Antecedents of the Type A Behavior Pattern
Condition: Cardiovascular Diseases; Heart Diseases
MeSH terms: Cardiovascular Diseases; Heart Diseases
Study type: Observational

Summary: 
      To identify the early emergence and stability of children's hostile behaviors and their
      associated psychophysiological responses to behavioral challenges, which are possible risk
      factors for cardiovascular diseases in adulthood; and to specify their determinants and
      consequences.
    

Detailed description: 
      DESIGN NARRATIVE:

      Beginning in 1980, the longitudinal study examined the Type A behavior pattern, hostility,
      physiological responses and family interactive behaviors in primarily white, upper-middle
      class children and parents. The study was renewed several times. In the fiscal year 1992
      renewal, the research was extended to include the study of Black children and those from
      lower-middle to middle class families. The inclusion of these groups is important not only
      because these they have been understudied, but also because an examination is needed of
      developmental factors that may be important in accounting for the much higher incidence of
      hypertension and related disorders in Blacks and in lower and lower-middle class groups. The
      current study examines the patterns of cardiovascular responses exhibited by Black and white
      children in order to better assess hemodynamic and autonomic nervous system mechanisms that
      underlie these responses. It also examines how these hemodynamic patterns relate to
      cardiovascular risk factors such as body fat distribution, left ventricular geometry (via
      echocardiography), as well as insulin, glucose, and lipid levels and it explores a new
      conceptualization of hostility indices and cardiovascular risk factors.

      A total of 184 Black and white children and adolescents of both genders are recruited for
      participation, half being pre-pubescent (9-10 years old) and half being post-pubescent (15-16
      years old). The first laboratory session consists of a fasting venous blood draw, collection
      of anthropomorphic data, a psychophysiological stress protocol involving four tasks selected
      to elicit different autonomic nervous system responses, and completion of standardized
      questionnaires to assess hostility and social support. A second session involves an
      echocardiographic assessment of left ventricular geometry and cardiac performance variables,
      the Type A Structured Interview, and an interview examining how subjects process information
      about hostile intentions and actions of others.

      The study has been extended through August 2007 to re-assess adolescents enrolled in Project
      Pressure three years after their initial assessment to address key hypotheses regarding the
      early emergence of behavioral risk factors for cardiovascular disease (CVD) in adolescence
      and their antecedents and consequences. In the initial phase of Project Pressure, the
      investigators collected data from 217 black and white, male and female high school students
      to test cross-sectionally a model of the development of CVD risk factors. Their model
      suggests that adolescents' socioeconomic status and ethnicity affect their exposure to
      psychological stress, including discrimination, which, in turn, is thought to lead to the
      development of the propensity to be vigilant for possible threat, to view ambiguous
      situations as potentially harmful, and to mistrust others. These cognitive propensities may
      become more automatic with development and lead to stable traits of hostility, anxiety, and
      heightened cardiovascular responsivity to stress. These traits may then affect the early
      development of vascular stiffness and left ventricular mass. They now propose to test the
      model longitudinally using the same measures as in the initial assessment, plus adding some
      new measures that take advantage of recent technological and conceptual advances: (a)
      endothelial dysfunction and carotid intima medial thickness; (b) coping with discrimination
      and ethnic identity; and (c) depression. They anticipate that 165 of the previous adolescents
      will be reassessed, which is adequate in terms of power to test our key hypotheses. The
      longitudinal design will be a stronger test of the model than the previous cross-sectional
      study.
    

Observational model: Ecologic or Community
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Adolescents from one high school in Pittsburgh