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Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis

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Title:
Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis
Translated Title:
Formulando indicadores culturalmente pertinentes para los factores de estrés y la calidad de vida en San Luis ( )
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English
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Cowherd, Gene Kornelis, Anne Montiel-Ishino, Alejandro F. Whittington, Anna
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Subjects / Keywords:
Stress, Psychological--Prevention & control   ( lcsh )
Quality of life   ( lcsh )
Costa Rica--Puntarenas--Monteverde Zone--San Luis   ( lcsh )
Estrés, sicológico--Prevención y control
Calidad de vida
Costa Rica--Puntarenas--Zona de Monteverde--San Luis
Community Health 2010
Stress and coping
Salud Communitaria 2010
Estrés y afrontamiento
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Reports   ( lcsh )
Reports

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Abstract:
A field study on how stress affects the quality of life in San Luis, Costa Rica
Abstract:
Un estudio de campo sobre como el estrés afecta la calidad de vida en San Luis, Costa Rica
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Text in English.
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usfldc doi - M38-00058
usfldc handle - m38.58
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Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis Gene Cowherd Anne Kornelis Francisco Alejandro Montiel-Ishino Anna Whittington 15 July 2010 Instituto de Monteverde University of South Florida Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis

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Introduction Costa Rica was called the happiest place in the world, but not until recently has the Costa Rican public health sector started to study stress in Costa Ricans, or "Ticos." The reason is because stress is now an important facet in health care, as stress is being identified as an important factor for disease, both mental and physiological (Dressler, 2004;Dressler,2007). The physiological manifestations, of which we will focus on in this study, are things such as diabetes and cardiovascular disease (CVD) (Dressler, 2004;Dressler,2007). Yet, before assessing the impact of stress in health, we must identify culturally relevant stressors and quality of life indices as they are both environmentally and culturally constructed (Aznar & Casta–—n, 2005;Diener & Suh, 1997;Ice, 2007;Ice & James, 2007). Our field study for this proposed study will be in San Luis a rural town in Guanacaste, a cant—n of Costa Rica. As medical anthropologists and public health students in conjunction with the University of South Florida and the Instituto de Monteverde, we are creating a preliminary stress baseline in rural San Luis. We are formulating culturally relevant indicators of stress and Quality of Life (QoL) indices in effort to find a relationship between stress and chronic disease. Once the relevant stressors and QoL issues are identified we can then test for any statistical significance and correlations. Background CNN.com reported on the 5th of July, 2009 that Costa Rica is one of the happiest places on earth according to The New Economics Foundation's (NEF) Happy Planet Index (HPI)(Costa Rica tops the list of 'happiest' nations, 2009). So, if Costa Rica places as one of the happiest places on earth, how does it rank with stress? The purpose of this study is to assess stress in San Luis, which is located in the cant—n or province, of Guanacaste, Costa Rica. No stress assessment has been made in the area, so our team will measure the perceived stress and stressors of the individuals living in San Luis. Culture constructs the way groups and individuals perceive and respond to their environment. Stress comes as an emotional and behavioral response to a stressor, or something that changes the homeostasis, or balance, of a given environment (Dressler, 2007;Ice, 2007;Ice & James, 2007). However we must realize that culture and stress are not universals. How individuals understand stress and quality of life, or the ability to become happy, must be approached ethnographically to understand the underlying behavioral, psychological, cognitive and physiological responses to their environment (Dressler, 2007;Dressler, 2004). Stress is a mutable term making it necessary to identify cultural stressors from ethnographic research (Dressler, 2007). QoL is an important measure when considering the happiness and the ability of an individual to attain happiness (Aznar & Casta–—n, 2005). As such, QoL must also be approached in a manner sensitive to the area being researched as it is also culturally defined and constructed (Aznar & Casta–—n, 2005; Diener & Suh, 1997). A QoL baseline must be created using the social or contextual, material or objective, and personal or subjective indices of the San Luis community to incorporate the multiple dimensions of QoL (Aznar & Casta–—n, 2005; Diener & Suh, 1997). Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 2

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Methods A health fair was conducted in the community of San Luis, in conjunction with the Monteverde Institute and the students from the University of South Florida Globalization and Community Health Field School 2010. The health fair consisted of 12 stations, including stations for blood pressure, blood glucose, sociodemographic intake information, and other anthropometric data. Also, the health fair consisted of numerous stations with surveys focusing on research topics such as nutrition, exercise, menopause, and stress. The participants of the health fair were first asked a series of questions about their sociodemographic information, including age, place of residence, occupation, type of water used in home, type of stove, size of household, and years in current residence. This information was placed in a folder for each household, and the participants took their folder to the subsequent station. Blood pressure and blood glucose was taken of every participant that was older than 18 years of age. Other anthropometric data was taken of all participants, including height, weight, and body mass index (BMI). Waist and upper arm circumferences, as well as suprailiac and tricep skin folds were taken of every participant over 18 years of age. A 24-hour food recall was completed for every participant above 50 years old. Also, all women over 18 years of age completed a menopause survey. All participants over 18 completed the illness recall, exercise survey, and stress survey. Of the twelve stations at the health fair, we analyzed information from the stress survey, blood pressure, blood glucose, sociodemographic intake information, and anthropometric data stations. The stress survey consisted of 6 questions, 3 were multiple choice and three were open ended (See Appendix A). The first question was Ud. c—mo describe el estrŽs ? (How would you describe stress?). The second question was, Ud. c—mo califica su nivel del estrŽs? (How would you rate your level of stress?). For this question, the participants were give four options: Muy estresado (Very stressed), estresado (Stressed), un poco estresado (a little stressed), or nada estresado (Not stressed). The third question was, En los œltimos 5 a–os su nivel del estrŽs ha:" (in the last 5 years, your level of stress has:), and the possible answer choices were subido (risen), no ha cambiado (has not changed), or bajado (lowered). The fourth question was, Ud. podr’a enumerar las cosas que le causan el estrŽs? "(Can you explain the things that cause stress?). The fifth question was, Mi nivel del estrŽs es: (My level of stress is:). The participants were given three options: Es m‡s alto que los dem‡s en mi comunidad (Is higher than those in my community) Es igual que los dem‡s en mi comunidad (Is the same as those in my community), or Es m‡s bajo que los dem‡s en mi comunidad (Is lower than those in my community). The last question was, Ud. hace algo para aliviarse el estrŽs? ," (Do you have something to aleviate stress?) For this question, if the participant answered positively, they were asked to explain the things that relieve their stress. By the end of the health fair, we had a total of 37 stress surveys. From the results of the stress surveys from the health fair, common words were extracted from the dictations. From these lists, main themes and common phrases were listed in their respective frequencies. Using a visual experimental qualitative research method, known as Word Clouds, the presence of certain words and phrases can be seen visually in sizes related to their respective frequencies (See Appendix C). Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 3

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From the 37 stress surveys that were obtained from the health fair, we chose 10 random participants to conduct semi-structured interviews with. A total of 6 women and 4 males were interviewed. The interviews took place at each participant's homes and took place at convenient times for the interviewee. If the interviewee was a female, then two females conducted her interview. For the four males, they were each interviewed by two males. For each of the semi-structured interviews, each interviewee was asked 10 questions about things such as the role family plays in stress, what worries they have, what role they believe stress has on health, and whether men and women handle stress similarly (See Appendix B). The interviews took place over two days, with 3 interviews being conducted the first day and seven interviews being conducted the second day. Each interview was audio recorded, and written consent for both the interview and audio recording was received prior to the interviews. The interviews lasted about 10-15 minutes each and each interview was completed in its entirety. The interviews were dictated in Spanish and main themes were extracted for further qualitative analysis. Data Analysis We conducted stress surveys on July 2nd, 2010 in the San Luis Feria de Salud held in the Altos de San Luis School. Thirty-seven surveys were taken, but 35 surveys were used for data analysis due to duplicate surveys, of these twenty-nine women and six men participated in the surveys: 31.4% were "not stressed," 42.9% were "a little stressed," 5.7% were "stressed" and 20.0% were "very stressed." The overall level of stress of men however was lower when compared to women as 33.3% men were "not stressed," 50.0% men were "a little stressed" and 16.7% men were "stressed;" no respondents were "very stressed." When asked how they compared to the overall stress of the community 57.1% (n=20) said they were lower, 28.6% (n=10) said they were the same and 14.3% (n=5) said their stress was higher. Using free-lists we identified five major community descriptors of stress: dolores (n=10), preocupaciones (n=9), no sŽ (n=9), trabajo (n=4) and enfermedad (n=4). The five major community causes of stress are: preocupaciones (n=21), trabajo (n=14), enfermedad (n=10), hijos (n=8), and familia (n=7). The results of the SPSS frequencies on the perceived level of stress and anthropometrics, and other physiological measures, are as follows: thirty-one participants were used to run their level of stress against blood glucose. Using SPSS to run an ANOVA test there was a 0.752 level of significance on a 95% confidence interval. Thirty-four participants's levels of stress were compared to systolic and diastolic blood pressure. Using SPSS to run an ANOVA test, both blood pressure measures were found with 0.643 and 0.881 level of significance respectively, on a 95% confidence interval. Thirty-four participants were used to run their level of stress against body mass index (BMI). Using SPSS to run an ANOVA test there was a 0.934 level of significance on a 95% confidence interval. Therefore, none of the intervals show statistical significance that will be accounted for in the limitations section. We then compared the level of stress to the sociodemographic factors sex, age and length of residence. Age and length of residence were tested for significance using an ANOVA analysis with a 95% confidence interval, while sex was run as a frequency against perceived levels of stress. Sex could not be used as an ANOVA test due to their not being categories to test it against. The age of the participants was problematic as some participants were not certain of Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 4

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their age, but did recall their year of birth. The age had to be corrected for in the database. The ANOVA results for significance of age and length of residence against perceived levels of stress are as follows: age had a significance of 0.565 using the corrected age to fix any discrepancies. Length of time showed a significance of 0.670. Again, as with anthropometrics, none of the intervals show statistical significance that will be accounted for in the limitations section. Analysis of the interview data shows a general consensus between males and females on the relationship between stress and illness, stress and depression, stress and pain, stress and health and causes of stress. Two themes emerged from the interview data as central causes of stress in this community: lack of transportation and work-related issues. Transportation was reported as a fundamental quality of life constraint. Lack of transportation limits physical access to healthcare, education, job opportunities, and social events. While respondents did not give specific examples of work related stress, general comments were made about stress over economic change, where money would come from in the future, and aging affecting their ability to work. Despite these themes however, respondents reported an overall low level of stress in this community. Despite a general consensus between men and women on causes of stress, the interview data suggests that men and women conceptualize stress differently. When asked if women and men experience stress differently, a majority of the men said yes, but only half of the women said yes, the other half said it was equal. When asked to elaborate, more men attributed this to the differences between how men and woman process life events. In this model, stress is a result of the individual's reaction to events. Women, however, seemed to conceptualize stress as a constant, and the result of accumulation of stressors. Half of the women interviewed reported men as having more stress than women because they worked more, the other half reported that stress was equal between men and women. However, these data are most likely skewed because men were in the room during the interview process. Limitations The data and analysis presented here are constrained by several obstacles encountered by the research team. The short amount of time allocated for field work during the field school presented obstacles that limited other factors of the study. Conducting research in a Spanishspeaking country also presented an obstacle to three members of the team who were non-native Spanish speakers with an intermediate level of proficiency. While the team members felt confident in their abilities to conduct interviews, local colloquialisms and terms unfamiliar to the researchers challenged the researchers' ability to capture the full context of respondents' comments. This affected the ability of non-native Spanish speakers to probe for clarification or elaboration. However, despite this limitation, the researchers feel confident that key data points are accurately represented in the reported data. The time constraints of the field school and the travel time between interview locations limited our sample selection to a small convenience sample. Thirty-seven surveys were administered to respondents at the feria de salud in San Luis. From these 37, 10 individuals were selected for follow up with semi-structured interviews. These Interviews were conducted at participants' homes during the week to minimize respondent burden and to simplify the logistics of transportation. Interviews were conducted in respondents' salas, or living rooms, and often in Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 5

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the presence of other members of the household. It became clear during a few of the interviews that the presence of spouses and children affected respondents' responses to sensitive questions pertaining to stress and the family, stress and gender, and respondents' personal level of stress. Conclusions The residents of San Luis reported an overall low level of stress, however most reported a great deal of preocupaciones (worries). Women reported higher levels of stress compared with men, and were the only ones to perceive themselves as being "very stressed." From the stress surveys obtained from La Feria de Salud some of the main descriptors of stress were dolores (pain), preocupaciones (worries), no sŽ (do not know), trabajo (work) and enfermedad (illness). Also, from the stress survey it was found that some of the main causes of stress are preocupaciones (worries), trabajo (work), enfermedad (illness), hijos (children), and familia (family). Overall, individuals perceived their stress as being lower than others in their community. Walking was found to be the most common way to relieve stress, followed by working and dancing. It was interesting that work was both a cause and relief of stress. During the semi-structured interviews, transportation was a theme that emerged as a main cause of stress, which was not present during the stress surveys. Work, money, and illness were found as common causes of stress. Family was found to be a relief of stress for some, while for others it was one of the main causes of stress. There was no relationship found in the responses as to whether there is a difference between how men and women handle stress. Recommendations As a preliminary study, this research found some culturally relevant indicators for San Luis, and although not statistically significant, the ground work has been laid for future stress research in the area. One of these major stressors and quality of life issues that should be researched is transportation. Transportation was found to be cause of stress for many residents in San Luis; however, more research would need to be performed to determine whether transportation concerns truly affect quality of life in San Luis. For future studies, a larger samples size would help to potentially normalize the data or to reach statistical significance. Researching further into the differences of perceived stress for males and females, and the differences that may be present in terms of coping mechanisms for stress would benefit future research. An in depth study focusing on the understanding of preocupaciones could serve to deconstruct this main theme that was prominent in all aspects of the current research. Some factors of preocupaciones were identified such as family and economic situations. However, a recommendation would be for future studies to explore further into what exactly preocupaciones means for a person or family, and how these worries impact quality of life. The next possible step could be a larger examination of how stressors and other quality of life indices affect physiological health. Since no prior stress studies have been performed in San Luis, the role of stress in quality of life is unknown and needs to be further explored. The relationship between stress and heath indicators, such as anxiety and depression, would need to be researched in San Luis to determine whether stress is negatively impacting quality of life. Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 6

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References Aznar, A. S. & Casta–—n, D. G. (2005). Quality of life from the point of view of Latin American families: a participative research study. Journal of Intellectual Disability Research 49(10):784788. Diener, E. and Suh, E. (1997). Measuring Quality of Life: Economic, Social, and Subjective Indicators. Social Indicators Research 40(1/2): 189-216. Dressler, W. W. (2007). Cultural dimensions of the stress process: measurement issues in fieldwork In Measuring Stress in Humans: A Practical Guide for the Field. Gillian H. Ice, Gary D. James (eds). Cambridge University Press: New York. Dressler, W. W. (2004). Culture, stress and cardiovascular disease. In The Encyclopedia of Medical Anthropology, pp. 328-334. Carol R. Ember and Melvin Ember (eds) New York: Kluwer Academic/Plenum Publishers. Ice, G. H. (2007). Measuring emotional and behavioral response. In G. H. Ice and G. D. James (eds) Measuring Stress in Humans: A Practical Guide for the Field. Pp. 60-93. Cambridge University Press: New York Ice, G. H. and James, G. D. (2007). Foreward and Conducting a field study of stress: General principles. In G. H. Ice and G. D. James (eds.) Measuring Stress in Humans: A Practical Guide for the Field. Pp. xi-24. Cambridge University Press: New York Weaver, L. & Hadley, C. (2009). Moving Beyond Hunger and Nutrition: A Systematic Review of the Evidence Linking Food Insecurity and Mental Health in Developing Countries. Ecology of Food and Nutrition, 48(4), 263-284. Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 7

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Appendices Appendix A: Health Fair Stress Survey Cuestionario (Questionnaire) 1. C—mo describe usted el estrŽs? (How would you describe stress?) 2. C—mo califica usted su nivel de estrŽs? (How would you classify your level of stress?) o Muy estresado (Very stressed) o Estresado (Stressed) o Un poco estresado (A little stressed) o No estoy estresado (Not stressed) 3. En los œltimos 5 a–os su nivel del estrŽs ha: (In thepast 5 years, your level of stress has:) o Subido mucho (Risen a lot) o Subido (Risen) o No ha cambiado (Hasn't changed) o Bajado (Lowerd) o Bajado mucho (Lowerd a lot) 4. Por quŽ? (Why?) 5. Podr’a enumerar usted las cosas que le causan estrŽs? (Can you please describe the things that cause stress) 6. Mi nivel del estrŽs es: (My level of stress is:) o Es m‡s alto que los dem‡s en mi comunidad (Higher than others in my community) o Es igual que los dem‡s en mi comunidad (Is equal to those in my community) o Es m‡s bajo que los dem‡s en mi comunidad (Is lower than others in my community) 7. Hace usted algo para aliviar el estrŽs? (Do you have something to relieve stress?) o S’ o No (Yes or No) o Por ejemplo que hace para aliviar el estrŽs. (For example, what do you do to relieve stress?) Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 8

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Appendix B: Semi-structure Interview Questions 1. C—mo dir’a Ud. que est‡ en tŽrminos de estrŽs? (What is your stress level?) o Muy estresado (Very Stressed) o Estresado (Stressed) o Un poco estresado (A little stressed) o Nada estresado (Not stressed) 2. Ud. piensa que el estrŽs afecta su salud? (Do you think stress affects your health?) o Si (Yes) o No Como? (How?) 2. Ud. asocia el estrŽs con dolores corporales? (Do you associate physical pain with stress?) Si que tipos? (Yes what types?) Ud. piensa que el estrŽs causa dolores corporales, o los dolores corporales causan estrŽs? (Do you think that stress causes body pain, or body pain causes stress?) 2. Ud. piensa que el estrŽs esta relacionado con la ansiedad [if not: nervios/irritabilidad] y la depresi—n [if not: tristeza]? (Do you feel that stress is related to anxiety and depression?) 3. De que se preocupa la gente en San Luis? (What are some things people worry about here?) 4. Hay temporadas durante el a–o que son mas estresantes que otras? (Are there times of the year that are more or less stressful?) 5. En la feria de salud en la escuela de San Luis, encontramos que varias personas no sab’an que era el estrŽs Ud. que opina sobre eso? (A lot of people at the health fair didn't know what stress was, what is your opinion?) 6. Ud. piensa que los hombres y mujeres experimentan [if not understood: tienen una distinta experiencia sobre el estrŽs] el estrŽs diferentemente? (Do you think there is a difference in the stress levels of men and women?) Como? Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 9

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Por que? 2. Que papel juega la familia en el estrŽs? (What role does family play in stress?) 3. Ha sentido mucha preocupaci—n? (Have you felt a great deal of worry?) a. Si Cuando est‡ preocupado(a) que cosas piensa?) (When you are worried what do you think of?) i. Cuales son los motivos que lo(la) mantienen preocupado(a)? Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 10

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Appendix C Table 1: Free List Frequency for stress survey question, "C—mo describir’a usted el estrŽs?" (How would you describe stress?) Word Frequency dolores 10 preocupacion(es)/preocupado 9 no se 9 trabajar/o/a 5 hacer 4 mal car‡cter/mal humor/irritable/bravo 4 enfermedad 4 ansiedad 4 cansancio/cansado 3 tranquilidad/calma 3 aburrido/a 3 tensa cuerpo 2 tristeza/Triste 2 dormir 2 nervios 1 temblorina 1 agitado 1 afecta/molesta la persona 1 inestabilidad 1 sueno 1 presion 1 salir 1 comunicaci—n 1 motivacion 1 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 11

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Figure 1: Word Cloud for stress survey question, "C—mo describir’a usted el estrŽs?" (How would you describe stress?) Table 2: Free List Frequency for stress survey question, "Por quŽ?" {follow-up question for, "En los œltimos 5 anos su nivel del estrŽs a:" (In the last 5 years, your level of stress has:)} Word Frequency trabajo 10 no estrŽs 9 hijos 5 preocupaci—n 5 edad 3 problemas 3 ejercicio 3 no sŽ 2 masajes 2 econ—mico 2 comida 2 seguridad 1 Dios 1 muerte 1 dolor 1 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 12

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enfermedades 1 comunicaci—n 1 familia 1 ocupado 1 falta de sue–o 1 cambiarse 1 m‡s tiempo libre 1 vivir sola 1 manera de alimentaci—n 1 Figure 2: Word Cloud for stress survey question, "Por quŽ?" {Follow-up question for, "En los œltimos 5 anos su nivel del estrŽs a:" (In the last 5 years, your level of stress has:)} Table 3: Free List Frequency for stress survey question, "Por favor enumera las causes que le causan estrŽs," (Please explain what causes stress) Word Frequency preocupaciones 21 trabajo 14 enfermedad 10 hijos 8 familia 7 no hacer nada 6 estado econ—mico 5 no tengo 2 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 13

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pareja 2 dolor 2 no tener comunicaci—n 2 NA 2 no dormir 1 menopausia 1 lluvia 1 Soledad 1 estudiar mucho 1 mucho pensar 1 malas noticias 1 no poder trabajar como antes 1 no poder caminar 1 no la a padecido 1 ir a las cl’nicas 1 otras personas 1 tiempo 1 cansancio 1 no sabe 1 Figure 3: Word Cloud for stress survey question, "Por favor enumera las causes que le causan estrŽs," (Please explain what causes stress) Table 4: Free List Frequency for "No" responses to the stress survey question, "Ud. hace algo para aliviarse el estrŽs," (Do you have something to alleviate stress?) Word Frequency Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 14

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puede 3 trabajar 2 preocupacion/preocuparse 2 ejercicio/caminar 2 quisiera 2 NA 1 Dios 1 tranquila 1 estrŽs 1 no Se 1 Figure 4: Word Cloud for "No" responses to the stress survey question, "Ud. hace algo para aliviarse el estrŽs," (Do you have something to alleviate stress?) Table 5: Free List Frequency for "Yes" responses to the stress survey question, "Ud. hace algo para aliviarse el estrŽs," (Do you have something to alleviate stress?) Word Frequency caminar 15 Trabajando 7 Bailar 5 ejercicio 5 escuchar mœsica 4 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 15

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Familia 4 Pasear 4 platicar 3 oraciones 3 Distracciones 3 amigos 3 Actividades 3 masajes 2 correr 2 cuidando animales 2 ver animales 2 soledad 2 Meditando 2 siendo saludable 2 ayudarlos en los estudios 1 una pomada para relajar 1 dormir 1 tomar suero de vaca 1 Figure 5: Word Cloud for "Yes" responses to the stress survey question, "Ud. hace algo para aliviarse el estrŽs," (Do you have something to alleviate stress?) Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 16

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Table 6: Frequency of Participant Genders at Health Fair Frequency Percent Valid Percent Cumulative Percent Male 7 18.9 18.9 18.9 Female 30 81.1 81.1 100.0 Total 37 100.0 100.0 Table 7: Frequency of Responses for Stress Survey Question, "How would you describe your level of stress?" Table 7: Frequency of Responses for Stress Survey Question, "How would you describe your level of stress?" Table 7: Frequency of Responses for Stress Survey Question, "How would you describe your level of stress?" Table 7: Frequency of Responses for Stress Survey Question, "How would you describe your level of stress?" Table 7: Frequency of Responses for Stress Survey Question, "How would you describe your level of stress?" Table 7: Frequency of Responses for Stress Survey Question, "How would you describe your level of stress?" Table 7: Frequency of Responses for Stress Survey Question, "How would you describe your level of stress?" Frequenc y Percent Valid Percent Cumulative Percent Not stressed 13 13 35.1 35.1 35.1 A little Stressed 15 15 40.5 40.5 75.7 Stressed 2 2 5.4 5.4 81.1 Very stressed 7 7 18.9 18.9 100.0 Total 37 37 100.0 100.0 Table 8: Gender Frequency Percentages of Responses for Stress Survey Question, "How would you describe your level of stress?" Participant Gender Participant Gender Total Male Female Total How would you describe your level of stress? Not stressed 33.3% 31.0% 31.4% How would you describe your level of stress? A little Stressed 50.0% 41.4% 42.9% How would you describe your level of stress? Stressed 16.7% 3.4% 5.7% How would you describe your level of stress? Very stressed 0.0% 24.1% 20.0% Total Total 100.0% 100.0% 100.0% Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 17

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Figure 6: Pie Chart for Stress Level Responses Table 9: Frequency Percentages for the stress survey question, "En los œltimos 5 anos su nivel del estrŽs a:" (In the last 5 years, your level of stress has:) Frequency Percent Valid Percent Cumulative Percent Lowered a lot 4 11.4 11.4 11.4 Lowered 7 20.0 20.0 31.4 Has not changed 10 28.6 28.6 60.0 Risen 9 25.7 25.7 85.7 Risen a lot 5 14.3 14.3 100.0 Total 35 100.0 100.0 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 18

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Figure 7: Bar Graph of Responses for the stress survey question, "En los œltimos 5 anos su nivel del estrŽs a:" (In the last 5 years, your level of stress has:) Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 19

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Table 10: Frequency Percentages for the Stress Survey Question, "Compared with your community, would you say your level of stress is:" Table 10: Frequency Percentages for the Stress Survey Question, "Compared with your community, would you say your level of stress is:" Table 10: Frequency Percentages for the Stress Survey Question, "Compared with your community, would you say your level of stress is:" Table 10: Frequency Percentages for the Stress Survey Question, "Compared with your community, would you say your level of stress is:" Table 10: Frequency Percentages for the Stress Survey Question, "Compared with your community, would you say your level of stress is:" Table 10: Frequency Percentages for the Stress Survey Question, "Compared with your community, would you say your level of stress is:" Frequency Percent Valid Percent Cumulative Percent Valid Lower than those in your community 20 57.1 57.1 57.1 Valid Same as those in your community 10 28.6 28.6 85.7 Valid Higher than those in your community 5 14.3 14.3 100.0 Valid Total 35 100.0 100.0 Figure 10: Bar Graph for Responses to stress survey question, "Compared with your community, would you say your level of stress is:" Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 20

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Table 11: ANOVA of Glucose, Systolic, Diastolic, and Body Mass Index versus Stress Level Groups Table 11: ANOVA of Glucose, Systolic, Diastolic, and Body Mass Index versus Stress Level Groups Table 11: ANOVA of Glucose, Systolic, Diastolic, and Body Mass Index versus Stress Level Groups Table 11: ANOVA of Glucose, Systolic, Diastolic, and Body Mass Index versus Stress Level Groups Table 11: ANOVA of Glucose, Systolic, Diastolic, and Body Mass Index versus Stress Level Groups Table 11: ANOVA of Glucose, Systolic, Diastolic, and Body Mass Index versus Stress Level Groups Table 11: ANOVA of Glucose, Systolic, Diastolic, and Body Mass Index versus Stress Level Groups Sum of Squares df Mean Square F Sig. Glucose Between Groups 400.188 3 133.396 .403 .752 Glucose Within Groups 8933.490 27 330.870 Glucose Total 9333.677 30 BP-Systolic Between Groups 612.736 3 204.245 .643 .593 BP-Systolic Within Groups 9523.529 30 317.451 BP-Systolic Total 10136.265 33 BP-Diastolic Between Groups 317.903 3 105.968 .881 .462 BP-Diastolic Within Groups 3610.362 30 120.345 BP-Diastolic Total 3928.265 33 Body Mass Index (kg/m^2) Between Groups 84.683 3 28.228 .934 .437 Body Mass Index (kg/m^2) Within Groups 906.841 30 30.228 Body Mass Index (kg/m^2) Total 991.525 33 Sex Between Groups .435 3 .145 .991 .410 Sex Within Groups 4.536 31 .146 Sex Total 4.971 34 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 21

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Figure 11: Bar Graph of the Association between Stress Level and Sex Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 22

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Figure 12: Bar Graph of a Means Plot of the Association between Stress Level and Mean Blood Glucose Level, Significance of .752 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 23

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Figure 13: Bar Graph of a Means Plot of the Association between Stress Level and Mean Level of Blood PressureSistolic, Significance of .593 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 24

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Figure 14: Bar Graph of a Means Plot of the Association between Stress Level and Mean Level of Blood PressureDiastolic, Significance of .462 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 25

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Figure 15: Bar Graph of a Means Plot of the Association between Stress Level and Mean Body Mass Index, Significance of .437 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 26

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Figure 16: Bar Graph of a Means Plot of the Association between Stress Level and Mean Amount of Time Lived in the Monteverde Zone, Significance of .670 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 27

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Figure 17: Bar Graph of a Means Plot of the Association between Stress Level and Mean Age, Significance of .875 Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis 28


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Cowherd, Gene Kornelis, Anne Montiel-Ishino, Alejandro F. Whittington, Anna
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Formulando indicadores culturalmente pertinentes para los factores de estrs y la calidad de vida en San Luis
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Formulating Culturally Relevant Indicators for Stressors and Quality of Life Issues in San Luis
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A field study on how stress affects the quality of life in San Luis, Costa Rica
Un estudio de campo sobre como el estrs afecta la calidad de vida en San Luis, Costa Rica
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Text in English.
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Stress, Psychological--Prevention & control
Quality of life
Costa Rica--Puntarenas--Monteverde Zone--San Luis
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Estrs, sicolgico--Prevencin y control
Calidad de vida
Costa Rica--Puntarenas--Zona de Monteverde--San Luis
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Community Health 2010
Stress and coping
Salud Communitaria 2010
Estrs y afrontamiento
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Reports
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MVI
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t Monteverde Institute : Community Health
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M38-00056, Formulating culturally relevant stressors and QoL indicators in San Luis; M38-00057, El estrs y la pura vida
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