SUMMARY The magnitude of the cardiovascular response to stress has been implicated in the pathogenesis of cardiovascular disease. Psychological stress procedures have received increased usage as an alternative to expensive physical (exercise) stress procedures. In the present investigation, 213 healthy, black or white, male or female children between the ages of 6 and 18 years were exposed to the psychological stress of a video game. The video game challenge was administered by a black or a white experimenter and was played under three levels of increasing stress, 1) personal challenge, 2) experimenter's challenge, and 3) experimenter's challenge accompanied by a financial incentive, while blood pressure and heart rate were monitored. Results indicated that the video games provoked significant and incremental cardiovascular reactivity across the games. Black children demonstrated significantly greater reactivity than white children; the racial difference was more reliably observed for systolic and diastolic blood pressure than for heart rate. Furthermore, the race of the experimenter exerted a significant effect and often interacted with the race of the child, such that greater reactivity occurred in same-race pairings than in mixed-race pairings. These results suggest that reactivity is affected by an individual's race and social milieu and that reactivity may be one mechanism responsible for the greater prevalence of hypertension among blacks. (Hypertension 8: 1075(Hypertension 8: -1083(Hypertension 8: , 1986 hypertension, ""^ but this association has not been consistent. 23 ' 2 * Unfortunately, the effects of race were not evaluated in these previous studies.In our previous studies 25 ' M with healthy children and adolescents, we found racial differences in the hemodynamic responses to the physical stress of maximal voluntary exercise on a cycle ergometer. Black children of both genders demonstrated significantly greater systolic BP (SBP) reactivity (maximal minus resting BP values) than did white children. These racial differences were obtained despite the demonstration that blacks and whites in the same gender groups showed no differences in either resting SBP or maximal heart rate (HR) during exercise. Because maximal exercise testing is a time-consuming and expensive procedure, we sought to evaluate the efficacy of a less involved procedure, the psychological challenge of playing a television video game, in provoking CV reactivity in a similar biracial sample of healthy children. Given the significance of the child's race during our physical stress studies, we also questioned whether the race of the experimenter would affect reactivity. As with the effects of the child's race, the effect of the experimenter's race on CV reactivity has received scant atten-

Cross-sectional follow-up data on 111 adolescents in a re-education residential facility were obtained in three domains--school, legal, and level of care--at 6, 12, 18, and 24 months postdischarge. Reports by community-based professionals on individual functioning were assessed on several criteria, the most stringent of which indicated successful outcomes for nearly 60% of the adolescents. Characteristics of the more successful students are noted, applications of the psychoeducational residential approach for program structure are considered, and implications for positive ecological outcomes are discussed.

The purpose of this study was to examine ambulatory blood pressure and heart rate patterns in healthy, normotensive adolescents and to determine the influence of race and gender on these patterns. Ambulatory blood pressure recordings were performed on 199 adolescents; 42 were black males, 55 were white males, 65 were black females, and 37 were white females. The mean age (±SD) was 13±2 years. Blood pressure readings were obtained with an automatic, noninvasive recorder. Black adolescents and white adolescents had similar blood pressures while awake (116/69 vs. 116/69 mm Hg), with boys having higher levels of systolic blood pressure (118 vs. 114 mm Hg) and comparable levels of diastolic blood pressure (69 vs. 69 mm Hg) relative to girls. The patterns while the adolescents were asleep, however, were different. White boys (106 mm Hg), white girls (105 mm Hg), and black girls (105 mm Hg) had similar systolic blood pressures during sleep. Black boys (112 mm Hg), however, had significantly higher systolic blood pressures while asleep. Black adolescents, as a group, had significantly higher diastolic blood pressures than white adolescents while asleep (64 vs. 61 mm Hg). Changes in blood pressure from awake to asleep were not related to changes in heart rate. Results of this study indicate that both race and gender are important determinants of the diurnal pattern of blood pressure and heart rate in adolescents. (Hypertension 1989;14:598-603)

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