C. David Jenkins

A scale for the estimation of sleep problems in clinical research.

Problems in sleeping are widely prevalent in modern society and are often one of the presenting complaints of patients consulting physicians. In addition, there is scattered epidemiologic evidence and considerable clinical support that disturbed or inadequate sleep may be a risk factor for clinical emergence of cardiovascular disease and for total mortality. The role of sleep problems both as a precursor and as a sequela of disease states could be better delineated in large groups by the availability of a brief, reliable and standardized scale for sleep disturbance. Such a scale could also be used to evaluate the impact of different therapies upon sleep problems. This paper presents data from two study populations responding to three and four item self-report scales. From 9 to 12% of air traffic controllers reported various sleep problems to have occurred on half or more of the days during the prior month, whereas 12-22% of patients 6 months after cardiac surgery reported such frequent sleep problems. Utilizing data from the 6 and 12 month follow-ups, test-retest reliability of the three-item scale in cardiac surgery patients was found to be 0.59. Internal consistency coefficients for the three and four-item scales were 0.63 and 0.79 respectively.

Coronary heart disease in the Western Collaborative Group Study

Abstract A prospective study of coronary heart disease (CHD) was initiated in 1960–1961 in 39–59 year old men. Some of the relevant findings observed during a mean four and one-half year period of follow-up of 3182 subjects are presented. A significantly increased incidence of CHD was found to be associated with parental history of CHD, elevated systolic or diastolic blood pressure, cigarette smoking, higher serum levels of cholesterol, triglyceride and beta lipoproteins, and the Type A behavior pattern. The association of the Type A behavior pattern with a significantly increased rate of CHD was not found to be ascribable to an association of the behavior pattern with other risk factors.

Development of an objective psychological test for the determination of the coronary-prone behavior pattern in employed men☆

Abstract An overt behavior pattern described by investigators of the Harold Brunn Institute of the Mt. Zion Hospital and Medical Center, San Francisco, has been shown in several studies to be associated both with prevalence and incidence of coronary heart disease. The coronary-prone behavior pattern is characterized by intense striving for achievement, competitiveness, aggressiveness, pressures for vocational productivity, excessive sense of time urgency, impatience and restlessness. Because of the importance of this behavior pattern in predicting risk to coronary heart disease, a rapid, objective method for measuring the pattern is needed for use in epidemiologic studies and for mass-screening in industrial health programs. This paper describes the development of a self-administered, machine-scored psychological test to measure this behavioral pattern. The present form of the test questionnaire distinguishes at high levels of statistical significance between groups of men clinically judged to manifest the coronary-prone behavior pattern and those groups judged not to manifest the pattern. Categorization of individuals is also promising. A series of validity studies using biological and medical criteria is underway.

Prediction of Clinical Coronary Heart Disease by a Test for the Coronary-Prone Behavior Pattern

Abstract Prospective study of 2750 employed men who completed a computer-scored test questionnaire measuring the coronary-prone Type A behavior pattern showed that high scorers had twice the incide...

Basic dimensions within the coronary-prone behavior pattern

Recent studies have demonstrated the relation of the “coronary-prone behavior pattern (Type A)” to prevalence and incidence of coronary heart disease (CHD). A self-administered, computer-scored questionnaire—The Jenkins Activity Survey (JAS)—has been shown to identify men having this coronary-prone behavior pattern with over 70 per cent accuracy. To resolve the question of whether this behavior pattern is a single unified set of responses or an aggregation of distinct traits, independent factor analyses were performed on JAS responses from four large samples of employed men. These analyses all concurred that the coronary-prone behavior pattern is actually composed of at least three major, conceptually independent behavioral syndromes: I. Hard Driving, II. Job Involvement, and III. Speed and Impatience. A system was constructed for deriving factor scores for individuals on these dimensions, and these scores were demonstrated to be reliable across forms of the test and stable over time. The 3 scores were uncorrelated with each other. The behavioral factors defined and measured here are in concordance with variables found to be associated with coronary heart disease by numerous other investigators using other methods.

Cigarette Smoking Its Relationship to Coronary Heart Disease and Related Risk Factors in the Western Collaborative Group Study

The association of the incidence of coronary heart disease (CHD) with smoking habits was studied for 4½ years in over 3,000 healthy, employed men, aged 39 to 59 years, at intake into a prospective, epidemiological investigation. The risk of CHD was significantly associated both with current and former cigarette usage. More specifically, this association was found to prevail in men suffering symptomatic and fatal myocardial infarction but not in men sustaining silent myocardial infarction or angina pectoris only and was much stronger in younger than in older age groups. Altered risk of CHD was not found in pipe or cigar smokers.Cigarette habits at intake were associated with differences in serum lipids and other risk variables, but when the latter were controlled statistically, the smoking-CHD associations remained.The cigarette-CHD relationship was studied further in men with and without the coronary-prone behavior pattern (type A). In the younger age decade the increased risk of CHD associated with moderate and heavy cigarette smoking occurred primarily in men with the type A behavior pattern.

The coronary-prone behavior pattern in employed men and women.

Abstract The Coronary-Prone Behavior Pattern is a hard-driving, aggressive style of life which previous work has shown to be associated with a substantially increased risk of coronary heart disease. A questionnaire, the Jenkins Activity Survey, yields a Type A score which is a measure of the Coronary-Prone Behavior Pattern. A previous factor analysis of questionnaire responses given by older employed white men yielded three factors designated Speed-and-Impatience, Job-Involvement and Hard-Driving-and-Competitive. Factor analyses for our sub-samples of younger and older employed white men and women all yielded factors closely related to the three factors derived previously. Factor analyses for the subsamples of black men and black women yielded factors which were similar but suggested some cultural differences. For employed women, maximum values of Type A and Speed-and-Impatience scores were observed at ages 30–35. The scores for employed men did not show this peak. We hypothesize that women who are more T...

Clinically unrecognized myocardial infarction in the Western Collaborative Group Study

Abstract The occurrence of silent and other clinically unrecognized myocardial infarction prior to the study was observed in 42 men and in 31 new cases of infarction during a four and a half year follow-up of 3,182 men, aged 39 to 59 years, participating in an epidemiologic study of coronary heart disease. Among subjects aged 39 to 49 years, a statistically significantly higher frequency of unrecognized infarction occurred in those with a parental history of coronary heart disease, higher annual income, fasting serum triglycerides exceeding 150 mg./100 ml. and in those who exhibited the Type A behavior pattern, compared with subjects without such attributes. A higher frequency also was observed in the younger subjects who were cigarette smokers compared with former smokers and nonsmokers of cigarettes and in those with elevated blood pressure compared to those with normal pressure, but these differences were not statistically significant. A significantly higher incidence of unrecognized infarction also was observed in all subjects with elevated serum beta/alpha lipoprotein ratios compared to those with lower ratios. This appears to be particularly striking since there were no significant differences in the incidence of such infarction among subjects with elevated serum cholesterol levels compared to those with low levels. Most cases of unrecognized infarction were associated with the Type A behavior pattern, and this was independent of the blood pressure, serum lipid or lipoprotein levels, cigarette smoking, parental history or any of the other factors under study.

Psychosocial Modifiers of Response to Stress

The impact of stress upon an organism is far more complex than the simple design of most stress research implies. We offer an expanded model for studying the relation of stressors to pathological outcomes, which takes into account both the adaptive capacity of the organism before the stressor occurs and the defenses marshalled in response to the stressor. The model also distinguishes among the initial responses of alarm, sustained defensive behaviors, and the relatively irreversible endstates which remain after resistance has ended. Realizing that only a multidiscomplinary approach can begin to capture the wholeness of human experience, this research paradigm anticipates that stressors, adaptive capacities, defenses, alarm reactions, and pathologial end-states will take place at the biological, psychological, interpersonal and sociocultural levels simultaneously and successively. Data on life change stress and psychological health outcomes gathered as part of the Air Traffic Controller Health Change Study are analyzed to illustrate the use of the model in identifying psychosocial and biological modifiers of response to stress.

Prevention and Health Promotion: Decades of Progress, New Challenges, and an Emerging Agenda.

Daily habits (e.g., smoking, diet, and exercise) and their immediate consequences (e.g., obesity) confer risk for most of the major health problems in industrialized nations. Hence, determinants of these behaviors and their modifications have been central topics in health psychology. Considerable scientific and applied progress has been made, but the field faces important challenges and opportunities in the future. These challenges and opportunities include changes in demographics and patterns of health, the need for a more comprehensive model of the domain of health behavior and prevention, the need to integrate behavioral and psychosocial risk and resilience, the incorporation of new technologies, and addressing a variety of professional and economic barriers to the implementation of prevention in health care.