Ethnic Differences in Resting Total Peripheral Resistance: A Systematic Review and Meta-Analysis.

OBJECTIVE: Decades of research suggest that there may be important ethnic differences in the hemodynamic mechanisms that co-determine arterial blood pressure, the primary diagnostic index of hypertension. In general, studies have observed that, compared with European Americans (EAs), African Americans (AAs) exhibit higher total peripheral resistance (TPR), an important summative index of peripheral vascular constriction. In contrast, EAs have been reliably shown to exhibit greater cardiac output (CO), which is directly linked to left ventricle and overall cardiac blood flow. We have previously proposed that elevated basal TPR, in particular, represents one component of the cardiovascular conundrum, characterized, paradoxically, by elevated resting heart rate variability among AAs relative to EAs. The present meta-analysis and systematic review of the literature sought to extend this previous work by establishing the magnitude of the empirically implied ethnic differences in resting TPR and CO. METHODS: A search of the literature yielded 140 abstracts on differences in TPR between AAs and EAs; 40 were included. Sample sizes, means, and standard deviations for baseline TPR with samples that included EAs and AAs were collected, and Hedges g was computed. RESULTS: Findings indicated that AAs had higher baseline TPR than did EAs (Hedges g = 0.307, SE = 0.043, confidence interval= 0.224 to 0.391, p < .001). In addition, EAs had higher resting CO than did AAs (Hedges g = -0.214, SE = 0.056, confidence interval = -0.324 to -0.104, p < .001). CONCLUSIONS: We discuss the present findings in the context of the role of elevated TPR in the deleterious effects of high blood pressure specifically for AAs.

A look at the increasing demographic representation within behavioral medicine.

Meeting the behavioral medicine research and clinical needs of an increasingly diverse United States population is an issue of national concern. We examine the trends in the demographic representation of the behavioral medicine scientific workforce through an analysis of the training grants funded by National Institutes of Health for the field of behavioral medicine from 1980 to 2018. We report the topics of these training grants, and we depict the demographic representation of the training leaders. We provide the demographic representation of the trainees, and of the first authors of publications reported within those training grants. Finally, we report the topics addressed in these behavioral medicine publications, to determine if topic diversity increased as the behavioral medicine scientific workforce diversified. Visualizations are presented that tell a story of how we have, and have not, advanced representation within the field of behavioral medicine. Best practices for launching future successful behavioral medicine scientists are then presented, to ensure optimal representation and diversification occurs in our workforce, our science, and our delivery of our clinical care.

Impact of Racial Discrimination and Hostility on Adrenergic Receptor Responsiveness in African American Adults.

OBJECTIVE: Racial discrimination is increasingly recognized as a contributor to increased cardiovascular disease (CVD) risk among African Americans. Previous research has shown significant overlap between racial discrimination and hostility, an established predictor of CVD risk including alterations in adrenergic receptor functioning. The present study examined the associations of racial discrimination and hostility with adrenergic receptor responsiveness. METHODS: In a sample (N = 57) of young to middle-aged African American adults (51% female) with normal and mildly elevated blood pressure, a standardized isoproterenol sensitivity test (CD25) was used to evaluate ß-AR responsiveness, whereas the dose of phenylephrine required to increase mean arterial pressure by 25 mm Hg (PD25) was used to assess α1-AR responsiveness. Racial discrimination was measured using the Perceived Racism Scale and hostility was assessed using the Cook-Medley Hostility Scale. RESULTS: In hierarchical regression models, greater racial discrimination, but not hostility, emerged as a significant predictor of decreased ß-adrenergic receptor responsiveness (ß = .38, p = .004). However, moderation analysis revealed that the association between racial discrimination and blunted ß-adrenergic receptor responsiveness was strongest among those with higher hostility (ß = .49, 95% confidence interval = .17-.82, p = .004). In addition, hostility, but not racial discrimination, significantly predicted α1-AR responsiveness. CONCLUSIONS: These findings suggest racial discrimination was associated with blunted ß-adrenergic receptor responsiveness, providing further evidence of the potential contribution of racial discrimination to increased CVD risk among African Americans. The adverse effects of discrimination on cardiovascular health may be enhanced in individuals with higher levels of hostility.

Understanding associations among race, socioeconomic status, and health: Patterns and prospects.

Race/ethnicity and socioeconomic status (SES) are social categories that capture differential exposure to conditions of life that have health consequences. Race/ethnicity and SES are linked to each other, but race matters for health even after SES is considered. This commentary considers the complex ways in which race combines with SES to affect health. There is a need for greater attention to understanding how risks and resources in the social environment are systematically patterned by race, ethnicity and SES, and how they combine to influence cardiovascular disease and other health outcomes. Future research needs to examine how the levels, timing and accumulation of institutional and interpersonal racism combine with other toxic exposures, over the life-course, to influence the onset and course of illness. There is also an urgent need for research that seeks to build the science base that will identify the multilevel interventions that are likely to enhance the health of all, even while they improve the health of disadvantaged groups more rapidly than the rest of the population so that inequities in health can be reduced and ultimately eliminated. We also need sustained research attention to identifying how to build the political support to reduce the large shortfalls in health. (PsycINFO Database Record

Statement of the American Psychological Association in response to the "joint principles: integrating behavioral health care into the patient-centered medical home".

Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011), presented by the Working Party Group on Integrated Behavioral Healthcare. The American Psychological Association (APA) shares concerns about the lack of reference to behavioral health care in the original 2007 Joint Principles of the Patient-Centered Medical Home for which this new document is intended to supplement but not replace. The decision to support the supplemental Joint Principles was not an easy one for APA, as there is one area of significant concern. That concern is related to the use of the term "physician-directed medical practice"

Urbanicity affects blood pressure and heart rate reactivity to a speech stressor in Cameroon.

OBJECTIVE: To examine the interactive influence of urbanicity on cardiovascular reactivity to speech stressors among 103 urban and 93 rural Cameroonians. METHOD: Heart rate, systolic, and diastolic blood pressure (HR, SBP, and DBP) changes from baseline were assessed during a speech preparation period, speech stressor task, and post-speech recovery period. RESULTS: After adjusting for income, age, BMI, and sex, urban subjects showed greater diastolic reactivity to the pre-speech and speech conditions than to recovery. Urban subjects also showed greater reactivity to the speech stressor than to other conditions. Urban subjects showed greater HR reactivity to the speech stressor. Rural subjects showed greater diastolic reactivity to the pre-speech and speech stressor and less recovery. CONCLUSION: Urbanicity affects blood pressure and heart rate differently for urban and rural Cameroonians. It also affects recovery from stressors. More exploration into the influence of urbanization on hypertension risk factors in developing countries is warranted.

Educational attainment and response to HAART during initial therapy for HIV-1 infection.

OBJECTIVE: Previous research has demonstrated an association between educational attainment (EA) and negative physical and psychological outcomes. This study investigated whether EA is associated with regimen failure during initial therapy with highly active antiretroviral treatment (HAART) and whether adherence self-efficacy (ASE), a coping resource, moderates the relationship between EA and regimen failure. METHODS: A secondary analysis of AIDS Clinical Trial Group Protocol 384, an international, multicenter, randomized, partially double-blinded trial, included 799 male and 181 female antiretroviral-naïve subjects (age, 37.0+/-9.5 years). Participants were recruited from 1998 to 1999 and followed for a median of 2.3 years across 81 centers. The dependent variable was "time to first regimen failure." Covariates include baseline HIV-1 log(10)RNA and CD4(+) counts, self-reported adherence, study site, ASE, age, sex, race, treatment assignment, and baseline use of nonantiretroviral medications. RESULTS: ASE significantly moderated the relationship between EA and regimen failure. Results showed that for every 10-unit increase in ASE, individuals with "less than high school" education had a 17% reduction in regimen failure (hazard ratio=0.83; 95% confidence interval=0.70-0.98) when compared to the reference group "college/graduate," even after adjusting for baseline factors known to contribute to regimen failure. The time to first regimen failure was shorter with decreasing EA, trending toward significance (P=.08). CONCLUSIONS: There is a social gradient in HAART effectiveness, and ASE reduces the deleterious effects of lower EA on regimen failure. We recommend designing controlled interventions to evaluate the effectiveness of programs that increase ASE prior to initiation with HAART, particularly for those with lower EA.

Editorial policies of the American Psychologist.

This year marks the 60th anniversary of the American Psychologist (AP). Since the publication of its first issue in January 1946, AP has served as the flagship journal for the American Psychological Association (APA) and has played an important and unique role for the field of psychology. Because of the quality of the articles published in AP, the journal has evolved into one of the most influential and widely cited publications in psychology. The purpose of this editorial is to outline a revised set of policies for the journal that builds on and expands those developed by previous editors (see, e.g., Fowler, 1993; Goodstein, 1987; Kiesler, 1976; Pallack, 1981). Before outlining these policies, I would like to explore the relative status and influence of AP within the universe of psychological and social science journals.

Genes, race, and psychology in the Genome Era: an introduction

It presents an introduction on the issue of race and genetics for the journal American Psychologist, Vol. 60, No. 1, Jan. 2005. Archive on PDF format, requires Acrobat Reader.

Genes, race, and psychology in the genome era: an introduction.

The mapping of the human genome has reawakened interest in the topic of race and genetics, especially the use of genetic technology to examine racial differences in complex outcomes such as health and intelligence. Advances in genomic research challenge psychology to address the myriad conceptual, methodological, and analytical issues associated with research on genetics and race. In addition, the field needs to understand the numerous social, ethical, legal, clinical, and policy implications of research in this arena. Addressing these issues should not only benefit psychology but could also serve to guide such thought in other fields, including molecular biology. The purpose of this special issue is to begin a discussion of this issue of race and genetics within the field of psychology. Several scholars who work in the fields of genetics, race, or related areas were invited to write (or had previously submitted) articles sharing their perspectives.

Sociodemographic diversity and behavioral medicine.

The broad array of economic and cultural diversity in the U.S. population correlates with and impacts on the study of behavioral aspects of health. The purpose of this article was to provide a selective overview of behavioral medicine research on sociodemographically diverse populations, with a focus on ethnicity, gender, and socioeconomic status. Suggestions are provided with regard to methodological refinement of research and insights into possible future directions in behavioral medicine research on ethnically and economically diverse populations.