heart disease and hence that type A is not a risk factor for heart disease. Since that
time there seems no further evidence to support a link. Perhaps most damning of all
for the type A construct has been a paper by Petticrew, Lee and McKee (2012), which
suggests that the initial positive results were due to the fact that much of the early
research was funded by the tobacco industry and ‘selected results used to counter
concerns about tobacco and health’ (2012: 2018). Evidence that type A caused disease
could be used to suggest that smoking was merely a result of type A and not itself a
risk factor.
However, interest in at least one aspect of type A continues as a number of meta-
analytic reviews (e.g. Booth-Kewley and Friedman, 1987; and Matthews 1988) raised
the possibility that one component of type A behaviour (hostility) is predictive of heart
disease. While a certain amount of research continues into the type A behaviour pattern
the emphasis has now shifted towards investigating hostility.
HOSTILITY
Hostility, like type A, is a complex and multidimensional construct. It has been defined
as ‘a negative attitude towards others, consisting of enmity, denigration and ill will’
(Smith, 1994: 26). Components of this characteristic are cynicism about others’
motives, mistrust and hostile attributional style, i.e. a tendency to interpret other
people’s actions as aggressive (Smith et al., 2004). While this definition is primarily
cognitive, the associated emotional and behavioural constructs of anger and aggression
are often incorporated within the construct (Miller et al., 1996). The construct is
measured using items such as ‘Some of my family have habits that bother and annoy
me very much’ and ‘It is safer to trust no-one’; with a response of ‘true’ indicating
higher levels of hostility. These items are taken from the Cook–Medley hostility scale,
which is a commonly used measure (Cook and Medley, 1954). Hostility has been
found to be correlated quite highly with the hard-driving component of type A
behaviour (r=.44). It is also positively correlated with a range of measures of
neuroticism (r =.27 to .54) and negatively with measures of extraversion (r= –.48)
(Carmody, Crassen and Wiens, 1989). Some authors discuss hostility as one (negative)
expression of the Big Five personality trait agreeableness (Ozer and Benet-Martinez,
2006), i.e. hostility is low agreeableness.
Following from the tradition of research in type A behaviour, most research in this
area has focused on the role of hostility in CHD. As for the research on type A, meta-
analyses have assessed the strength of effects (Miller et al., 1996). Miller et al. (1996)
included 45 studies in their review and concluded that hostility was an independent
risk factor for CHD. As was the case with the research into type A, they found that
the strongest relationships were found using structured interviews to assess hostility,
which emphasize the expressive component of hostility (i.e. verbally and physically
aggressive behaviour). These studies suggested that the effects were at least similar in
magnitude to those reported for traditional risk factors such as smoking, high blood
pressure and cholesterol. Even among studies using self-report measures (the
Cook–Medley scale: Cook and Medley, 1954), the review found small but consistent
relationships with heart disease. It should be noted, however, that a more recent meta-
122 COPING RESOURCES