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. Author manuscript; available in PMC: 2018 Jul 1.
Published in final edited form as: Health Psychol. 2017 May 22;36(7):673–681. doi: 10.1037/hea0000491

Socioeconomic status and parenting during adolescence in relation to ideal cardiovascular health in Black and White men

Karen A Matthews 1,2, Jennifer M Boylan 1, Karen P Jakubowski 2, Jenny Cundiff 1, Laisze Lee 1, Dustin A Pardini 3, J Richard Jennings 1,2
PMCID: PMC5524051  NIHMSID: NIHMS877876  PMID: 28530431

Abstract

Objective

American Heart Association (AHA) developed a new metric to evaluate ideal cardiovascular health based on optimal levels of seven cardiovascular risk factors and health behaviors. We evaluated the relationships of parenting characteristics and academic achievement in adolescence in relation to ideal cardiovascular health in midlife men.

Methods

We measured cardiovascular risk factors in 171 Black and 136 White men and their ideal cardiovascular health score was constructed based on AHA guidelines. When the participants were 13–16 years old, annual measures of parent-child communication, positive relationship, parental monitoring, family cohesion, boys’ involvement in family activities, and academic achievement were recorded and averaged.

Results

Confirmatory factor analysis of adolescent parenting measures revealed a single Parenting Composite. Multiple linear regressions showed a significant Race by Parenting Composite interaction term, β = −.19, p = .03; better parenting was significantly related to more ideal cardiovascular health in Blacks only, β = −.23, p = .004, which remained after adjustments for adolescent and adult socioeconomic status (SES). Academic achievement was related to ideal cardiovascular health, β = −.13, but was no longer significant after controls for adult SES. Adult SES was a strong correlate of ideal cardiovascular health in both Black and White men.

Conclusions

Black men exposed to positive parenting during adolescence had more ideal cardiovascular health based on AHA guidelines. Improving academic achievement in adolescence may benefit adult cardiovascular health, indirectly through improving adult SES. This is the first study of adolescent family predictors of the extent of ideal cardiovascular health.

Keywords: cardiovascular health, parenting, race, men, longitudinal

INTRODUCTION

American Heart Association (AHA) objectives for 2020 are to reduce the rates of cardiovascular diseases (CVD) and stroke by 20% and to increase ideal cardiovascular health by 20% in the United States (Lloyd-Jones et al., 2010). Because the latter was a new objective, a blue ribbon panel of experts convened to define the metrics of cardiovascular health. Based on a large body of epidemiological evidence, the group recommended clinical criteria for poor, intermediate, and ideal cardiovascular health, separately for adults and children, based on the combination of seven CVD risk factors: smoking, body mass index, dietary intake, physical activity, blood pressure, fasting blood glucose, and fasting cholesterol. Adults in mid-life who are able to maintain optimal CVD health live longer and are at much lower risk that adults who have developed more risk factors earlier in life (Lloyd-Jones, Dyer, Wang, Daviglus, & Greenland, 2007; Stamler et al., 1999). More ideal cardiovascular health in childhood and adolescence is related to reduced risk for hypertension, metabolic syndrome, and carotid intima thickness at mid-life in the Young Finns Study (Laitinen et al., 2012).

Unfortunately, ideal cardiovascular health is uncommon in middle-aged adults (Bambs et al., 2011; Shay et al., 2012) and less prevalent than one might anticipate in adolescents as well (Shay et al., 2013). For adults to maintain optimal cardiovascular health, ideal levels of health factors must start in childhood and adolescence and continue into young and middle adulthood (Lloyd-Jones et al., 2010). Leading cardiologists have highlighted the role of the family-based approaches to cardiovascular health promotion, citing as health-promoting the roles of warm and responsive parenting combined with firm but not overly demanding of children’s self-control (Vedanthan et al., 2016). Prior research has examined the role of family factors in contributing to the development of individual components of ideal cardiovascular health, including obesity, physical activity, and smoking (Loucks et al., 2014; Lytle et al., 2003; O'Byrne, Haddock, & Poston, 2002; Thomas, Hypponen, & Power, 2008). To our knowledge, the Young Finn Study is the only one to examine prospectively childhood and adolescent predictors of ideal cardiovascular health in adulthood (Pulkki-Raback et al., 2015). In their analysis, a cumulative index of six psychosocial factors in childhood and adolescence was related to better ideal cardiovascular health in adulthood, with the strongest associations obtained for a favorable socioeconomic environment and participants’ self-regulatory behaviors. The other psychosocial factors were optimal parental health behaviors, low number of stressful events in the family, child social adjustment, and positive family emotional environment.

The present investigation addresses whether family socioeconomic (SES) status and parenting styles during adolescence are prospectively related to cardiovascular health in Black and White men in their thirties. We focus on adolescence because it is a period of increasing cardiovascular risk (Shay et al., 2013; Weintraub et al., 2011) and changes in family dynamics and processes. Extensive reviews of family and parenting characteristics conclude that parental coldness and neglect, conflictual family relationships, and family disorganization are associated with stress-responsive biological regulatory systems, including sympathetic-adrenomedulary and hypothalamic-pituitary-adrenocorticol functioning, processes linked to later physical illness e.g., (Felitti et al., 1998; Repetti, Taylor, & Seeman, 2002; Troxel & Matthews, 2004). Some evidence indicates differences in parenting styles and in vulnerability to stress by race (Mezuk et al., 2010; Wickrama, Bae, & O'Neal, 2016; Steinberg, Lamborn, Darling, Mounts, & Dornbusch, 1994), suggesting that race/ethnicity may be an important factor to consider in relation to cardiovascular health. Furthermore, cumulative indices of childhood adversity are related to later adult cardiometabolic risk, in part through personality factors, adverse health behaviors, and adult educational attainment (e.g., Hampson, Edmonds, Goldberg, Dubanoski, & Hillier, 2015; Wickrama, O'Neal, Lee, & Wickrama, 2015).

Conversely, in the present study, we hypothesize that more ideal cardiovascular health in midlife is related to more positive parent-child communication and relationships, better family cohesion, and more consistent parental discipline during adolescence. We also hypothesize that adult cardiovascular health is related to adolescent academic achievement because it is an indirect measure of ability, self-control, and investment in the future, all facets related to later physical health (Batty, Deary, & Gottfredson, 2007; Moffitt et al., 2011). We further test whether these associations are independent of adolescent and adult SES and evaluate whether relationships differ by race.

Method

Participants

Participants were drawn from the Pittsburgh Youth Study (PYS). Initiated in 1987, PYS is an ongoing study of black and white men originally designed to examine the development of delinquency, antisocial behavior, and related mental health problems. Details of the original study and follow-up recruitment are published elsewhere (Loeber, Farrington, Stouthamer-Loeber, & van Kammen, 1998; Lynam, Loeber, & Stouthamer-Loeber, 2008). Briefly, a random sample of boys was drawn from Pittsburgh public school students enrolled in either first or seventh grade, hereafter referred to as the youngest and oldest cohorts. Recruitment involved an initial screening (screening sample N = 849 and 856 for the youngest and oldest cohorts, respectively) based on ratings from parents, teachers and youth to assess the boys’ behavior problems (e.g., fighting, stealing). Boys who scored in the upper 30th percentile on the screen within each cohort were selected for longitudinal follow-up, along with a roughly equal number of boys randomly selected from those scoring below the 30th percentile. This led to a follow-up sample of 503 boys in the youngest cohort and 506 boys in the oldest cohort. Boys in the longitudinal study were not different from the overall screening sample in terms of race, standardized reading scores, or parental education. Just over half the sample was Black (56% youngest; 55% oldest), and the rest was almost all non-Hispanic White (41% youngest, 42% oldest).

A subsample from the original PYS study was recruited to participate in the Pathways to Healthy Hearts Study. Men were ineligible if they were: incarcerated, lived more than 75 miles away from Pittsburgh and were not planning to return, were severely mentally disabled, had withdrawn from the original PYS study, or were deceased. Recruitment began with the younger cohort. Of the 322 eligible men in the younger cohort, 272 participated in all or some portion of the study. Because the target sample size was 300 men for the measurement of cardiovascular risk, we then recruited 40 additional participants from potentially eligible men in the older cohort. To be in the current analysis, men had to provide a fasting blood draw, and complete a medical history and health behavior interview; 307 men were in the analysis. This study was approved by the Institutional Review Board at the University of Pittsburgh and all participants provided informed consent. The analytic sample was similar to the younger cohort and the potentially eligible men from the older cohort in proportion of blacks (p = .92), high risk screening group (p=.74), and mean socioeconomic status of the family (p = .36).

Protocol Overview

Participants who lived within driving distance of Pittsburgh or planned to return for a visit were scheduled for a laboratory assessment. Upon arrival at the laboratory after an eight hour fast, they completed consent forms, had anthropometrics measured, and a blood draw. After a light meal and resting for 10 minutes, they performed a series of challenging tasks while cardiovascular measures were taken. Finally, they were interviewed regarding sociodemographic characteristics, health history, and health behaviors, and completed questionnaires regarding personal characteristics. Study procedures were approved by the Institutional Review Board at the University of Pittsburgh.

Psychosocial Measures

Socioeconomic Status

SES was measured annually via the two-factor Hollingshead index (Hollingshead, 1975), which incorporates parental educational attainment and occupational status as reported by the boy’s primary caretaker (childhood SES) or by the participant (adult SES). For childhood SES, the higher of the two parents was used for two-parent families. The mean Hollingshead SES across 4 occasions between ages 13 and 16 was used as the overall index of childhood SES. Adult SES was only measured on one occasion using the same index. In supplementary analyses, we developed an SES risk score, such that higher scores were lower SES. This score was based averaging across the annual assessments the following: yes/no family on public assistance; yes/no parent unemployed for at least 4 months of the year; yes/no living with single parent; yes/no parental occupation being semi-skilled or lower; and yes/no parental education less than high school. A similar score was developed for adult SES risk, except that single parent status was not included. This score was developed to differentiate the lower end of the distribution of SES and was similar to the SES risk index developed by Brody et al. (2013).

For all participants, the 1990 census data were used to construct a neighborhood poverty factor composed of the percent of households in the of census track that were unemployed, on welfare, and below the poverty level, standardized and averaged. The 1990 census data on proportion of Blacks in the neighborhood were also evaluated.

Measures during adolescence
Academic Achievement

Ratings of academic achievement in the subjects of reading, writing, mathematics, and spelling when the boys were ages 13 to 16 years were provided each year by the boys, their primary caregivers, and their teachers, with exception that teacher ratings were unavailable for one of the four assessments. Ratings were on a 4 point scale, 1= above average; 2 = average; 3 = below average; and 4 = failing. These ratings were averaged across informants and across the years.

Parenting

The boys and their primary caregivers (86.3% were biological mother) completed scales annually that measured parental monitoring (parent only), consistent discipline, relationship with primary caretaker, caretaker/child communication, and boys’, Stouthamer-Loeber, & White, 2008). In all cases the responses were on a 3 point scale (e.g., 1= almost never, 2 = sometimes, and 3 = almost always, or not applicable), such that a higher score was more negative parenting. In general these scales were based on pilot research conducted at the Oregon Social Learning Center (Loeber et al. 1998), literature reviews of the impact of parenting, and items from existing scales adapted for an urban sample with a substantial minority membership and a range of SES (e.g. Family Environment Scale (Moos & Moos, 1974), and Family Assessment Measure (Skinner, Steinhauer, & Santa-Barbara, 1983), followed by detailed psychometric analyses. Parental monitoring was assessed with 6 items (e.g., “Do you know who your son’s companions are when he is not a home?”). Consistent discipline was based on 4 items (e.g., Do you let your son get away with things? If you ask your son to do something and he does not do it, do you give up trying to get him to do it?). Relationship with primary caregiver was measured by 32 items (e.g., thought your child is a good kid, enjoyed spending time with him). Parent-child communication was measured with 34 items regarding the parent-child relationship (e.g., “Do you openly show affection to your son?” “Do you think that your son feels close to you?”). Boy’s involvement in the family was measured by 4 items (e.g., boy gets involved in family activities). For all scales but parental monitoring, the primary caretaker and the participant both completed the instrument, and these ratings were averaged at each assessment wave. An overall score was then calculated for each dimension by averaging the four annual assessments collected from age 13–16. Mean alpha coefficients for the scales based on PYS were .59 for parental monitoring; .65 for consistent discipline; .89 for relationship with caregiver; .89 for parent-child communication; and .67 for family involvement.

A confirmatory factor analysis was calculated on the five parenting scales.. Although a single factor model provided a good fit to the data, separate analyses in Blacks and Whites separately showed that the consistent discipline scale loaded separately for Blacks. Therefore, the factor analysis was repeated without Consistent Discipline included. A single factor model provided a good fit to the data in the full sample, χ2 (2) = 3.54, p = .17, RMSEA = .05, CFI = .997, and SRMR = .02. Standardized factor loadings for the four parenting scales varied from .50 to .93. To enhance quantitative parsimony, analyses were conducted using a single composite positive parenting index, which was created by converting the four parenting scales to z-scores and then averaging these standard scores. Consistent discipline was analyzed as a separate measure. A higher z-score reflected more negative parenting.

Ideal Cardiovascular Health in Adulthood

Following the American Heart Association guidelines for ideal, intermediate and poor cardiovascular health for the seven indicators, we constructed a measure of ideal cardiovascular goals. Blood pressure was assessed three times in a seated position in the last 5 minutes of a 10 minute resting period using a CARESCAPE Dinamap V100 Vital Signs Monitor. Values of SBP < 120 mmHg SBP and < 80 DBP were assigned “2”; SBP 120–139 mmHg or DBP 80 – 89 mmHg or pharmacologically treated to ideal goal “1”; and SBP ≥ 140 or DBP ≥ 90 mmHg “0”. Fasting blood was assayed for total cholesterol determined by coupled enzymatic methods and glucose by hexokinase-coupled reaction (Boehringer Mannheim Diagnostics). Fasting glucose < 100 mg/dL was assigned “2”; 100–125 mg/dL or treat to goal “1”; and ≥ 126 mg/dL “0”. Total cholesterol < 200 mg/dL was assigned “2”, 200–239 mg/dL or pharmacologically treated to ideal goal “1”; and ≥ 240 mg/dL “0”. Body mass index was measured in the laboratory. BMI of < 25 kg/m2 was assigned “2”; 25 – 29.9 kg/m2 “1”; and > 30 kg/m2 “0”. Men reported whether they smoked cigarettes in the last year, number of days they smoked in the last year, and how many cigarettes they smoked. The responses were coded into “2”, never smoked or have not smoked for more than 12 months, “1” smoked ≤ 90 days per year and ≥ 10 cigarettes per day; and “0” smoking more than 90 days per year or > 10 cigarettes per day. Data on fruit and vegetable consumption were collected using six items from the Behavioral Risk Factor Surveillance System fruit and vegetable module (Centers for Disease Control and Prevention, 2011). Responses were coded as “2” for reporting at least 2 servings of both fruits and vegetables daily; “0” < 1 serving of fruit and vegetables daily; and “1” intermediate. Physical activity was measured using the Paffenbarger Physical Activity Questionnaire (Paffenbarger, Jr., Wing, & Hyde, 1978) and coded into “2” ≥ 150 minutes/week of moderate intensity exercise or 75 minutes per week vigorous intensity or 150 minutes per week of moderate and vigorous exercise combined; “0” no physical exercise reported; and “1” intermediate between the two categories.

Statistical Analyses

Chi squares and t-tests were used to describe racial differences in predictors and outcomes. Pearson correlations were calculated among the predictor variables and cardiovascular health score. Primary hypotheses were evaluated by linear regression models testing the associations of composite parenting score, consistent discipline, and academic achievement in adolescence, respectively, and the adult cardiovascular health score. In model 1, we adjusted for high risk screening status, race (Black=1, White = 0), and adolescent family SES; in model 2 we evaluated whether the associations varied by race by adding an interaction term of the predictor variable (z-scored) and race; and we evaluated a final model, which added the men’s adult SES, to examine whether the effects were obtained with controls for both adolescent family SES and adult SES. A secondary analysis substituted the SES risk score for Hollingshead SES.

Results

Sample Characteristics

Table 1 shows the sample characteristics for the full sample and separately by race. The men were in their early to mid thirties, and low to middle-class as a group, as indexed by the Hollingshead SES score. As adolescents, Whites were from higher SES families (Hollingshead and SES risk composite), higher SES neighborhoods, had more parental monitoring, more positive parent-child communication, and had somewhat higher academic achievement ratings than Blacks. Blacks were more likely to live in neighborhoods with a higher proportion of Blacks. Blacks and Whites were similar in positive relationships with their caregiver, consistency of discipline, and family involvement.

Table 1.

Descriptive statistics in full sample and race stratified.

Full Sample
n = 307		 Blacks
n = 171		 Whites
n = 136		 p-value
M(SD) or N(%) Range M(SD) or N(%) Range M(SD) or N(%) Range
High Risk Screening Group (% yes) 153(49.8%) 86(50.3%) 67(49.3%) .86
Adolescence
    Percent of Blacks in Census Track 0.4 (0.4) 0–1 0.6 (0.3) 0.03–1 0.08 (0.1) 0–0.9 <.001
    Standardized Neighborhood Poverty 0.2 (0.1) 0.02–0.7 0.2 (0.2) 0.03–0.7 0.1 (0.04) 0.02–0.2 <.001
Score
    Family SES (Hollingshead) 38.4(9.7) 9–66 37.0(9.3) 9–66 40.2(9.8) 16–66 .004
    SES Riska 0(1.0) −2.6–2.9 .36(.87) −1.8–2.8 −.47(.96) −2.6(2.9) <.001
    Parental Monitoringa 7.3(1.3) 6–12.5 7.6(1.4) 6–12 6.9(1.1) 6–12.5 <.001
    Caretaker-child Communicationa 52.7(7.0) 38–72 53.5(7.0) 38–72 51.7(6.8) 38–72 .03
    Relationship with Primary Caretakera 7.0(3.8) 0–19.3 7.2(3.8) 0–18.25 6.8(3.9) 0.2–19.3 .39
    Consistent Disciplinea 7.1(1.0) 4–11 7.1(0.9) 4–9.3 7.1(1.2) 4–11 .84
    Family Involvementa 7.9(1.3) 1–11 7.8(1.2) 4.9–10.7 8.0(1.4) 4–11 .16
    Academic Achievementa 2.2(0.5) 1–4 2.3(0.5) 1–4 2.1(0.5) 1–4 .05
Adulthood
    Age (years) 33.1(2.6) 30–41 33.1(2.6) 30–41 33.0(2.6) 31–41 .74
    SES (Hollingshead) 31.1(14.5) 6–66 28.0(14.0) 9–61 35.0(14.3) 6–66 <.001
    SES Riska 1.1(1.1) 0–4 1.3(1.1) 0–4 .80(1.0) 0–4 <.001
    Ideal Cardiovascular Health Metrics 7.7(2.1) 2–13 7.7(2.2) 2–12 7.7(2.1) 3–13 .87
      Systolic blood pressure (mmHg) 122.9(13.1) 99–180 124.4(14.0) 100–178 121.0(11.7) 99–180 .03
      Diastolic blood pressure (mmHg) 72.7(9.5) 52–104 74.0(10.1) 52–104 71.2(8.4) 56–94 .009
      Ideal blood pressure (yes) 143(46.6%) 74(43.3%) 69(50.7%) .10
      Total cholesterol (mg/dL) 182.6(39.2) 103–322 180.9(40.3) 103–322 184.7(37.8) 122–315 .40
      Ideal cholesterol (yes) 205(66.8%) 120(70.2%) 85(62.5%) .41
      Glucose (mg/dL) 95.4(28.6) 46–313 94.8(29.7) 46–313 96.1(27.2) 47–292 .68
      Ideal glucose (yes) 229(74.6%) 130(76.0%) 99(72.8%) .86
      Physical activity (kcal) 1505.5(1921.7) 0–14,716 1613.9(2178.1) 0–14,716 1369.1(1537.0) 0–9918 .27
      Ideal physical activity 75(24.4%) 50(29.2%) 25(18.4%) .09
      BMI kg/m2 29.7(7.3) 17–63 29.7(7.4) 17–56 29.8(7.3) 17–63 .92
      Ideal BMI 75(24.4%) 49(28.7%) 26(19.1%) .07
      Current smoking (% yes) 170(55.4%) 104(60.8%) 66(48.5%) .03
      Ideal smoking 137(44.6%) 67(39.2%) 70(51.5%) .10
      Weekly servings fruits and vegetables 16.4(12.3) 0–85 17.0(14.3) 0–85 15.7(9.4) 0–56 .40
      Ideal diet (% yes) 25 (8.1%) 22(12.9%) 3(2.2%) <.001
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Note. p-values reflect test for race differences with independent sample t-tests and Pearson Chi-square tests. SES was measured using the two-factor Hollingshead index in adolescence and adulthood.

a

Higher scores on the adolescent variables reflect more adverse profiles (e.g., more SES risk, less parental monitoring, lower academic achievement).

In adulthood, Whites were higher in SES than Blacks (Hollingshead and SES risk composite). Whites and Blacks did not differ in overall cardiovascular health scores. Blacks were more likely to meet ideal criteria for weekly consumption of fruits and vegetables, with trends favoring Blacks for greater physical activity and lower BMI, and trends favoring Whites for lower blood pressure and less smoking.

Univariate associations of ideal cardiovascular health scores and predictor variables

Table 2 shows the correlational analyses among study variables. Ideal cardiovascular health scores were associated with the parenting composite score, adolescent academic achievement, and adult Hollingshead score; they were not associated with race, consistent discipline, or adolescent family Hollingshead scores. Parenting composite was associated with consistent discipline and both the parenting composite and consistent discipline were associated with adolescent academic achievement and adolescent and adult Hollingshead scores.

Table 2.

Bivariate correlations among study variables.

1. 2. 3. 4. 5. 6. 7.
1. High risk screening group --
2. Race (1=Blacks) .01 --
3. Adolescent family SES (Hollingshead) −.05 −.17* --
4. Parenting Compositea .20* .11 −.31* --
5. Adolescent Academic Achievementa .17* .11 −.29* .48* --
6. Consistent Disciplinea .10 .01 −.21* .28* .22* --
7. Adult SES (Hollingshead) −.25* −.24* .25* −.32* −.44* −.02 --
8. Ideal cardiovascular health −.07 .01 .09 −.14* −.15* .05 .23*
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Note.

*

p < .05.

a

Higher scores on the adolescent variables reflect more adverse profiles (i.e., less positive parenting, less consistent discipline, lower academic achievement).

Multivariate associations of ideal cardiovascular health scores and predictor variables

Parenting during adolescence. Linear regression models show that parenting composite was marginally related to ideal cardiovascular health score, independent of risk screening group, race, and adolescent family Hollingshead scores (Table 3; model 1). The significant interaction term for Race by Parenting Composite (model 2) showed that Blacks who had higher ideal cardiovascular health scores had lower parenting composite scores (more positive parenting), B(SE) =−.61(.21), β= −.23, p = .004, whereas Whites’ ideal health scores were unrelated to parenting composite scores, B(SE) = .08(.25), β= .03, p = .74. The Race by Parenting Composite interaction remained significant with the addition of the adult Hollingshead scores; simple slopes were similar with adult Hollingshead scores added to the model (Blacks: B(SE) = −.47(.21), β = −.18, p =.03; Whites: B(SE) = .18(.25), β = .07, p =.46). See Figure 1 for unadjusted data illustrating the interaction of Race and Parenting Composite. Consistent Discipline scores were unrelated to ideal health scores as main effects, ps > .17, or in interactions with Race, ps > .90.

Table 3.

Results from linear regression model with socioeconomic status (defined by the Hollingshead), parenting, and adolescent characteristics predicting ideal cardiovascular health scores in adulthood.

Model 1 Model 2 Model 3
B(SE) β p B(SE) β p B(SE) β p
Risk screening group −.14(.25) −.03 .57 −.15(.25) −.04 .55 .02(.25) .00 .94
Race (1=African American) .07(.25) .02 .80 .05(.25) .01 .86 .23(.25) .05 .38
Adolescent family SES .13(.13) .06 .33 .12(.13) .06 .35 .07(.13) .03 .62
Parenting Compositea −.32(.17) −.12 .056 .08(.25) .03 .74 .18(.25) .07 .46
Race * Parenting Composite −.70(.32) −.20 .03 −.66(.31) −.19 .03
Adult SES .03(.01) .20 .002
Risk screening group −.15(.25) −.04 .55 −.15(.25) −.04 .55 .00(.25) .00 .99
Race (1=African American) .07(.25) .02 .77 .07(.25) .02 .77 .25(.26) .06 .34
Adolescent Family SES .13(.13) .06 .32 .14(.13) .07 .28 .10(.13) .05 .46
Academic Achievementa −.29(.13) −.13 .031 −.16(.18) −.07 .40 .02(.19) .01 .91
Race * Academic Achievement −.25(.25) −.08 .31 −.29(.25) −.10 .24
Adult SES .03(.01) .20 .003
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Note.

a

Higher scores on the adolescent variables reflect more adverse profiles (i.e., less positive parenting, lower academic achievement).

Figure 1.

Figure 1

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Scatterplots of Adolescent Parenting Composite (Z-scores) and Ideal Cardiovascular Health in Whites and Blacks separately. Higher scores on parenting composite reflect worse parenting.

Academic achievement during adolescence. Adolescent Academic Achievement ratings were related to ideal cardiovascular health scores, independent of risk group, race, and adolescent family Hollingshead scores (Table 3; model 1). The interaction of Academic Achievement and Race was nonsignificant (model 2). The addition of adult Hollingshead scores resulted in the Academic Achievement score being nonsignificant (Model 3). Adult Hollingshead scores were significantly related in each of the models that including adolescent predictor variables.

Multivariate results were similar in models that used SES risk scores in lieu of the Hollingshead scores (see Supplement Table 1).

Discussion

The objective of our analysis was to test for the first time whether family SES and key parenting characteristics in adolescence were predictors of subsequent ideal cardiovascular health status in Black and White men in their thirties. There were a number of unique findings. First, positive parenting composite was related to later ideal cardiovascular health in Black men and not in White men. Second, academic achievement in adolescence was related to later ideal cardiovascular health in Black and White men, an association that was largely explained by adolescents who were more successful academically achieving a higher SES as adults, independent of the family SES as adolescents. Third, concurrent adult SES but not adolescent family SES was related to ideal cardiovascular health – this pattern was true for both the Hollingshead SES measure, which is a continuous composite score based on the full range of occupation and education grades, and an ordinal SES risk measure, which is a count of number of low SES indicators.

We did not have a priori hypotheses regarding the direction of race differences in the associations of parenting and ideal cardiovascular health. The association of parenting and ideal cardiovascular health in Blacks only was not due to Black adolescents experiencing more overall positive parenting, given the null association between race and the parenting composite. It was also not due to race differences in ideal cardiovascular health as Blacks and Whites had similar scores. One possible explanation is that Blacks benefitted more than Whites from positive parenting because of the features of the communities in which they lived, despite the fact that they lived in segregated and usually less advantaged neighborhoods, including participants in our study. Some theorists suggest that family and community resources in Black communities, namely extended family structure, ethnic density, and supportive family arrangements along with positive parenting may protect Black adolescents from responding to early socioeconomic disadvantage in negative ways (Wickrama, Noh, & Bryant, 2005; McLeod & Nonnemaker, 2000). In the present case, more positive parenting – warm relationships, good communication, adolescent involvement in the family, and parental monitoring – may have offset the impact of segregated neighborhoods and lower SES environments experienced by Blacks in our sample. On the other hand, some evidence suggests racial/ethnic minorities are less vulnerable to environmental adversity, compared to majority White young adults (Wickrama et al., 2015). In any event, our results on the health benefits of positive parenting in Blacks are consistent with the results of an intervention designed to improve parenting and adolescent competence among poor Black children: the intervention was associated with better inflammatory profiles in young adulthood and the effect was partially mediated by improvements in parenting (Miller, Brody, Yu, & Chen, 2014).

We were surprised that consistent discipline by parents was not predictive of later ideal cardiovascular health. Consistent discipline is often thought a key dimension of good parenting (Loeber et al. 1998, 2008) but it may be more important for lowering the risk of behavioral problems, as opposed to benefiting cardiovascular health. In this sample, factor analysis showed that it was a separate dimension of parenting from other positive parenting characteristics in Blacks whereas in Whites it was part of a single positive parenting factor and that caregivers of Whites reported higher levels of monitoring than caregivers of Blacks. We suspect that consistent discipline in the teenage years has a different effect than in childhood because of the rapid changes in social, behavioral, and sleep behaviors in the adolescent period. Perhaps consistent discipline is not as important as other parenting factors or that flexibility in discipline is better suited to the nuances of parent-child relationships at that time period.

The consistent association of academic achievement and ideal adult cardiovascular health is noteworthy. We based our hypothesis on the notion that academic achievement reflects ability, self-control skills, and investment in the future. It also reflects to some degree intelligence and other data suggest that higher intelligence is related to better health and longevity (e.g., Batty et al., 2007). The facts that statistical models including adult SES reduced the association of academic achievement to nonsignificance and that adult SES was a strong concurrent correlate of ideal cardiovascular health suggest that the association of academic achievement in adolescence with later cardiovascular health, controlling for adolescent family SES, may be due to the opportunities and experiences afforded by obtaining a higher status job and more education in adulthood (see Matthews & Gallo, 2013 for other mechanisms accounting for association between adult SES and cardiovascular health). We should note, however, that our findings on academic achievement differ somewhat from those obtained in a rural sample of Black adolescents. Among those from lower SES families, those rated as socially and academically competent by their teachers had elevated cardiometabolic scores in young adulthood, suggesting costs of achievement striving in some subgroups (Brody et al., 2013).

The study has a number of limitations and strengths. The primary limitation is that the analysis is based on men who were enrolled in a single urban public school system. As consequence, the findings cannot be generalized to rural samples or to women. However, there is some evidence that the associations between positive parenting relationships and cardiovascular health might be stronger in women than in men (Ehrlich, Hoyt, Sumner, McDade, & Adam, 2015). The sampling plan also recruited about half who were at high risk for anti-social behavior based on screening interviews; however, our analysis adjusted for the risk screen stratification, which was also unrelated to the ideal cardiovascular health score. Furthermore, our sample was similar in proportion to the original sample in those at high risk, so we did not experience differential loss to follow-up. We do not think this is a major flaw. The study is observational and cause and effect cannot be ascertained. Finally, the effects are statistically significant but small. The strengths of the study include its prospective design; a substantial number of both Black and White men in the sample, which allowed the examination of race differences; the repeated assessment of parenting factors based on both boys’ and parent interviews; the availability of the key theoretical dimensions of parenting in those interviews; and assessments of adolescent school achievement by teachers, parents, and youth.

Conclusions and future research

Among Black men in their thirties, positive parenting in adolescence was related to later ideal cardiovascular health. Parenting interventions that improve parent-child relationships overall may have the benefit of improving cardiovascular health in mid-life. It is critical for future research to address whether interventions are most effective when targeting the interventions on adolescents and their caregivers vs different life stages and on the family as unit vs the child-caregiver, while simultaneously taking into account the unique cultural and sociodemographic make-up of families. Improving academic achievement in adolescence may benefit cardiovascular health, indirectly through increasing adult SES. Evaluating whether the academic achievement has its benefits through abilities that can be enhanced, improving self-regulatory skills, and developing a future orientation has promise for designing methods for improving cardiovascular health. This is the first study focusing on adolescent family predictors of ideal cardiovascular health in adulthood. It hopes to be a guide to future research that increases the likelihood of optimal cardiovascular health in mid-life, a goal not many achieve.

Supplementary Material

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Acknowledgments

This research was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health (R01HL111802 and T32HL07560). Data collection for the Pittsburgh Youth Study has been funded by the National Institute on Drug Abuse (DA411018), National Institute on Mental Health (MH48890, MH50778), Pew Charitable Trusts, and the Office of Juvenile Justice and Delinquency Prevention (96-MU-FX-0012). Special thanks to the study originators Drs. Rolf Loeber and Magda Stouthamer-Loeber.

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