Challenges of measuring diurnal cortisol concentrations in a large population-based field study
Section snippets
Salivary cortisol
Technical advances have allowed for assay of cortisol in saliva. Saliva collection is low-risk and non-invasive, making cortisol measurement outside of laboratory and clinical settings both practical and affordable. Sampling ease makes salivary cortisol measurement especially useful for large scale studies. Moreover, salivary cortisol concentrations are highly correlated with serum and plasma-based measures of non protein-bound cortisol concentrations, allowing for inference about its most
Methods
The National Longitudinal Study of Adolescent Health (Add Health) is a nationally representative survey of U.S. adolescents enrolled in grades 7 through 12 in the 1994–1995 school year. Over 90,000 adolescents in 132 schools participated in the Wave I in-school survey, with 20,745 also completing subsequent in-depth Wave I in-home interviews (1994–1995 school year). Follow up in-home interviews were completed in 1996 (Wave II), 2001–2002 (Wave III), and 2008 (Wave IV). For more details on the
Sample characteristics
Of the 193 respondents participating in the pretest, 52% were female, with a mean age 27.8 years (standard error = 0.14; range: 24–31). Race/ethnicity composition was 69% white, 19% black, 8% Latino, and 4% other. Nine of 10 pretest respondents had completed high school (diploma/GED) and 31% had a college degree or some education beyond college. Sixty one percent were employed at the time of the interview. Of interviewed respondents, 46% had children under age 12 living in the household at the
Discussion
Based on protocols tested in smaller extant studies (e.g., Broderick et al., 2004, Kudielka et al., 2003), we had expected that respondents would be more likely to adhere to protocol—or more likely to self-report the actual collection time had they deviated from it—if they believed there was a good chance they were being monitored. Protocol adherence among study participants who are aware they are being monitored has been reported as greater than 90% (Kudielka et al., 2003). We also expected
Conclusions
The Add Health Wave IV pretest experience indicates that large population-based field studies should carefully evaluate the feasibility of, adherence to, and reliability of biomarkers assayed in unsupervised, participant-conducted biospecimen collection protocols. The implications of our results should also be considered in light of a number of unresolved issues surrounding identification of influences on and interpretation of the CRA. In a recent review Fries et al. (2009) suggest that age,
Roles of funding source
NICHD had no role in study design, data collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Conflict of interest
None declared.
Acknowledgments
This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle
References (24)
- et al.
Assessing salivary cortisol in large-scale, epidemiological research
Psychoneuroendocrinology
(2009) - et al.
Salivary cortisol sampling compliance: comparison of patients and healthy volunteers
Psychoneuroendocrinology
(2004) - et al.
The cortisol awakening response in relation to objective and subjective measures of waking in the morning
Psychoneuroendocrinology
(2008) - et al.
The cortisol awakening response (CAR): facts and future directions
Int. J. Psychophysiol.
(2009) - et al.
Predictors and patterns of participant adherence to a cortisol collection protocol
Psychoneuroendocrinology
(2011) - et al.
Several daily measurements are necessary to reliably assess the cortisol rise after awakening: state- and trait components
Psychoneuroendocrinology
(2007) - et al.
The diurnal patterns of the adrenal steroids cortisol and dehydroepiandrosterone (DHEA) in relation to awakening
Psychoneuroendocrinology
(2005) - et al.
Electronic monitoring of salivary cortisol sampling compliance in daily life
Life Sci.
(2005) - et al.
Salivary cortisol in psychoneuroendocrine research: recent developments and applications
Psychoneuroendocrinology
(1994) - et al.
Differences in cortisol awakening response on work days and weekends in women and men from the Whitehall II cohort
Psychoneuroendocrinology
(2004)
Free cortisol levels after awakening: a reliable biomarker for the assessment of adrenocortical activity
Life Sci.
Stressors and mood measured on a momentary basis are associated with salivary cortisol secretion
Psychoneuroendocrinology
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