Loyola University Chicago Loyola eCommons Dissertations Theses and Dissertations 1989 Psychosocial Risk Factors for Essential Hypertension among Black Women Stephanie L. Livingston Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_diss Part of the Education Commons Recommended Citation Livingston, Stephanie L., "Psychosocial Risk Factors for Essential Hypertension among Black Women" (1989). Dissertations. 2746. https://ecommons.luc.edu/luc_diss/2746 This Dissertation is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Dissertations by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1989 Stephanie L. Livingston PSYCHOSOCIAL RISK FACTORS FOR ESSENTIAL HYPERTENSION AMONG BLACK WOMEN by Stephanie L. Livingston A Dissertation Submitted to the Faculty of the Graduate School of Loyola University of Chicago in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy December 1989 ACKNOWLEDGEMENTS I would like to sincerely express my appreciation to my dissertation co­ chairpersons, Dr. Kevin Hartigan and Dr. Steven Brown, for their guidance and support during the this project. Special thanks goes to Dr. Hartigan who was helpful throughout my graduate school career as an advisor, teacher, and clinician. I would also like to thank Dr. Sara Knight who also served on the committee and who has been instrumental in my clinical training. The support that I received from the staff while collecting data in the Hypertension Clinic and Nutrition and Weight Control Clinics at The University of Chicago Hospitals, is greatly appreciated. I would like to thank Michael Murphy, M.D. and Robert Kushner, MD. for allowing the use of their patients as subjects in the Hypertension and Nutrition and Weight Control clinics, respectively. I would especially like to pay tribute to my parents, Horace and Osceen Livingston, and siblings who provided the family support and encouragement I needed to complete this process. Also, to my dear friends, "Thanks for listening." i i VITA The author, Stephanie Lennore Livingston, is the daughter of Horace and Osceen Livingston. She was born September 2, 1952 in Decatur, Illinois. Her elementary and secondary education was completed in Decatur, Illinois. She graduated from Stephen Decatur High School. She received a Bachelor of Arts Degree in Administration of Justice from Southern Illinois University, Carbondale, Illinois in May, 1975. In May, 1982 she completed the requirements for a Master of Arts degree in Psychology from Sangamon State University, Springfield, Illinois. Ms. Livingston was awarded the Illinois Minority Graduate Incentive Program Fellowship, while attending Loyola University of Chicago. She completed a one year pre­ doctoral, clinical psychology internship in Behavioral Medicine at The University of Chicago Hospitals beginning July, 1988. She currently holds a clinical appointment in the Department of Psychiatry--Behavioral Medicine Section and serves on the faculty of The Pritzker School of Medicine at The University of Chicago and affiliated hospitals. iii TABLE OF CONTENTS page ACKNOWLEDGEMENTS ........................................................................ .ii VITA ................................................................................................. .iii LIST OF TABLES .................................................................................. .ix CONTENTS OF APPENDICES ................................................................... xi Chapter I. INTRODUCTION TO THE PROBLEM ............................................. 1 Etiology of Essential Hypertension ............................................... 1 Inter-Racial Differences ............................................................ 3 Biological Mechanisms ................................................... .4 Sodium Retention ................................................ .4 Sympathetic Nervous System Hypothesis ..................... 5 Parental History of Hypertension ............................... 5 Cardiovascular Reactivity ........................................ 7 Psychosocial Mechanisms ................................................ 8 Socio-ecological Factors ......................................... 8 Intra-Racial Differences ............................................................ 9 Gender Differences ........................................................ 9 Psychosocial Factors .................................................... 10 John Henryism .................................................. 10 Type A Behavior Pattern ....................................... 11 Social Mobility ................................................... 11 II. REVIEW OF RELATED LITERATURE ........................................... 15 The Concept of Race .............................................................. 15 IV Etiology of Essential Hypertension ............................................ 18 Biological Factors ....................................................... 18 Sympathetic Nervous System ................................. 18 General Adaptation Syndrome ................................ 20 Specificity Theory .............................................. 21 Parental History ................................................. 23 Gender Differences ............................................. 24 Hormonal Influences ........................................... 25 Psychosocial Factors .................................................... 25 Synchrony/De synchrony ....................................... 25 Controllability and Predictability .............................. 26 Racial Differences ........................................................ 28 Inter-racial Differences ........................................................... 30 Biological Mechanisms .................................................. 30 Sodium Retention Hypothesis ................................. 30 Plasma-Renin Hypothesis ...................................... 34 Cardiovascular Activity/Reactivity ............................ 35 Heart Rate ........................................................ 35 Blood Pressure .................................................. 36 Parental History ................................................. 36 Physical Stressors.. .. .......................................... 37 Psychosocial Stressors ......................................... 37 Psychosocial Mechanisms ............................................. .41 Psychological Distress ........................................ .41 Socio-ecological Stressors .................................... .46 Intra-racial Differences ........................................................... 46 V Biologic Risk Factors ................................................. 46 Parental History .............................................. .46 Psychologic Risk Factors ............................................ .49 Type A Behavior Pattern .................................... .49 John Henryism................................................ 56 Controllability and Predictability ............................ 58 Self-Efficacy & John Henryism ................... 62 Learned Helplessness & John Henryism ......... 63 Socioecologic Risk Factors ........................................... 63 Social Mobility ................................................ 63 Summary and Conclusions .................................................... 65 Hypotheses ............................................................. 68 Hypothesis 1 .................................................. 68 Hypothesis 2 .................................................. 68 Hypothesis 3 .................................................. 68 Hypothesis 4 .................................................. 68 Hypothesis 5 .................................................. 68 Hypothesis 6 .................................................. 68 III. METHOD ............................................................................ 69 Subjects .......................................................................... 69 Design ............................................................................ 70 Instrumention .................................................................... 70 Demographic Questionnaire (DQ) .................................... 71 John Henryism Active Coping Scale (JHAC12) ................... 71 Duncan Socioeconomic Index Revised (MSEI2) ................... 71 Systolic and Diastolic Blood Pressue ................................ 72 vi Procedure ......................................................................... 72 Data Analysis ..................................................................... 73 IV. RESULTS ............................................................................ 75 Treatment of Missing Data...................................................... 75 Sample Description .............................................................. 75 Intercorrelations among Variables ............................................. 76 Tests of Hypotheses ............................................................. 81 Summary .......................................................................... 87 V. DISCUSSION .......................................................................