i n k about s i t u a t i o n f. d w e l l o r "stew" about problem g. use s p e c i f i c r e l a x a t i o n t e c h n i q u e s such as Yoga, T.M., p r o g r e s s i v e muscle r e l a x a t i o n h. remove y o u r s e l f from s i t u a t i o n i . t r y to f i g u r e out what the problem i s j . d r i n k a l c o h o l , smoke k. e a t f o r s a t i s f a c t i o n 1. use medicines m. i n v o l v e y o u r s e l f i n something e l s e you do w e l l such as a hobby n - d r i v e f a s t , s q u e a l t i r e s , make smoke o. a c t out i n some way 1- 1-3 2 4 67 5 68 ' 6 69 7 70 8 71 9 72 10 73 11 74 12 75 13 76 14 77 15 78 16 79 17 80 18 8.1 19 82 20 83 21 84 22 85 23 86 24 i 87 25 88 26 89 27 16. What h e l p s you d e i i l w i t h - s t r e s s ? 166 17. What makes i t more d i f f i c u l t f o r you to manage s t r e s s ? 18. The f o l l o w i n g i s a l i s t o f a l t e r n a t i v e s which e x p e r t s i n s t r e s s suggest i n f l u e n c e the - response to s t r e s s . P l e a s e i n d i c a t e i n the a p p r o p r i a t e column whether each a l t e r n a t i v e h e l p s you or h i n d e r s you i n your response to s t r e s s . HELPS HINDERS DON'T KNOW a. h a v i n g a say or some c o n t r o l i n the s i t u a t i o n b. h a v i n g a c l o s e f r i e n d i n whom you can c o n f i d e c. h a v i n g a broad range of i n t e r e s t s and f e e l i n g a c c o m p l i s h e d i n some of these d. g e t t i n g enough s l e e p a t n i g h t e. h a v i n g time f o r y o u r s e l f f . b e i n g a b l e to say "no" wi t h o u t f e e l i n g g u i l t y g. e a t i n g a w e l l - b a l a n c e d d i e t h. g e t t i n g r e g u l a r p h y s i c a l e x e r c i s e at l e a s t t h r e e times a week i . h a v i n g c o n f i d e n c e i n y o u r s e l f j . p r e v i o u s l y e x p e r i e n c i n g a s i m i l a r s i t u a t i o n and managing k. b e i n g a b l e to a n t i c i p a t e what i s going to happen next 1. f e e l i n g good about y o u r s e l f 90 28-91 29_ 92 30 93 31_ 94 32_ 95 33_ 96 34_ 97 35_ 98 36_ 99 37_ 100 38_ 101 39 19. How does p r o l o n g e d , accumulated or s e v e r e s t r e s s a f f e c t h e a l t h ? 167 20. What do you t h i n k w i l l happen to your h e a l t h i f you e x p e r i e n c e accumulated, p r o l o n g e d or s e v e r e s t r e s s ? 21. Do you happen to r e c a l l h a v ing e x p e r i e n c e d accumulated, severe o r p r o l o n g e d s t r e s s ? Yes No Don't Know If y e s, what was the e f f e c t on your h e a l t h ? 102 40 22. In your o p i n i o n , which of the f o l l o w i n g f r e q u e n t l y i d e n t i f i e d problems might be r e l a t e d to accumulated o r p r o l o n g e d s t r e s s ? YES . NO DON'T KNOW a. headaches — ; b. stomach u l c e r s c. a c c i d e n t s d. depression;, r e q u i r i n g m e d i c a l c a r e e. asthma f. s p o r t s i n j u r i e s g. mental i l l n e s s ( f r e a k out) h. c o l d s i . h y p e r t e n s i o n ( h i g h b l o o d p r e s s u r e ) j . h e a r t a t t a c k k. a l l e r g i e s 1. a l c o h o l i s m , drug abuse m. l a c k o f c a r i n g about s e l f , p a r e n t s , f a m i l y , o t h e r s 103 41 104 42 105 43 106 44 107 45 108 46 109 47 110 48 111 49 112 50 113 51 114 52 115 53 23. On a s c a l e i n d i c a t i n g the l e v e l of s t r e s s you are f e e l i n g a t the pr e s e n t time, where would you p l a c e y o u r s e l f ? (0) i s no s t r e s s to (9) i s much s t r e s s C i r c l e the a p p r o p r i a t e response f o r you 0 1 2 3 4 5 6 7 8 9 i 16 54 i 168 The f o l l o w i n g are a few q u e s t i o n s about your r e a c t i o n s to the p r e v i o u s q u e s t i o n s . 24. Which q u e s t i o n ( s ) d i d you f i n d d i f f i c u l t Co answer because they were u n c l e a r or hard to understand? P l e a s e i n d i c a t e the q u e s t i o n number(s) 25. Which q u e s t i o n s , i f any, were too p e r s o n a l ? P l e a s e i n d i c a t e the q u e s t i o n number(s) 26. Q u e s t i o n s have d i f f e r e n t e f r e c t s on p e o p l e . P l e a s e i n d i c a t e whether the f o l l o w i n g q u e s t i o n s would make most p e o p l e (1) v e r y uneasy (2) moderately uneasy (3) s l i g h t l y uneasy or (4) not at a l l uneasy Record the a p p r o p r i a t e number i n the b l a n k f o l l o w i n g the l i n e a. q u e s t i o n s c o n c e r n i n g what causes s t r e s s f o r you q u e s t i o n s about how you f e e l , how you f e e l l i k e behaving and how your body responds to s t r e s s . c. q u e s t i o n s about the e f f e c t s t r e s s has on h e a l t h . d. q u e s t i o n s about what you do i n response to s c r e s s . 27. In doing c h i s q u e s t i o n n a i r e , w a s t h e r e a new i d e a or an a s p e c t of s t r e s s management p r e s e n t e d to you which might be h e l p f u l ? Yes No 1.17 118 55-62 63-66 119 67-. 120 68 121 69 122 70 123 71 I f y es, p l e a s e s p e c i f y Now a few q u e s t i o n s which w i l l a i d i n c a t e g o r i z i n g the i n f o r m a t i o n . Remember, at no time w i l l any of t h i s i n f o r m a t i o n be used,to i d e n t i f y you. P l e a s e i n d i c a t e the a p p r o p r i a t e response f o r you. 28. Sex 29. Age Male _ Female 30. Date of B i r t h Day Month Year 31. L a s t Grade completed i n s c h o o l 32. When comparing y o u r s e l f to o t h e r s i n your grade i n terms of academic achievement, would you c o n s i d e r y o u r s e l f at the upper t h i r d of the c l a s s , middle t h i r d , o r lower t h i r d o f the c l a s s ? Upper t h i r d - _ M i d d l e t h i r d Lower t h i r d 33. Have you p a r t i c i p a t e d i n s t r e s s management c l a s s ? Yes No 163 ( c a r d 1) 1 1-3 2 4 1 3 5 6-7 13 6 14-15 7 16 8 17 T h i s c oncludes the q u e s t i o n n a i r e . Your p a r t i c i p a t i o n i n t h i s study i s v e r y much a p p r e c i a t e d . Thankyou f o r g i v i n g your time and thought and s h a r i n g your p e r s p e c t i v e on the ever p r e s e n t , but e l u s i v e s u b j e c t , s t r e s s . THANKS AND GOOD STRESS MANAGEMENT TO YOU! Appendix F: Open-Ended Responses to Causes of S t r e s s Frequency and C a t e g o r i e s 171 Open-Ended Responses to Causes of stress: Frequency and C a t e g o r i e s UlorK £1 6 5 3 1 working, j o b , s t a r t i n g neu j o b , employer emergencies, t e a c h i n g . K i d s , having s i c K Kids def iance p e r f o r m i n g , p e r f o r m i n g in c r o u d , p u b l i c s p e a k i n g uorK o v e r l o a d excess ive demands Peers 9 3 6 5 2 2 1 r e l a t i o n s h i p s , enemies, when people bug me sex, l o v e , g i r l or boy f r i e n d s peer p r e s s u r e , peer group s o c i a l l i f e , a s k i n g someone o u t , dances, meeting neu p e o p l e , l a r g e crouds arguments f r iends not being i n c l u d e d in a c t i v i t i e s u i t h f r i e n d s Schoo1 16 9 4 4 s c h o o l b e f o r e t e s t , t e s t s homeuorK, c o n c e n t r a t i o n , s p e l l i n g , s t u d y i n g f a i l i n g t e s t , bad marks, doing b a d l y in s c h o o l Fami1v 9 1 f a m i l y , f a m i l y arguments, m a r i t a l d i f f i c u l t i e s , c o n f l i c t s u i t h s i s t e r pets Parents 10 p a r e n t s , parent p r e s s u r e A u t h o r i t y F i g u r e s 2 2 uhen I've done something wrong, being in t r o u b l e , g e t t i n g in t r o u b l e from h i g h e r author i t y l y i n g , u n t r u t h r e s t r i c t ions Self -Concept 4 3 1 1 1 appearance, age, h e i g h t uhen people h u m i l i a t e me. not do ing u e l l pushing s e l f to l i m i t c 1 ean1iness shout at me Time Deadl lines 7 a 1 time, d e a d l i n e s f r u s t r a t i o n over time assignments due LPS-S 5 i l l n e s s , i n j u r y 3 death of someone c l o s e £ b e l o n g i n g s , l o s t p e r s o n a l a r t i c l e s Empt ions Change sad moments, d e p r e s s e d , f r i g h t , b e ing p a r a n o i d anger, e x c i t e m e n t , nervousness ignorance of neu emotion 5 something urong, can't f i g u r e something o u t , not Knouing uhat to do £ uhen t h i n g s don't go r i g h t 1 doing something neu 1 r o u t i n e s F inane iai 7 f i n a n c i a l problems, lacK of money, debt Cars ca r t r o u b l e , t r a v e l l i n g , d r i v i n g , t r a f f i c S i t u a t ion £ £ 1 e x c e s s i v e n o i s e a lcoho 1 , drugs b e i n g Kept in darK Compet it ion 3 c o m p e t i t i o n , c o m p e t i t i v e s p o r t s , games Other headaches monthly p e r i o d s f a t igue Appendix G* Open-Ended Responses to Symptoms of S t r e s s Frequency and C a t e g o r i e s 174 Open-Ended Responses to Symptoms o-f S t r e s s ! Frequency and C a t e g o r i e s Phvs iolpqical 18 n e rvous, j i t t e r y , t e n s e , jumpy e a s i l y , edgy u p t i g h t , t i g h t e n e d muscles 7 headaches 6 f e e l i l l , s i c k , s h i t t y 5 t i r e d , s1eepy 5 sueaty , p e r s p i r a t i o n 4 Knots in stomach, u l c e r a c t s up, stomachache b u t t e r f 1 i e s in stomach 3 e x h i 1 e r a t i o n , a d r e n a l i n s t a r t s pumping through body 2 b l u s h 1 h i g h e r p u l s e r a t e 1 f e e l hot 1 t i g h t f e e l i n g in my chest and my b r a i n i s l o o k i n g f o r a uay out of the s i t u a t i o n subconsc i o u s l y Behav i o r a l 15 argue, get mad f o r no r e a s o n , i r r i t a t e d , bad mood ready to e x p l o d e , angry, s h o r t tempered 4 l o s e a p p e t i t e , eat l e s s because of l e s s time 2 make m i s t a k e s , make i r r a t i o n a l move or mistake 2 f e e l l i k e c r y i n g , screaming 1 r e q u i r e l e s s s l e e p 1 f i d g e t i n g 1 in t r o u b l e at s c h o o l 1 smokemore 1 u n t r u t h f u l Affect ive 7 p r e s s u r e , l o t s of p r e s s u r e , u o r r i e d change in e a t i n g h a b i t s 4 f e e l i n g depressed 4 u p s e t , uncomfortable 2 f e e l alone 2 t r o u b l e s o r t i n g out a l l t h a t i s on mind, can't t h i n k c l e a r l y 1 f e e l t h i n g s come doun on you 1 f e e l u n c e r t a i n about myself 1 e v e r y t h i n g t h a t can go wrong, u i l l Appendix Hs Open-Ended Responses to Responses to S t r e s s Frequency and C a t e g o r i e s 176 Open-Ended Answers to Responses "to S t r e s s : Frequency and C a t e g o r i e s Relaxation Techniques 15 t r y to mellow o u t , r e l a x , r e s t 8 s l e e p 6 smoKe, smoKing m i l d drugs 5 s i t doun 3 d r i n k i n g , a c i d e r 2 do something to r e l a x and get my mind o f f my problems, do what I f e e l l i k e doing 2 l i e down, go to bed 2 take a few deep b r e a t h s , breathe in one n o s t r i l , out the o t h e r 2 meditate 1 go on v a c a t i o n 1 p a r t y Social Support 31 t a l k to c l o s e f r i e n d , c a l l my f r i e n d , g i r l f r i e n d 1 t a l k i n g about i t u i t h p a r e n t s 1 good company u i t h o t h e r people 1 my c a t 1 f a m i l y support Music and D i v e r s i o n a r y A c t i v i t i e s 10 1 i s t e n to mus i c , mus i c 3 p l a y i n s t r u m e n t , p l a y g u i t a r 3 o t h e r n o i s e s to take my mind o f f 2 uatch T.V. 2 read 2 doing something, doing a hobby 1 be c r e a t ive P h y s i c a l A c t i v i t y 5 go i n t o r e a l l y bad and a g g r e s s i v e mood, get mad, h i t my p i l l o w , r i p t h i n g s up, get v i o l e n t , get madder than s t i n k 3 c r y 2 go b ike r i d i n g 2 p l a y hockey 1 go f o r a ualk 1 j o g g i n g 1 stop e a t i n g Cognitive Thinking 11 t h i n k a l o n e , be a l o n e , s i t alone 2 t h i n k , t h i n k c l e a r l y and r a t i o n a l l y 1 worry 177 Escape 9 being alone 3 g e t t i n g r i d of i t , g e t t i n g auay 1 go out and get drunk 1 stop t h i n g about i t Problem S o l v i n g 7 r e s o l v e problem, d e c i d e hou to h a n d l e , a n a l y z e and p l a n , t h i n k i f I r e a l l y have a problem 2 b e l i e v e t h a t I am r e s p o n s i b l e f o r my problems and a b l e to s o l v e " t h e m Symptoms 1 sweat 1 f e e l d i s o r i e n t e d 1 f e e l t i c k e d o f f Other 1 p e r s o n a l problem Appendix Is Open-Ended Responses to Outcomes to S t r e s s Frequency and Categor ies 179 Open-Ended Responses to Outcomes o-f S t r e s s i Frequency and C a t e g o r i e s Phvs ical 14 s i c K , h e a l t h goes d o w n h i l l , d e c r e a s e , d e t e r i o r a t e 7 f a t i g u e , get very t i r e d , l e t h a r g i c 5 u l c e r s 3 not a b l e to s l e e p 3 l o s s of a p p e t i t e , weight l o s s 2 stomach aches 2 headaches 2 hypertens ion 2 h e a r t problems 1 o v e r e a t 1 one can f o r c e y o u r s e l f to be i l l 1 sweat ing 1 makes me throw up 1 c o l d 1 h u r t Mental 2 u p s e t , s t a y s Knotted up i n s i d e and then one day breaks down, s o r t of burns you out 2 depressed 2 edgy, too nervous 1 s e l f - c o n s c i o u s 2 t i r e s m e n t a l l y , body g i v e s out on mind 1 mental problems Don ' t Know 2 don 't know 2 noth ing 1 become s t r o n g and muscular Soc iai 1 don't l i k e a n y t h i n g or anyone 

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