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The Impact of Goal-Striving Stress on Physical Health of White Americans, African Americans, and Caribbean Blacks

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The Impact of Goal-Striving Stress on Physical Health of White Americans, African Americans, and Caribbean Blacks THE IMPACT OF GOAL-STRIVING STRESS ON PHYSICAL HEALTH OF WHITE AMERICANS, AFRICAN AMERICANS, AND CARIBBEAN BLACKS Objective: To contribute to the growing Sherrill L. Sellers, PhD; Harold W. Neighbors, PhD; understanding of US Black-White health dis- Rong Zhang, PhD; James S. Jackson, PhD parities by examining psychosocial stress as an important contributor to physical health prob- lems. INTRODUCTION Methods: Data are from the National Survey Goal-striving stress is the of American Life, an integrated national Despite recent efforts to narrow the household probability sample of White Amer- health disparities gap, compared to discrepancy between icans, African Americans, and Caribbean Blacks. Regression analysis was used to assess Whites, Blacks in the United States aspirations and achievement, associations between goal-striving stress and have a higher death rate from breast, hypertension, BMI, physical health problems, lung, and colorectal cancer, are at weighted by the subjective and self-rated health. greater risk for cardiovascular disease, are more likely to be overweight or probability of success and the Results: After accounting for sociodemo- graphic factors and three additional stressors obese, and are two times more likely to level of disappointment 1–3 –personal problems, lifetime racial discrimina- rate their health as ‘‘fair’’ or ‘‘poor.’’ tion, and everyday racial discrimination–goal- Interestingly, these racial health dispar- experienced if goals are not striving stress was a significant predictor of ities do not hold for all Blacks living in reached. hypertension, physical health problems, and the United States. Compared to US- diminished self-rated health. Ethnicity moder- ated the relationship; the negative association born Blacks (herein referred to as a between goal-striving stress and physical health African Americans), Black Caribbean problems was strongest for Caribbean Blacks. immigrants report better physical health, and are at lower risks for discrepancy between aspirations and Conclusions: This study extends the research hypertension, obesity, chronic condi- achievement, weighted by the subjective on goal-striving stress and adds to a growing 4,5 probability of success and the level of literature documenting relationships between tions, and activity limitations. disappointment experienced if goals are social processes and disease. (Ethn Dis. However, the immigrant advantage 2012;22(1):21–28) erodes over time; by second and later not reached. It has the characteristics of generations, the health status of Carib- a chronic stressor–insidious, unrelent- Key Words: Goal-striving Stress, Physical bean Blacks begins to resemble that of ing, and continuous in the sense that it Health, Health Disparities, Racial Discrimina- African Americans.6 is embedded in daily roles and struc- tion 10–13 Factors associated with health ero- tures. Goal-striving stress captures sion include acculturation, lifestyle some aspects of the American dream: changes and exposure to racism and individual accomplishment, upward so- discrimination.7 A causal mechanism cial and economic mobility, and self- linking racism and discrimination to confident belief in one’s ability to health is thought to lie within the stress overcome obstacles. These ideals may process.8,9 be particularly salient for immigrants and One particular stress, goal-striving their children, as many have chosen the stress, has been associated with lower U.S. for the explicit purpose of pursuing levels of mental health and wellbeing.10–12 this dream. Children of immigrants may From the Department of Family Studies To date, no study has examined associ- be reminded of the sacrifices that their and Social Work, Miami University (SLS); ations of goal-striving stress and phys- parents made and may be especially the Program for Research on Black Ameri- ical health. Goal-striving stress is the motivated to maximize their chances cans, The Institute for Social Research, The for achievement.14, 15, 16 But for those University of Michigan (HWN, RZ); and the Institute for Social Research, The University defined as ‘‘Black’’ the U.S. offers of Michigan (JSJ) a With 6–10% of the Black population opportunities for achievement and up- reporting foreign ancestry, immigrant histo- ward mobility while simultaneously Address correspondence to Sherrill L. ry and status are important sources of constraining their advancement through Sellers; Associate Professor; Department of variation within the U.S. Black population. Family Studies and Social Work; Miami Caribbean Blacks are the largest subgroup discrimination and group disadvan- 17 University-Oxford; Oxford, OH 45056. of Black immigrants, comprising approxi- tage. The resulting discrepancy be- [email protected] mately 4.4% of the US.Black population. tween aspirations and achievement can Ethnicity & Disease, Volume 22, Winter 2012 21 IMPACT OF GOAL-STRIVING STRESS ON HEALTH - Sellers et al be especially stressful and deleterious to identity as their racial context shifts.4,18 count of physical health problems is the health and wellbeing. The White sample was a stratified, sum of yes answers. It ranged from 0 to This article has two main aims: 1) to disproportionate sample of White adults 13 with a mean of 1.3. Because self- investigate the associations between residing in households located in census rated health appears to be a robust goal-striving stress and physical health tracts and blocks that have a 10% or measure of health and wellbeing, it was among White Americans, African greater African American population. also included.19 Self-rated physical Americans, and Caribbean Blacks, and White Americans in this study represent health was measured by asking respon- 2) to assess race and ethnicity as 14% of the White population in the dents, ‘‘How would you rate your potential moderators of these associa- United States. overall physical health at the present tions. Most interviews (86%) were com- time?’’ Responses ranged from excellent pleted face-to-face using a computer- (coded 5) to poor (coded 1). assisted instrument and lasted an aver- METHODS age of 2 hours and 20 minutes. The Predictors remaining interviews were either par- Race is a categorical variable defined Sample tially or entirely conducted by tele- as 1 – African American, 2 – Caribbean The National Survey of American phone. All the interviews were conduct- Black and 3 – White. Sex is defined as 1 Life (NSAL) is part of a National ed in English. Data collection was –maleand2–female.Ageisa Institute of Mental Health Collabora- completed between February 2, 2001 continuous variable measured in years, tive Psychiatric Epidemiology Surveys and June 30, 2003. ranging from 18 to 94. Employment initiative. The NSAL adult sample was The final response rate was 72.3% status assessed whether respondents an integrated national household prob- overall: 70.7% for African Americans, were employed or not (1 5 employed ability sample of 3,570 African Amer- 77.7% for Caribbean Blacks, and and 0 5 not employed). Education was icans, 891 non-Hispanic Whites, and 69.7% for White Americans. For all a self-report of the number of years of 1,621 Blacks of Caribbean descent three race/ethnic samples, the NSAL formal schooling completed and ranged (Caribbean Blacks), for a total sample weights were designed to correct for from 0 to 17. Region contrasted those of 6,082 individuals 18 years and older. disproportionate sampling, nonre- who resided in the South (more than The African American sample, the core sponse, and population representation half of the respondents) with those sample of the NSAL, is a nationally across various sociodemographic char- residing in other regions. Marital status representative sample of households acteristics. compared those who were married or located in the 48 contiguous states with living with a partner to those who were at least one Black adult 18 years and Measures never married or formerly married (ie, older. divorced, widowed, separated). Poverty The term African American is used Outcomes status was measured by dichotomizing to describe persons who self-identified Physical health was measured along the ratio of household income to the as Black and did not identify ancestral four dimensions—hypertension, obesi- 2001 census poverty threshold. If the ties to the Caribbean. Caribbean Blacks ty, count of physical health problems, ratio was less than or equal to 1, the are persons who self-identified as Black and self-rated health. Hypertension is a respondent was classified as poor. In- and indicated that they were of West dichotomous variable to the question come was measured by asking respon- Indian or Caribbean descent, that they whether ‘‘a doctor has ever told you that dents to estimate their total household were from a country included on a list you had hypertension,’’ with yes coded income from all sources. of Caribbean countries presented by the 1andnocoded0.Obesityisa Goal-striving stress consisted of four interviewers, or that their parents or continuous variable measured by the items measuring the discrepancy be- grandparents were born in a Caribbean respondent’s body mass index (BMI tween aspirations and achievement country. For our study, we excluded based on self-reported height and weighted by the chance of, and level of first generation Caribbean Blacks be- weight) and ranged from 10 to 66. disappointment associated with, failing cause language, accent, clothing and Count of physical health problems was to achieve one’s goals. Respondents
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