Childhood adversity and physical health among Asian Indian emerging adults in the United States: Exploring disease-specific vulnerabilities and the role of anger.

Objective: The link between adverse childhood experiences (ACEs) and negative health outcomes is well established among middle-aged adults and within the general population; however, ACEs' impact on physical health among emerging adults and specific ethnic minority groups, such as distinct Asian American subgroups, remains understudied and poorly understood. The aim of this study was to examine the relationships between ACEs, anger expression, stress, and physical health in a sample of Asian Indian (AI) emerging adults (18-29 years) living in the United States. Method: Participants (N = 132; Mage = 23.52; 13.6% first generation; 86.4% born in United States) completed an electronic questionnaire measuring variables of ACEs, anger expression, recent stress, health history, self-rated health, and recent physical illness symptoms. Chi-square, regression, and mediation analyses were conducted to examine associations among variables. Results: ACEs significantly predicted greater anger expression, perceived stress, number of chronic health conditions, and recent physical illness symptoms. Ninety-four percent of participants with ≥ 3 ACEs endorsed at least 1 previously diagnosed medical condition, and these participants exhibited remarkably high odds of diabetes and high blood pressure. Mediation analyses indicated anger expression significantly mediated ACEs' impact on recent stress and physical illness symptoms. Conclusions: Findings evidence that ACE-related physical health consequences are, in fact, already detectable by emerging adulthood among AI Americans. The distinct ACEs patterns and pronounced ACE-related health consequences found in this population warrant further study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Anger and globalization among young people in India.

This article addresses the challenges faced by youth in developing countries. Using India as an example of a fast-globalizing country, this article highlights the experience and challenges faced by adolescents and emerging adults as they search for their interpersonal and professional identities. The difficulties of defining identity in the context of rapid globalization where people are exposed to diverse cultural forces that may conflict with each other are particularly salient when dealing with anger. Anger frequently results from thwarted wants and needs. In globalizing developing economies, young people often face inequitable access and opportunities that may be cause for distress-anger and depression. However, the skills to deal with anger are frequently culturally determined and may not be effective in situations where multiple cultural rules are operational. For example, India being a collectivist culture traditionally encourages the suppression of anger. However, situations and rules of conduct in a global economic order require the assertive expression of anger and the confrontation of conflict. Research that is methodologically and culturally appropriate is needed in exploring these issues and ameliorating distress associated with inequity, conflicts, and challenges.

Social support and networks: cardiovascular responses following recall on immigration stress among Chinese Americans.

Social support has been shown to act as a buffer for cardiovascular responses to stress. However, little is known about how social support and networks are related to cardiovascular responses to immigration stress recall. The current study evaluated the impact of structural and functional support on cardiovascular reaction following immigrant stress recall provocation as well as the moderation effect of interdependent self-construal among first-generation Chinese immigrants. One hundred fifty Chinese immigrants were recruited in the New York Chinatown area. Participants completed questionnaires assessing their levels of social support and networks, and interdependent self-construal. Following adaptation, participants recalled a recent post-immigration stress-provoking situation. Cardiovascular measures were taken during adaptation, stressor task, and recovery period. Hierarchical multiple regression analysis was performed. Social network size and type, as well as perceived emotional support were positively predictive of systolic blood pressure (SBP) reactivity changes. Instrumental support seeking was a positive predictor of SBP and diastolic blood pressure (DBP) reactivity. The moderation effect between instrumental support seeking and interdependent self-construal were significantly predictive of DBP reactivity and recovery, suggesting that perceptions about themselves in relation to others is a crucial factor for determining whether support seeking is beneficial or not. Social support was not a direct buffer on cardiovascular responses to stress among Chinese immigrants. Chinese values of interdependence and collectivism may partly explain the disconfirming results. Still, when interdependent self-construal was taken into account, Chinese immigrants who had less interdependent self-construal, but solicited more instrumental support, had faster adaptation to stress over the long term.

Clustering of cardiac risk factors associated with the metabolic syndrome and associations with psychosocial distress in a young Asian Indian population.

The metabolic syndrome is a precursor for coronary heart disease. However, its pathophysiology is not clear, its phenotypic expression may vary by region; also, the phenotypic manifestation may be exacerbated by psychosocial distress and family history. The purpose of the current study was to assess the factor structure of the metabolic syndrome in young urban Asian Indians. Asian Indian youth (N = 112) were evaluated for body mass index (BMI), waist-hip ratio, blood pressure (systolic: SBP; diastolic: DBP), blood sugar, triglycerides, cholesterol, insulin, psychosocial distress and family health history. Factor analyses were computed on components of the metabolic syndrome. Three factors were identified for the entire sample: hemodynamic-obesity (SBP, DBP, waist-hip ratio), Lipid (cholesterol, triglyceride), and insulin-obesity (blood sugar, BMI, insulin). Similar to previous research with this population, three distinct factors with no overlap were identified. Factors did not correlate with psychosocial distress or family history. Lack of correlation with family history and psychosocial distress may be a function of the young age and demographics of the sample.

Perceived social support, coping styles, and Chinese immigrants' cardiovascular responses to stress.

BACKGROUND: Social support and coping strategies are important determinants of health, especially for those in the immigrant community adjusting to a new environment. PURPOSE: This study assessed the buffering effects of perceived social support and different coping styles on cardiovascular reactivity to stress among Chinese immigrants in the New York City Chinatown area. METHOD: Participants (N = 50, 76% women, and 22-84 years old) completed questionnaires assessing their perceived social support and coping strategy preferences. They were then asked to recall a stress-provoking event related to their immigration experience in a semi-structured interview format. RESULTS: Hierarchical multiple regression analyses confirmed the interaction effect between perceived social support and problem-focused, emotion-focused, or reappraisal coping on heart rate reactivity. Additionally, Chinese immigrants who upheld more Chinese values were highly correlated with stronger perceived availability of social support and were more likely to incorporate the use of problem-focused and reappraisal coping styles. CONCLUSION: Findings suggest that high level of social support and the use of reappraisal coping strategies were associated with attenuated cardiovascular responses to stress.

A pilot study measuring the impact of yoga on the trait of mindfulness.

BACKGROUND: The current study examined whether yoga would increase levels of mindfulness in a healthy population. METHOD: Forty-six participants were randomly assigned to an 8-week yoga intervention group or a wait-list control group. Mindfulness was assessed pre and post yoga, using the Freiburg Mindfulness Inventory (FMI). RESULTS: Results indicate that the yoga group experienced a significant increase in Overall mindfulness, and in three mindfulness subscales; Attention to the present moment, Accepting and open attitudes toward experience, and Insightful understanding (p < .01). The control group experienced a significant increase in overall mindfulness (p < .02) and insightful understanding (p < .01). Findings suggest that a yoga intervention may be a viable method for increasing levels of trait mindfulness in a healthy population, potentially implicating yoga as a preventive method for the later development of negative emotional mood states (i.e. anxiety and depression). The control group also experienced moderate elevations of mindfulness at the second assessment.

Relationship between forgiveness and psychological and physiological indices in cardiac patients.

BACKGROUND: Research suggests that forgiveness is associated with better psychological and physical health and in particular cardiovascular functioning. Despite these findings, most forgiveness studies involve healthy participants. PURPOSE: The current study assessed the psychological and physiological correlates of forgiveness in individuals with coronary artery disease (CAD). METHOD: Self-reported forgiveness, perceived stress, anxiety, and depression, and physiological data, including triglycerides, total cholesterol, high- (HDL) and low-density lipoprotein (LDL) cholesterol, were obtained from 85 hospitalized CAD patients. RESULTS: Higher levels of forgiveness were associated with lower levels of anxiety (p < 0.05), depression (p < 0.01), and perceived stress (p < 0.005) as well as lower total cholesterol to HDL and LDL to HDL ratios (both at p < 0.05) after controlling for age and gender. The psychological indices did not mediate the relationship between forgiveness and cholesterol ratios. CONCLUSIONS: Results suggest that the psychological correlates of forgiveness are similar in cardiac patients and healthy individuals. Further, among cardiac patients, forgiveness may be associated with reduced risk for future cardiovascular events.

Subjective and objective measures of socioeconomic status: predictors of cardiovascular risk in college students in Mumbai, India.

The relationship between socioeconomic status (SES) and health changes as a society develops. In developed countries, high SES is associated with better health, but in developing countries, high SES is associated with poorer health. However, measuring SES is difficult in countries like India, where the traditional class and caste system are interwoven and complex. The current study explored the relationship between subjective and objective indices of SES and between SES and the metabolic syndrome among Asian Indians residing in Mumbai, India. Participants were a subset of young adults (N = 112, median age 19 years, 24% male) who were part of larger study assessing psychosocial correlates of the metabolic syndrome. SES was assessed through objective (father's education) and subjective (SES ladder) indices. Data indicated that high subjective SES was correlated with fasting blood sugar (r = .28, P < .003), and father's education was correlated with high cholesterol (r = .32, P < .005). Subjective and objective indices of SES were also correlated with each other (r = .24, P < .04). These data reiterate that the link between SES and health is obvious from an early age, regardless of the measures used to assess SES. Given the complexity of assessing SES in developing countries, objective subjective indices should be used in assessing SES.

A qualitative assessment of barriers and facilitators to achieving behavior goals among obese inner-city adolescents in a weight management program.

PURPOSE: The purpose of this study was (1) to examine the reasons for managing weight, (2) to investigate the barriers and facilitators to achieving behavior goals, and (3) to assess how a behavior coach affects the goal-setting process of obese inner-city adolescents in a weight management program. METHODS: Obese adolescents participating in a pilot study assessing the role of a behavior coach on successful weight management (n = 18) were interviewed to identify barriers and facilitators to reaching behavior goals. Data were analyzed using descriptive statistics and the constant comparative method of qualitative analysis. RESULTS: In the rationale for weight control, adolescent girls and boys reported a desire to improve physical appearance and physical conditioning, respectively. Barriers to reaching physical activity goals among girls included unsafe neighborhoods and a negative body image. Maintaining unrealistic behavior and weight goals hindered satisfaction with behavior change and weight loss in both genders. Overall, coaching provided support that helped the obese teens feel more successful in the goal-setting process and address issues related to their disruptive environments. CONCLUSIONS: Diabetes educators can include a behavior coach as part of a weight management program to help teens set behavior goals and overcome barriers to reaching behavior goals.

The impact of forgiveness on cardiovascular reactivity and recovery.

The current study investigated the relationship between trait forgiveness and cardiovascular reactivity (CVR) and recovery in 99 normotensive participants (mean age=33.8). Cardiovascular parameters were obtained at 2-minute intervals during a 10-minute baseline period and a 20-minute recovery period, and at 1-minute intervals during a 4-minute anger recall task and a 4-minute serial subtraction task without harassment. Participants filled out a self-report measure of forgiveness prior to the laboratory procedure. Although forgiveness was not related to CVR, higher levels of trait forgiveness were predictive of lower diastolic blood pressure (DBP) at baseline (p<.02) and faster DBP recovery (p<.003). Findings suggest that forgiveness may be related to overall reductions in blood pressure levels and may aid in cardiovascular recovery from stress. The results also provide preliminary evidence that forgiveness may impact cardiovascular health not through a myocardial or vascular pathway, but through another mechanism.

Urban stress and health in developing countries: development and validation of a neighborhood stress index for India.

Stress caused by chronic difficulties encountered by people residing in poor urban neighborhoods is associated with health problems and disease in developed countries, but the relationship between neighborhood stress and health in developing nations, such as India, has not been assessed. In this study, the authors administered the City Stress Inventory, a self-report measure assessing stress experienced as a function of environmental conditions unique to living in large cities that was validated in the United States, to 163 high school students in New Delhi, India. Components of urban stress in India, with some modifications, appear to be similar to components of urban stress reported by adolescents in the United States. Urban stress was predictive of high blood pressure as reported by the adolescents 'parents. In addition, urban stress also predicted health habits, such as chewing tobacco and alcohol use, and psychosocial characteristics, such as hostility. Adolescents' reports of parental stress concerning money and social pressures were also associated with city stress. The current study indicates that the City Stress Inventory is valid in an Indian sample and is predictive of health problems.

Increased personality disorders and Axis I comorbidity in atypical depression.

OBJECTIVE: Comparison of patients with and without atypical depression on comorbid Axis I and I disorders to determine whether atypical depression is associated with a higher comorbidity. METHOD: Twenty-nine major depressive disorder patients with and without atypical depression were compared on clinical measures using multiple regression analyses. RESULTS: Atypical depression predicted the presence of comorbid Axis I (100% vs 33%), Axis II (90% vs 35%), and both Axis I and II (65% vs 8.14%) disorders. Personality disorders did not mediate the relationship between atypical depression and Axis I comorbidity. CONCLUSIONS: The high prevalence of Axis I and II comorbidity in major depression may be explained, at least in part, by the presence of atypical depression. Our findings also suggest that the increased Axis I comorbidity observed in atypical depression is independent of the effects of personality disorders and is probably a direct effect of atypical depression subtype. Future research should confirm whether clinical findings associated with atypical depression are independent of their association with personality disorders in a larger sample of depressed patients and also examine treatment implications in atypical depression other than a preferential monoamine oxidase inhibitor responsivity.

Factor structure, reliability, and validity of the Penn State Worry Questionnaire: differences between African-American and White-American college students.

This study examined differences in the factor structure of the Penn State Worry Questionnaire (PSWQ) between African-American (n=181) and White-American (n=180) college students. Results from a confirmatory factor analysis indicated that the traditional single-factor solution did not provide the best fit for the data from either ethnic group. A multiple-group factor analysis indicated that underlying structure of Factor 1 was roughly equivalent between ethnic groups. Structure of Factor 2, however, differed between groups. Specifically, item 10 loaded on different factors for each group. In support of these analyses, an exploratory factor analyses (EFA) among White-American participants indicated the presence of a two-factor model while an EFA among African-Americans indicated the presence of three factors. Despite some overlap in the overall factor structure between ethnic groups, African-Americans scored significantly lower on the PSWQ than the White-American group. Furthermore, among African-Americans level of ethnic identity was negatively related to state and trait measures of anxiety, but unrelated to measures of depression and worry.

Relationship of socioeconomic markers to daily life ischemia and blood pressure reactivity in coronary artery disease patients.

BACKGROUND: Socioeconomic status (SES) is an important predictor of clinical outcomes in patients with coronary artery disease (CAD). PURPOSE: We hypothesized that a selected sample of low SES cardiac patients would display heightened cardiovascular stress responses in the laboratory and increased daily life ischemia compared to otherwise comparable higher SES patients. METHODS: Eighty-two patients (M age=61.8+/-9.4 years; 71 men, 11 women) with a known history of CAD engaged in a stressful mental arithmetic task while blood pressure (BP) measures were collected. Myocardial ischemia was subsequently assessed via 48-hr ambulatory electrocardiographic monitoring in a subgroup of 51 patients. SES was defined by participants' residential block groups, which were linked to Census Bureau data about their neighborhood, including per capita income, percentage of the population below poverty, educational level, as well as self-report of number of years of education. RESULTS: Contrary to expectation, high SES participants in the study displayed higher diastolic BP (p<.01) and systolic BP (p<.001) responses to mental stress in the laboratory. CONCLUSIONS: Participants with daily life ischemia came from wealthier neighborhoods using indexes of poverty (p<.01), income (p<.02), and education (p<.04) compared to patients without ambulatory ischemia. This relationship was not accounted for by age, sex, race, body mass index, marital status, or measures of disease severity.

Church-based obesity treatment for African-American women improves adherence.

This study compared adherence to Behavioral Choice Treatment (BCT), a 12-week obesity treatment program that promotes weight loss and exercise, among 22 Caucasian-American and 10 African-American overweight women in a university setting to 10 African-American overweight women in a church setting. Behavioral Choice Treatment (BCT) promotes moderate behavior change that can be comfortably and therefore permanently maintained. Participants obtained feedback from computerized eating diaries and kept exercise logs. Results indicated that both university groups exhibited comparable eating pathology at pre- and post-treatment and comparable weight loss, despite the African-American sample attending fewer sessions. The African-American church group exhibited less disordered eating attitudes, less interpersonal distrust (eg, reluctance to form close relationships or sense of alienation) at pre-treatment, and experienced significantly greater weight loss than either university group. All groups lost weight and maintained these losses at 12-month follow-up. Preliminary results suggest treatment setting may play an important role in treatment adherence and sample characteristics.

Workstyle and upper-extremity symptoms: a biobehavioral perspective.

OBJECTIVES: Workstyle has been proposed to help explain the link between ergonomic and psychosocial factors in work-related upper-extremity symptoms/disorders. This study investigated ergonomic factors, work demands, job stress, and workstyle on pain and functional limitations in computer users. METHODS: One hundred sixty-nine participants completed self-report ratings of job stress, ergonomic exposures, and workstyle at baseline. Three months, later ratings of pain and functional limitations were obtained. RESULTS: Multivariable logistic regression indicated that ergonomic exposure (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.3-5.5), time spent at a computer (OR = 1.9, 95% CI = 0.95-3.6), and higher scores on a workstyle measure (2.4, 95% CI = 1.1-5.3) were independently associated with case status. Path analyses revealed that a model that included ergonomic exposure, work demands, and workstyle predicted pain and functional limitations at 3 months. CONCLUSIONS: Workstyle contributes to case definition and is predictive of future pain and functional limitations in office workers with upper extremity symptoms.

Factor structure and construct validity of the Anxiety Sensitivity Index among island Puerto Ricans.

The factor structure and convergent and discriminant validity of the Anxiety Sensitivity Index (ASI) were examined among a sample of 275 island Puerto Ricans. Results from a confirmatory factor analysis (CFA) comparing our data to factor solutions commonly reported as representative of European American and Spanish populations indicated a poor fit. A subsequent exploratory factor analysis (EFA) indicated that a two-factor solution (Factor 1, Anxiety Sensitivity; Factor 2, Emotional Concerns) provided the best fit. Correlations between the ASI and anxiety measures were moderately high providing evidence of convergent validity, while correlations between the ASI and BDI were significantly lower providing evidence of discriminant validity. Scores on all measures were positively correlated with acculturation, suggesting that those who ascribe to more traditional Hispanic culture report elevated anxiety.

Anger cognitions and cardiovascular recovery following provocation.

The current study describes the creation and validation of the Anger Cognitions Inventory (ACI) to assess the cognitive appraisals associated with resentful and reflective anger. The ACI was created based on a content analysis of self-reports of participants' thoughts and feelings following anger provocation in the laboratory. Exploratory and confirmatory factor analyses on two separate college student samples (N = 267 and N = 276, respectively) revealed five subscales which could validly be grouped into resentful and reflective anger. Convergent and divergent validity data showed that resentful anger correlated positively with anger-out/trait anger and reflective anger correlated positively with anger-in/brooding. A second study showed positive correlations between rumination and delayed cardiovascular recovery following anger provocation. Limitations of both studies include restricted samples which limit generalizability of results and cardiovascular recovery data collected in Study II which does not include assessment of autonomic balance between vagal and sympathetic responsivity.

Psychophysiological responses to anger provocation among Asian Indian and White men.

To examine cultural differences in response to anger provocation, affective, cognitive, behavioral, and cardiovascular responses to social confrontation, role plays were measured in 20 Indian male immigrants in the United States and 40 White men. Participants engaged in 2 interactions with a nonacquiescent male confederate and were instructed to suppress or express their anger in counterbalanced order. Following each role play, participants state anger, and resentful and reflective cognitions pertaining to anger were assessed. Participants' videotaped behavioral responses were assessed for problem-solving skills and negative and positive verbal and nonverbal behaviors. Blood pressure and heart rate (HR) responses were recorded throughout the session. Results revealed that Indian participants used more introspective strategies comprising of repression and rational coping self-statements to anger provocation than their White counterparts. White participants experienced significantly higher HR responses and showed more awareness of physiological sensation compared to the Indian participants, but only when asked to exhibit their anger. Indian participants had a faster diastolic blood pressure (DBP) recovery when allowed to engage in anger inhibition (which is a culturally determined mode of functioning) compared to when they had to exhibit anger before inhibiting it. White men showed a heightened cardiac response to anger expression, something not seen among Indian men. Indian men, in contrast, exhibited delayed DBP recovery from anger expression and increased introspective cognitive strategies when asked to engage in anger exhibition, a behavior not congruent with their culture of origin.

Vigilance to a persisting personal threat: unmasking cardiovascular consequences in adolescents with the Social Competence Interview.

We report the first systematic study of hemodynamic responses to the Social Competence Interview, using the original Ewart protocol, which focuses attention on a persisting personal threat. Physiologic changes in 212 African American and Caucasian urban adolescents during the Social Competence Interview, mirror tracing, and reaction time tasks showed that the Social Competence Interview elicits a pronounced vasoconstrictive response pattern, with diminished cardiac activity, that is more typical of alert mental vigilance than of active coping. This pattern was observed in all race and gender subgroups. Results suggest that the Social Competence Interview may be a broadly useful procedure for investigating the role of threat-induced vigilance in cardiovascular and other diseases.