The Journal of Psychology

ISSN: 0022-3980 (Print) 1940-1019 (Online) Journal homepage: http://www.tandfonline.com/loi/vjrl20

Psychosocial Measures and Cardiovascular Risk Factors in Children and Adolescents Thomas M. Wolf , Saundra M. Hunter & Larry S. Webber To cite this article: Thomas M. Wolf , Saundra M. Hunter & Larry S. Webber (1979) Psychosocial Measures and Cardiovascular Risk Factors in Children and Adolescents, The Journal of Psychology, 101:1, 139-146, DOI: 10.1080/00223980.1979.9915065 To link to this article: http://dx.doi.org/10.1080/00223980.1979.9915065

Published online: 02 Jul 2010.

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Date: 08 November 2015, At: 07:57

Published as a separate and in The Journal of Psychology, 1979, 101. 139-146.

PSYCHOSOCIAL MEASURES AND CARDIOVASCULAR RISK FACTORS I N CHILDREN AND ADOLESCENTS*' Lori isinno State 1Jniversit.y Medirnl Center

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THOMAS M.

WOLF, SAUNDRA

M. HUNTER,AND LARRYs. WEBBER

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SUMMARY The objective of this study was to test four psychosocial measures (self-concept, locus of control, goal blockage, A-B Rating Scale) which are hypothesixed to be correlates of cardiovascular risk factor variables in children and adolescents. The psychosocial questionnaire was administered to all eighth grade students in a biracial public school. The results, based on replies from 103 boys and girls, are reported for each meaSure, and, in addition, reliability correlation coefficients (six week test-retest) and intrachild correlation coefficients are reported for each of the four measures. It is concluded that the four psychosocial measures are suitable for future research and could be employed in association with risk factor studies. Finally, a theoretical model for psychosocially mediated disease is presented . A.

INTRODUCTION

Coronary artery disease (CAD) is considered to be a multifaceted disease of complex etiology ( 2 ) . Current evidence indicates that CAD begins early in life and goes through different developmental stages before becoming clinically apparent during the adult years (14, 20). Although CAD is considered by many to have its origins in childhood, the research conducted among children and adolescents relating to this problem has been limited. Hypertension is considered to be one of the most insidious risk

* Receivvd in the Editorial Office on November 20, 1978, and published immediately at Provincetown, Massachusetk. Copyright by The Journal Press. I Supported by funds from the National Heart, Lung, and Blood Institute of the United States Public Health Service, Specialized Center of Research-Arteriosclerosis (SCOK-.4) HL15103-and the American Heart Association-Louisiana. Inc. The authors thank Dr. Gerald S. B,erenson and Dr. Ralph R. Frerichs for their consultation and support. They also thank the New Orleans Public School System for its support, and certainly the children who participated. 1\39

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factors for CL4D,but only recently has emphasis been placed on determining criteria for blood pressure levels in children (13, 2 1 ) . Most research investigators have dealt with physical risk factors [hypertension, hyperlipidemia, diabetes, obesity, smoking ( 7 , 8, 19, 21)], but the role of psychosocial risk factors in CAD has been a neglected area of research until recently (10, 11). A recent review identifies the following major psychosocial categories as being associated with the risk of coronary disease: sociological indices, social mobility and status incongruity, anxiety and neuroticism, life dissatisfactions and interpersonal problems, stress and life change, and coronary-prone behavior pattern (11). An impetus to conduct psychosocial research and its role in CAD occurred with the finding by Rosenman and Friedman and their collaborators that overt behavior pattern (Type A behavior) was strongly related to coronary heart disease in a prospective study of 39- to 59-year-old employed men that included an 8E-year follow-up (9, 18). In that population of men, an overt behavior pattern interacted with other risk factors and made an independent contribution to the development of coronary heart disease. Other studies have been conducted that have documented the relationship between coronary disease, stress, and coronary-prone behavior pattern ( 10). We have attempted to develop a psychosocial questionnaire that consists of measures thought to be meaningfully related to CAD risk factor variables (blood pressure, lipids, obesity) in children and adolescents. The appropriateness of these measures for children and how they can be administered optimally are considered.

B. METHOD 1.

Procedure

A psychosocial questionnaire was filled out in the school cafeteria. About half the children completed it one day, and the other half completed it on another day. A third day was set aside for those children who had been absent. The same general procedure was used for both the first and second administrations. Standardized instructions were given for both administrations of the questionnaire, The children were told that it was important to answer all questions truthfully and honestly. It was emphasized that the questionnaire was not a test, that there were no right or wrong answers, and that all questions must be answered even if some were difficult. The children were also informed that the results would not affect their school grades, and that all information would be kept confidential. Instructions

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THOMAS M . WOLF

et al.

14 1

for each section were read aloud and the children were encouraged to read along for those portions of the instructions included in their questionnaires. Examples of how to fill out different types of questions were demonstrated on the blackboard. The children filled out the questionnaires on their own, although a monitor was available to answer any questions. Most children took 40-60 minutes to complete the questionnaire. 2.

Measures

There were four instruments used in this study: (a) The Piers-Harris Self-concept Scale (17) is a quickly administered 80-item (two-choice, yes-no) self-report instrument designed for children in a wide age range. Higher scores (range 0-80) are associated with higher self-concrpt. ( b ) The Nowicki-Strickland Locus of Control Scale for Children (15) is a 40-item (two-choice, yes-no) questionnaire designed to measure internal and external locus of control in children. Higher scores (range 0-40) are associated with a more external orientation. (c) The goal blockage instrument (1) is an eight-item (four choice, blockage: not a t all, some, much, very much) rating scale designed to assess the extent to which the environment is perceived as a block to future advancement. Higher scores (range 0-32) are associated with greater goal blockage. ( d ) The A-B Rating Scale is a 17-item (seven-point) rating scale developed by the authors but in part derived from the literature on coronaryprone behavior patterns (9, 18) and adapted from a short rating scale developed as a potential measure of pattern A behavior (4). Positive scores (range -51 to + 5 1 ) are more indicative of Type A behavior. Type A behavior pattern is an action-emotion complex which is characterized by competitive achievement striving, exaggerated sense of time urgency, and aggression and hostility, while the opposite behavior pattern is designated Type B ( 9 , 10). 3. Subjects and Participation

The p:iychosocial questionnaire was administered in a biracial New Orleans public school to all eighth-grade students who returned signed parental Iconsent forms approving their participation in the study. For the first administration of the questionnaire, 77% (113 of 147) of the children completed the questionnaire. For the second administration (about six

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weeks between test and retest), %%I (107 of 113) of the original sample completed the questionnaire. Ten children did not answer each item on the first administration, and hence only the results from 103 students will be reported. To study reliability a total of 90 students completed all questions on both administrations.

C.

RESULTS

Table 1 shows the means and standard deviations for each of the four measures by sex and race. Three children listed race as “other” and were omitted from the racial comparisons. Blacks had a higher level of selfconcept than whites (t = 2.41, p < .05), tended to be more externally oriented (t = 1.19, p < . l o ) , and tended to have a greater degree of goal blockage ( t = 1.78, p < . l o ) . Whites scored higher on Type A behavior than blacks (t = 2 . 1 1 , p < .05). No significant sex differences were noted. Intrachild correlation coefficients among the four measures are shown by sex and race in Table 2 . The major findings were as follows: ( a ) high self-concept was related to internal locus of control (all correlations); ( b ) high self-concept was related to low goal blockage (overall, females, whites); (c) high self-concept was related to Type B coronary-prone behavior pattern (all correlations except blacks); ( d ) external locus of control was related to high goal blockage (overall, males); and ( e ) internal locus of control was related to Type A coronary-prone behavior pattern (blacks only,. No significant difference was found between goal blockage and A-B Rating Scale. For the 90 children who completed every item in both the test and retest, reliability correlation coefficients for each of the four measures were as TABLE

MEANS AND .~~

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STANDARD

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Selfconcept Mean ___Sn

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Overall (S = lo.\) Sex Rfak (.v = 61) F’emak(.y=42)

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DEVIATIONS FOR FOUR

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INSTRUMENTS BY k h C E A N D bEX

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Goal blockage Mean SD

of control Mean SD LOCW

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A-B Rating Scale Mean SD ~~

56.2

12 7

15.6

4.7

12.4

3.7

.6

10.4

55.6 57.0

12.0

15.S 15.9

4.7

4.8

12.6 12.1

3.6 3.8

1.8 -1.0

11.4

12.6

53.8 1.3.3 60.0 11.1 -~

13.9 16.8

12.0 13.3

3.2 4.2

2.3 - 2 . 2 ~-

10.8

8.5

Rac e“ White(.V=63)

B l a ck(.V=3i)

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3.8 4.5 ~

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Psychosocial measures and cardiovascular risk factors in children and adolescents.

The Journal of Psychology ISSN: 0022-3980 (Print) 1940-1019 (Online) Journal homepage: http://www.tandfonline.com/loi/vjrl20 Psychosocial Measures a...
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