Changes in levels of the stress-sensitive hormone cortisol from morning to evening are referred to as diurnal cortisol slopes. Flatter diurnal cortisol slopes have been proposed as a mediator between chronic psychosocial stress and poor mental and physical health outcomes in past theory and research. Surprisingly, neither a systematic nor a meta-analytic review of associations between diurnal cortisol slopes and health has been conducted to date, despite extensive literature on the topic. The current systematic review and meta-analysis examined associations between diurnal cortisol slopes and physical and mental health outcomes. Analyses were based on 179 associations from 80 studies for the time period up to January 31, 2015. Results indicated a significant association between flatter diurnal cortisol slopes and poorer health across all studies (average effect size, r = .147). Further, flatter diurnal cortisol slopes were associated with poorer health in 10 out of 12 subtypes of emotional and physical health outcomes examined. Among these subtypes, the effect size was largest for immune/inflammation outcomes (r = .288). Potential moderators of the associations between diurnal cortisol slopes and health outcomes were examined, including type of slope measure and study quality indices. The possible roles of flatter slopes as either a marker or a mechanism for disease etiology are discussed. We argue that flatter diurnal cortisol slopes may both reflect and contribute to stress-related dysregulation of central and peripheral circadian mechanisms, with corresponding downstream effects on multiple aspects of biology, behavior, and health.

Laboratory social stress tests involving public speaking challenges are widely used for eliciting an acute stress response in older children, adolescents, and adults. Recently, a group protocol for a social stress test (the Trier Social Stress Test for Groups, TSST-G) was shown to be effective in adults and is dramatically less time-consuming and resource-intensive compared to the single-subject version of the task. The present study sought to test the feasibility and effectiveness of an adapted group public speaking task conducted with a racially diverse, urban sample of U.S. adolescents (N = 191; 52.4% female) between the ages of 11 and 18 (M = 14.4 years, SD = 1.93). Analyses revealed that this Group Public Speaking Task for Adolescents (GPST-A) provoked a significant increase in cortisol production (on average, approximately 60% above baseline) and in self-reported negative affect, while at the same time avoiding excessive stress responses that would raise ethical concerns or provoke substantial participant attrition. Approximately 63.4% of participants exhibited an increase in cortisol levels in response to the task, with 59.2% of the total sample showing a 10% or greater increase from baseline. Results also suggested that groups of 5 adolescents might be ideal for achieving more uniform cortisol responses across various serial positions for speech delivery. Basal cortisol levels increased with age and participants belonging to U.S. national minorities tended to have either lower basal cortisol or diminished cortisol reactivity compared to non-Hispanic Whites. This protocol facilitates the recruitment of larger sample sizes compared to prior research and may show great utility in answering new questions about adolescent stress reactivity and development.

As policy debates concerning LGBTQ+ students and staff continue across the American education system, there is not a clear description of the prevalence of local policy protections, even in states with legislative mandates, nor a strong understanding of how to expand reform initiatives. After conducting a document analysis of policies with a statewide, representative sample of districts, this study uses Illinois as a case study to describe several educational policy levers to scale gender and sexual diversity (GSD) reforms across federal, state, intermediary, and local institutions. The results indicate all districts complied with top-down legislative mandates, but few policies referenced gender or sexual diversity if not state-mandated. A minority of districts enacted policies through administrative guidance (27%), often using language from a state intermediary organization. Results from the regression analysis suggest local factors, such as district size, per pupil spending, and rurality, contribute to adopting guidance, but not policy protections. This study indicates both top-down and bottom-up pathways matter for expanding GSD-related reforms.

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