Active coping remains a poorly understood construct in cardiovascular reactivity testing. We have... more Active coping remains a poorly understood construct in cardiovascular reactivity testing. We have shown that active coping comprises two independent effects: the enhanced control and the effort of exercising control. The present study tested the proposition that, with effort left unconstrained, increased self-efficacy will increase cardiovascular response. Forty women were assigned to low or high self-efficacy conditions; self-efficacy was manipulated using false feedback. Subjects then engaged in a video game shape-matching task, while blood pressure and heart rate were monitored. SBP and DBP changes were smaller in the low self-efficacy group, as predicted: 17.9 versus 25.2 mmHG for SBP (p < 0.05); and 8.7 versus 13.0 mmHG for DBP (p = 0.07). Heart rate was similar for the two conditions. We conclude that self-efficacy for a task may be an integral part of the active coping process, indirectly affecting the blood pressure response by acting on the effort involved in the coping response.
Health education & behavior : the official publication of the Society for Public Health Education, Jan 13, 2015
We explored the effect of a culturally targeted calorie label intervention on food purchasing beh... more We explored the effect of a culturally targeted calorie label intervention on food purchasing behavior of elementary school students. We used a quasi-experimental design with two intervention schools and one control school to assess food purchases of third through fifth graders at standardized school food sales before and after the intervention (immediate and delayed) in schools. The intervention comprised three 1-hour assembly-style hip-hop-themed multimedia classes. A mean total of 225 children participated in two baseline preintervention sales with and without calorie labels; 149 children participated in immediate postintervention food sales, while 133 children participated in the delayed sales. No significant change in purchased calories was observed in response to labels alone before the intervention. However, a mean decline in purchased calories of 20% (p < .01) and unhealthy foods (p < .01) was seen in immediately following the intervention compared to baseline purchase...
This study examines the possibility that social support operates as a moderator of cardiovas- cul... more This study examines the possibility that social support operates as a moderator of cardiovas- cular reactivity, which may be a factor in the development of heart disease and hypertension. An experiment was performed in which each of 40 subjects was the object of verbal attack in a discussion of a controversial issue. In each session, one subject and three confederates
Use of mercury sphygmomanometer is being phased out due to environmental concerns from potential ... more Use of mercury sphygmomanometer is being phased out due to environmental concerns from potential mercury toxicity. To date, there is no consensus about valid replacement for its use. Currently, Ambulatory Blood Pressure Monitoring (ABPM) is considered the gold standard for accurate BP assessment in outpatient settings. Among 73 patients followed in 3 hospital-based practices, we compared BP readings from an automated oscillometric device (BpTRU) with ABPM readings and mercury sphygmomanometer readings taken by physicians (MDBP). We hypothesized that BpTRU readings would be highly correlated with mercury sphygmomanometer readings taken by physicians. The protocol included a 24 hour ABPM, 3 MDBP, and 6 BpTRU readings, taken on 2 consecutive days. Using ABPM as a gold standard, the BpTRU and MDBP readings were compared to ABPM readings. Agreement between the BP readings was evaluated using descriptive measures, Bland-Altman plots, and intra-class coefficient. Thirty percent of the systolic and 39% of the diastolic MDBP readings were higher than the corresponding ABPM, readings, while only 23% of the systolic and 19% of the diastolic BpTRU readings were higher than ABPM. The absolute difference in mean SBP and DBP between ABPM and BpTRU was 10.93 and 10.75 mm hg respectively. Similarly, the difference in mean SBP and DBP between ABPM and MDBP was 10.42 and 10.73 mm hg. The intra-class coefficients between ABPM and BpTRU was 0.89 (SBP) and 0.60 (DBP); while a coefficient of 0.89 (SBP) and 0.64 (DBP) was found between ABPM and MDBP We conclude that the agreement and correlation between BpTRU readings and ABPM are similar to that of MDBP and ABPM, with BpTRU having fewer proportions of higher readings than MDBP when compared to ABPM. Thus, BpTRU may serve as a valid substitution for mercury sphygmomanometer in outpatient settings.
A range of nonpharmacological interventions (e.g., meditation) have positive effects on blood pre... more A range of nonpharmacological interventions (e.g., meditation) have positive effects on blood pressure (BP) but tend to have poor adherence. These interventions may lower BP partly by absorbing and directing attention away from one's negative thoughts. We hypothesized that recurring self-selected activities (SSAs) that are attentionally absorbing may similarly lower BP. We examined the effect of reported engagement in SSAs during the previous month prior to participation on ambulatory BP (ABP) and whether those prone to rumination were less likely to show these effects. Participants (n = 38) reported engagement in SSAs and how absorbing they were, responded to trait rumination and perceived stress questionnaires, wore an ABP monitor for 24 hours, and at each ABP measurement answered electronic diary questions assessing activity levels, affect, social interactions, and caffeine and tobacco use. Regression analyses tested whether the reported absorption of SSAs, trait rumination, ...
Home blood pressure (HBP) monitoring plays an increasingly important role in the diagnosis and tr... more Home blood pressure (HBP) monitoring plays an increasingly important role in the diagnosis and treatment of hypertension. We evaluated the independent value of HBP compared with ambulatory blood pressure (ABP) and office blood pressure (OBP) in the prediction of cardiovascular end-organ damage in normotensive subjects and untreated patients with mild hypertension. One hundred sixty-three subjects underwent measurements of OBP, HBP, ABP, and echocardiography. A physician using a mercury-column sphygmomanometer performed three OBP measurements. The ABP was recorded using a noninvasive ambulatory monitor (mean, 35.4 awake readings per subject). Participants took HBP readings with an automatic, oscillometric device over a 10-week period (mean, 277.9 readings per subject). The left-ventricular mass index (LVMI) was calculated from measurements obtained from two-dimensionally guided M-mode or linear tracings on echocardiography. For systolic and diastolic blood pressures (SBP/DBP), the co...
This study examined the possibility that reactivity to acute stressors may be altered among women... more This study examined the possibility that reactivity to acute stressors may be altered among women facing the chronic stress of being at familial risk for breast cancer. Sixteen healthy women with histories of breast cancer in their families (Risk Group) and 32 women at normal risk (Comparison Group) were exposed to 15 min of classic laboratory stressors. Seventeen women at normal risk were randomly assigned to nonstressful tasks (manipulation check). Self-reported distress, natural killer cell activity (NKCA), and NK cell numbers (percentage of CD3-CD16/56+ lymphocytes) were assessed before and after the tasks. Cardiovascular activity was assessed throughout the session. The tasks elicited increases in distress, heart rate, NKCA, and NK cells numbers in both experimental groups. Supporting study hypotheses, the Risk Group had larger increases in distress, heart rate, NKCA, and NK cell numbers. These findings raise the possibility that the chronic stress associated with familial canc...
American Journal of Hypertension - AMER J HYPERTENS, 2003
Purpose: Physician measurement of BP is notoriously unreliable when performed in the usual manner... more Purpose: Physician measurement of BP is notoriously unreliable when performed in the usual manner, and correlates poorly with Ambulatory BP Monitoring (ABPM), which is emerging as the best BP predictor of risk. Our aim was to compare the BP readings from an automated oscillometric device (BPTru), that can be used in the outpatient setting with 24 hour ABPM and physician BP taken in accordance with standard guidelines (MDBP).Methods: Our study was conducted at two inner-city community hospitals: North General Hospital and Englewood Hospital. The protocol included 3 readings of MDBP taken with a mercury sphygmomanometer, 6 BPTru readings, both taken on 2 consecutive days, and a 24 hour ABPM. A total of 49 patients (11 hypertensive and 38 normotensive) were studied. The average 24 hour ABP was 132.8/86.8 mmHg, and the daytime average 135.1/88.9 mmHg. For days 1 and 2 MDBPs were 129.6/82.4 and 122.9/80.4, (p<0.05 for decrease of systolic BP fromday1-day2) and BPTrus were 125.6/76.9 a...
Cognitive, behavioral, and interpersonal vulnerabilities have been studied in patients fulfilling... more Cognitive, behavioral, and interpersonal vulnerabilities have been studied in patients fulfilling diagnostic criteria for major depression and dysthymia. The extent to which these vulnerabilities are present in cardiac patients with mild to moderate depressive symptoms--a risk factor for mortality--is unknown. Moreover, few studies have examined interrelations among depression vulnerabilities. A consecutive cohort of 314 patients with acute coronary syndrome completed the Beck Depression Inventory (BDI) and measures of cognitive, behavioral, and interpersonal vulnerabilities (Dysfunctional Attitudes Scale, Pleasant Events Schedule for the Elderly, Dyadic Adjustment Scale, and an inventory of role transitions) within 1 week of hospital admission. Of the patients, 166 were classified as nondepressed (BDI score, 0-4), 91 as mildly depressed (BDI score, 10-16), and 57 as moderately to severely depressed (BDI score, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;16). Compared with nondepressed patients, both mildly depressed and moderately to severely depressed patients exhibited higher mean levels of all vulnerabilities as well as a higher prevalence of more than one elevated vulnerability, defined by threshold scores. Vulnerabilities were only minimally interrelated (r = 0.01-0.25), and they were independently associated with mild and moderate depressive symptom status. This is the first study to show that cognitive, behavioral, and interpersonal depression vulnerabilities are uniquelyassociated with concurrent depressive symptoms. There appeared to be only modest overlap between vulnerabilities, supporting the idea that depression in medically ill patients is a multifaceted phenomenon, even in the presence of minimally elevated depressive symptoms. Longitudinal studies are required before causality and treatment implications can be addressed.
American Journal of Hypertension - AMER J HYPERTENS, 2000
A common finding of laboratory studies of cardiovascular reactivity to stress is a lack of corres... more A common finding of laboratory studies of cardiovascular reactivity to stress is a lack of correspondence between blood pressure (BP) and self-reports of emotional state. To evaluate differences between effects of mental and emotional stress on self-reported affect, 89 healthy nurses performed serial subtraction (2 minutes) and an anger-recall task (5 minutes). Resting periods were given prior to and following each task. BP was measured continuously using a Finapres 2300 monitor. Immediately following each stresser, Likert-type ratings were taken for how angry and how stressed the subject felt. Results showed that self-reported anger was significantly correlated with SBP and DBP during the emotional task (anger-recall; rs = .24 and .25, ps < .05, respectively). However, neither self-reported anger nor stress was lesser associated with BP during the mental stress task (serial subtraction). These data suggest either that cardiovascular reactivity is more directly related to affecti...
Active coping remains a poorly understood construct in cardiovascular reactivity testing. We have... more Active coping remains a poorly understood construct in cardiovascular reactivity testing. We have shown that active coping comprises two independent effects: the enhanced control and the effort of exercising control. The present study tested the proposition that, with effort left unconstrained, increased self-efficacy will increase cardiovascular response. Forty women were assigned to low or high self-efficacy conditions; self-efficacy was manipulated using false feedback. Subjects then engaged in a video game shape-matching task, while blood pressure and heart rate were monitored. SBP and DBP changes were smaller in the low self-efficacy group, as predicted: 17.9 versus 25.2 mmHG for SBP (p &lt; 0.05); and 8.7 versus 13.0 mmHG for DBP (p = 0.07). Heart rate was similar for the two conditions. We conclude that self-efficacy for a task may be an integral part of the active coping process, indirectly affecting the blood pressure response by acting on the effort involved in the coping response.
Health education & behavior : the official publication of the Society for Public Health Education, Jan 13, 2015
We explored the effect of a culturally targeted calorie label intervention on food purchasing beh... more We explored the effect of a culturally targeted calorie label intervention on food purchasing behavior of elementary school students. We used a quasi-experimental design with two intervention schools and one control school to assess food purchases of third through fifth graders at standardized school food sales before and after the intervention (immediate and delayed) in schools. The intervention comprised three 1-hour assembly-style hip-hop-themed multimedia classes. A mean total of 225 children participated in two baseline preintervention sales with and without calorie labels; 149 children participated in immediate postintervention food sales, while 133 children participated in the delayed sales. No significant change in purchased calories was observed in response to labels alone before the intervention. However, a mean decline in purchased calories of 20% (p < .01) and unhealthy foods (p < .01) was seen in immediately following the intervention compared to baseline purchase...
This study examines the possibility that social support operates as a moderator of cardiovas- cul... more This study examines the possibility that social support operates as a moderator of cardiovas- cular reactivity, which may be a factor in the development of heart disease and hypertension. An experiment was performed in which each of 40 subjects was the object of verbal attack in a discussion of a controversial issue. In each session, one subject and three confederates
Use of mercury sphygmomanometer is being phased out due to environmental concerns from potential ... more Use of mercury sphygmomanometer is being phased out due to environmental concerns from potential mercury toxicity. To date, there is no consensus about valid replacement for its use. Currently, Ambulatory Blood Pressure Monitoring (ABPM) is considered the gold standard for accurate BP assessment in outpatient settings. Among 73 patients followed in 3 hospital-based practices, we compared BP readings from an automated oscillometric device (BpTRU) with ABPM readings and mercury sphygmomanometer readings taken by physicians (MDBP). We hypothesized that BpTRU readings would be highly correlated with mercury sphygmomanometer readings taken by physicians. The protocol included a 24 hour ABPM, 3 MDBP, and 6 BpTRU readings, taken on 2 consecutive days. Using ABPM as a gold standard, the BpTRU and MDBP readings were compared to ABPM readings. Agreement between the BP readings was evaluated using descriptive measures, Bland-Altman plots, and intra-class coefficient. Thirty percent of the systolic and 39% of the diastolic MDBP readings were higher than the corresponding ABPM, readings, while only 23% of the systolic and 19% of the diastolic BpTRU readings were higher than ABPM. The absolute difference in mean SBP and DBP between ABPM and BpTRU was 10.93 and 10.75 mm hg respectively. Similarly, the difference in mean SBP and DBP between ABPM and MDBP was 10.42 and 10.73 mm hg. The intra-class coefficients between ABPM and BpTRU was 0.89 (SBP) and 0.60 (DBP); while a coefficient of 0.89 (SBP) and 0.64 (DBP) was found between ABPM and MDBP We conclude that the agreement and correlation between BpTRU readings and ABPM are similar to that of MDBP and ABPM, with BpTRU having fewer proportions of higher readings than MDBP when compared to ABPM. Thus, BpTRU may serve as a valid substitution for mercury sphygmomanometer in outpatient settings.
A range of nonpharmacological interventions (e.g., meditation) have positive effects on blood pre... more A range of nonpharmacological interventions (e.g., meditation) have positive effects on blood pressure (BP) but tend to have poor adherence. These interventions may lower BP partly by absorbing and directing attention away from one's negative thoughts. We hypothesized that recurring self-selected activities (SSAs) that are attentionally absorbing may similarly lower BP. We examined the effect of reported engagement in SSAs during the previous month prior to participation on ambulatory BP (ABP) and whether those prone to rumination were less likely to show these effects. Participants (n = 38) reported engagement in SSAs and how absorbing they were, responded to trait rumination and perceived stress questionnaires, wore an ABP monitor for 24 hours, and at each ABP measurement answered electronic diary questions assessing activity levels, affect, social interactions, and caffeine and tobacco use. Regression analyses tested whether the reported absorption of SSAs, trait rumination, ...
Home blood pressure (HBP) monitoring plays an increasingly important role in the diagnosis and tr... more Home blood pressure (HBP) monitoring plays an increasingly important role in the diagnosis and treatment of hypertension. We evaluated the independent value of HBP compared with ambulatory blood pressure (ABP) and office blood pressure (OBP) in the prediction of cardiovascular end-organ damage in normotensive subjects and untreated patients with mild hypertension. One hundred sixty-three subjects underwent measurements of OBP, HBP, ABP, and echocardiography. A physician using a mercury-column sphygmomanometer performed three OBP measurements. The ABP was recorded using a noninvasive ambulatory monitor (mean, 35.4 awake readings per subject). Participants took HBP readings with an automatic, oscillometric device over a 10-week period (mean, 277.9 readings per subject). The left-ventricular mass index (LVMI) was calculated from measurements obtained from two-dimensionally guided M-mode or linear tracings on echocardiography. For systolic and diastolic blood pressures (SBP/DBP), the co...
This study examined the possibility that reactivity to acute stressors may be altered among women... more This study examined the possibility that reactivity to acute stressors may be altered among women facing the chronic stress of being at familial risk for breast cancer. Sixteen healthy women with histories of breast cancer in their families (Risk Group) and 32 women at normal risk (Comparison Group) were exposed to 15 min of classic laboratory stressors. Seventeen women at normal risk were randomly assigned to nonstressful tasks (manipulation check). Self-reported distress, natural killer cell activity (NKCA), and NK cell numbers (percentage of CD3-CD16/56+ lymphocytes) were assessed before and after the tasks. Cardiovascular activity was assessed throughout the session. The tasks elicited increases in distress, heart rate, NKCA, and NK cells numbers in both experimental groups. Supporting study hypotheses, the Risk Group had larger increases in distress, heart rate, NKCA, and NK cell numbers. These findings raise the possibility that the chronic stress associated with familial canc...
American Journal of Hypertension - AMER J HYPERTENS, 2003
Purpose: Physician measurement of BP is notoriously unreliable when performed in the usual manner... more Purpose: Physician measurement of BP is notoriously unreliable when performed in the usual manner, and correlates poorly with Ambulatory BP Monitoring (ABPM), which is emerging as the best BP predictor of risk. Our aim was to compare the BP readings from an automated oscillometric device (BPTru), that can be used in the outpatient setting with 24 hour ABPM and physician BP taken in accordance with standard guidelines (MDBP).Methods: Our study was conducted at two inner-city community hospitals: North General Hospital and Englewood Hospital. The protocol included 3 readings of MDBP taken with a mercury sphygmomanometer, 6 BPTru readings, both taken on 2 consecutive days, and a 24 hour ABPM. A total of 49 patients (11 hypertensive and 38 normotensive) were studied. The average 24 hour ABP was 132.8/86.8 mmHg, and the daytime average 135.1/88.9 mmHg. For days 1 and 2 MDBPs were 129.6/82.4 and 122.9/80.4, (p<0.05 for decrease of systolic BP fromday1-day2) and BPTrus were 125.6/76.9 a...
Cognitive, behavioral, and interpersonal vulnerabilities have been studied in patients fulfilling... more Cognitive, behavioral, and interpersonal vulnerabilities have been studied in patients fulfilling diagnostic criteria for major depression and dysthymia. The extent to which these vulnerabilities are present in cardiac patients with mild to moderate depressive symptoms--a risk factor for mortality--is unknown. Moreover, few studies have examined interrelations among depression vulnerabilities. A consecutive cohort of 314 patients with acute coronary syndrome completed the Beck Depression Inventory (BDI) and measures of cognitive, behavioral, and interpersonal vulnerabilities (Dysfunctional Attitudes Scale, Pleasant Events Schedule for the Elderly, Dyadic Adjustment Scale, and an inventory of role transitions) within 1 week of hospital admission. Of the patients, 166 were classified as nondepressed (BDI score, 0-4), 91 as mildly depressed (BDI score, 10-16), and 57 as moderately to severely depressed (BDI score, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;16). Compared with nondepressed patients, both mildly depressed and moderately to severely depressed patients exhibited higher mean levels of all vulnerabilities as well as a higher prevalence of more than one elevated vulnerability, defined by threshold scores. Vulnerabilities were only minimally interrelated (r = 0.01-0.25), and they were independently associated with mild and moderate depressive symptom status. This is the first study to show that cognitive, behavioral, and interpersonal depression vulnerabilities are uniquelyassociated with concurrent depressive symptoms. There appeared to be only modest overlap between vulnerabilities, supporting the idea that depression in medically ill patients is a multifaceted phenomenon, even in the presence of minimally elevated depressive symptoms. Longitudinal studies are required before causality and treatment implications can be addressed.
American Journal of Hypertension - AMER J HYPERTENS, 2000
A common finding of laboratory studies of cardiovascular reactivity to stress is a lack of corres... more A common finding of laboratory studies of cardiovascular reactivity to stress is a lack of correspondence between blood pressure (BP) and self-reports of emotional state. To evaluate differences between effects of mental and emotional stress on self-reported affect, 89 healthy nurses performed serial subtraction (2 minutes) and an anger-recall task (5 minutes). Resting periods were given prior to and following each task. BP was measured continuously using a Finapres 2300 monitor. Immediately following each stresser, Likert-type ratings were taken for how angry and how stressed the subject felt. Results showed that self-reported anger was significantly correlated with SBP and DBP during the emotional task (anger-recall; rs = .24 and .25, ps < .05, respectively). However, neither self-reported anger nor stress was lesser associated with BP during the mental stress task (serial subtraction). These data suggest either that cardiovascular reactivity is more directly related to affecti...
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Papers by William Gerin