John Henryism and Blood Pressure among Detroit Residents

SOCIAL INEQUALITY AND RACIAL/ETHNIC DISPARITIES IN CARDIOVASCULAR RISK
John Henryism and Blood Pressure among Detroit Residents:
Findings from the Healthy Environments Partnership
Alana M. Wooley1, MS; Amy Schulz1, PhD MPH; Graciela Mentz1, PhD; Denise White-Perkins2, MD PhD
1School
of Public Health, University of Michigan, Ann Arbor, MI; 2Henry Ford Health System, Detroit, MI
Background
Results
• Blacks and Latinos experience excess risk of high blood
pressure, a risk factor for cardiovascular disease, compared to
Whites1,2,3.
• John Henryism (JH), a high-effort coping strategy that reflects
American values of hard work, may be one psychosocial
mechanism that contributes to excess rates of high blood pressure
(HBP) among Blacks and Latinos4. Persons who engage in such
active and effortful coping strategies, while also contending with
social and economic hardships may experience adverse health
effects such as HBP4. In contrast, for persons with adequate
resources, John Henryism coping strategies may serve as a
resource that promotes health4. Findings from analyses of the
relationship between John Henryism, socioeconomic position, and
HBP among Blacks and Whites have been mixed5.
• The influence of JH on the health of Latinos has not been
investigated. While JH was conceptualized as a construct that
reflects the health consequences of race-based oppression
experienced by Blacks4, an examination of the application of JH to
the experience of Latinos, the largest and fastest growing
racialized group in the U.S.6,7, is warranted. Similar to Blacks,
Latinos experience social, economic, and political marginalization.
Further, Latinos are increasingly subjected to anti-immigrant
sentiments that may influence occupational, social, and economic
marginalization8,9. The effect of high-effort coping, or JH, within the
context of social and economic oppression may adversely affect
the health of both Blacks and Latinos.
Table 1. Descriptive Variables
Race/ethnicity
Latino/Hispanic
Black
Methods
Analysis: We used logistic regression to test our models. Model 1
tested the hypothesis that JH is positively associated with blood
pressure. Model 2 tested whether poverty level modifies this
relationship. Model 3 tested whether education modifies this
relationship. Model 4 tested whether employment status modifies
Blood Pressure
Covariates:
Age, Gender, Use of hypertensive medication
Summary
RQ 1: Latinos and Blacks had 1.56 and 1.63 times the odds,
respectively, of high JH scores compared to Whites (p=0.04 for
Latinos, p<0.01 for Blacks). The odds of high JH scores were not
statistically significant for measures of SEP including education,
poverty level, and employment status (p>0.05)
RQ 2: John Henryism is positively associated with high blood
pressure (Model 1; p=0.02).
Table 2. Association between race/ethnicity, SEP and JH
RQ 3: Socioeconomic position did not modify the relationship
between JH and blood pressure (Model 2 & 3; p>0.05).
Discussion/Implications
• Similar to James10, we found that Blacks were more likely to
have higher JH scores as compared to Whites. Latinos were also
more likely to have higher JH scores as compared to Whites.
• Higher JH scores are associated with higher risk of HBP.
• In contrast to James 7,11, our findings do not show a modifying
effect of socioeconomic position on the relationship between JH
and blood pressure for Blacks.
1
Reference group for race/ethnicity is non-Hispanic White
2 Reference group for education is persons with associate’s degree or higher education.
Table 3. Association between JH and Blood Pressure
Sample: The Healthy Environments Partnerships (HEP)
Community Survey was conducted in 2002, with a stratified twostage probability sample of occupied housing units in Detroit. A
total of 919 face-to-face interviews were completed with White,
Black, and Latino adults aged 25 or older.
Measures: The dependent variable was hypertension, defined as
systolic blood pressure (SBP) >120 mmHg or diastolic blood
pressure (DBP) >80mmHg, measured at the time of interview, or
taking hypertensive medication. Continuous measures of SBP and
DBP were also examined. The independent variable was the
mean score from the 12-item JH Active Coping Scale. Moderating
variables included household poverty level, education (less than
high school, high school/GED, some college, and completion of
college or more), employment status, and self-reported
race/ethnicity. Demographic control variables included age
(years), gender, and use of hypertensive medication.
Socioeconomic Position
Poverty-to-Income Ratio
Education
Currently or recently employed
John Henryism
Research Questions
We examined the following research questions in a multiethnic
sample: 1) Are race/ethnicity and socioeconomic position (SEP)
associated with JH?; 2) Is JH positively associated with blood
pressure?; and 3) Is the relationship between JH and blood
pressure modified by SEP?
Figure 1: Relationships between John Henryism,
race/ethnicity, socioeconomic position, and blood pressure
Next Steps
• Examine models in this population stratified by race/ethnicity to
further explore the influence of JH and blood pressure among
Black and Latino participants.
• Further explore contexts in which high levels of JH may prove
deleterious for health by examining the influence of occupational
stressors, household responsibilities, neighborhood factors,
racial/ethnic discrimination and stressful life events on the
relationship between JH and blood pressure.
References
1
Unadjusted odds ratio
2 Adjusted for age, gender, race/ethnicity, and education
3 Adjusted for age, gender, race/ethnicity, and poverty level
4 Adjusted for age, gender, race/ethnicity, poverty level, and employment status
Acknowledgements
The Healthy Environments Partnership (HEP) is a community-based participatory
research partnership affiliated with the Detroit Community-Academic Urban Research
Center. We thank the members of the HEP Steering Committee for their contributions to
the work presented here, including representatives from Brightmoor Community Center,
Detroit Department of Health and Wellness Promotion, Detroit Hispanic Development
Corporation, Friends of Parkside, Henry Ford Health System, Warren Conner
Development Coalition, and University of Michigan School of Public Health. The study
and analysis were supported by the National Institute of Environmental Health Sciences
(NIEHS) (R01ES10936, R01ES014234), and the Promoting Ethnic Diversity in Public
Health Research Education project (5-R25-GM-058641-11). The views presented here
are those of the authors, and not necessarily those of the National Institutes of Health.
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