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Adolescence is a developmental period during which time individuals adopt health behaviors that affect their lifelong health and disease risk. Socioeconomic status, social–cultural values, and stress have all been hypothesized to play a role in this association, but very few studies have examined how these factors interrelate and explain differences in health behaviors in adolescence. To address this issue, we assessed youths’ socioeconomic status, social–cultural values, life stress levels across seven domains, and health behaviors in a national sample of 1,830 high school seniors living in the four largest cities in Croatia. Structural equation modelling examined the extent to which stress mediates the effects of socioeconomic status and social– cultural values on positive and negative health behaviors. As hypothesized, stress levels significantly mediated associations between youths’ socioeconomic status, social–cultural values, and healthy and unhealthy habits. Additionally, whereas better socioeconomic status predicted less stress, greater social–cultural value on achieving a “good life” predicted more stress. More stress, in turn, was associated with engaging in fewer healthy behaviors for both males and females, and more unhealthy behaviors for males. Socioeconomic status and social–cultural values thus appear to influence stress levels, which may in turn affect adolescents’ health behaviors and, potentially, their lifespan health.

IntroductionThe aim of the study was to examine basal hypothalamic-pituitary-adrenal (HPA) axis activity and to determine associations of various covariates (gender, sleep-wake rhythm, demographic, academic, life style and health-related characteristics) with altered daily salivary cortisol profiles in late adolescence.Materials and methodsThe total analytic sample consisted of 903 Croatian secondary school students aged 18 - 21 years (median 19 years). Salivary cortisol was sampled at home at three time points over the course of one week and its concentrations were measured by using the enzyme immunoassay.ResultsIn comparison to males, female students had a higher cortisol awakening response (CAR) (median 4.69, IQR 10.46 and median 3.03, IQR 8.94, respectively; P < 0.001), a steeper (“healthier”) diurnal cortisol slope (DCS) (median 0.51, IQR 0.55 and median 0.44, IQR 0.51, respectively; P = 0.001), and a greater area under curve with respect to ground (AUCG) (median 206.79, IQR 111.78 and median 191.46, IQR 104.18, respectively; P < 0.001). Those students who woke-up earlier and were awake longer, had a higher CAR (P < 0.001), a flatter (“less healthy”) DCS (P < 0.001), and a greater AUCG (P < 0.001), than students who woke-up later and were awake shorter. Less consistent but still significant predictors of salivary cortisol indexes were age, school behaviour, friendship, diet healthiness and drug abuse.ConclusionGender and sleep-wake up rhythm were major determinants of the altered daily salivary cortisol profiles in late adolescence. The predictive power of other covariates, although less clear, has a potential for identifying vulnerable subgroups such as male drug users and females without a best friend.

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