Continuing

Nursing
Education
Series

Adolescent Stress through

The Eyes of High-Risk
Teens
Denise E. LaRue

Judith W. Herrman

Adults often under-estimate the levels of stress in adolescents; however, stressors experienced by teens are
valid and have been described in both lay and professional literature. This article presents a thorough literature review as well as study results that explore teen perceptions about the stressors they face.

am stressed out is a phrase

that has been echoed by
teens down through the
ages. The level of stress
experienced by teens on a daily basis
has been described in lay and professional literature. Adults often underestimate this level of stress and may
not always be cognizant of the potential consequences of stress on teens
and young adults. This lack of appreciation of the stress experienced by
adolescents may be partially related
to a lack of awareness of the sources
of stress in teen life, the changing
nature of stressors through time, the
ever-evolving complexities of adolescent life, and the tendency for adults
to minimize their own personal stress
during the teen years or compare their
teen years to the experiences of others. Physiological development, cognitive differences, pubertal changes,
immature coping mechanisms, slower
recovery from stressful events, and
lack of experience in dealing with
stress may intensify the stressful
events experienced by adolescents
(Herrman, 2005).
The purpose of this study was to
determine teen perceptions about the

Denise E. LaRue, RN, is a Graduate of the

University of Delaware, School of Nursing,
Newark, DE.
Judith W. Herrman, PhD, RN, is the
Assistant Director and an Assistant
Professor, University of Delaware, Newark,
DE.

Objectives, the CNE

posttest, and disclosure
statements can be found
on pages 395-396.

stressors they face, offering an adolescent perspective to the literature related to teen stress. According to Lau
(2002), teens can experience a spectrum of stresses ranging from ordinary
to severe (p. 238). Stress has been
associated with a variety of high-risk
behaviors, including smoking, suicide,
depression, drug abuse, behavioral
problems, and participating in highrisk sexual behaviors (Finkelstein,
Kubzansky, Capitman, & Goodman,
2007; Finkelstein, Kubansky, &
Goodman, 2006; Goodman, McEwan,
Dolan, Schafer-Kalkhoff, & Adler,
2005). In addition, long-term exposure to stress is associated with a variety of chronic psychological and
physical illnesses (Goodman et al.,
2005). High-risk teens, or those who
live in social disadvantage, may be at
increased risk for illness related to
chronic exposure to stress, discrimination, stigma, and a harsh social
environment (Goodman et al., 2005,
p. 485). Chandra and Batada (2006)
purported that assessing adolescent
stressors and the impact of stress is
the first step in the prevention and
treatment of its associated chronic
diseases (p. 2). Understanding teen
stressors may assist pediatric nurses
working with adolescents by helping
teens develop resilience to stress,
thereby increasing teens levels of
health (Tussaie, Puskar, & Sereika,
2007).

Review of the Literature

The word stress has emerged as a
part of current daily vocabulary and is
not always well defined as a concept
or uniformly understood. Several
authorities have defined stress as it
relates specifically to teens. According
to Goodman et al. (2005), stress
refers to a stimulus generating psychosocial and physiologic demands,
and requiring action on the part of the

PEDIATRIC NURSING/September-October 2008/Vol. 34/No. 5

individual. Finkelstein et al. (2007)

differentiate stress in the adolescent
period as having both environmental
(objective assessments of conditions)
and psychological (subjective evaluations) perspectives of stressful events.
The psychosocial perspective views
stress from the experience of the individual and dictates that stress is
assessed from a variety of dimensions, including the personal meaning
of the stressor, the magnitude of the
stressor, the demands placed by the
stressor, and the coping mechanisms
available to react to the stimulus
(Finkelstein et al., 2007). The current
study is informed by this psychological, or personal subjective assessment, of the stress experience and
how stress is interpreted on the individual level.
Chandra and Batada (2006) asked
teens to use their own words to define
stress. One of the teens described his
stress as a great deal of pain thats
inside your body that you cant get
outand makes you feel bad
(Chandra & Batada, 2006, p. 4).
Another stated stress was characterized by worrying, keeping secrets,
gray hair, problems, anger, being
tense (Chandra & Batada, 2006, p.
4). These definitions of stress led to an
exploration of adolescent perceptions
on the origins of stress. The research
related to stress has identified several
key sources of stressors having an
impact on teens, including school,
family and home life, social disadvantage. and other stressors.
School stressors. Pressures in the
school setting were frequently cited as
stressful by adolescents. Using a pilesort activity, participants in a study by
Chandra and Batada (2006) identified
school work as the most frequent and
important source of stress in their
lives (p. 5). The 9th graders stated
that the sudden increase in homework
375

was a main stressor for them, along

with worrying about exams and
grades (Chandra & Batada, 2006, p.
5). Green, Holohan, and Feldheim
(2003) identified that for even the
most confident teen, schoolwork is
often the first area to fall apart under
duress (p. 4). Homework, tests,
needing to keep up with daily material, the presence of a learning disability, a conflict with a teacher, problems
with other students, or simply a dislike
of the school experience represented
common areas of stress for the school
setting (Green et al., 2003).
According to Lau (2002), there
were three main clusters of stress
associated with school that included
fear of success or failure, test or performance anxiety, and fears associated with the school setting (p. 241). In
addition, teens with a low self-esteem
were reported to seek acknowledgment and acceptance by teachers and
peers, which was also extremely
stressful (Lau, 2002, p. 241). Often,
a perceived lack of respect from
teachers as well as general conflicts
with teachers stressed teens within the
school setting and inhibited their academic performance and school functioning (Chandra & Batada, 2006, p.
5). Poor student-teacher relationships
were noted to have a profound impact
on learning, success in school, and
overall stress levels (Chandra &
Batada, 2006). Finally, teens tendency to look toward the future after the
school experience proved stressful as
well (National Campaign to Prevent
Teen Pregnancy, 1999). In focus
groups, participants disclosed finding
school and education as primary concerns in life, and students pointed out
that they were determined to get an
education to get somewhere in life
(National Campaign to Prevent Teen
Pregnancy, 1999, p. 6).
Family and home life stressors.
Rather than serving as a source of support, families and the home environment were often cited as major stressors in teens lives (Tarrant & Woon,
1995). One study cited four of the nine
major domains adolescents compiled
as life stressors, including the teens
home, parents, siblings, and extended
family members (Moos, 2002). The
teens involved in Chandra and
Batadas (2006) study noted that family conflicts usually involved doing their
homework, cleaning their room, and
doing chores (p. 4). In addition, teens
described family stress as including
worrying about the well being of family members, being nagged, and
conflict over family responsibilities with
siblings (Chandra & Batada, 2006, p.
376

4). Many boys discussed the stress of

being the only male in the household,
and therefore, feeling the need to
defend the home or to protect the
family (Chandra & Batada, 2006, pp.
4-5).
Teens noted that not getting along
with a sibling or parents were indicators
of family stress. Teens also cited that
hearing or seeing their parents fight
with each other and worrying about the
general outcome of these altercations
was a frequent stressor (Lau, 2002).
Customary methods families and parents use to deal with current stressors
and conflict, including arguing, yelling,
or physical fighting, may affect the
level of stress perceived by the teen
(Tarrant & Woon, 1995). According to
Lau (2002), the sibling stress that teens
mention often started with the birth of a
younger sibling and then continued
through the years with a sibling rivalry.
Problems, such as divorce or the
death of a family member, are more
serious than others (Green et al.,
2003, p. 3). Divorce may have other
effects on the family as well, such as
lowering the income or changing the
living arrangements, which in turn
could have negative effects on the
childs health, well-being, and school
achievement (Lau, 2002, p. 239).
Social disadvantage stressors.
Social disadvantage, whether real or
perceived, may be related to race,
community, ethnicity, or socioeconomic status. Potential stressors associated
with social disadvantage in the innercity environment may include violence,
drug use, or poor housing, all of which
can contribute negatively to the development of the adolescents living in
these areas (Miller, Webster, &
MacIntosh, 2002). The Urban Hassles
Scale was created to rate how frequently participants confronted each stressor. The most frequently cited stressors
were found to be being pressured to
join a gang and offered sex by drug
addicts for money (Miller et al., 2002,
p. 383).
Neighborhood stress was commonly reported as a source of stress. Urban
African-American adolescents cited
drug dealing and litter on the streets
as two of the top neighborhood stresses, which was also accompanied by
many girls voicing concerns about
men (Chandra & Batada, 2006, p. 6).
These teens expressed fear of living in
their neighborhoods and worrying
about going out on the streets. Drug
dealers, older boys hassling girls, and
gang violence were identified as causes
of stress (Chandra & Batada, 2006).
Lau (2002) noted that poor children
are being exposed to increasing levels

of violence in their homes, their

schools, and on the streets as well as
the fact that poverty is also associated
with serious mental disorders (p. 240).
An adolescent living in social disadvantage may encounter multiple and interrelated stressors creating a complex
environment for adolescent growth and
development.
Other stressors. Other stressors
have been identified as posing threats
to teens. For most adolescents, being
hospitalized would increase stress levels. Sources of anxiety may include the
threat of physical harm, separation
from parents, and fear of the unknown
and uncertainty about acceptable
behaviors (Lau, 2002, p. 243). Puskar
and Rohay (1999) found that geographic relocation may compromise or
retard the adolescent developmentally.
With a limited repertoire of coping skills
and an unfamiliar peer group, teens
may find the transition associated with
relocation particularly stressful (p.
16). Ethier et al. (2006) discovered
that stress manifested by depressive
symptoms, anxiety, or hostility was
associated with pregnancy, to have
had unprotected vaginal sex, to have
nonmonogamous sex partners, and to
not use any form of contraception and
further added to the stress (p. 269).
Other adolescent stressors included
obtaining or holding a job, money,
body image, relationships, and abuse
(Puskar & Rohay, 1999). Adolescents
have also identified major stressors
associated with war, natural disasters,
or community disasters. Tarrant and
Woon (1995) commented that the
escalating threat and damage to the
environment and constant world conflict which is graphically brought into
the home on a daily basis, questions
ones safety and security (p. 26).
A newer phenomenon associated
with teen stress has been the act of
cutting (Derouin & Bravender, 2004,
p. 13). The authors noted that adolescents who have low impulse control
and a high desire to be popular may be
unable to manage this mass influx of
information in a healthy way, and may
direct the violence expressed in the
news and media against themselves
(Derouin & Bravender, 2004, p. 15).
These acts of self-mutilation may be
used by teens as a coping mechanism
for managing their stress. To those who
participate in self-mutilating acts, the
episodes are depersonalizing events
occurring during periods of extreme
stress or marked anxiety (Derouin &
Bravender, 2004, p. 13). These events
may actually serve to escalate levels of
anxiety and provide an additional
source of stress for teens.

PEDIATRIC NURSING/September-October 2008/Vol. 34/No. 5

Adolescent Stress through The Eyes of High-Risk Teens

These studies demonstrate the wide
variety of the sources of stress impacting adolescents. Though Chandra and
Batadas (2006) study included teens
own words, most of the research was
quantitative in nature, using established measures of stress and adult perspectives in the analysis of results. The
current study provides a new perspective by using teens own words to
describe their levels of stress and those
stimuli that are associated with the
greatest levels of adolescent stress.

Materials and Methods

This qualitative study stemmed
from a focus group descriptive study
exploring teens perspectives of sex,
pregnancy, and teen births (Herrman,
2008). Rich and Ginsburg (1999)
addressed the benefits of gathering a
focus group for information, explaining
that it is a natural setting where questions are asked of groups that create
the give-and-take atmosphere in which
opinions naturally form (p. 373).
The qualitative format used in this
study was effective in allowing teens to
open up about their lives and eliciting
teens responses related to stress. The
facilitator asked questions, and the
teens would discuss their personal
responses, interact with other teens,
and share insights related to the perspectives of others in the group.
Quantitative methods are helpful in
identifying the sources and impact of
youth stress, but qualitative tools
would add a unique perspective on how
young people themselves discuss and
prioritize issues (Chandra & Batada,
2006, p. 2). Qualitative methods provided a mechanism to determine teens
stressors and examine causal factors
from the adolescents own perspective,
allowing adults an informed glimpse
into some of the realities of teen life.
Approval for this study was
received from the Institutional Review
Board (IRB) at the local academic institution. Due to the sensitive nature of the
material and the vulnerability of youth,
careful attention was paid to the
recruitment of the teens and to the consent/assent processes. High-risk youth
in the state of study were the population for this study, selected to inform
nursing and policy interventions and
glean new information about teen perceptions of the stress experienced by
this cohort. Focus group participants
were solicited from school-based wellness centers, health services, churches,
teen support groups, and non-profit adolescent programs. These sites served
teens considered at risk for negative
behaviors, whether by self-report,
demographics, or referral due to previ-

Figure 1.
Life Stressors of Teens
Miscellaneous
Graduation
College
Friends
Violence/fighting
Time (lack of)
STDs/AIDS
Becoming pregnant
Sex
Job
Being a mother
Parents
Relationships
Money
School/Grades
5

10

15

20

25

30

35

40

OccurRence

ous high-risk behaviors. Agency personnel were responsible for identifying

and recruiting study participants, distributing packets, and collecting completed assent and consent forms.
Employees and volunteers from the
advocacy groups were asked to identify youth who may take part in the focus
groups based on their participation in a
variety of teen support efforts, including programs focused on preventing
teen pregnancy, assisting teens to deal
with social disadvantage, and delaying
high-risk behaviors. The final purposive, non-random sample included 120
youths from throughout the state,
including 72 females and 48 males
ranging in age from 12 to 19 years. The
mean age of the participants was 16.1
years, with 68% of the youths identifying themselves as African American,
19% as Caucasian, 11% as Hispanic,
and 2% as another ethnic origin.
Seventeen focus groups were conducted over a span of six weeks. Each
group had 3 to 15 participants, and the
interviews averaged 40 minutes in
length. One focus group included pregnant girls, 1 included teen fathers, 3
had teen mothers, and 12 were composed of non-parenting teens. The
non-parenting groups included 4
female groups, 2 male groups, and 6
with boys and girls. The focus groups
were conducted in private conference
rooms and were recorded using a
handheld digital recorder, saved to a
CD-ROM, and transcribed verbatim.
The interviews included ice-breaker
questions, including Tell me about
your life as a teen right now, and
What are some of your concerns as a
teen? These prompts led to various
probing questions about stress and

PEDIATRIC NURSING/September-October 2008/Vol. 34/No. 5

angst in their daily lives, and resulted in

the group discussing the sources of
stress.
The Principal Investigator conducted all interviews, and made marginal
and observational notes during and following each interview. Summaries at
the end of each interview provided a
mechanism for member checking or
reviewing and validating data with each
group participant (Rich & Ginsburg,
1999). Saturation of the data was
achieved in the final interviews, when
no new information was solicited. Each
transcription was checked against the
audio-recording for accuracy. The data
were coded and analyzed using the
Ethnograph v 5.08. The teens most
common stressors were then ranked
from the most commonly found to the
least commonly found. Marginal notes,
transcripts, and audiotapes were used
to determine the intensity of responses
related to stressors in addition to the
frequency of responses.

Results
In qualitative research, the results
are often best understood through the
words of the participants, in this case,
the teenagers themselves. The stressful aspects of the teens lives emerged
as themes from the data. Each of the
stressors was ranked from most common to least common using Microsoft
Excel. The frequency of the most
commonly noted stressors is found in
Figure 1. The most frequently noted
stressor was school, followed by
money, relationships, and parents.
The following is a discussion of these
stressors with exemplary quotes.
School. The greatest stressor discovered in this study was school and
377

its related components. Maintaining

good grades, passing their classes,
making it to graduation, and being
accepted into college were all worries
that the students cited as stressors.
One student admitted to stressing
over like whether Im gonna pass or
not, or your grades. For some, this
stress existed because they found
school challenging on a normal basis,
while for others it was because they
took on increased challenges. For
example, one student mentioned that
things in school were more difficult
because of the fact that he took a lot
of harder classes this year, so its
hard.
Seniors taking part in this study
had an additional group of stressors
than the rest of the participants. They
cited the increased pressure of keeping up with school and graduating,
stating that it adds a lot of pressure
your senior year cause you wanna
graduate with your classyou dont
wanna be left behind. At this point in
time, the seniors also have to think
about getting scholarships, looking
for colleges, [and] start writing your
resumes and stuff. Another student
said it best when stating that senior
year was the time to act right if you
have not in the previous three years.
Pulling themselves together and
staying on track in order to graduate
were very important to many of the
students. In the interviews, students
also brought up the fact that depending on ones job, its hard to make
money, even with a bachelors degree
today, so with just a high school
diploma, you aint making nothing.
The discussion of school and later
work success led into a discussion of
money.
Money. The teens financial status
was an issue in their lives. Depending
on whether they had a baby to support, were planning to put themselves
through college in the upcoming
years, or just wanted extra spending
money, obtaining money to meet their
needs was perceived as difficult.
Adolescents verbalized the fear of debt
if they did not learn sound budgeting
skills. Some teens were able to work
and manage school, but were still finding themselves low on cash due to the
many demands for money in their
lives. For example, respondents noted
every paycheck that is coming in
right now, I am saving it, and it already
has an owner and Its going right
back out. Some of the teens shared
that they were in search of money to
pay for common high school memorabilia, activities, and other necessities. For instance, a class ring, school
378

pictures, class dues, SATs, prom tickets, tuxedo rental, and a prom dress
were all listed as adding to their stress.
With these expenses in mind, the
overall biggest complaint heard
repeatedly was how to get it. This
was especially true of young parents
who suddenly found themselves needing to pay for daycare and to purchase
diapers, wipes, formula, and other
miscellaneous items that were necessary for raising a baby. For example,
one young mother stated, Today I
just found out that my daycare bill is
$120.93, and Im like, how am I gonna
pay that? As is evidenced by the adolescents statements, money caused a
large amount of stress in their lives,
which is then compounded even further for some by parenting.
Relationships. Participants discussed the troubles they were having
both with their friends and significant
others. Many females seemed to have
problems with young men either
cheating on them or lying to them.
For instance one girl noted that they
say that youre the only one they
messing with and then theyre lying,
[you] find out they mess with somebody else. Another comment indicated that guys will tell you one thing,
then its another thing. Many of the
girls demonstrated signs of stress
when merely speaking about these
relationships and the young mens
behavior. Two young women mentioned trouble from guys trying to
pressure you and who just dont
know when to stop. Conversely,
young men stated that relationships
were stressful when asked about their
life stressors. More specifically, girlfriends get on my nerves said one
boy. The overall feeling among the
males regarding relationships was
best stated by one young man, who
said that girls were nothing but in the
way sometimes. Topping off the discussion on relationships was one male
who stated, Girls aint worth my trouble or my time.
Parents. Several participants referred to parents as sources of stress.
One teen discussed her father, stating,
He dont realize how much pressure
he puts on me. A second girl
expressed stress about her mom, stating, Im scared of my mom. Another
teen commented that her parents
make me sick sometimes. One participant explained that her parents
daily after-school request of her to
fold up the clothes, and clean the
bathroom, and make sure that everythings cleaned before they get home
at like 4:00 or 5:00, and if its not
doneoh my, youre in trouble posed

significant stress in her life. Demands

like these were interpreted as difficult
by several teens given that they got up
early in the morning, went to school
all day, and then came home and were
asked to do chores. This was a prime
example of how various stressors tie
into one another in which schoolwork,
cleaning the house, and fatigue all
created a difficult situation.

Discussion
The teens involved in the focus
groups ranked school as their number
one stressor in life. This held true for
all grade levels and both genders,
demonstrating that school, along with
its associated workload and worries,
caused stress for these teens. These
results coincided with the literature as
school being teens main stressor
(Chandra & Batada, 2006; Miller et
al., 2002; National Campaign to
Prevent Teen Pregnancy, 1999). In
addition, several of the other stressors,
including money, relationships, and
parents, were in concert with those
identified in the literature (Chandra &
Batada, 2006; Green et al. 2003; Lau
et al, 2002, Miller et al., 2002). Being
a mother also ranked highly as a
stressor, validating the stressors anticipated associated with being a young
mother (Herrman, 2008).
The participants often used the
term pressure to describe their
stress. This referred to pressure
from parents to complete chores or
get good grades, from teachers to
hand in assignments, from friends to
always be available on request, or
from significant others. Ethier et al.
(2006) noted that the word pressure
was used by teens when describing
the duress placed on teens to participate in sexual activity or to describe
the need to compare ones personal
behavior to peers. Pressure was a
word that was consistently cited in
other resources; this theme pervaded
the adolescents expressions of stress
both in this study and in the literature
(Chandra & Batada, 2006; Miller et
al., 2002).
Another noticeable trend among
the answers given by the teens were
references to the emotions inherent in
their daily lives. For example the teens
often spoke of being worried about
exams or grades, graduation, college,
getting pregnant, or simply the future.
Some voiced concerns of doubt, while
others talked about being upset or
mad. For instance, to sum up the
stressors experienced in the relationship with her parents, one girl stated,
Oh my gosh, that makes me so
mad! Comments the teens gave

PEDIATRIC NURSING/September-October 2008/Vol. 34/No. 5

Adolescent Stress through The Eyes of High-Risk Teens

expressing their emotions of fear or
disdain when discussing their families
included, Im scared of my mom,
To me, family is foul, and They
make me sick sometimes. As was
seen here, the focus group format
allowed the teens to be open and say
what they truly felt without needing to
hold back. This was also evident in the
teens enthusiasm, with many of the
students jumping in with answers to
questions before the entire question
had even been asked. The comments
they then made were often times very
emphatic in nature. For example,
when one girl quickly exclaimed that
boys! were a stressor, the next couple responded with Yes! Oh my
[gosh]! and Yeah, that is stressful.
Responses like these were seen frequently throughout the interviews.
Despite the fact that the data on
stress found here were taken from a
teen pregnancy prevention study, it
provided insight into the lives of teens
and the daily stressors they face. The
teens stressors built upon each other,
causing greater cumulative stress in
their lives. Teenagers expressed feeling overwhelmed by their studies and
schoolwork. They were distracted by
troubles with their friends and significant others while attending school.
Upon being dismissed from school,
they returned home to complete all of
the required tasks assigned by their
parents, while putting off studying and
homework. Some teens also had to
juggle a job in order to manage the
costs of a new baby or simply the
costs of living.

Limitations
The sample of this study represents teens considered to be at risk for
both negative youth behaviors and
pregnancy, and all participants were
from a single state, limiting its generalizability. The timing of the study was
during the last month of the school
year in finals week with graduation on
the horizon, which may have contributed to the emphasis on school as
the highest priority stressor. Although
it is not known whether school was
truly paramount or if the time of
intense emphasis on studying influenced schools high ranking, much of
the research in the literature cited
school as a major source of stress in
adolescents lives (Chandra & Batada,
2006; Green et al., 2003, Lau, 2002;
Miller et al., 2002). The qualitative
nature of this study limits the ability to
generalize findings to a different population but does offer insights to the
unique perspectives of teens identified
as high risk.

Clinical Implications
Appreciating what teens reported
regarding the stress in their lives leads
to numerous measures that can be
taken to aid them in dealing with those
stressors. First and foremost, adults
need to be aware of the stresses that
confront teens. This study provided
important data related to the teens

effectiveness of youth-based initiatives. Stress management programs

to enhance coping, increase resiliency
resources, increase optimism, and fortify community supports may be
effective in assisting teens to deal with
stress (Tussaie et al., 2007).
Simply convening youth to specifically deal with stress or facilitating the

urses, as well as other adults, may make a

difference by encouraging all teens, no
matter their level of stress, to seek out and talk
to their parents or another adult role model
with whom they are comfortable.

own perception of the stress experience and the sources of stress they
encounter. Many adults feel that since
the teens have not yet entered adulthood, their lives are stress-free. The
realization that teens experience stress
and the origins of those stressors may
assist adults to empathize with teens
and enhance communication between
adults and teens. For many teens,
adults contribute to the high-stress
levels experienced. Disseminating
information about common stresses
and their causes to teens, youth advocates, and families with adolescents is
of prime importance. Because stressors are believed to lead to chronic illness and due to the potential for adolescents to live long lives, adults need
to be attentive to teen levels of stress
and means to assist adolescent coping (Goodman et al., 2005).
The key sources of stress offer
insight into the world of teens and the
means to intervene with teens about
the stress experience. It is important to
recognize the role of school in a teens
life, as several other sources also identify school as a major stressor in their
lives (Chandra & Batada, 2006; Green
et al., 2003, Lau, 2002; Miller et al.,
2002). Intervention is necessary to
address these stressors, and adults
should assist teens to cope with school
and its associated stressors.
It may be extremely beneficial for
teens to have access to stress management programs. Developing such
programs in their schools, recreation
centers, and/or churches, or with the
help of pediatric nurses in hospitals,
would be a valuable resource to aid
them in learning to manage their
stress. Constructing a stress management program based on teen perceptions of stress may lend validity to the
program content and enhance the

PEDIATRIC NURSING/September-October 2008/Vol. 34/No. 5

discussion of stress in already established group meetings may provide

the opportunity for teens to ventilate
concerns, receive peer and adult
leader support, and pursue healthy
coping mechanisms to manage the
stress inherent of teen life. Support
groups designed to assist teens to deal
with a variety of issues, including loss,
substance abuse, chronic illness, or
violent behaviors, may benefit from
discussions framed within the context
of the universal nature of stress, the
recognition of the teen years as stressful, and the need to learn ways to cope
with stress on a progressive and
developmental basis (Tussaie et al.,
2007). Methods to enhance stress
resilience, including assisting teens to
use cognitive reframing to interpret
stressful stimuli, informing parents of
their need to provide support to teens
during stressful times, and the provision of psychological counseling as
needed, should be employed to
reduce the stress experience (Tussaie
et al., 2007).
Researchers have explored the
relationship of optimism with increased
abilities to deal with the stressors confronted in daily life (Finkelstein et al.,
2007; Tussaie et al., 2007). Assisting
teens to identify positive aspects of
their lives, providing role models who
have surmounted similar challenges
of social disadvantage, and offering
opportunities for success and happiness may help teens develop the
resilience to handle life stressors
(Finkelstein et al., 2007).
Nurses, as well as other adults,
may make a difference by encouraging all teens, no matter their level of
stress, to seek out and talk to their
parents or another adult role model
with whom they are comfortable.
Having a role model to talk to and
379

confide in during the teen years has

positive benefits (Tussaie et al.,
2007). Pediatric nurses may have an
impact on a young persons life
through counseling teens and their
families on the value of a mentor.
They can also help adults build relationships with teens based on adolescents needs, developmental norms,
and associated stressors. Teens may
find that when working with a nurse,
as someone they can trust, they can
become better able to deal with the
stress in their lives. In their roles as
youth advocates and parent/teen educators, pediatric nurses may communicate common stressors to parents
as a means to enhance communication and parents capacities to serve
as youth role models (Herrman,
2005).
Teens also need to be told the
importance of being assertive with
boyfriends or girlfriends when they
start feeling pressured to engage in
any activity, including sexual behavior,
for which they may not be ready.
Discussions related to gender identity,
difficulties with relationships, personal
attitudes and activities, and high-risk
behaviors may be initiated from the
disclosure of these research findings
of the common stressors of adolescents. Stressors associated with sexual activity and decision making may
provide the springboard for further
discussion of responsible sexual
behavior, the role of relationships in
sexual activity, abstinence, comprehensive sexuality education, and teen
pregnancy/sexually transmitted dis-

ease prevention (Herrman, 2008).

Further studies should be done to
compare a larger and more diverse
sample of high-risk and low-risk teens
to explore their array of stressors.
Youth stressors should be examined
for their role in high-risk behaviors,
such as substance abuse, violence,
sexual behavior, and defiance of rules
and laws (Finkelstein et al., 2006).
They should also be investigated for
their relationship to adolescent mental
health issues, including suicide,
depression, self-mutilation, and anxiety. The impact of stress on sleep,
nutrition, dealing with peer pressure,
school performance, and quality of life
should be topics of research. Future
research to discover effective coping
mechanisms used by teens and the
means to enhance coping in teens
with varying levels of stress and concurrent manifestations of stress on
their lives should be priorities for pediatric nurses. Above all, nurses, adult
role models, and parents should consider the stress levels experienced by
teens, develop ways to reduce those
stress levels, continue to explore the
impact of stress on todays youth, and
design interventions to assist teens to
cope with a complex world.

References
Chandra, A., & Batada, A. (2006). Exploring
stress and coping among urban AfricanAmerican adolescents: The shifting the
lens study. Preventing Chronic Disease:
Public Health Research, Practice, and
Policy, 3(2), 1-10.

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rural adolescents.

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5 environmental
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34/No.and
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2008/Vol.
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Septembe
individuals among adolescent
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keep current 1
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Derouin, A., & Bravender, T. (2004). Living on

the edge: The current phenomenon of
self-mutilation in adolescents. MCN The
American Journal of Maternal Child
Nursing, 29(1), 12-20.
Ethier, K.A., Kershaw, T.S., Lewis, J.B., Milan,
S., Niccolai, L.M., & Ickovics, J.R. (2006).
Self-esteem, emotional distress, and
sexual behavior among adolescent
females: Inter-relationships and temporal
effects. Journal of Adolescent Health, 38,
268-274.
Finkelstein, D.M., Kubzansky, L.D., Capitman,
J., & Goodman, E. (2007). Socioeconomic differences in adolescent stress:
The role of psychological resources.
Journal of Adolescent Health, 40(2),
127-134.
Finkelstein, D.M., Kubzansky, L.D., &
Goodman, E. (2006). Social status,
stress, and adolescent smoking. Journal
of Adolescent Health, 39(5), 678-675.
Goodman, E., McEwen, B.S., Dolan, L.M.,
Schafer-Kalkhoff, T., & Adler, N.E.
(2005). Social disadvantage and adolescent stress. Journal of Adolescent
Health, 37, 484-492.
Green, S.E., Holohan, E., & Feldheim, A.
(2003). Stress in the family. Retrieved
August 26, 2008, from http://www.ecb.
org/guides/pdf/CE_68_05.pdf
Herrman, J. (2005). The teen brain as a work
in progress: Implications for pediatric
nurses. Pediatric Nursing, 31(2), 144148.
Herrman, J. (2008). Adolescent perceptions of
teen births. Journal of Obstetrical,
Gynecological, and Neonatal Nursing,
37(1), 42-50.
Lau, B.W.K. (2002). Does the stress of childhood and adolescence matter? A psychological perspective. The Journal of
the Royal Society for the Promotion of
Health, 122(4), 238-244.
Miller, D.B., Webster, S.E., & MacIntosh, R.
(2002). Whats there and whats not:
Measuring daily hassles in urban AfricanAmerican adolescents. Research on
Social Work Practice, 12(3), 375-388.
Moos, R.H. (2002). Life stressors, social
resources, and coping skills in youth:
Applications to adolescents with chronic
disorders. Journal of Adolescent Health,
34, 22-29.
National Campaign to Prevent Teen
Pregnancy. (1999). What about the
teens? Research on what teens say
about teen pregnancy: A focus group
report. Washington, DC: Author.
Puskar, K.R., & Rohay, J.M. (1999). School
relocation and stress in teens. Journal of
School Nursing, 15(1), 16-22.
Rich, M., & Ginsburg, K.R. (1999). The reason
and rhyme of qualitative research: Why,
when, and how to use qualitative methods in the study of adolescent health.
Journal of Adolescent Health, 25, 371378.
Tarrant, B., & Woon, A. (1995). Adolescent suicide: An overview. Australian Journal of
Emergency Care, 2(1), 26-30.
Tusaie, K., Puskar, K., & Sereika, S.M. (2007).
A predictive and moderating model of
psychosocial resilience in adolescents.
Journal of Nursing Scholarship, 39, 54-60.

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