Testing the John Henryism Hypothesis on Cardiometabolic Health Among Older African Americans

In the context of racism, the John Henryism Hypothesis posits that prolonged high-effort coping, which is referred to as John Henryism, may take a toll on physical health among individuals from low socioeconomic status (SES) backgrounds, particularly low SES African Americans. This study aimed to test the John Henryism Hypothesis among older African Americans by examining the combined effect of John Henryism and childhood SES on cardiometabolic health indexed by metabolic syndrome and systemic inflammation. Data were drawn from a sample of 170 urban older African Americans (Mage = 67.4 years, 75.9% female), who completed questionnaires assessing John Henryism and childhood SES (i.e., parental education). Blood pressure, waist circumference, and fasting blood were also collected to assess metabolic syndrome and systemic inflammation. Results indicated that John Henryism was significantly associated with elevated metabolic syndrome symptoms among older African Americans reporting low childhood SES (b = 0.42, 95%CI = [0.02, 0.83]), but not among those with high childhood SES (b = -0.33, 95%CI = [-0.78, 0.13]). This result was robust to a variety of demographic variables, lifestyle behavioral factors, and health conditions that are known to be associated with metabolic syndrome. A similar pattern of results, however, did not emerge for systemic inflammation. Our findings highlight the importance of considering the joint impact of early childhood socioeconomic backgrounds and individual psychological proclivities in explaining the elevated cardiovascular disease risk among older African Americans.

John Henryism and Cognitive Function and Decline

Older Black adults in the US have higher prevalence and incidence of dementia and perform lower on cognitive tests than whites. Some of these differences have been attributed to facets of structural racism such as access to and quality of education and fewer socioeconomic resources. Here, we consider whether John Henryism (JH), a measure of self-perceived high-effort coping in the face of chronic environmental and psychosocial stressors, is associated with cognitive function and decline. JH has been associated with adverse cardiovascular health outcomes among African-Americans, especially those with fewer socioeconomic resources. Using data from MARS, we assessed whether JH, measured with an 8-item questionnaire (mean=16.9, sd=4.8, range: 4-27), was associated with level of cognitive function and rate of cognitive decline. We found one standard deviation increase in JH was associated with lower average cognitive function (□=-0.05, 95% CI: -0.09, -0.01). Higher JH was not associated with rate of cognitive decline.

Childhood Socioeconomic Status and Cardiometabolic Health: A Test of the John Henryism Hypothesis in African American Elders

Background John Henryism (JH) is a form of active high-effort coping. Low socioeconomic status (SES) African Americans adopting JH to deal with structural racism and other chronic stressors might be more likely to display cardiovascular disease risk factors. Previous tests of this hypothesis have mostly focused on the moderating role of current SES and hypertension as the outcome variable. Further, most of the previous work has been conducted among young and middle-aged adults. The present study aimed at extending work on the JH hypothesis by testing the combined effect of JH and childhood SES on metabolic syndrome and systemic inflammation among African American elders. Methods One-hundred and seventy urban African American older adults (Mage = 67.64 years, 75.9% female) were recruited. Participants completed questionnaires assessing JH, childhood SES, and other variables used as covariates (i.e., demographic information, chronic conditions, medication use, and health behaviors). Blood pressure, waist circumference, and blood were also collected. Triglycerides, HDL cholesterol, hemoglobin A1C, and C-Reactive Protein levels were measured from the blood samples. Results JH was positively associated with MetS symptoms among participants reporting low childhood SES levels, but not among those reporting high childhood SES levels. The same pattern did not emerge when we considered current SES. Similar patterns of results did not emerge as far as systemic inflammation was concerned. Conclusions Our findings highlight the importance of considering the joint impact of objective conditions early in life and individual psychological proclivities in explaining increased risk for cardiovascular disease risk in this population.

Is John Henryism a Health Risk or Resource?: Exploring the Role of Culturally Relevant Coping for Physical and Mental Health among Black Americans

Research shows that John Henryism, a high-effort, active coping style, is associated with poor physical health, whereas others suggest it may be psychologically beneficial. As such, it is unclear whether John Henryism represents a health risk or resource for black Americans and whether its impact varies across sociodemographic and gender groups. The present study used data from a representative community sample of black Americans (n = 627) from the Nashville Stress and Health Study (2011–2014) to clarify the physical and mental health consequences of John Henryism by assessing its relationship with depressive symptoms and allostatic load (AL). Results indicate that John Henryism is associated with increased AL scores and fewer depressive symptoms. Additionally, the association between John Henryism and AL is conditional on socioeconomic status. Study results underscore the importance of evaluating both physical and mental health to clarify the health significance of John Henryism among black Americans.

Impostor Phenomenon and Psychological Well-Being: The Moderating Roles of John Henryism and School Racial Composition Among Black College Students

The impostor phenomenon (IP), or erroneous cognitions of intellectual incompetence, is a risk factor for poor psychological adjustment among Black emerging adults. Grounded in Lazarus and Folkman’s Stress and Coping Framework, the current study investigated John Henryism’s active coping and institutional racial composition as moderators of the association between IP and indicators of psychological well-being among 266 Black students (77% women; Mage = 19.87) attending predominately White institutions (PWIs) and historically Black colleges/universities (HBCUs). Hierarchical moderation regression analyses revealed that IP was associated with decreases in well-being indicators among students attending PWIs and HBCUs. Moreover, students who attended PWIs and reported higher levels of John Henryism (+1 SD) were most vulnerable to increases in social anxiety, particularly at higher levels of IP. Results suggest that the interaction between IP, John Henrysim, and institutional racial composition may negatively influence psychological well-being. We discuss how these findings can be used to inform clinical and educational practices to best support Black college students.

Clinical Implications of Active Coping on Sleep: John Henryism in a Sickle Cell Disease Cohort

Background: Approximately 57% of individuals with Sickle Cell Disease (SCD) suffer from sleep disorders and poor sleep quality. Poor sleep quality may cause excessive daytime sleepiness and is often associated with psychosocial and clinical factors contributing to disease burden and stress levels. One of these psychosocial factors is John Henryism (JH). Defined as a high-effort, active coping style, JH is used by persons with a strong determination to succeed in the face of chronic stressors. Both sleep and JH have mostly been shown to be negatively associated with cardiovascular health. Living with SCD is a unique stressor and how persons cope with their disease may impact their quality of life and health outcomes. The objective of this study is to 1) evaluate the impact of sleep quality and 2) quantify the effect of sleep quality on high-effort coping among persons with SCD. Methods: The sample comprised 191 adults aged 19-71 with SCD. Most participants were women (57%) and had a mean age of 39 years (SD+12.2) (see Table 1). All participants were enrolled in the Insights into Microbiome and Environmental Contributions to SCD and Leg Ulcers (INSIGHTS) study (NCT02156102). All participants were administered a variety of psychosocial measures, a comprehensive medical history and physical exam, and provided blood and saliva samples for clinical and research analysis. Our binary outcome assessed participants' high or low utilization of JH coping style by using the John Henryism Active Coping Scale (JHAC12). JHAC12 scores were measured from participant responses to a 12-item Likert scale. Scores range from 12 to 60 with higher scores indicting higher utilization of JH active coping. Based on the median JH score of our participants, scores between 12-50.9 were categorized as low utilization of JH and scores between 51-60 were categorized as high utilization of JH. Predictors included demographic data and psychosocial measures. Sleep quality was assessed via clinical and survey measures. Clinically, obstructive sleep apnea was self-reported during a comprehensive medical exam. The ASCQ-ME sleep survey is a 5-item measure, and was used to ascertain participant sleep patterns within the past seven days. Scores range from 40 to 60. Scores less than 50 are considered abnormal. Multivariable logistic regression was performed to evaluate differences within the cohort. Results: Mean ASCQ-ME sleep score of the entire cohort was 46, indicating worse sleep quality for participants compared to the ASCQ-ME national SCD reference cohort. Obstructive sleep-apnea was self-reported by 23 participants (12%). The mean JH score was 52, indicating high utilization of active coping. Poorer sleep quality was associated with higher JH coping (OR:1.14, 95% CI: [1.06-1.22]) (see Table 2). There were no significant associations between utilization of JH active coping with the demographic data including sex, age, education and marital status. Worse sleep quality within the SCD cohort was associated with increased usage of hydroxyurea (r= .16, p<.05), history of cardiovascular disease (r= .13, p<.05), higher pain score at study visit (r=.15, p<.05) and increased systolic blood pressure (r=.18, p<.01). Conclusion: Preliminary findings support a relationship between JH and sleep quality in a SCD cohort. In a disease population with high sleep apnea prevalence, these findings have potential clinical implications. Future work should focus on how these psychosocial factors impact sleep and clinical presentation. Disclosures Minniti: Doris Duke Foundation: Research Funding.

An Examination of John Henryism, Trust, and Medication Adherence Among African Americans With Hypertension

Background. John Henryism is defined as a measure of active coping in response to stressful experiences. John Henryism has been linked with health conditions such as diabetes, prostate cancer, and hypertension, but rarely with health behaviors. Aims. We hypothesized that reporting higher scores on the John Henryism Scale may be associated with poorer medication adherence, and trust in providers may mediate this relationship. Method. We tested this hypothesis using data from the TRUST study. The TRUST study included 787 African Americans with hypertension receiving care at a safety-net hospital. Ordinal logistic regression was used to examine the relationship between John Henryism and medication adherence. Results. Within our sample of African Americans with hypertension, lower John Henryism scores was associated with poorer self-reported adherence (low, 20.62; moderate, 19.19; high, 18.12; p < .001). Higher John Henryism scores were associated with lower trust scores (low John Henryism: 40.1; high John Henryism: 37.9; p < .001). In the adjusted model, each 1-point increase in the John Henryism score decreased the odds of being in a better cumulative medication adherence category by a factor of 4% (odds ratio = 0.96, p = .014, 95% confidence interval = 0.93-0.99). Twenty percent of the association between medication adherence and John Henryism was mediated by trust (standard deviation = 0.205, 95% confidence interval = 0.074-0.335). Discussion. This study provides important insights into the complex relationship between psychological responses and health behaviors. It also contributes to the body of literature examining the construct of John Henryism among African Americans with hypertension. Conclusion. The findings of this study support the need for interventions that promote healthful coping strategies and patient–provider trust.