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John Henryism and Blood Pressure Among Detroit Residents: Findings from the Healthy Environments Partnership Alana M

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John Henryism and Blood Pressure Among Detroit Residents: Findings from the Healthy Environments Partnership Alana M 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 Figure 1: Relationships between John Henryism, • Blacks and Latinos experience excess risk of high blood Table 1. Descriptive Variables race/ethnicity, socioeconomic position, and blood pressure Race/ethnicity Socioeconomic Position pressure, a risk factor for cardiovascular disease, compared to Whites1,2,3. Latino/Hispanic Poverty-to-Income Ratio Black Education • John Henryism (JH), a high-effort coping strategy that reflects Currently or recently employed American values of hard work, may be one psychosocial mechanism that contributes to excess rates of high blood pressure John Henryism Blood Pressure 4 (HBP) among Blacks and Latinos . Persons who engage in such active and effortful coping strategies, while also contending with Covariates: social and economic hardships may experience adverse health Age, Gender, Use of hypertensive medication effects such as HBP4. In contrast, for persons with adequate resources, John Henryism coping strategies may serve as a Summary 4 resource that promotes health . Findings from analyses of the relationship between John Henryism, socioeconomic position, and RQ 1: Latinos and Blacks had 1.56 and 1.63 times the odds, HBP among Blacks and Whites have been mixed5. respectively, of high JH scores compared to Whites (p=0.04 for • The influence of JH on the health of Latinos has not been Latinos, p<0.01 for Blacks). The odds of high JH scores were not statistically significant for measures of SEP including education, investigated. While JH was conceptualized as a construct that reflects the health consequences of race-based oppression poverty level, and employment status (p>0.05) 4 experienced by Blacks , an examination of the application of JH to RQ 2: John Henryism is positively associated with high blood the experience of Latinos, the largest and fastest growing pressure (Model 1; p=0.02). 6,7 racialized group in the U.S. , is warranted. Similar to Blacks, Latinos experience social, economic, and political marginalization. RQ 3: Socioeconomic position did not modify the relationship between JH and blood pressure (Model 2 & 3; p>0.05). Further, Latinos are increasingly subjected to anti-immigrant Table 2. Association between race/ethnicity, SEP and JH sentiments that may influence occupational, social, and economic Discussion/Implications marginalization8,9. The effect of high-effort coping, or JH, within the context of social and economic oppression may adversely affect • Similar to James10, we found that Blacks were more likely to the health of both Blacks and Latinos. have higher JH scores as compared to Whites. Latinos were also more likely to have higher JH scores as compared to Whites. Research Questions • Higher JH scores are associated with higher risk of HBP. We examined the following research questions in a multiethnic 7,11 sample: 1) Are race/ethnicity and socioeconomic position (SEP) • In contrast to James , our findings do not show a modifying associated with JH?; 2) Is JH positively associated with blood effect of socioeconomic position on the relationship between JH pressure?; and 3) Is the relationship between JH and blood and blood pressure for Blacks. 1 Reference group for race/ethnicity is non-Hispanic White pressure modified by SEP? 2 Reference group for education is persons with associate’s degree or higher education. Next Steps Methods Table 3. Association between JH and Blood Pressure • Examine models in this population stratified by race/ethnicity to Sample: The Healthy Environments Partnerships (HEP) further explore the influence of JH and blood pressure among Community Survey was conducted in 2002, with a stratified two- Black and Latino participants. stage probability sample of occupied housing units in Detroit. A • Further explore contexts in which high levels of JH may prove total of 919 face-to-face interviews were completed with White, deleterious for health by examining the influence of occupational Black, and Latino adults aged 25 or older. stressors, household responsibilities, neighborhood factors, racial/ethnic discrimination and stressful life events on the Measures: The dependent variable was hypertension, defined as relationship between JH and blood pressure. systolic blood pressure (SBP) >120 mmHg or diastolic blood References pressure (DBP) >80mmHg, measured at the time of interview, or 1 Unadjusted odds ratio 1. Egan BM, Zhao Y, Axon RN. US Trends in Prevalence, Awareness, Treatment, and Control of Hypertension, taking hypertensive medication. Continuous measures of SBP and 2 Adjusted for age, gender, race/ethnicity, and education 1998-2008. Journal of the American Medical Association 2010; 303(20): 2043-2050. 2. Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in Hypertension Prevalence, Awareness, 3 Adjusted for age, gender, race/ethnicity, and poverty level Treatment, and Control Rates in United States Adults between 1988-1994 and 1999-2004. Hypertension 2008; 52: DBP were also examined. The independent variable was the 4 Adjusted for age, gender, race/ethnicity, poverty level, and employment status 818-827. mean score from the 12-item JH Active Coping Scale. Moderating 3. Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP, Hazuda HP. All-Cause and Cardiovascular Mortality Acknowledgements among Mexican-American and Non-Hisphanic White Older Participants in the San Antonio Heart Study: Evidence variables included household poverty level, education (less than Against the “Hispanic Paradox”. American Journal of Epidemiology 2003; 158(11): 1048-1057. high school, high school/GED, some college, and completion of The Healthy Environments Partnership (HEP) is a community-based participatory 4. James SA. John Henryism and the Health of African Americans. Culture, Medicine and Psychiatry. 1994;18:163- 182. college or more), employment status, and self-reported research partnership affiliated with the Detroit Community-Academic Urban Research 5. James SA. John Henryism and Blood Pressure in Black Populations: A Review of the Evidence. African Center. We thank the members of the HEP Steering Committee for their contributions to American Research Perspectives 2000; 6(3): 1-10. race/ethnicity. Demographic control variables included age 6. Humes KR, Jones NA, Ramirez RR. 2010 Census Briefs: Overview of Race and Hispanic Origin 2011. the work presented here, including representatives from Brightmoor Community Center, 7. Passel JS, Cohn D, Lopez MH. Census 2010: 50 Million Latinos: Hispanics Account for More than Half of (years), gender, and use of hypertensive medication. Detroit Department of Health and Wellness Promotion, Detroit Hispanic Development Nation’s Growth in Past Decade. Pew Hispanic Center 2011. Corporation, Friends of Parkside, Henry Ford Health System, Warren Conner 8. Brown MP. Immigrant Workers: Do They Fear Workplace Injuries More than They Fear Their Employers? In Gender, Race, Class and Health 2006. Schulz AJ and Mullings L (Eds). San Fransisco: Jossey-Bass. Analysis: We used logistic regression to test our models. Model 1 Development Coalition, and University of Michigan School of Public Health. The study 9. Hacker K, Chu J, Leung C, Marra R, Pirie A, Brahimi M, Marlin RP. The Impact of Immigration and Customs tested the hypothesis that JH is positively associated with blood and analysis were supported by the National Institute of Environmental Health Sciences Enforcement on Immigrant Health: Perceptions of Immigrants in Everett, Massachusetts, USA. Social Science and (NIEHS) (R01ES10936, R01ES014234), and the Promoting Ethnic Diversity in Public Medicine, 73, 586-594. pressure. Model 2 tested whether poverty level modifies this 10. James SA. Strogatz DS, Wing SB, Ramsey DL. Socioeconomic Status, John Henryism, and Hypertension in Health Research Education project (5-R25-GM-058641-11). The views presented here Blacks and Whites. American Journal of Epidemiology 1987; 126(4): 664-673. relationship. Model 3 tested whether education modifies this are those of the authors, and not necessarily those of the National Institutes of Health. 11. James SA, Keenan NL, Strogatz DS, Browning SR, Garrett JM. Socioeconomic Status, John Henryism, and relationship. Model 4 tested whether employment status modifies Blood Pressure in Black Adults: The Pitt County Study. American Journal of Epidemiology 1992; 135 (1): 59-67. this relationship. .
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