Sociotropic cognition moderates stress-induced cardiovascular responsiveness in college women.

This study examined the moderating effects of sociotropic cognition (SC), a nondefensive need for approval, on stress-induced cardiovascular responsiveness (CVR) in women. Sixty-seven college-age females had blood pressure (BP) and heart rate (HR) monitored during baseline, anticipation, story-telling (where participants were randomly assigned to a low or high threat condition), and recovery periods. SC showed a positive association with CVR only in the high interpersonal threat context during task and early stages of the recovery periods. SC was positively correlated with such variables as anxiety, ruminative style, dysphoria, and anger. This is the first report examining the moderating effects of SC on interpersonal stress-induced CVR prior to, during, and following a task, using an explicit manipulation of social evaluation. The data help define risk factors for CVR in women, which may aid in the understanding of how emotions and stress affect physical health and well-being.

Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension.

OBJECTIVES: This study evaluated the effects of aerobic exercise physical education on blood pressure in high-risk, predominantly African-American, adolescent girls. METHODS: Ninth-grade girls (n = 99) with blood pressure above the 67th percentile were randomized to 1 semester of aerobic exercise classes or standard physical education classes. RESULT: The study was completed by 88 girls. At posttest, only members of the aerobic exercise group increased their estimated cardiorespiratory fitness. The aerobic exercise group had a greater decrease in systolic blood pressure than the standard physical education group (P < .03). CONCLUSIONS: Aerobic exercise physical education is a feasible and effective health promotion strategy for high-risk adolescent girls.

Sociotropic cognition moderates blood pressure response to interpersonal stress in high-risk adolescent girls.

This article tests the hypothesis that 'sociotropic cognition'--heightened preoccupation with being accepted by others--increase vulnerability to cardiovascular stress in females. Adolescent girls (55 African-American; 23 Caucasian) at increased risk of developing essential hypertension due to persisting high normal blood pressure, completed measures of sociotropic cognition, social competence, trait affect and social support. Later, their blood pressure and heart rate were measured during non-social stress (mirror image tracing) and interpersonal stress [Social Competence Interview (SCI)]. Comparisons of blood pressure responses to the tasks disclosed a significant Task main effect, replicating a previous finding that blood pressure is elevated more by SCI than by non-social stress. When Sociotropy was introduced as a moderator, however, a significant Task by Sociotropy interaction indicated that the comparatively greater reactivity to SCI occurred mainly in girls who exhibited high levels of sociotropic thinking. Cognitive sociotropy was associated with a profile of social emotional and environmental deficits suggesting increased susceptibility to chronic stress and impaired coping.

Negative affect, gender, and expressive style predict elevated ambulatory blood pressure in adolescents.

Excessive blood pressure elevations during daily activities increase cardiovascular risk and may be related to individual differences in emotionality and expressive style. Emotional traits and ambulatory blood pressure were measured during a typical school day in 228 Black and White adolescents at risk of developing essential hypertension. Trait affect (depression, anger) predicted prevailing blood pressure levels; this association was moderated by gender, social setting (in classroom vs. with friends), and nonverbal expressive style. Relationships between emotion and blood pressure were not explained by obesity, smoking, or alcohol use. The uniform environment and regimen of the school made it possible to attribute variations in prevailing blood pressure to personality differences involving ways adolescents perceive and negotiate their social world.

Predicting ambulatory blood pressure during school: effectiveness of social and nonsocial reactivity tasks in black and white adolescents.

We evaluated a newly developed stress task, the Social Competence Interview, and three nonsocial tasks (video game, mirror drawing, mental arithmetic) for ability to predict ambulatory blood pressure in 237 black and white adolescents. Blood pressure was measured in laboratory, classroom, and transition (between-class) settings. A resting laboratory baseline explained 10-49% of the variance in ambulatory blood pressure levels; the ability of the stress tasks to explain additional variance was assessed in multiple regression analyses. Only the blood pressure response to the interview enhanced prediction of classroom and transition systolic and diastolic pressures in the total sample and in blacks, whites, females, and males--even when the interview data were entered into a hierarchical regression model after those for the other three tasks were entered. Mirror drawing improved prediction of transition systolic blood pressure in the total sample, and mental arithmetic plus the interview improved prediction of classroom diastolic pressure in black males; however, video game failed to enter any predictive equation. Racial subgroup analyses disclosed that the interview data predicted systolic pressure in whites but predicted diastolic pressure in blacks, indicating biological differences in blood pressure regulation. An interview that elicits characteristic thoughts and social behaviors appears to represent a promising approach to examining environmental influences on blood pressure.

Diminished pulse pressure response to psychological stress: early precursor of essential hypertension?

An excessive blood pressure response to mental stress is a widely reported characteristic of young normotensive offspring of hypertensive parents. At odds with these reports are data from a large biracial study showing that high risk adolescent offspring had diminished pulse pressure under mental stress and no evidence of greater blood pressure reactivity. We examined this apparent contradiction in a similar but larger sample of 213 normotensive adolescents, comparing blood pressure and heart rate responses to video game, mirror drawing, mental arithmetic, interview, and physical exercise in high- and low-risk offspring. Results replicated the diminished pulse pressure finding, suggesting it is characteristic of African Americans and is evoked by behavioral tasks that entail skeletal-motor inhibition. Submaximal physical exercise failed to discriminate between offspring groups. Possible biologic correlates of diminished pulse pressure in black adolescents with "high normal" blood pressure warrant further investigation.

Emotional inhibition in essential hypertension: obstacle to communication during medical visits?

A substantial literature on the "hypertensive personality" links essential hypertension (EH) with the suppression of negative emotions, implying that suppression may elevate blood pressure. Yet affective inhibition might also impair communication with health care providers and exacerbate EH by limiting therapeutic collaboration. We studied 542 patient-physician interviews from a national sample to see if patients with EH (n = 203) were less likely to exhibit negative emotions than normotensive patients (n = 339) as rated by their physicians and independent observers. EH patients did not differ from others on self-rated emotional or physical health. However, physicians were less accurate in characterizing the emotional states of EH patients than those of normotensive patients, and they rated EH patients as exhibiting fewer signs of distress during the visit. Independent observers also judged the EH patients as less distressed than normotensives, thereby validating the physicians' appraisals. Content analysis disclosed that physicians paid less attention to psychosocial concerns and concentrated on biomedical matters to a greater degree with hypertensive patients than with their normotensive patients. EH patients, particularly those experiencing emotional distress, appear to have patterns of self-presentation that could present an obstacle to effective communication with their physicians, and this difficulty may be amplified by physicians' disinclination to probe for emotional difficulty.

Social action theory for a public health psychology.

Many illnesses can be prevented or limited by altering personal behavior, and public health planners have turned to psychology for guidance in fostering self-protective activity. A social theory of personal action provides an integrative framework for applying psychology to public health, disclosing gaps in our current understanding of self-regulation, and generating guidelines for improving health promotion at the population level. A social action view emphasizes social interdependence and interaction in personal control of health-endangering behavior and proposes mechanisms by which environmental structures influence cognitive action schemas, self-goals, and problem-solving activities critical to sustained behavioral change. Social action theory clarifies relationships between social and personal empowerment and helps explain stages of self-change.

Social competence interview for assessing physiological reactivity in adolescents.

Difficulties in predicting "real life" physiological variation from responses to controlled stress tasks suggest the need for more ecologically valid laboratory challenges. The Social Competence Interview (SCI) measures physiological changes elicited by re-experiencing a life situation in which a valued striving was unexpectedly hindered. The 14-minute interview yields data on subjects' goals, skills, problem-solving strategies, and social resources. We compared the SCI to video game (VG), mirror drawing (MD), and mental arithmetic (MA) in a racially balanced sample of 260 adolescents (age 14 to 15 years). Blood pressure changes during SCI exceeded those during the other tasks, and were unaffected by race or gender. Blood pressure responses to SCI correlated with responses to MA and MD but appeared to capture a unique domain of social reactivity. Test-retest correlations over 6 months in a random subsample of 27 subjects showed that blood pressure reactivity to SCI and other tasks was reproducible. Intrasubject analyses of responses to the different tasks disclosed subgroups of consistently high and consistently low responders who may be at higher or lower risk. The SCI is not threatening and was rated by subjects as less frustrating or demanding than MD or MA. Its demonstrated effectiveness when administered by several different interviewers suggests the SCI is a promising technique for large scale studies of younger populations.

High blood pressure and marital discord: not being nasty matters more than being nice.

Theories linking anger and blood pressure (BP) reactivity to cardiovascular disease must be able to identify naturally occurring stressors that arouse emotion with sufficient frequency to cause chronic physiologic stress. We examine the impact of normal family arguments on 43 patients (24 women, 19 men) with essential hypertension. Patients and their partners discussed a threatening disagreement for 10 min while BP and conversation were recorded. Discussing problems increased BP, but the causal pathways differed by sex. In women, hostile interaction and marital dissatisfaction were associated with increased BP; "supportive" or "neutral" exchanges were unrelated to BP. In men, BP fluctuations were related only to the patient's speech rate. These findings are consistent with other research on sex differences in communication and social problem-solving styles and implicate different mechanisms (frequent anger, active coping) through which marital discord could increase risk. Implications for intervention are considered.

Theoretical and baseline considerations for diet and weight control of diabetes among blacks.

This article outlines theoretical considerations for diet and weight control of non-insulin-dependent diabetes mellitus (NIDDM) and identifies factors that may be of particular importance in influencing the success of diet and weight control of NIDDM in the Black population. Long-term adherence to dietary or weight-control regimens requires that the patient evaluate and restructure established eating and physical activity patterns. With the use of the social action theory as a conceptual framework, this complex behavioral change task can be understood as a function of the interplay of various self-regulatory mechanisms. These mechanisms are influenced by the person's capabilities for making changes, his/her physical condition and general health status, the physical and social environmental context, and the person's material and social resources. Many of these factors may differ for Blacks and Whites in a direction that suggests a lesser potential for effective diet and weight-loss therapy among Black NIDDM patients. For example, compared with Whites, Blacks are more likely to have limited incomes, low educational attainment, ambivalence about weight control, multiple health problems, and high-fat high-sodium low-fiber diets or food preferences. However, some evidence suggests that state-of-the-art counseling approaches can be as effective for Blacks as for Whites. The challenge is to adapt the types of approaches suggested by the social action theory for culturally appropriate and cost-effective delivery in Black community health-care settings.

Child problem solving competence, behavioral adjustment and adherence to lipid-lowering diet.

Dietary problem solving competence, behavioral adjustment and low density lipoprotein cholesterol (LDLC) changes were evaluated in a cross-sectional study of 55 hyperlipidemic children and adolescents more than 12 months after they had been prescribed lipid-lowering diets. Adolescents who were able to generate multiple ways to cope with dietary temptations described in hypothetical vignettes evidenced better dietary adherence than adolescents who could produce fewer coping strategies. Observation of parent-child interaction during a standard menu planning task revealed that child satisfaction with the diet was positively associated with parental attempts to solicit and reinforce the child's involvement in meal planning. Findings raise the possibility that behavioral problem solving training might improve long term dietary adherence in adolescents and encourage further research on families' responses to nutritional counseling.

Psychological effects of resistive weight training: implications for cardiac patients.

Cardiac patients' perceptions of their physical capabilities ("self-efficacy") often exert greater influence over their return to normal activities than does their actual medical status. The first part of this review explains how self-efficacy perceptions are formed and how participation in resistive weight training can promote adherence to safe and effective exercise. The second part of the paper reviews data showing how exercise contributes to emotional well-being and reports changes in self-efficacy and negative affect that recently have been found to accompany strength gains achieved in circuit weight training.

The effectiveness of smoking cessation advice given during routine medical care: physicians can make a difference.

Physicians may be hesitant to advise their patients to give up cigarette smoking partly because they doubt their own effectiveness. The three studies cited in this paper indicate that physicians can help their patients quit smoking if they briefly explain the benefits of quitting and provide concrete advice on how to go about it. This advice is effective primarily with light smokers. If smokers require medical care at least as frequently as nonsmokers and if physicians advise them (during routine care) to quit smoking, some 38 of the 54 million smokers could be reached in a single year. Further research is needed in areas such as physician motivation and the provision of information on smoking.

Identifying coronary-prone behavior in adolescents using the Bortner Self-Rating Scale.

Brief measures to identify coronary-prone (Type-A) behavior in young persons are greatly needed for longitudinal epidemiologic study of cardiovascular diseases. We examined the suitability of a modified 14-item Bortner Self-rating Scale (ABS) for use in an adolescent population. Responses of 549 racially mixed, low to middle income urban high school students were analyzed to see if ABS measurement properties matched those of the parent version. Construct validity was explored by correlating ABS scores with measures of anger expression, social support, life satisfaction, academic achievement and blood pressure. Results disclosed that the distribution and factor structure of adolescent ABS responses closely resembled findings obtained with adults. Scale validity was supported by significant associations of ABS scores with degree of overt anger expression, lack of social support, and dissatisfaction with school and life in and life in general. Academic achievement and blood pressure were found not to correlate with adolescent ABS scores. Possible race and sex differences are considered.

Feasibility and effectiveness of school-based relaxation in lowering blood pressure.

Progressive muscle relaxation (PMR) is a broadly useful anxiety reduction technique that has been found to lower blood pressure (BP) in essential hypertension. The present investigation is the first to evaluate the feasibility and efficacy of wide-scale PMR instruction as a public health promotion strategy aimed at adolescents. Students (N = 1,400) in Grades 9 and 10 at two large Baltimore City public high schools underwent BP screening; those with BP persistently above the 85th percentile were randomly assigned to (a) 12 weeks daily PMR instruction provided in class for academic credit or (b) a control condition. The latter students had their BP measured at the same frequency as the PMR students and completed the PMR course during the following year. Approximately two thirds of eligible students entered and completed the study. Results demonstrated that treatment students (n = 51) enjoyed daily PMR, mastered the technique, and achieved reduced systolic BP at posttest relative to the untrained controls (n = 59). At follow-up 4 months later, group BP differences were not significant. Implications for use of PMR to promote cardiovascular health are discussed.

Self-efficacy mediates strength gains during circuit weight training in men with coronary artery disease.

Motivation to engage in health-promoting exercise has been ascribed to global personality traits such as self-esteem or athletic self-confidence. Self-Efficacy Theory challenges this view by proposing that highly specific estimates of personal capabilities mediate adoption of new or difficult behavior patterns. We tested this assumption by measuring self-efficacy perceptions in 40 men with coronary artery disease who participated in an experiment evaluating effects of circuit weight training (CWT). Specific self-efficacy estimates were assessed during baseline strength/endurance testing and after 10 wk participation in CWT or volleyball. Correlational analyses of self-efficacy in relation to performance on strength/endurance tests strongly supported the contention that adoption of novel activities is governed by highly specific self-perceptions. Participation in CWT produced greater strength and endurance gains than did volleyball, and these changes were accompanied by increased self-efficacy in CWT subjects for activities resembling the training tasks. The assertion that self-efficacy perceptions directly mediate involvement in challenging physical activities was supported by multiple regression analyses. These revealed that pre-training self-efficacy judgments predicted post-test strength gains even after controlling for baseline strength, type of training and frequency of participation in exercise sessions.

Diminished pulse pressure under mental stress characterizes normotensive adolescents with parental high blood pressure.

An exaggerated blood pressure response to mental stress is believed to characterize young adults with genetic risk of essential hypertension, suggesting that stress-induced changes might provide a useful index of pathogenetic processes. We explored this by studying pressor responsivity to competitive tasks in adolescents drawn from a large urban population. Individuals with systolic or diastolic pressures persistently between the 85th and 95th percentiles were evaluated on basal blood pressure, parental history of hypertension, and pressor and heart rate response to a challenging video game. Basal pressure was measured again at 6, 10, and 14 months. A persistently diminished pulse pressure was the cardiovascular characteristic that most reliably typified normotensive subjects with familial hypertension. Response to the video game was the best indicator of risk status. Contrary to expectations derived from research with convenience samples, epidemiologic investigation points to an increased peripheral resistance and lower cardiac output as the cardiovascular pattern more prominently associated with genetic risk in the normotensive adolescent.

Usefulness of self-efficacy in predicting overexertion during programmed exercise in coronary artery disease.

Overexertion during group jogging was evaluated in relation to self-perceived functional capacity and ability to self-monitor exertional heart rate in 40 men, mean age 55 +/- 9 years, with documented coronary artery disease. Patients' confidence in their ability to jog various distances was measured with a jog self-efficacy (SE) scale before a group exercise program was begun. Depression, type A personality, and performance of symptom-limited treadmill exercise were also assessed. Later, each patient was monitored with ambulatory (Holter) electrocardiography during programmed group jogging. Ambulatory monitoring disclosed significant noncompliance with exercise prescriptions: 33% of patients exceeded their prescribed range of 70% to 85% of maximal treadmill heart rate for at least 10 minutes of the 20-minute exercise bout. Another 25% spent 10 minutes or longer exercising below the prescribed range. Pretest jog SE predicted the number of minutes patients exercised above or below the prescribed intensity, but depression, type A and treadmill performance measures did not. Self-monitoring accuracy (the amount of agreement between exercise heart rate recorded by the electrocardiogram and by the patient) was also related to the number of minutes patients exercised outside the prescribed range. Comparison of SE and self-monitoring accuracy variables revealed that "overachievers" were patients who overestimated their ability to jog, while "underachievers" were those who overestimated their heart rate during exercise. Self-perceptions and self-monitoring skills appear to be important independent predictors of behavioral compliance to exercise guidelines.