Daniel Noronha
6/9/01
Advanced Biology Final Project
This study
is the second attempt to monitor the health of students at Oyster River High
School. The first study, which was completed at the end of 2001, looked at many
general factors that have potential influence on student health. This study
picked up some of the loose strings from earlier on as well as narrowed its
focus to the specific effects of stress on health.
Some things
in the first study worked well; overall conclusions of student health over the
given period showed definite fluctuations, indicating large outbreaks of
illness at certain points. Other things did not go so well; data was not
collected frequently nor tabulated accurately. Much of the data taken was not
used, either because it could not be quantified or because there was too little
of it to draw any definite comparisons. Due to new methods of collecting and
tabulating data, accuracy of information in this second study was kept very
high.
Before the
project could begin it was important to define stress in relation to our
research. This is an often ambiguous and confused concept. The definition of
stress for this study is as follows: stress is an internal process that occurs
when a person is faced with a demand that is perceived to exceed the resources
available to effectively respond to it. Furthermore failure to effectively deal
with the demand has important undesirable consequences. In other words, stress
is experienced when there is an awareness of a substantial imbalance between
demand and capability, under conditions where failure to meet the demand is
perceived to have unwanted consequences.
The purpose of
this project is two-fold:
1. To design an
interactive database entry application that allows easy input and management of
data in a large-scale study.
A
windows-based application was used to help with management of the data
collected from students via questionnaires. The format for this application was
based directly on the questionnaires that were given to students. A detailed
description of these questionnaires can be found under "Project Design and
Methodology." Because the application follows the visual layout of the
questionnaires, using the application to input data is very user-friendly. Data
from the application is stored in pre-defined Microsoft Excel files. Using this
method allowed us to easily generate graphs and analyze the collected results.
2. To
demonstrate the effect of stress on the immune system
As an
observation from the first study conducted at ORHS, the health of students
tended to decline dramatically in correlation with periods of intense study
directly preceding vacations. One might speculate that as a typical student
spends long periods in school without breaks, his immune system is negatively
affected by loss of sleep and increased stress levels. By comparing the health
of individuals with high stress to others with low stress, this study examined
these factors on a school-wide scale.
BACKGROUND
INFORMATION:
When the
symptoms from the original study were graphed over the three-month interval
from which information was collected, there emerged definite trends among the
data. Data tended to cluster into three groups – cold, flu, and fatigue-related
systems. Although certain symptoms can often be traced to multiple ailments, in
general they tend to correspond to specific diseases. Frequent coughing, for
example, is generally caused by throat irritation resulting from the common
cold. However, it can also indicate lung diseases such as bronchitis and
asthma, and could be caused simply by an individual's allergies.
The group
that plotted temperature with student health determined a direct correlation
between student health and average daily temperature. Though temperature itself
does not contribute to a decline in student health, it often confines students
indoors, where the combination of low humidity and poor air circulation
provides ideal conditions for viruses to spread. Students are also likely to
exercise less in the winter – a factor that may inhibit the proper function of
their immune systems.
In
continuing the disease study, we decided to concentrate on stress, which is
commonly thought to be a factor responsible for the decline of health in an
individual. In this study we have defined health as a balance between the
physical, mental and emotional states of a person. Our questionnaires reflected
this by asking students to rate each of these factors daily. We have used these
values to evaluate an "average health rating" for each student.
In
prehistoric times, the physical changes in response to stress were an essential
adaptation for meeting natural threats. Even in the modern world, the stress
response can be an asset for raising levels of performance during critical
events such as a sports activity, an important meeting, or in situations of
actual danger or crisis. If stress becomes persistent and low-level, however,
all parts of the body's stress apparatus (the brain, heart, lungs, vessels, and
muscles) become chronically over- or under-activated. This may produce physical
or psychological damage over time.
In regards
to physical health, stress is also known to decrease the efficiency of the
immune system; many stressors have been found to lower the number of cells in
the blood that fight infection. When the immune system is weakened, humans
become more susceptible to illnesses such as the common cold, flu, as well as
more serious illnesses. Chronic stress appears to blunt the immune response and
increase the risk for infections. Once any person catches a cold or flu, stress
can exacerbate symptoms.
In regards
to mental health, stress has been shown to have a significant effect on the
brain, particularly on memory. The typical victim of severe stress suffers loss
of concentration at work, at school, and at home and may become inefficient and
accident-prone. Severe stress may even break down the blood-brain barrier, a
physiological mechanism that helps protect the brain from toxins, bacteria, and
other potentially harmful substances that may be carried in blood. A 1999 study
looked at the effect of chronic stress on learning in middle school children.
It was found that the physiologic responses to stress could clearly inhibit learning.
The study also found that training in stress and anger management led to
significant improvements in the children's emotional balance, focus, and
relationships.
In regards
to emotional health, severe stress is associated with the onset of depression
or anxiety. It has been hypothesized that people genetically predisposed to
depression also may have a tendency to become involved in high-stress
situations. Certainly, stress diminishes the quality of life by reducing
feelings of pleasure and accomplishment, and relationships are often
threatened.
Typical
stressful situations include financial difficulties, health problems, home
instability, lack of free time, job security, dieting, etc. In this project we
have focused on the situations that are most pertinent to Oyster River
students. In the data analysis of the last study, for example, it was noted
that students felt considerably better after breaks than they did before. This
could be attributed to several factors, and we will try to determine the cause
with the help of our new questionnaires and data analysis methods. The updated
questionnaire will address habits in the sleep, exercise, and diet patterns of
subjects. In analyzing the data, we will make note of special events that occur
in the school – for example, testing periods like sophomore testing and finals.
We will also identify any vacations or long weekends.
When our
bodies experience stress they prepare to combat, prevent, and heal injuries. In
the brain, hypothalamus triggers the pituitary gland to release ACTH, which in
turn gives off two types of chemicals. The first type is catecholamines, which
exist as epinephrine or adrenaline. These chemicals have the effect of arousing
the body. This chain of events makes our heart rate increase, and causes us to
feel more energetic and alert. If the body experiences stress in the form of an
injury, the second chemical, corticosteriods, resists the negative effects of
the stress.
According
to Ceuesta College, there are five quick ways to detect stress. First, it is
possible to check for muscle tension by checking for tension or pain in the
face, shoulders, and back. Breathing should also be checked for any rapid
increases. Hand temperature can be checked by moving and holding one’s hand to
one’s neck. If the temperature of the hand is noticeably cooler than the neck,
then the body could be experiencing stress. A third indicator is perspiration;
this is an involuntary stress response caused by the secretion of certain
stress hormones. Rapid pulse is another indicator; pulse rates higher than 75
beats per minute may indicate that the body is responding to a stressor. It is
also possible to check for rapid, shallow breathing. People who are tense often
tighten their stomach muscles and breathe through their chests. We have
carefully considered these factors and applied them to this study at ORHS.
PROJECT DESIGN
AND METHODOLOGY:
There were
approximately 100 students participating in the study. Of these, 65 students
provided full and accurate information. There were two types of questionnaires
given to students (both attached). The first is the "one-time"
questionnaire that determined the health habits of students. There were 11 data
points on this questionnaire. The second survey given to students was a packet
that contained a series of short, identical questionnaires, one of which was to
be filled out every school day. There
were 10 data points on the daily questionnaire.
All
students were assigned unique ID numbers that were used to keep track of their
individual input over time. Both the teacher and Dan and I had copies of
assigned ID numbers for each student, to make sure that ID numbers were not
forgotten. An example of one such ID-name sheet is attached. The ID numbers
were also used to correlate results between the daily and one-time
questionnaires. An additional sheet is attached entitled "ID Assignments
and Information" which describes the specific ID numbers given to various
classes as well as other related information. Teachers were also given an
information sheet ("Information on the Study for Teachers") which
explained some common concerns pertaining the study. This sheet is also
attached.
Data was
collected daily from 5 classrooms, representing all four grade-levels. Data was
generally analyzed by graphing multiple data types against one another – for
example, an individual’s health vs. the number of hours he spent sleeping
during a week, or doing homework. This data was also analyzed against others
and against time.
Based on
the scope of the study described, there were approximately 25,000 data points
that were entered into the database. The created application has the ability to
open an instance of an excel spreadsheet, as well as use the Excel graph
functions by programming against the Excel object model.
The most
logical method of working with such large volumes of data was to input data
into preformatted tables in Excel (.xls) files. The structure of the
cells/columns in the tables these sections referenced was directly based on the
design of the questionnaires. As mentioned earlier the user interface of the
application was also designed based of the questionnaires. Thus there are two
basic sections to the user interface of the application. The first deals with
data input for the "one time" questionnaire and the second deals with
the "daily" questionnaire. For data analyzation; graphs of different
data correlations were linked to the tables, so that the graphs are
automatically modified as data is entered. The application also manages all error
handling to ensure a high standard of inputted data. A "screen shot"
of the application as well as a print outs of all the code used and a CD
containing the Visual Basic project files is included with this project
evaluation.
DISCUSSION:
As
discussed earlier, students were given an average health rating that was based
on their emotional, physical, and mental health. Each day students had the
opportunity to rate themselves on a 1-4 scale in each of these categories. The
1 value was used to specify the best health and 4 used to specify the worst
health. Thus it should be noted that health levels approaching 1.0 on the graph
are the best health levels. We are quite confident in the validity and accuracy
of the data because of the relatively large numbers of responding students. For
example it can be noted that on the graph discussing average test numbers per
day the students responded that there were an average of a little over 3 tests
the day before April vacation, and nearly none the day of return. Such a cycle
is a common practice among teachers.
The
first two graphs found in this packet show the total health of students over
the one and a half-month period the study was conducted. The fist graph
(labeled 1) shows each of the 3 health sectors separately. The second graph
(labeled 2) shows an "average trend line" that will be used to refer
to student health. This is the average of all three of the health levels that
are collectively referred to as "average student health" this is
labeled simply as "average" and is found in red on the graphs.
As can be
observed from this second graph student health fluctuated between 1.4 and 1.9
in the duration of the study. These values were also the end points of the
graphs. Students entered the study feeling their worst, and left feeling their
best. Other quick points of interest show that students felt noticeably better
following the "early release day" on may 9th, however
their health generally remained unchanged following the April break (April
23-27)
There
was a relatively large fluctuation in the number of hours that students spent
working throughout the week. (Time spent
working, as described in our questionnaire, included both time spent on
homework and time spent working jobs.) While the average time worked by a
student stayed at a relatively constant 2.5 hours until mid-May, it became
quite sporadic after that. On May 17 the average student spent an all-time low
of 1.3 hours working, followed by 2.1 hours the next day (a Friday, not
surprisingly). Yet, the next Monday this figure jumped to an incredible 3.9
hours per student.
Interestingly,
there was no correlation between these sporadic work periods and students'
health, but with the exception of these dates the graph plotting the number of
hours worked vs. health showed a fairly strong correlation. It could be
suggested from this that the health of people is indeed negatively affected by
overworking.
Graph 4
shows perhaps some of the most conclusive data from the study. This graph
compares the number of hours of sleep students accumulated in comparison to
their average health levels. It was hypothesized that as hours of sleep
increase, health should also increase. Again because better health is
represented by lower values, the hypothesis would show up as an inverse
relationship between the two lines. Such a trend can be clearly seen especially
in the first part of the graph. Over the period of time 4/14/01 to 5/10/01 the
graphs mirror each other, sometimes with a slight delay between action and
re-action. Following the 10th of May the relationship can still be
seen, however it is not quite as apparent.
From the
background reading we had learned that the tensions of unresolved stress
frequently cause insomnia, generally keeping the stressed person awake or causing
awakening in the middle of the night or early morning. Thus having more stress,
and less sleep could decrease a person's health. Such a situation appears to be
demonstrated by our test subjects and this graph. Sleep or lack thereof seemed
to affect mental health the most. This is shown in graph 5. Mental health
fluctuated the most out of the 3 health levels described in the study. It is
hypothesized that lack of sleep would cause one to be drowsy and un-alert thus
earning a low mental health rating.
Of the 65
students surveyed on the initial questionnaire, 19% responded with a “1”, 38%
with a “2”, 31% with a “3”, and the
remaining 12% with a “4”. These four groups of students were then compared in
the categories of physical, mental, emotional, and overall (averaged) health.
There was generally little variation between the health of those who responded
with 2’s or 3’s, but the graphs that compared the “1” respondents with the “4”
respondents turned out to be very conclusive.
The
difference in health between high-stress and low stress was perhaps most
noticeable in their physical health (graph 6); regarding this criteria, the
relation between students with low and high stress was actually inversely
proportional. Low-stress students recorded their best health on the days that
high-stress students were feeling their worst. On four days, in fact, every one
of the low-stress students reported perfect health (“1” out of 4). High-stress
students, however, recorded as bad as an average 2.5 on one of these four days.
On other
interesting thing about this graph was that there were a high average number of
tests (graph 10) given by teachers on those days that the greatest difference
in health occurred. This may suggest that high-stress students allowed the
pressure of upcoming tests to take a toll on their health.
The
difference between high-stress and low-stress student health was least
noticeable regarding mental health (graph 7); on some days, all students in
both categories gave themselves 1’s for mental health. Despite this
consideration, there were still generally substantial differences between these
two types of students. On the first day on which the survey was distributed,
low-stress students averaged a 1.5, while high-stress students averaged 3.5.
Emotional health (graph 8) showed the same types of correlations observed in the physical and emotional graphs. Again, often all of the low-stress students reported perfect health on several days, while there were only three such days for high-stress students.
CONCLUSION:
Throughout
the project analysis we evaluated many factors that could potentially be
stressors and effect health levels. The discussion covers some of the more
interesting results that were found. Because stress can be caused by a variety
of factors it would be very difficult if not impossible to map a direct
relationship between one particular stressor and the health level of a person.
In this study of high school students, several areas showed promise. We found
relationships between sleep levels and overall health, particularly mental
health. The hours a student worked also correlated strongly with their overall
health levels.
The most conclusive
results were found when comparing students who had indicated low and high
stress levels in the "one-time" questionnaire. Overall students who
specified low stress levels had vastly better health than students with high
stress levels, in all three of the determined health categories.
BIBLIOGRAPHY:
“Searching
For The Biological Pathways Between Stress And Health.” http://annualreviews.org/
1997 http://publhealth.annualreviews.org/cgi/content/full/18/1/437
This re-published report from the
department of Health Care and Epidemiology at the University of British
Columbia takes a biological view at the links between stress and health. The
report set criteria to evaluate potential physiological markers of chronic
stress. Five areas were reviewed in detail; these include glycosylated
proteins, the immune system, homeostasis, peripheral benzodiazepine receptors,
and the waist-hip ratio.
“Health
Report - Effects of Stress on the Immune System.” Australian Radio National
04/27/98 http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s10844.htm
Research from the U.S. is showing
considerable effects of stress on the immune system - from how well the flu
vaccine produces immunity right down to how long it takes a wound to heal. The
report also classifies characteristics that determine the vulnerability of an
individual to be affected by stress.
“Regular
Exercise May Protect Against Negative Effects Of Stress On Immune System.” The
University Of Colorado at Boulder. 11/12/1998.
This University of Colorado At Boulder study suggests that choosing to
exercise regularly in moderation may help guard against the negative effects of
stress on the body's immune system. The study, based on experiments conducted
with rats, concludes that people who exercise regularly are less likely to get
sick after stressful situations than people who do not.
“Effects of Stress on the Immune
System.” Radio National: The Health Report. 04/27/1998.
This interview with Dr. Ronald
Glaser (from the Ohio State University College of Medicine) discusses the many
experiments that he and his wife have conducted to research and demonstrate the
effect of various stress factors on the immune system. In one experiment, they
injected a group of medical students with the hepatitis B vaccine. Blood
samples of the students over a period indicated that antibodies and T-cells of
students who showed more stress and anxiety responded much less significantly
than in “unstressed” students.
Blakeslee, Thomas R. Emotions and
the Immune System. 2/25/2000.
Going beyond physical factors that
are stress contributors (lack of sleep, exercise habits, etc.) this source
references a number of studies that demonstrated the tendency of individuals
undergoing emotional trauma to be more susceptible to illnesses than healthy
individuals. One massive study in Finland examined the health records of 96,000
widowed people and found that their probability of dying was actually doubled
in the week after losing their mate.
CONTACT
INFORMATION:
Boris Masis Daniel
Noronha
Phone: 868-3067 Phone:
749-6056
Email: boris@borism.net Email:
danielnoronha@hotmail.com
Website: www.borism.net Website: geocities.com/danieljnoronha/index.html