Several large-scale studies have shown that children and adolescents with elevated cholesterol levels tend to maintain these elevations into adulthood (Lauer, Lee, & Clarke, 1988; Webber, Srinivasan, Wattigney, & Berenson, 1991). Elevated serum cholesterol has been identified as a primary risk factor associated with the development of coronary heart disease (CHD) through the process of atherosclerosis (Castelli et al., 1986). Further, data have indicated that atherosclerosis begins before the age of 20. These findings have fueled interest in early assessment and intervention for CHD.
Treatments for adolescents with elevated cholesterol levels have focused on dietary and pharmacological interventions (National Cholesterol Education Program, 1991). However, some researchers have expressed concern over these approaches (Schoen, 1992), arguing that dietary interventions among adults typically have resulted in cholesterol reductions of only 5-10% (see Newman, Browner, & Hulley, 1990), and that placing children on restrictive diets not only may be difficult to implement and maintain (Read, Harveywebster, & Usinger-Lesquereux, 1988), but also may hinder growth and lead to negative labeling by peers (Newman et al., 1990; Lifshitz & Moses, 1989).
These concerns have led health investigators to expand the search for factors associated with adolescent cholesterol levels. Such factors have included physical activity, television-viewing habits, and smoking (Durant, Linder, Harkess, & Gray, 1983; Wong et al., 1992; Dwyer, Rieger-Ndakorerwa, Semmer, Fuchs, & Lippert, 1988). Despite a substantial literature base among adults suggesting a relationship between psychological stress and total cholesterol, the role of stress on adolescent cholesterol levels is often overlooked (see Dimsdale & Herd, 1982, for review; Tucker, cole, & Friedman, 1987; Troxler & Schwertner, 1985). Although the exact mechanisms responsible for the relationship are still a matter of debate, it has been suggested that stress precipitates an arousal response that leads to increases in circulating catecholamines, which may raise plasma lipid levels (Van Doornen & Orlebeke, 1982; Dimsdale & Herd, 1982).
One reason the link between adolescent stress and cholesterol has yet to be thoroughly examined is that the development of methods for measuring stress among adolescents has lagged behind that of adults (Johnson, 1986). Further, it appears that work-related stressors are more clearly associated with cholesterol elevations (Friedman, Roseman, & Carroll, 1958; McCann, Warnick, & Knopp, 1990), and corollary sources of stress among adolescents have only recently been recognized (Johnson, 1986; Compas, 1987).
The adolescent years are associated with numerous biological, psychological, and social changes. The family, school, peers, and other interpersonal domains can all be sources of stress (Compas, 1987). Stressful events encountered by adolescents have been shown to be related to psychological as well as physical problems (Johnson, 1986). It has been suggested that frequent minor stressors, such as daily hassles, may be better predictors of mental and physical difficulties than are major but more infrequent life events, such as the death of a loved one (Kanner, Coyne, Schafer, & Lazarus, 1981; DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982; Compas, 1987).
Among adults, stress and other potentially modifiable variables, such as diet, smoking, and activity level, appear to be important contributors to elevated cholesterol levels (Jenkins, 1988). The present study was designed to examine whether such factors present a risk for adolescents. Specifically, the relationship of stress, dietary fat, activity level, sedentary behavior, and smoking to total serum cholesterol levels among healthy adolescents was investigated.
The initial sample …