Urban adolescents at high risk for cardiovascular disease (CVD) exhibit a pattern of hemodynamic responses that: (a) is evoked by social encounters that arouse anger, defensiveness, and distrust; (b) appears related to increased insulin resistance; (c) is more pronounced in males and African Americans; and (d) may constitute a pathway via which chronic exposure to stressful social environments increases CVD risk. The proposed project will evaluate these possibilities by studying patterns of hemodynamic responses to social and nonsocial stressors, ambulatory blood pressure (BP), fasting insulin, fasting glucose, lipid profiles, and central obesity in adolescents from a wide range of socioeconomic status (SES) backgrounds. During the 4-year project, a total of 1600 students entering Grade 9 in Baltimore public high schools will be screened on blood pressure, height and weight; 600 will participate in the proposed studies (equal numbers of males, females, blacks, and whites).Study 1 (Years 1-2) will measure hemodynamics in 200 subjects to test the hypothesis that hostile distrust is associated with increased total peripheral resistance (TPR) response to social challenge, and that adolescents exhibiting this response pattern have elevated levels of ambulatory BP, fasting insulin, glucose, blood lipids, and central obesity. Study 2 will follow 200 subjects for 4 years to determine if defensive hostility and distrust are related to tracking at higher levels of BP (measured every 6 months), and insulin/ glucose/ cholesterol (measured once per year). Study 3 (years 3-4) will evaluate the influence of race on the cross-situational consistency of hostile distrust/BP by measuring the latter responses in 200 adolescents during structured encounters with a friend of the same race and sex, an unfamiliar same-race peer, and an unfamiliar other-race peer (black or white). Study 4 will evaluate video and audiotape recordings from Studies 1 and 3 to test the hypothesis that distrustful individuals express more hostile affect in encounters with others, elicit more negative treatment, are perceived as hostile regardless of observer race or gender, and thus experience chronic, health-damaging interpersonal stress. Study 4 data will be used to examine the possibility that hostile distrust is related to exposure to crime, poverty, and racial discrimination.
