Antecedents of the Type A Behavior Pattern

描述（由申请人提供）：本竞争性更新申请（5 R01 HL25767-24）建议在初始评估三年后重新评估参加项目压力的青少年，以解决有关青少年心血管疾病（CVD）行为风险因素早期出现及其前因和后果的关键假设。青少年是研究CVD危险因素发展的重要时期，因为CVD危险因素在青少年中跟踪并预测以后的临床CVD，而且行为和生物学危险因素在青少年中倾向于聚集在一起。在项目压力的初始阶段，我们收集了217名黑人和白人、男性和女性高中生的数据，对心血管疾病危险因素发展的横截面模型进行了测试。我们的模型表明，青少年的社会经济地位和种族会影响他们对心理压力的暴露，包括歧视，这反过来又被认为会导致对可能的威胁保持警惕的倾向的发展，将模棱两可的情况视为潜在的危害，以及不信任他人。随着发展，这些认知倾向可能会变得更加自动化，并导致敌意、焦虑和心血管对压力的反应增强等稳定特征。这些特征可能会影响血管僵硬和左心室肿块的早期发展。我们现在建议使用与最初评估相同的测量方法对模型进行纵向测试，并添加一些利用最新技术和概念进步的新测量方法：(a)内皮功能障碍和颈动脉内膜内侧厚度；(b)处理歧视和族裔认同问题；（三）抑郁。我们预计之前的165名青少年将被重新评估，这足以检验我们的关键假设。纵向设计将是对模型的更强有力的测试，而不是先前授予的支持横断面研究的拨款。该项目将有助于建立预防亚临床CVD早期发展所需的知识库。

DESCRIPTION (provided by applicant): This competing renewal application (5 R01 HL25767-24) proposes 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. Adolescence is an important period to study the development of CVD risk factors because CVD risk factors track in adolescents and predict clinical CVD later in life and because behavioral and biological risk factors tend to cluster together in adolescents. In the initial phase of Project Pressure, we 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. Our 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. We 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. We 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 previously awarded grant supporting the cross-sectional study. This project will contribute to the knowledge base necessary to prevent the early development of sub clinical CVD.