The Role of Agonistic Striving in the Association Between Cortisol and High Blood Pressure.

OBJECTIVE: A social action theory of chronic stress proposes that agonistic striving (seeking to influence or control others) impairs cardiovascular health by magnifying the impact of high adversity-induced cortisol levels on blood pressure. We tested three predictions of social action theory: (1) the social action theory taxonomy of regulatory strivings characterizes young adults from high-adversity neighborhoods; (2) high cortisol levels predict high blood pressure more reliably in the subgroup with the agonistic striving profile than in subgroups with other profiles; (3) the association of higher cortisol and higher blood pressure with agonistic striving is not explained by negative affect (depressive symptoms/dysphoria, anger, hostility). METHODS: Participants were young adults (N = 198, mean [SD] age = 32 [3.4] years); 71% female; 65% black) from disadvantaged urban neighborhoods. Motive profiles (including agonistic strivings) were assessed using the Social Competence Interview. Cortisol levels were derived from saliva samples; blood pressure level was obtained during two days of ambulatory monitoring. Psychological measures of negative affect were assessed using questionnaires. RESULTS: The predicted taxonomy of regulatory strivings was replicated in this sample; the interaction between cortisol and motive profile was significant (F(2, 91) = 6.72, p = .002); analyses of simple effects disclosed that higher cortisol levels predicted higher ambulatory blood pressure only in individuals who exhibited agonistic striving. Depressive symptoms/dysphoria, trait anger, and hostility were not correlated with agonistic striving, cortisol, or blood pressure. CONCLUSIONS: Agonistic striving may represent a distinctive (and novel) social-cognitive mechanism of toxic stress and cardiovascular risk.

Gender Differences in Relations among Perceived Family Characteristics and Risky Health Behaviors in Urban Adolescents.

BACKGROUND: Research regarding the role of gender in relations between family characteristics and health risk behaviors has been limited. PURPOSE: This study aims to investigate gender differences in associations between family processes and risk-taking in adolescents. METHODS: Adolescents (N = 249; mean age = 14.5 years) starting their first year at an urban high school in the northeastern USA completed self-report measures that assessed family characteristics (i.e., parental monitoring, family social support, family conflict) and health behaviors (i.e., tobacco use, alcohol use, marijuana use, sex initiation) as part of a prospective, community-based study. Multivariate logistic regression models were used to investigate gender differences in associations between the family characteristics and health behaviors. RESULTS: Among males, higher levels of perceived parental monitoring were associated with lower odds of using tobacco and having ever engaged in sex. Among females, higher levels of perceived parental monitoring were associated with lower odds of marijuana use, alcohol use, and having ever engaged in sex. However, in contrast to males, among females (a) higher levels of perceived family social support were associated with lower odds of alcohol use and having ever engaged in sex and (b) higher levels of perceived family conflict were associated with higher odds of marijuana use and having ever engaged in sex. CONCLUSION: Family processes were more strongly related to health behaviors among adolescent females than adolescent males. Interventions that increase parental monitoring and family social support as well as decrease family conflict may help to protect against adolescent risk taking, especially for females.

Background lead and mercury exposures: Psychological and behavioral problems in children.

BACKGROUND: The potential harm from exposure to nonessential metals, particularly mercury (Hg) and lead (Pb), has been the focus of research for years. Initial interest focused on relatively high exposures; however, recent evidence suggests that even background exposures might have adverse consequences for child development. Identifying the extent of these consequences is now a priority. METHODS: We assessed blood Pb and Hg levels in a biracial sample of 9-11 year-old children (N = 203). Neurodevelopment and psychological functioning assessments included hostility, disruptive behaviors, emotion regulation, and autism spectrum disorder behaviors. Parasympathetic (vagal) responses to acute stress were indexed by heart rate variability (HRV) at rest and during stress. RESULTS: With increasing Pb levels, children exhibit higher levels of hostile distrust and oppositional defiant behaviors, were more dissatisfied and uncertain about their emotions, and had difficulties with communication. These significant associations were found within a range of blood Pb levels from 0.19 to 3.25µg/dL, well below the "reference value" for children of >5µg/dL. Vagal reactivity interacted with Hg such that increasing Hg was associated with increasing autism spectrum behaviors for those children with sustained vagal tone during acute stress. CONCLUSIONS: This study is the first to demonstrate an association between very low-level Pb exposure and fundamental psychological mechanisms that might explain prior associations with more complex outcomes such as delinquency. Analyses of vagal reactivity yielded entirely novel associations suggesting that Hg may increase autism spectrum behaviors in children with sustained vagal tone during acute stress. The novelty of these later findings requires additional research for confirmation and the cross-sectional nature of the data caution against assumptions of causality without further research.

The interaction between the dopamine receptor D4 (DRD4) variable number tandem repeat polymorphism and perceived peer drinking norms in adolescent alcohol use and misuse.

Peer drinking norms are arguably one of the strongest correlates of adolescent drinking. Prospective studies indicate that adolescents tend to select peers based on drinking (peer selection) and their peers' drinking is associated with changes in adolescent drinking over time (peer socialization). The present study investigated whether the peer selection and socialization processes in adolescent drinking differed as a function of the dopamine receptor D4 (DRD4) variable number tandem repeat genotype in two independent prospective data sets. The first sample was 174 high school students drawn from a two-wave 6-month prospective study. The second sample was 237 college students drawn from a three-wave annual prospective study. Multigroup cross-lagged panel analyses of the high school student sample indicated stronger socialization via peer drinking norms among carriers, whereas analyses of the college student sample indicated stronger drinking-based peer selection in the junior year among carriers, compared to noncarriers. Although replication and meta-analytic synthesis are needed, these findings suggest that in part genetically determined peer selection (carriers of the DRD4 seven-repeat allele tend to associate with peers who have more favorable attitudes toward drinking and greater alcohol use) and peer socialization (carriers' subsequent drinking behaviors are more strongly associated with their peer drinking norms) may differ across adolescent developmental stages.

How neighborhood disorder increases blood pressure in youth: agonistic striving and subordination.

Growing evidence links perceptions of neighborhood disorder to adverse health outcomes but little is known about psychological processes that may mediate this association. We tested the hypothesis that two psychological mechanisms-agonistic striving and subordination-mediate the link between perceived neighborhood disorder and hypertension risk in youth. Perceived neighborhood disorder, agonistic striving, subordination experiences, negative affect, obesity, and ambulatory blood pressure during daily activities (48 h) were assessed in a multiethnic sample of 167 low- to middle-income urban adolescents. Path analyses revealed that agonistic striving, subordination, and obesity each independently mediated the association between neighborhood disorder and blood pressure; these variables accounted for 73 % of the shared variance, 42 % of which was explained by agonistic striving. The direct relationship between perceived neighborhood disorder and blood pressure was no longer significant in the presence of these mediators. Negative affect was associated with neighborhood disorder and subordination, but not blood pressure. Agonistic striving proved to be a significant and substantial mediator of the association between perceived neighborhood disorder, blood pressure, and future hypertension risk. New research should seek to clarify the processes by which stressful neighborhoods induce persistent agonistic motives and perceptions of subordination in adolescents.

How implicit motives and everyday self-regulatory abilities shape cardiovascular risk in youth.

BACKGROUND AND PURPOSE: Tested hypotheses from social action theory that (a) implicit and explicit measures of agonistic (social control) motives and transcendence (self-control) motives differentially predict cardiovascular risk; and (b) implicit motives interact with everyday self-regulation behaviors to magnify risk. METHODS: Implicit/explicit agonistic/transcendence motives were assessed in a multi-ethnic sample of 64 high school students with the Social Competence Interview (SCI). Everyday self-regulation was assessed with teacher ratings of internalizing, externalizing, and self-control behaviors. Ambulatory blood pressure and daily activities were measured over 48 h. RESULTS: Study hypotheses were supported: implicit goals predicted blood pressure levels but explicit self-reported coping goals did not; self-regulation indices did not predict blood pressure directly but interacted with implicit agonistic/transcendence motives to identify individuals at greatest risk (all p ≤ 0.05). CONCLUSIONS: Assessment of implicit motives by SCI, and everyday self-regulation by teachers may improve identification of youth at risk for cardiovascular disease.

Use of the social competence interview and the anger transcendence challenge in individuals with alcohol use disorder.

Interpersonal stress is a significant determinant of relapse following treatment for Alcohol Use Disorders (AUDs), but there remains little specific information about the mechanisms underlying the relationship between interpersonal stress and AUD relapse. Application of Social Action Theory provides one new approach to advancing knowledge about the interpersonal stress-relapse relationship. Especially relevant are the Social Action Theory construct of social-emotional competence, with its accompanying measurement procedures of the Social Competence Interview and the Anger Transcendence Challenge. This study evaluated the use of the Social Competence Interview and Anger Transcendence Challenge in a sample of 63 men and women in AUD intensive outpatient treatment. The results support the use of the Social Competence Interview and the Anger Transcendence Challenge with an adult AUD clinical sample, so that these measures may help to advance knowledge about the relationship between interpersonal stress and alcohol relapse.

Associations Between Health Literacy and Health Behaviors Among Urban High School Students.

BACKGROUND: Health literacy is crucial to develop health-related knowledge, adopt healthy lifestyles, and benefit from health care services. However, research on the association between health literacy and adolescent health outcomes, particularly on their prospective associations, is rare. We assessed health literacy using 3 validated measures, and examined cross-sectional and prospective associations between health literacy and adolescent health behaviors and outcomes. METHODS: We conducted a short-term prospective study of 250 adolescents (mean age = 14 years; 57% female; 48% African American) who were entering or in the ninth grade in an urban school district. Health literacy was assessed by individual interviews at baseline, and health-related behaviors and outcomes were assessed by a paper-and-pencil survey at baseline and at a 6-month follow-up. RESULTS: Nearly half of the sample was reading at least 2 grades below expected levels. Lower baseline health literacy was associated with a lower self-rating of general health, unhealthier diet, heavier weight, and greater engagement in problem behaviors and sexual behaviors at baseline. Lower baseline health literacy also was associated with a greater increase in substance use over time. CONCLUSIONS: Results point to the pressing need to improve health literacy in urban high school students.

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.

Sociotropic cognition moderates stress-induced cardiovascular responsiveness in women through effects on total peripheral resistance, but not cardiac output.

Although cardiovascular disease (CVD) remains the leading cause of mortality in women, few studies have examined the role of psychosocial factors in its development. This study examined the moderating effects of sociotropic cognition (SC), a need for social acceptance and approval, on psychosocial stress-induced cardiovascular responsiveness (CVR) and affect reactivity in women. Sixty-eight normotensive, college-aged females were randomly assigned to a low or high social threat condition. Measures of systolic, diastolic and mean arterial blood pressures (SBP, DBP and MAP, respectively), heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and negative affect were collected during rest, and under conditions of high vs. low interpersonal threat. A two-step hierarchical regression analysis was performed to predict all response variables (BPs, HR, CO, TPR and affect). Increases in SBP, DBP, MAP, TPR and negative affect were greater in the high threat than low threat condition. Changes in SBP, MAP and TPR positively covaried with SC under conditions of high interpersonal threat, but showed no significant covariation in the low threat condition. The data suggest that an excessive need for social acceptance may contribute to rises in BP through an increase in TPR, but not CO under conditions of high social threat.

Interaction effects between the 5-hydroxy tryptamine transporter-linked polymorphic region (5-HTTLPR) genotype and family conflict on adolescent alcohol use and misuse.

AIMS: To investigate whether the effects of family conflict on adolescent drinking differed as a function of 5-hydroxy tryptamine transporter-linked polymorphic region (5-HTTLPR) genotype cross-sectionally and prospectively in two independent samples of adolescents. DESIGN: Path analysis and multi-group analysis of two prospective datasets were conducted. SETTINGS: United States and United Kingdom. PARTICIPANTS: Sample 1 was 175 adolescents in the United States (mean age = 15 at times 1 and 2 with a 6-month interval); Sample 2 was 4916 adolescents in the United Kingdon (mean age = 12 at time 1 and 15 at time 2). MEASUREMENTS: In both samples, demographics, tri-allelic 5-HTTLPR genotype and perceived family conflict were assessed at time 1. Alcohol use (frequency of drinking) and alcohol misuse (frequency of intoxication, frequency of drinking three or more drinks, maximum number of drinks) were assessed at times 1 and 2. FINDINGS: A significant gene-environment interaction on alcohol misuse at time 1 was found in both sample 1 (ß = 0.57, P = 0.001) and sample 2 (ß = 0.19, P = 0.01), indicating that the 5-HTTLPR low-activity allele carriers exposed to higher levels of family conflict were more likely to engage in alcohol misuse than non-carriers. A significant gene-environment interaction effect on change in alcohol misuse over time was found only in sample 1 (ß = 0.48, P = 0.04) but not in sample 2. CONCLUSIONS: Compared with non-carriers, adolescents carrying the 5-HTTLPR low-activity allele are more susceptible to the effects of family conflict on alcohol misuse.

Discovering how urban poverty and violence affect health: development and validation of a Neighborhood Stress Index.

Health problems of the urban poor have been attributed to psychosocial effects of environmental stress. Testing such models requires an ability to measure neighborhood characteristics that make life stressful. The City Stress Inventory (CSI) uses self-report to assess perceived neighborhood disorder and exposure to violence. Data from an interracial sample of urban adolescents show the CSI to be internally consistent, stable, and correlated with census indices of social disadvantage. Validity for stress research is indicated by correlations with trait depression, anger, hostility, self-esteem, and mood changes during a debate with an unfamiliar peer. The CSI can be completed by persons with an 8th-grade education.

Agonistic interpersonal striving: social-cognitive mechanism of cardiovascular risk in youth?

The social competence model (SCM) of cardiovascular disease (CVD) risk identifies combinations of goal-oriented strivings, expressive behaviors, and social skill deficits that contribute to persisting interpersonal difficulties and chronic health-damaging stress in youth. SCM hypotheses were tested on 187 Black and White adolescents who completed the Social Competence Interview (SCI) and later underwent ambulatory blood pressure (ABP) monitoring. Cluster analyses of stress narratives assessed via SCI identified 3 predicted stress profiles: agonistic (interpersonally focused), transcendent (self-development focused), and avoidant. Group comparisons using social, hemodynamic, and ABP data supported the SCM hypothesis that youths who exhibit the agonistic striving profile display diminished social competence, negative social impact, and heightened cardiovascular responding during a stress interview, and elevated ABP during normal social interactions, thus suggesting higher risk of CVD.

Cardiovascular reactivity during social and nonsocial stressors: do children's personal goals and expressive skills matter?

The relationships between social competence and cardiovascular reactivity were evaluated in 180 children (ages 8-17; 52% female; 53% Caucasian). Participants performed a social task (Social Competence Interview [SCI]) and 2 nonsocial tasks while reactivity measures were obtained. Social competence was coded from SCI audiotapes. Among adolescents, higher scores on the Acceptance-Affiliation subscale were associated with increased heart rate (HR) and blood pressures and with decreased HR variability during the SCI. Among boys, greater Acceptance-Affiliation scores were associated with increased vascular reactivity during the SCI. During the nonsocial tasks, higher Self-Defensiveness and Expressiveness scores were associated with increased cardiac output and stroke volume among African American children. Personal strivings and expressive skills do matter for understanding cardiovascular responses in children.

Hypertension Intervention Pooling Project.

Data from 12 independently designed and conducted randomized trials of behavioral interventions for hypertension, consisting principally of variants of relaxation and biofeedback therapies, were aggregated to assess current progress of research in this area. Meta-analytical methods revealed a statistically significant decrease in diastolic blood pressure for nonmedicated patients at the end of intervention. No significant improvement was detected in medicated patients, but potential differential effectiveness of prescribed medications and differences in compliance among patients prohibits separation of changes due to behavioral treatments alone. The need to devise criteria for selection of patients, and to establish the most appropriate patient-treatment match is emphasized.

Measuring stress resilience and coping in vulnerable youth: the Social Competence Interview.

A brief interview to measure stress coping capabilities was developed and tested in 4 samples of African American and White adolescents in low-income neighborhoods of 2 large U.S. cities. The Social Competence Interview (SCI) is a 10-min social stressor that assesses physiological and social-emotional responses to a recurring real-life problem. A new behavioral coding system using audiotapes permits reliable and valid assessment of components of social competence, including Interpersonal Skills (expressiveness, empathy), Goal-Oriented Strivings in coping (self defense, social acceptance, competitiveness, stimulation-pleasure, approval, self improvement), and Social Impact (high vs. low affiliation/control). High SCI expressiveness and self-defensive striving create a critical-aggressive social impact, which is correlated with increased hostility and anger.

Can agonistic striving lead to unexplained illness? Implicit goals, pain tolerance, and somatic symptoms in adolescents and adults.

OBJECTIVES: We tested the social action theory hypotheses that (a) psychological stress induced by struggling to control others (agonistic striving) is associated with higher levels of subjective somatic symptoms than stress induced by struggling to control the self (transcendence striving); (b) the association between agonistic striving and symptoms is moderated by the ability to tolerate pain; and (c) associations among agonistic goals, pain tolerance, and subjective symptoms are not explained by personality and affective traits or negative emotional responses to personal stressors. METHODS: Implicit motives and negative emotional reactivity to recurring personal stressors were assessed by Social Competence Interview in 333 adolescents and adults who participated in longitudinal research on functional abdominal pain at a university medical center. Pain tolerance was assessed by graduated thermal pain protocol; subjective somatic symptoms, and personality/affective traits assessed by questionnaires. The primary outcome measure was the self-reported severity of 35 somatic symptoms often experienced in the absence of diagnosable disease. RESULTS: All hypotheses were supported. CONCLUSIONS: Nonconscious agonistic strivings may increase the perceived frequency and severity of subjective somatic symptoms; this tendency is greatly magnified by difficulty in self-regulating responses to painful stimuli. Implicit agonistic motives and their associations with symptoms are not explained by individual differences in trait neuroticism, anxiety, depression, anger, or low self-esteem or by negative emotional reactivity to a personal stressor. These findings may afford fruitful insights into mechanisms by which stressful social environments undermine health and suggest promising directions for clinical intervention.

Do agonistic motives matter more than anger? Three studies of cardiovascular risk in adolescents.

OBJECTIVES: Three motivational profiles have been associated with recurring psychological stress in low-income youth and young adults: Striving to control others (agonistic striving), striving to control the self (transcendence striving), and not asserting control (dissipated striving). Agonistic striving has been associated with elevated ambulatory blood pressure during daily activities. Three studies tested the hypotheses that: (1) agonistic striving is associated with poor anger regulation, and (2) agonistic striving and poor anger regulation interactively elevate blood pressure. DESIGN: Motivational profiles, anger regulation, and ambulatory blood pressure were assessed in a multiethnic sample of 264 urban youth. MAIN OUTCOME MEASURES: (1) anger regulation/recovery during laboratory challenge; (2) anger/blood pressure during daily activities (48 hours). RESULTS AND CONCLUSION: Replication of the profiles in distant cities showed they occur with similar frequency across differences of region, race, and gender. Analyses controlling for body size, race, and gender revealed that individuals with the agonistic striving profile had higher ambulatory pressure, especially during social encounters. They became more openly angry and aggressive when challenged but did not exhibit difficulty regulating anger in the laboratory, nor did they feel angrier during monitoring. However, individuals with the agonistic striving profile who did display poor anger regulation in the lab had the highest blood pressure; deficient self-regulatory capability amplified the positive association between agonistic striving and cardiovascular risk in both genders and all ethnic groups. Although anger is thought to increase cardiovascular risk, present findings suggest that anger and elevated blood pressure are coeffects of agonistic struggles to control others.

Application of the social action theory to understand factors associated with risky sexual behavior among individuals in residential substance abuse treatment.

Risky sexual behavior (RSB) is a leading cause of HIV/AIDS, particularly among urban substance users. Using the social action theory, an integrative systems model of sociocognitive, motivational, and environmental influences, as a guiding framework, the current study examined (1) environmental influences, (2) psychopathology and affect, (3) HIV-related attitudes and knowledge, and (4) self-regulatory skills/deficits as factors associated with event-level condom use (CU) among a sample of 156 substance users residing at a residential substance abuse treatment center (M age = 41.85; SD = 8.59; 75% male). RSB was assessed using event-level measurement of CU given its advantages for improved accuracy of recall and ability for an examination of situational variables. A logistic regression predicting event-level CU indicated the significant contribution of partner type (environmental influences), less favorable attitudes towards condoms (HIV-related attitudes and knowledge), and higher levels of risk-taking propensity (self-regulatory skills/deficits) in predicting greater likelihood of not having used a condom at one's most recent sexual encounter. This study contributes to the literature examining HIV risk behaviors among substance users within a theory-driven model of risk.

Assessing cardiovascular reactivity in working women with the social competence interview.

The Social Competence Interview (SCI), an interview to induce cardiovascular reactivity through recounting a stressful life experience, was used with a sample of 120 working women employed as childcare providers. Women recounted their most stressful work factor while cardiovascular reactions were monitored at 2-minute intervals (data points included 4 baseline, 6 SCI, and 3 recovery). Increases were found when comparing mean baseline and SCI measures: systolic blood pressure (SBP) increased 10.00 mmHg; diastolic blood pressure (DBP)increased 10.63 mmHg; and heart rate increased 4.57 beats per minute. Consistent with the literature SBP and DBP were higher for some subgroups of women (those who were 50 years or older, were obese, or had 4 or more risk factors) across all data points. There were no time by individual difference interactions, indicating that the patterns of change over time were the same across groups. In a logistic regression, comparing women who reached SBP > or = 140 mmHg and/or DBP > or = 90 mmHg during the SCI versus those who did not, higher BP was associated with being older and obese, having a higher level of acceptance coping, and a lower level of suppression of competing activities coping.