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The most important risk factors for coronary heart disease (CHD) appear to be high blood pressure, elevated blood cholesterol, and smoking. However, 'type A behavior' is also thought to increase the risk of CHD. Type A behavior has been used to describe individuals who are highly competitive, oriented towards meeting deadlines, aggressive, and hostile, while type B behavior is characterized by an absence of these traits. A study was done in which 375 young adults living in rural Kentucky were assessed for risk factors for CHD. Data were collected on blood pressure, smoking habits, body weight and height, and blood cholesterol and triglycerides; subjects were also characterized as either type A or type B, based on the Jenkins Activity Survey. The participants were approximately 21 years old at the first evaluation and 29 at the second. It was found that type A subjects had significant increases in blood pressure and in cigarettes smoked during this eight-year period. Systolic blood pressure (when the heart contracts) rose an average of 2.9 mm Hg, while diastolic (when the heart relaxes) rose 3.8 mm Hg on average. Type A subjects were smoking an average of 3.3 more cigarettes per day in their late twenties than their early twenties. The type B subjects had no significant changes in blood pressure or smoking; changes in weight, blood cholesterol and blood triglycerides were similar for both groups. When analyses were performed by sex and race, differences between type A and type B subjects in blood pressure were found for women but not men, and for black subjects but not white subjects. The results indicate that type A behavior may be a significant CHD risk factor that is present in young adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

This study investigated the relationship of American Indian boarding school attendance and chronic physical health. We hypothesized boarding school attendance would be associated with an increased number of chronic physical health problems. We also examined the relationship between boarding school attendance and the 15 chronic health problems that formed the count of the chronic health conditions. American Indian attendees had a greater count of chronic physical health problems compared with nonattendees. Father's attendance was independently associated with chronic physical health problems. Attendees were more likely to have tuberculosis, arthritis, diabetes, anemia, high cholesterol, gall bladder disease, and cancer than nonattendees. [ABSTRACT FROM AUTHOR]

Background: An explicit clinical significance (CS) criterion was added to many DSM-IV diagnoses in an attempt to more closely approximate the clinical diagnostic process and reduce the proportion of false positives in epidemiological studies. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) offered a unique opportunity to examine the success of this effort., Objective: To determine the impact of distress, impairment, and help-seeking reported in a lay structured interview on concordance with a clinical reappraisal. Further, to test the efficacy of 5 operationalizations of CS on the concordance and prevalence of DSM-IV lifetime disorders., Design: Completed between 1997 and 2000, a cross-sectional probability sample survey with clinical reappraisal of approximately 10% of participants., Setting: General community., Participants: A population-based sample of 3084 members of 2 American Indian tribal groups, who were between the ages of 15 and 54 years and resided on or near their home reservations, were randomly sampled from the tribal rolls and participated in structured psychiatric interviews. Clinical reappraisals were conducted with approximately 10% of the lay-interview participants. The response rate for the lay interview was 75%, and for the clinical reappraisal it was 72%., Main Outcomes Measures: The AI-SUPERPFP Composite International Diagnostic Interview (CIDI), a culturally adapted version of the CIDI, University of Michigan version. Adapted to assess DSM-IV diagnoses, questions assessing the CS criterion were inserted in all diagnostic modules. The Structured Clinical Interview for DSM-III-R (SCID) was used in the clinical reappraisal., Results: Most participants who qualified as having AI-SUPERPFP CIDI lifetime disorders reported at least moderate levels of distress or impairment. Evidence of increased concordance between the CIDI and the SCID was lacking when more restrictive operationalizations of CS were used; indeed, the CIDI was very likely to underdiagnose disorders compared with the SCID (false negatives). Concomitantly, the CS operationalizations affected prevalence rates dramatically., Conclusion: The CS criterion, at least as operationalized to date, demonstrates little effectiveness in increasing the validity of diagnoses using lay-administered structured interviews.