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John Henryism and Blood Pressure Among Nigerian Civil Servants J Epidemiol Community Health: first published as 10.1136/jech.52.3.186 on 1 March 1998. Downloaded from 186 J Epidemiol Community Health 1998;52:186–190 John Henryism and blood pressure among Nigerian civil servants Nina Markovic, Clareann H Bunker, Flora A M Ukoli, Lewis H Kuller Abstract African-Americans of low socioeconomic sta- Study objective—Among urban Nigerian tus or of low educational attainment, those civil servants, higher socioeconomic sta- with high John Henryism scores show in- tus is related to increased blood pressure. creased blood pressure or increased prevalence In the United States, the relation between of hypertension.9–12 This finding has also been increased blood pressure and low socio- confirmed in a white Dutch population.13 More economic status or low level of education recently, high John Henryism has also been has been found to be potentiated by high found to potentiate an association between eVort active coping (John Henryism) high job status and blood pressure among among African-Americans. Thus, the po- women and African-Americans employed in tentiating eVect of high eVort active the United States.14 However, the combination coping as measured by the John Henryism of high John Henryism and low education was Active Coping Scale, on socioeconomic not associated with increased blood pressure in status, as measured by job grade, was a young cohort (18–30 year olds).15 considered in relation to blood pressure in Among civil servants in Nigeria, we have a Nigerian civil servant population. observed a positive association between blood Design—The influence of John Henryism pressure and socioeconomic status, with in- on the association between educational creased blood pressure measurements among level or socioeconomic status and in- those of higher staV status.16 During our most creased blood pressure was examined recent comprehensive blood pressure survey of during a comprehensive blood pressure civil servants in Benin City, Nigeria, we used survey. John Henryism refers to a strong the John Henryism Active Coping Scale17 to behavioural predisposition to actively examine its application in this non-Westernised cope with psychosocial environmental population. We wanted to replicate the analyses stressors. of James et al,9–12 that is, to test the hypothesis Setting—Benin City, Nigeria. that those with lesser material coping resources Participants—Nigerian civil servant sam- (for example, lower educational attainment, ple of 658 adults, aged 20 to 65 years. lower job grade) who scored high on the John Main results—Among those with high Henryism Active Coping Scale, would have John Henryism scores of upper socio- increased blood pressure. Alternatively, we economic status, whether measured by sought to examine whether or not this measure education level or job grade, there was a of active coping further explained our previous http://jech.bmj.com/ trend toward higher systolic and diastolic finding of increased blood pressure among blood pressures, adjusted for age and body those of higher staV status. mass index, in men and women, though not statistically significant. Department of —This trend is consistent Methods Epidemiology, Conclusions with recent findings of increased blood We recruited 84% of the civil servants at three Graduate School of ministries of Edo State in Benin City, Nigeria, Public Health, pressure among women and African- University of Americans with high John Henryism and for participation in a comprehensive blood on September 27, 2021 by guest. Protected copyright. Pittsburgh, Pittsburgh, high status jobs. pressure survey. This population has been pre- USA viously described18 and is characterised as a N Markovic (J Epidemiol Community Health 1998;52:186–190) lean population with a low protein and fat C H Bunker intake, moderate sodium intake, and a very low L H Kuller rate of smoking. These analyses are restricted Department of Increased blood pressure has been seen to be to the 658 (81.3%) of the 809 civil servants, Community Health, associated with a number of physical, socio- between the ages of 20 and 65 years, who com- University of Benin demographic, and psychological factors.1–5 Nu- pleted the John Henryism Active Coping Scale. Teaching Hospital, merous epidemiological studies have found Administration of the John Henryism Active Benin City, Edo State, socioeconomic status to be inversely related to Coping Scale was begun after the start of study Nigeria F A M Ukoli increased blood pressure among populations in data collection, thus the first 151 participants European countries and the United States.6–8 did not complete the John Henryism Active Correspondence to: Among African-Americans residing in the Coping Scale. Each individual was seen at Nina Markovic, Department United States, the relation is thought to be three morning appointments scheduled over of Epidemiology, Graduate School of Public Health, influenced, in part, by a coping strategy called one week at the study site located in each of the University of Pittsburgh, 130 “John Henryism”. John Henryism has been respective ministries. At each of the three visits, DeSoto Street, Pittsburgh, defined as a strong behavioural predisposition three blood pressure determinations were PA 15261, USA. to cope in an active, determined, and hard- made by Nigerian study team members, certi- 19 Accepted for publication working manner with the stressors of everyday fied by a standard protocol. First and fifth 22 April 1997 life.9 The influence is such that among KorotoV sounds were recorded as systolic and J Epidemiol Community Health: first published as 10.1136/jech.52.3.186 on 1 March 1998. Downloaded from Nigerians, John Henryism, and blood pressure 187 Table 1 Mean systolic (SBP) and diastolic blood pressure (DBP)* for the four groups were constructed for assessing educa- education-John Henryism (JH) groups by sex, Benin City Nigeria Civil Servants 1992 tion and John Henryism, based on the median splits of the John Henryism Active Coping Scale Men Women and educational attainment of the sample.9 For Number SBP DBP Number SBP DBP the second presented analysis, four contrast groups were constructed based upon the High education: High JH 74 122.4 78.3 47 115.8 73.7 median splits of the John Henryism Active Low JH 63 119.2 77.7 32 110.1 72.7 Coping Scale score and job grade status (Junior Low education: or Senior)16 for the analysis of sta status and High JH 140 121.6 77.5 92 113.6 71.7 V Low JH 126 118.1 75.4 84 111.3 72.0 John Henryism. Entire sample 403 120.3 77.0 255 112.8 72.3 ANOVA p values: Education 0.76 0.74 0.71 0.65 Results John Henryism 0.10 0.26 0.04 0.82 The John Henryism Active Coping Scale Education × JH 0.73 0.36 0.26 0.46 scores among these Nigerian civil servants Post hoc ANOVA: Between high JH and high education ranged from 22 to 60, with a highly skewed versus all others combined p=0.75 p=0.88 p=0.20 p=0.39 distribution to the higher end of the scale. The median John Henryism Active Coping Scale * Mean systolic and diastolic blood pressures are an average of six readings across three visits, adjusted for age and body mass index. score in this population was 57, with 16.8 per cent of the respondents scoring 60. The John diastolic blood pressure respectively. Mean Henryism score mean and standard deviation blood pressures calculated as the average of the were 55.9 and 4.14. The median for education second and third determinations made at each was completion of secondary level education, of the three study visits were used in all so that those who had completed technical presented analyses. school beyond secondary school or university Demographic data were collected at the first were grouped as “high” education. visit, and included recording of level of educa- John Henryism Active Coping Scale scores tion attained, job grade, marital status, ethnic did not diVer significantly between men and tribe, height, and weight (in light clothing women (mean scores of 55.8 and 56.1 respec- without shoes). Education was categorised tively), nor were there significant diVerences from no education, completion of primary between women and men in the proportion education, completion of secondary education, classified as “high John Henryism” (per cent completion of technical education, to comple- classified as high John Henryism among men tion of a university degree. Nigerian civil serv- was 78.7 and among women 80.4). No signifi- ant job grades are ranked from 1 to 16, such cant correlations were noted between John that grades 1 to 6 are considered Junior staV Henryism scores and age (r=0.0002, p>0.05), (unskilled workers, semi-skilled workers, and body mass index (r=0.038, p>0.05), job grade entry level administrators), while those of level (r=0.011, p>0.05), or level of formal edu- grades 7 to 16 are considered Senior staV cation (r=0.028, p>0.05). No significant diVer- (highly skilled workers and administrators). ences were identified among marital status cat- Marital status was recorded as never married, egories or among the ethnic tribes. married, divorced, and widowed. Ethnic tribal Mean systolic and diastolic blood pressures aYliation was self reported. Body mass index were positively associated with levels of educa- http://jech.bmj.com/ was calculated as kg/m2. tion (r=0.03, r=0.06 respectively) and staV Before administration the John Henryism level (r=0.18, r=0.19 respectively), age Active Coping Scale was translated into pidgin (r=0.04, r=0.28 respectively) and body mass English, which is the common language for this index (r=0.16, r=0.19, respectively).
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