John Henryism and blood pressure differences among black men

African American Female Offender's Use of Alternative and Traditional Health Services After Re-Entry: Examining the Behavioral Model for Vulnerable Populations

This is the first known study to use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict African American women's use of three types of health services (alternative, hospitalization, and ambulatory) in the 18 months after release from prison. In the multivariate models, the most robust predictors of all three types of service utilization were in the vulnerable theoretical domains. Alternative health services were predicted by ethnic community membership, higher religiosity, and HIV/HCV. Hospitalizations were predicted by the lack of barriers to health care and disability. Ambulatory office visits were predicted by more experiences of gendered racism, a greater number of physical health problems, and HIV/HCV. Findings highlight the importance of cultural factors and HIV/HCV in obtaining both alternative and formal health care during community re-entry. Clinicians and policymakers should consider the salient role that the vulnerable domain plays in offender's accessing health services.

John Henryism Active Coping, Acculturation, and Psychological Health in Korean Immigrants

This study aimed to explore the levels of John Henryism (JH) active coping and its association with acculturation status and psychological health (specifically perceived stress, acculturative stress, anxiety, and depression) in Korean immigrants to the United States. In 102 Korean immigrants, JH active coping was measured by the JH Scale; acculturation by the Bidimensional Acculturation Scale; perceived stress by the Perceived Stress Scale; acculturative stress by the Social, Attitudinal, Familial, and Environmental Scale; anxiety by the State Anxiety Subscale of the Spielberger State-Trait Anxiety Inventory; and depression by the Center for Epidemiological Studies Depression Scale. The levels of JH active coping in this sample of Korean immigrants appear to be lower than the levels reported in other racial groups. Independent of demographic factors, JH active coping was a significant predictor of higher acculturation status and better psychological health as indicated by lower levels of perceived stress, acculturative stress, anxiety, and depressive symptoms.

The Interdependence of African American Men's Definitions of Manhood and Health

In this article, we explore themes that cut across how 24- to 77-year-old African American men define manhood and health. Utilizing a thematic approach, we analyzed data from 9 focus groups (N = 73). We found that manhood and health were relational constructs that are interrelated in men's minds and experiences. Manhood and health were defined by the characteristics men embody, the behaviors men engage in, and the goals and values men had to positively influence their families and communities. Thus, manhood and health are interdependent constructs and their interrelationship should be considered in efforts to promote African American men's health.

Racial Composition Over the Life Course: Examining Separate and Unequal Environments and the Risk for Heart Disease for African American Men

PURPOSE

Studies have demonstrated the effects of segregated social and physical environments on the development of chronic diseases for African Americans. Studies have not delineated the effects of segregated environments specifically on the health of African American men over their lifetime. This study examines the relationship between life course measures of racial composition of social environments and diagnosis of hypertension among African American men.

DESIGN

We analyzed cross-sectional data from a convenience sample of African American men seeking health care services in an outpatient primary care clinic serving a medically underserved patient population (N=118). Multivariable logistic regression analyses were used to examine associations between racial composition of multiple environments across the life course (eg, junior high school, high school, neighborhood growing up, current neighborhood, place of employment, place of worship) and hypertension diagnosis.

RESULTS

The majority (86%) of participants were not currently in the workforce (retired, unemployed, or disabled) and more than half (54%) reported an annual household income of <$9,999; median age was 53. Results suggest that African American men who grew up in mostly Black neighborhoods (OR=4.3; P=.008), and worked in mostly Black environments (OR=3.1; P=.041) were more likely to be diagnosed with hypertension than those who did not.

CONCLUSION

We found associations between mostly Black residential and workplace settings and hypertension diagnoses among African American men. Findings suggest exposure to segregated environments during childhood and later adulthood may impact hypertension risk among African American men over the life course.

"We get what we deserve": the belief in a just world and its health consequences for Blacks

This study explored whether individual differences in the endorsement of the belief that the world is a just place (i.e., the just world belief) would predict individual differences in resilience/vulnerability to the negative health consequences of discrimination. One-hundred and thirty Blacks participated in a vital check and completed a computer-based questionnaire that included measures of the just world belief, perceived discrimination, physical and mental health, and the presence/absence of chronic illnesses. Endorsement of the just world belief was not associated with self-reported physical/mental health; however, it moderated the effects of perceived discrimination on the number of chronic illnesses and systolic blood pressure. These findings suggest that Blacks who believe that the world is a just place where they get what they deserve may be at a particularly higher risk for the negative health consequences of discrimination. Theoretical and clinical implications of the findings are discussed.

Childhood trauma and personal mastery: their influence on emotional reactivity to everyday events in a community sample of middle-aged adults

Childhood trauma is associated with premature declines in health in midlife and old age. Pathways that have been implicated, but less studied include social-emotional regulation, biological programming, and habitual patterns of thought and action. In this study we focused on childhood trauma’s influence via alterations in social-emotional regulation to everyday life events, a pathway that has been linked to subsequent health effects. Data from a 30-day daily diary of community residents who participated in a study of resilience in Midlife (n = 191, M_age = 54, SD = 7.50, 54% women) was used to examine whether self-reports of childhood trauma were associated with daily well-being, as well as reported and emotional reactivity to daily negative and positive events. Childhood trauma reports were associated with reporting lower overall levels of and greater variability in daily well-being. Childhood trauma was linked to greater reports of daily negative events, but not to positive events. Focusing on emotional reactivity to daily events, residents who reported higher levels of childhood trauma showed stronger decreases in well-being when experiencing negative events and also stronger increases in well-being with positive events. For those reporting childhood trauma, higher levels of mastery were associated with stronger decreases in well-being with negative events and stronger increases in well-being with positive events, suggesting that mastery increases sensitivity to daily negative and positive events. Our results suggest that childhood trauma may lead to poorer health in midlife through disturbances in the patterns of everyday life events and responses to those events. Further, our findings indicate that mastery may have a different meaning for those who experienced childhood trauma. We discuss social-emotional regulation as one pathway linking childhood trauma to health, and psychosocial resources to consider when building resilience-promoting interventions for mitigating the detrimental health effects of childhood trauma.

Is John Henryism a resilience factor in women experiencing intimate partner violence?

BACKGROUND

Research suggests that posttraumatic stress disorder (PTSD) and depression are two common mental health problems in intimate partner violence (IPV) survivors. Research has found that while Black women consistently report higher rates of victimization than White women, they also report less severe PTSD and depressive symptoms, suggesting that Black IPV survivors might be more resilient to PTSD and depression than are White survivors.

DESIGN

We implemented a correlational study with 81 Black and 100 White female survivors of IPV to determine if John Henryism (JH; i.e., a predisposed active coping mechanism) contributes to the resilience observed in Black IPV survivors.

METHODS

Participants completed the John Henryism Active Coping Scale, Center for Epidemiological Studies Depression Scale, Davidson Trauma Scale, and the Abusive Behavior Inventory.

RESULTS

Results demonstrated that White woman endorsed more severe depressive symptoms as compared to Black women. Severity of PTSD symptoms and JH was not significantly different between races. JH did not moderate the relationship between race and depression; however, for PTSD, JH was found to be protective of PTSD in White women, while demonstrating little impact on Black women.

CONCLUSIONS

The implications of these findings are discussed in terms of the minority stress model.

Exploring moderating effects of John Henryism Active Coping on the relationship between education and cardiovascular measures in Korean Americans

OBJECTIVE

John Henryism Active Coping (JHAC) is defined as a strong behavioral predisposition to cope with stressors in an effortful and determined manner. The well-known inverse relationship between socioeconomic status (SES) and blood pressure (BP) has been hypothesized to be stronger for individuals who have high JHAC than those with low JHAC, suggesting that JHAC may place people with low SES at higher cardiovascular risk. Previous studies testing this hypothesis have presented mixed findings; therefore, this study was conducted to test the JHAC hypothesis by examining the main and interaction effects of SES and JHAC on cardiovascular risk (measured by BP and arterial stiffness [AS]).

METHODS

The sample was 102 Korean Americans (aged 21-60years). Measures included age, sex, body mass index, smoking, SES (measured by income and education), JHAC (measured by the 12-item JHAC Scale), BP, and AS.

RESULTS

In terms of the SES measures, only education was significantly related to systolic BP (p=0.003), diastolic BP (p=0.001), and AS (p<0.000). The interaction effects of education and JHAC on systolic BP and AS were also significant (p=0.019 and p=0.018, respectively), indicating that the inverse relationships of education to systolic BP and AS were more prominent in subjects with lower JHAC scores.

CONCLUSION

Contrary to the JHAC hypothesis, JHAC may be associated with low cardiovascular risk in people with low education in certain groups. Studies are recommended to examine potential beneficial effects of JHAC on cardiovascular health in a larger sample and to identify their mechanisms.

Are single mothers' higher smoking rates mediated by dysfunctional coping styles?

Background

Smoking prevalence has been shown to be considerably higher among single mothers as compared to their married or cohabiting counterparts. This study examines whether this could be attributed to single mothers’ different capability in dealing with stress.

Methods

Based on cross-sectional data of 3129 German mothers, the study explores the associations between single motherhood, coping styles and moderate and heavy smoking pattern using a regression-based ‘parallel multiple mediator model’.

Results

Single mothers showed higher rates of negative coping styles than partnered mothers, holding for ‘self-blame/rumination’ (p < 0.001), ‘blaming others’ (p = 0.048) and in particular for ‘substance consumption’ (p < 0.001). With respect to positive coping styles the findings were heterogeneous: while partnered mothers scored higher on ‘active influence’ (p < 0.001), single mothers showed higher values of ‘positive self-verbalisation’ (p < 0.001). Evidence for a mediating effect of coping styles on the relationship between single motherhood and moderate as well as heavy smoking was only found for ‘substance consumption’. Moreover, single motherhood may moderate the effect of ‘self-blame/rumination’ on heavy smoking (p = 0.025). Against expectations, higher levels of ‘active influence’ were not associated with lower but with significant higher odds of moderate smoking (OR = 1.19).

Conclusion

Single mothers compared to partnered mothers showed a different ability to cope with stress. However, only the coping strategy ‘substance consumption’ mediates the relationship between single motherhood and smoking. Exclusively in single mothers, ‘self-blame/rumination’ was associated with heavy smoking, indicating that they might utilize smoking as a way to come to terms with negative ruminative thoughts.

A systematic review of genetic influences on coping

Coping refers to the way that an individual manages stress. Coping strategies vary; for example, problem-focused coping is directed at reducing or removing a stressor, while emotion-focused coping is directed more at managing reactions that accompany the stressor. How individuals cope with stress can impact their health, but the physiological effects of coping are not well understood. The field of genetics provides tools that could help illuminate the physiology of coping. This review of the literature was conducted to determine what is currently known about the phenotype of coping from a genetic perspective. PubMed, HubMed, PsychInfo, Medline, Scopus, and Google Scholar databases were used to conduct the search, and reference lists were reviewed to identify additional publications. Only studies that measured coping style or a coping domain specifically, were written in English language, and were human-subject focused were included in the review. We identified 19 studies that met these criteria, and 2 types of genetic studies emerged for the review: heritability (n = 9) and candidate gene association (n = 10) studies. Heritability estimates of .68-.76 support a nonadditive genetic component to coping. Replication of association was found for the serotonin transporter and adrenergic receptor beta 2 genes. In addition to finding evidence supporting a role for genetic variability with coping phenotype, it is worth noting that the review revealed a lack of consistency in instruments used to phenotype coping across studies.

Coping during pregnancy: a systematic review and recommendations

Extensive evidence documents that prenatal maternal stress predicts a variety of adverse physical and psychological health outcomes for the mother and baby. However, the importance of the ways that women cope with stress during pregnancy is less clear. We conducted a systematic review of the English-language literature on coping behaviours and coping styles in pregnancy using PsycInfo and PubMed to identify 45 cross-sectional and longitudinal studies involving 16,060 participants published between January 1990 and June 2012. Although results were often inconsistent across studies, the literature provides some evidence that avoidant coping behaviours or styles and poor coping skills in general are associated with postpartum depression, preterm birth and infant development. Variability in study methods including differences in sample characteristics, timing of assessments, outcome variables and measures of coping styles or behaviours may explain the lack of consistent associations. To advance the scientific study of coping in pregnancy, we call attention to the need for a priori hypotheses and greater use of pregnancy-specific, daily process, and skills-based approaches. There is promise in continuing this area of research, particularly in the possible translation of consistent findings to effective interventions, but only if the conceptual basis and methodological quality of research improve.

Relationship of John Henryism to cardiovascular functioning at rest and during stress in youth

John Henryism, a coping style characterized by a strong predisposition to confront daily psychosocial stressors in an active and effortful manner, has been associated with cardiovascular (CV) disease risk in adults. This study examined the relationship of John Henryism to CV functioning at rest and during laboratory stressors (i.e. forehead cold stimulation, postural change, and treadmill exercise) in 173 normotensive 10-to 17-year-old African-American and White children. High John Henry scores were associated with higher blood pressure, higher total peripheral resistance, and lower cardiac index at rest. These relationships were qualified by an interaction with socioeconomic status (SES) such that those from lower SES backgrounds who were high on John Henryism had particularly high levels of resting CV measures. No significant associations were observed with CV reactivity to the stressors. Findings are discussed in terms of possible impact of coping styles to environmental stress upon physiological functioning and health.

Associations between coping, affect, and social support among low-income African American smokers

OBJECTIVE

Previous research has documented disparities in smoking cessation between African Americans and Caucasians. Many low-income African American smokers face a range of circumstances that may inhibit effective coping during quit attempts, yet previous research has not considered factors that influence coping in this population. This study examined (a) affect (positive and negative) and (b) perceived social support in association with coping strategies.

METHODS

The baseline assessment of African American smokers (N = 168) enrolled in a randomized controlled trial included the Positive and Negative Affect Schedule, the Multidimensional Scale of Perceived Social Support, and the Brief COPE. A factor analysis of the Brief COPE resulted in two factors, adaptive and maladaptive strategies.

RESULTS

Participants were mostly single (64%), women (61%), with ≥12 years of education (68%), and low-income. They were middle aged (M = 46.1, SD = 8.7), smoked 21.8 (SD = 13.3) cigarettes/day for 24.3 (SD = 11) years, and were moderately nicotine dependent. Results demonstrated that adaptive coping was positively correlated with positive affect and social support. Maladaptive coping was positively correlated with negative affect, and inversely related to positive affect and social support. Multivariate analyses revealed that positive affect and social support were independently associated with adaptive coping strategies. In contrast, maladaptive coping was independently associated with negative affect, but not social support.

CONCLUSIONS

Interventions that harness positive resources, such as social support and positive mood, may facilitate adaptive coping. Also, addressing negative affect among low-income African American smokers may be important to reduce maladaptive coping strategies.

Socioeconomic status, John Henryism and blood pressure among African-Americans in the Jackson Heart Study

John Henryism connotes a strong behavioral predisposition to engage in effortful, active coping with difficult social and economic stressors. This behavioral predisposition is measured by the 12 item John Henryism Scale for Active Coping (JHAC). The John Henry hypothesis predicts that the well-known inverse socioeconomic status (SES)-blood pressure association will be stronger among persons who score high rather than low on the JHAC. We tested this hypothesis in a large African American cohort using baseline data from the Jackson Heart Study. Unlike previous studies, we used multiple indicators of SES: income, education, occupation, childhood SES and cumulative SES. Because the hypothesis is most relevant for adults still in the labor force, we excluded retired participants, yielding a sample size of 3978. Gender-specific Poisson regression models for hypertension adjusting for age, John Henryism, SES, and a John Henryism-SES interaction term, were fit to examine associations. Separate models were fit for each SES indicator. We found some evidence that John Henryism modified the association between income and hypertension in men: low income was associated with higher prevalence of hypertension in men who scored high on John Henryism (prevalence ratio (PR) for low vs. high income tertile 1.12), but with lower hypertension prevalence among men who scored low on John Henryism (PR 0.85, one sided P value for multiplicative interaction <0.05). For women, the association of low income with higher hypertension prevalence was stronger at lower than higher levels of John Henryism (PR 1.27 and 1.06 at low and high levels of John Henryism respectively, P value<0.05). There was no evidence that John Henryism modified the associations of hypertension with other SES indicators in men or women. The modest support of the John Henryism Hypothesis in men only, adds to the literature on this subject, but underscores questions regarding the gender, spatial, socioeconomic and historical contexts in which the hypothesis is valid.

An intersectional approach to social determinants of stress for African American men: men's and women's perspectives

Stress is a key factor that helps explain racial and gender differences in health, but few studies have examined gendered stressors that affect men. This study uses an intersectional approach to examine the sources of stress in African American men's lives from the perspectives of African American men and important women in their lives. Phenomenological analysis was used to examine data from 18 exploratory focus groups with 150 African American men, ages 30 years and older, and eight groups with 77 African American women. The two primary sources of stress identified were seeking to fulfill socially and culturally important gender roles and being an African American man in a racially stratified society. A central focus of African American men's daily lives was trying to navigate chronic stressors at home and at work and a lack of time to fulfill roles and responsibilities in different life domains that are traditionally the responsibility of men. Health was rarely mentioned by men as a source of stress, though women noted that men's aging and weathering bodies were a source of stress for men. Because of the intersection of racism and economic and social stressors, men and women reported that the stress that African American men experienced was shaped by the intersection of race, ethnicity, age, marital status, and other factors that combined in unique ways. The intersection of these identities and characteristics led to stressors that were perceived to be of greater quantity and qualitatively different than the stress experienced by men of other races.

Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors

The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.

Nature and nurture of human pain

Humans are very different when it comes to pain. Some get painful piercings and tattoos; others can not stand even a flu shot. Interindividual variability is one of the main characteristics of human pain on every level including the processing of nociceptive impulses at the periphery, modification of pain signal in the central nervous system, perception of pain, and response to analgesic strategies. As for many other complex behaviors, the sources of this variability come from both nurture (environment) and nature (genes). Here, I will discuss how these factors contribute to human pain separately and via interplay and how epigenetic mechanisms add to the complexity of their effects.

John Henryism, Depression, and Perceived Social Support in Black Women

John Henryism, a construct developed to describe high effort coping, may help explain the observed health disparities between Blacks and Whites. Previous research suggests that John Henryism is associated with negative physical health factors. However, little research has focused on the relationship between John Henryism and psychological distress. Accordingly, in this exploratory study, we examined the relationships between John Henryism, psychological distress, and well-being in a diverse sample of Black women. Results indicate that there is a negative correlation between John Henryism and depressive symptomatology. This finding is in contrast to past research and suggests that John Henryism may be maladaptive to physical health but not mental health. The limitations and implications of the findings are discussed.

Racial Discrimination and Depressive Symptoms Among African-American Men: The Mediating and Moderating Roles of Masculine Self-Reliance and John Henryism

Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this association among African-American men are poorly understood. Guided by the Transactional Model of Stress and Coping, we frame masculine self-reliance and John Henryism as appraisal mechanisms that influence the relationship between racial discrimination, a source of significant psychosocial stress, and depressive symptoms among African-American men. We also investigate whether the proposed relationships vary by reported discrimination-specific coping responses. Participants were 478 African-American men recruited primarily from barbershops in the West and South regions of the United States. Multiple linear regression and Sobel-Goodman mediation analyses were used to examine direct and mediated associations between our study variables. Racial discrimination and masculine self-reliance were positively associated with depressive symptoms, though the latter only among active responders. John Henryism was negatively associated with depressive symptoms, mediated the masculine self-reliance-depressive symptom relationship, and among active responders moderated the racial discrimination-depressive symptoms relationship. Though structural interventions are essential, clinical interventions designed to mitigate the mental health consequences of racial discrimination among African-American men should leverage masculine self-reliance and active coping mechanisms.

Too Much of a Good Thing? Psychosocial Resources, Gendered Racism, and Suicidal Ideation Among Low-SES African American Women

Very few studies have examined predictors of suicidal ideation among African American women. Consequently, we have a poor understanding of the combinations of culturally-specific experiences and psychosocial processes that may constitute risk and protective factors for suicide in this population. Drawing on theories of social inequality, medical sociology, and the stress process, we explore the adverse impact of gendered racism experiences and potential moderating factors in a sample of 204 predominantly low-SES African American women. We find that African American women's risk for suicidal ideation is linked to stressors occurring as a function of their distinct social location at the intersection of gender and race. In addition, we find that gendered racism has no effect on suicidal ideation among women with moderate levels of well-being, self-esteem, and active coping, but has a strong adverse influence in those with high and low levels of psychosocial resources.

The physiological expression of living in disadvantaged neighborhoods for youth

Evidence suggests that the consequences of chronic exposure to stressors extend beyond psychological effects, and that adolescents living in socio-economically disadvantaged neighborhoods may experience an accumulation of exposure to stressors that wears down the physical systems in the body, resulting in hyper-activation of the stress response. This research examines the relationship between exposure to neighborhood stressors and salivary cortisol reactivity in a sample of 163 at-risk African American adolescents (average age 21; 50% female) living in disadvantaged urban neighborhoods. More specifically, the relationship between neighborhood stressors and physiological stress, measured by baseline cortisol and cortisol reactivity is assessed. This research also examines several moderating pathways between exposure to neighborhood disadvantage and cortisol reactivity including substance use, high effort coping, psychological stress and social support. Results indicate that both individual and neighborhood-level factors influence adolescent cortisol. High effort coping and psychological stress were associated with cortisol in the sample, and exposure to neighborhood socio-economic disadvantage resulted in an atypical cortisol response. In addition, neighborhood disadvantage interacted with intra- and interpersonal factors to affect cortisol indirectly. Thus, living in disadvantaged neighborhoods may take a psychological and physiological toll on adolescents, and it also may exert synergistic effects through individual coping and vulnerabilities.

Life events, coping, and antihypertensive medication adherence among older adults: the cohort study of medication adherence among older adults

The authors examined the association between life events and antihypertensive medication adherence in older adults and the moderating role of coping. A cross-sectional analysis was conducted by using data (n = 1,817) from the Cohort Study of Medication Adherence among Older Adults (recruitment conducted from August 2006 through September 2007). Life events occurring in the 12 months preceding the study interview were assessed via the Holmes Rahe Social Readjustment Rating Scale (SRRS), and coping levels were assessed via an adapted version of the John Henry Active Coping Scale. Low adherence to antihypertensive medication was defined as scores less than 6 on the 8-item Morisky Medication Adherence Scale (known as "MMAS-8"). Of study participants, 13.2% had low adherence, and 27.2% and 5.0% had medium (150-299) and high (≥300) SRRS scores, respectively. After multivariable adjustment, the odds ratios for low adherence associated with medium and high, versus low, SRRS were 1.50 (95% confidence interval: 1.11, 2.02) and 2.11 (95% confidence interval: 1.24, 3.58), respectively. When multivariable models were stratified by coping level, the association between life events and adherence was evident only among participants with low coping levels.

The relationship between gender role conflict and condom use among black MSM

Gender role conflict may influence condom use among black MSM. We examined relationships between the Gender Role Conflict Scale (GRCS), social/demographic variables and condom use among 456 black MSM. Higher total GRCS scores did not predict unprotected insertive anal intercourse (UIAI) or unprotected receptive anal intercourse (URAI) with men, but were associated with unprotected vaginal or anal intercourse (UVI/UAI) with women among bisexually active participants (n = 69). Higher perceived HIV risk reduced the likelihood of both UIAI and URAI with men. Internet recruitment venues, sexual discrimination experiences, higher numbers of sex partners and UVI/UAI with women all increased the likelihood of UIAI with men, while education (college/technical school or college degree) was associated with URAI with men. Future sexual health interventions for black MSM should emphasize broader social/demographic and alternative gender role variables with male sexual partners, while traditional GRCS variables may prove useful among those with female sexual partners.

Discrimination and psychological distress: does Whiteness matter for Arab Americans?

The white racial category in the U.S. encompasses persons who have Arab ancestry. Arab Americans, however, have always occupied a precarious position in relationship to Whiteness. This study examined differences in reporting racial/ethnic discrimination among Arab Americans. It also investigated whether and how the association between discrimination and psychological distress varies by characteristics that capture an Arab American's proximity to/distance from Whiteness. We used data from the Detroit Arab American Study (2003; n = 1016), which includes measures of discrimination and the Kessler-10 scale of psychological distress. A series of logistic regression models were specified to test the discrimination-psychological distress association, stratified by five measures that capture Whiteness--subjective racial identification, religion, skin color, ethnic centrality, and residence in the ethnic enclave. Discrimination was more frequently reported by Muslim Arab Americans, those who racially identify as non-white, and who live in the ethnic enclave. Conversely, the association between discrimination and psychological distress was stronger for Christian Arab Americans, those who racially identify as white, who have dark skin color, and who live outside the ethnic enclave. Even though Arab Americans who occupy an identity location close to Whiteness are less subjected to discrimination, they are more negatively affected by it. The findings illuminate the complex pathways through which discrimination associates with psychological distress among 'white' immigrants. Further research on discrimination and health among Arab Americans can help unpack the white racial category and deconstruct Whiteness.

Mental health consequences of international migration for Vietnamese Americans and the mediating effects of physical health and social networks: results from a natural experiment approach

Although the existing literature on immigrant mental health is extensive, major substantive and methodological gaps remain. Substantively, there is little population-based research that focuses on the mental health consequences of migration for Vietnamese Americans. More generally, although a wide range of mental health problems among immigrants has been identified, the potential causal or mediating mechanisms underlying these problems remain elusive. This latter substantive shortcoming is related to a key methodological challenge involving the potentially confounding effects of selection on migration-related outcomes. This article addresses these challenges by employing a "natural experiment" design, involving comparisons among three population-based samples of Vietnamese immigrants, never-leavers, and returnees (N=709). Data were collected in Ho Chi Minh City and in New Orleans between 2003 and 2005. The study investigates the long-term impact of international migration on Vietnamese mental health, and the potential mediating effects of social networks and physical health on these migration-related outcomes. The results reveal both mental health advantages and disadvantages among Vietnamese immigrants relative to the two groups of Vietnamese nationals. Selection can be ruled out for some of these differences, and both social networks and physical health are found to play important explanatory roles.

Alternative therapies in women with chronic vaginitis

OBJECTIVES

To describe the use of complementary alternative medicines in women with chronic vaginitis and to evaluate epidemiologic factors associated with these treatments.

METHODS

In this prospective cohort study, patients with chronic vaginitis completed a questionnaire about past diagnoses and treatments. Information regarding demographics, medical and social history, perceived mental and emotional stress, and current symptoms was collected. All patients underwent a standard physical examination and laboratory testing and were assigned a specific diagnosis.

RESULTS

A total of 481 women were enrolled; 64.9% used complementary alternative medicines. The most common treatments were yogurt and acidophilus pills. In univariate analysis, compared with nonusers, users of complementary alternative medicines were younger (83.4% younger than 50 compared with 73.1%; P=.032), not African American (11.9% compared with 21.3%; P=.018), had increased measures of perceived stress (P=.008), and reported that their symptoms interfered with both work (59.1% compared with 40.6%; P=.001) and social lives (57.9% compared with 40.2%; P=.001). Patients using complementary alternative medicines had seen more doctors (median 2 compared with 1; P<.001) and were more likely to report a history of vulvovaginal candidiasis (98.4% compared with 90.5%; P<.001) or bacterial vaginosis (34.3% compared with 22.8%; P=.007). In the multivariable analysis, interference with social life, higher number of doctors seen, symptoms of itching or burning, and previous diagnoses of yeast infection remained associated with alternative medicine use. A current diagnosis of vulvovaginal candidiasis was not associated with alternative medicine use.

CONCLUSION

Complementary alternative medicine use is common in women with chronic vaginitis, particularly in those who are young, have more disruptive symptoms, and report greater stress.

LEVEL OF EVIDENCE

II.

Perceived positive impact of cancer among long-term survivors of childhood cancer: a report from the childhood cancer survivor study

OBJECTIVE

Investigations examining psychosocial adjustment among childhood cancer survivors have focused primarily on negative effects and psychopathology. Emergent literature suggests the existence of positive impact or adjustment experienced after cancer, as well. The purpose of this study is to examine the distribution of Perceived Positive Impact (PPI) and its correlates in young adult survivors of childhood cancer.

METHODS

6425 survivors and 360 siblings completed a comprehensive health survey, inclusive of a modified version of the Post-traumatic Growth Inventory (PTGI) as a measure of PPI. Linear regression models were used to examine demographic, disease and treatment characteristics associated with PPI.

RESULTS

Survivors were significantly more likely than siblings to report PPI. Endorsement of PPI was significantly greater among female and non-white survivors, and among survivors exposed to at least one intense therapy, a second malignancy or cancer recurrence. Survivors diagnosed at older ages and fewer years since diagnosis were more likely to report PPI. Income, education and marital/relationship status appeared to have varied relationships to PPI depending upon the subscale being evaluated.

CONCLUSIONS

The existence and variability of PPI in survivors in this study suggest that individual characteristics, inclusive of race, gender, cancer type, intensity of treatment, age at diagnosis and time since diagnosis, have unique and specific associations with different aspects of perceived positive outcomes of childhood cancer.

Experiences and perceptions of medical discrimination among a multiethnic sample of breast cancer patients in the Greater San Francisco Bay Area, California

OBJECTIVES

We conducted qualitative interviews with breast cancer survivors to identify themes related to institutional, personally mediated, and internalized discrimination in the medical setting.

METHODS

We conducted 7 focus groups and 23 one-on-one interviews with a multiethnic sample of breast cancer survivors randomly selected from a population-based registry covering the Greater San Francisco Bay Area, California.

RESULTS

Participants reported experiencing different forms of medical discrimination related to class, race, and language. Among African Americans, participants reported experiencing internalized discrimination and personal or group discrimination discrepancy-perceiving discrimination against them as a racial/ethnic group, yet not perceiving or discussing personal experiences of discrimination. Among Asian immigrants, participants reported experiencing institutional and personally mediated overt types of discrimination, including lack of access to quality and readily available translation services. Our results also indicated well-established coping mechanisms in response to discrimination experiences in both groups.

CONCLUSIONS

Participants reported experiencing medical discrimination at all 3 levels, which may have deleterious health effects through the biopsychosocial stress pathway and through active coping mechanisms that could lead to delayed- or underutilization of the health care system to avoid discrimination.

Measuring masculinity in research on men of color: findings and future directions

The purpose of this study was to examine the association between masculinity and the health of US men of color aged 18 years and older. We identified 22 population-based studies that included a measure of masculinity and a measure of health behavior, mental health, or physical health. The associations between masculinity and health were complex and varied by construct and health outcome, though they generally were significant in the hypothesized directions. Future research should explore the centrality of masculinity versus other identities and characteristics, how the relationship between masculinity and health varies by health outcome, and the identification of the conceptions and aspects of masculinity that are most relevant to and associated with specific health behaviors and health outcomes.

"Shift-and-Persist" Strategies: Why Low Socioeconomic Status Isn't Always Bad for Health

Some individuals, despite facing recurrent, severe adversities in life such as low socioeconomic status (SES), are nonetheless able to maintain good physical health. This article explores why these individuals deviate from the expected association of low SES and poor health and outlines a "shift-and-persist" model to explain the psychobiological mechanisms involved. This model proposes that, in the midst of adversity, some children find role models who teach them to trust others, better regulate their emotions, and focus on their futures. Over a lifetime, these low-SES children develop an approach to life that prioritizes shifting oneself (accepting stress for what it is and adapting the self through reappraisals) in combination with persisting (enduring life with strength by holding on to meaning and optimism). This combination of shift-and-persist strategies mitigates sympathetic-nervous-system and hypothalamic-pituitary-adrenocortical responses to the barrage of stressors that low-SES individuals confront. This tendency vectors individuals off the trajectory to chronic disease by forestalling pathogenic sequelae of stress reactivity, like insulin resistance, high blood pressure, and systemic inflammation. We outline evidence for the model and argue that efforts to identify resilience-promoting processes are important in this economic climate, given limited resources for improving the financial circumstances of disadvantaged individuals.

Effects of Angiotensinogen and Angiotensin II Type I Receptor Genes on Blood Pressure and Left Ventricular Mass Trajectories in Multiethnic Youth

The objective of this study was to evaluate the impact of variations of the angiotensinogen (AGT) and angiotensin II type I receptor (AGTR1) genes on progression of blood pressure (BP) and left ventricular mass (LVM) in multiethnic youth. The study was longitudinal involving 581 European American (EA) and African American (AA) youth with 12 assessments over a 15-year period. AGT M235T and three AGTR1 polymorphisms (C-521T, L191L and A1166C) were genotyped and individual growth curve modeling analyses were conducted. Single nucleotide polymorphism (SNP) analyses found a significant 3-way interaction between M235T, ethnicity and gender on BP levels. Systolic BP (SBP) levels were 5.8 mmHg (p = .00003) and diastolic BP (DBP) levels were 2.6 mmHg (p = .005) lower in carriers versus noncarriers of the M235 allele in AA males only. Furthermore, the AGTR1 L191 allele showed a SBP lowering effect in subjects with a high socioeconomic status (SES; p = .048) and a DBP lowering effect in AAs (p = .038). Haplotype analyses identified a protective haplotype (C-521, 191L and A1166) for LVM levels (p = .03). LVM in individuals homozygous for this haplotype was 12.9 g lower than those homozygous for the most common haplotype (–521T, 191L and A1166). No significant interactions were found between the AGT M235T polymorphism and any of the single SNPs or haplotypes of the AGTR1 gene. Our results in multiethnic youth uncover an ethnicity and gender-specific effect of the AGT M235T polymorphism and a SES or ethnicity-specific effect of the AGTR1 L191L polymorphism on the progression of hypertension risk. A protective AGTR1 haplotype for LVM was also identified.

Protective factors for adults from low-childhood socioeconomic circumstances: the benefits of shift-and-persist for allostatic load

OBJECTIVE

Low socioeconomic status (SES) early in life is one of the most well-established social predictors of poor health. However, little is understood about why some adults who grew up in low-SES environments do not have poor health outcomes. This study examined whether the psychological characteristic of "shift-and-persist" protects adults from the physiological risks of growing up in low-SES households. Shift-and-persist consists of reframing appraisals of current stressors more positively (shifting), while simultaneously persisting with a focus on the future. We hypothesized that this characteristic would be associated with reduced physiological risk in low-childhood SES individuals.

METHODS

A national sample of 1207 adults (aged 25-74 years) from the Survey of Midlife Development in the United States completed psychological questionnaires and were queried about parent education. Biologic assessments consisted of 24 different measures across seven physiological systems, from which a composite measure representing cumulative physiological risk (allostatic load) was derived.

RESULTS

Among adults who grew up in low-SES households, those who engaged in high-shift-and-high-persist strategies had the lowest allostatic load (b = -0.15, p = .04). No benefit of shift-and-persist was found for those from higher-childhood SES backgrounds (p = .36).

CONCLUSIONS

Identifying the health-related protective qualities that naturally occur in some low-SES individuals represents one important approach for developing future health improvement interventions for those who start out life low in SES. Moreover, the psychological qualities that are protective from future disease risk for those from low-SES backgrounds are different from those beneficial to high-SES individuals.

The use of psychosocial stress scales in preterm birth research

Psychosocial stress has been identified as a potential risk factor for preterm birth. However, an association has not been found consistently, and a consensus on the extent to which stress and preterm birth are linked is still lacking. A literature search was performed with a combination of keywords and MeSH terms to detect studies of psychosocial stress and preterm birth. Studies were included in the review if psychosocial stress was measured with a standardized, validated instrument and if the outcomes included either preterm birth or low birthweight. Within the 138 studies that met inclusion criteria, 85 different instruments were used. Measures that had been designed specifically for pregnancy were used infrequently, although scales were sometimes modified for the pregnant population. The many different measures that have been used may be a factor that accounts for the inconsistent associations that have been observed.

Depressive symptoms in women working in a poultry-processing plant: a longitudinal analysis

BACKGROUND

Work in poultry-processing plants is physically demanding, and a number of studies have documented the effects of such work on the physical health of workers. Few studies, however, have examined the potential effects on mental health.

METHODS

Longitudinal data were collected on 223 women who worked in two poultry-processing plants in northeastern North Carolina. Effects on depressive symptoms of demographic variables, work tenure at baseline, musculoskeletal pain, psychosocial job characteristics, coping style, and health-related quality of life were examined using mixed models.

RESULTS

Psychosocial job characteristics were not associated with depressive symptoms as measured by the Center for Epidemiologic Studies Depression scale (CES-D) in this cohort of workers. CES-D scores decreased with increasing work tenure at the plant, which suggests a healthy worker survivor effect (HWSE).

CONCLUSIONS

These exploratory analyses draw attention to the need to more carefully explore the possibility that the HWSE may extend to mental health outcomes as well as physical ones.

Goal-striving stress and the mental health of college-educated Black American men: the protective effects of system-blame

The present study examined the relationship between goal-striving stress and well-being in a survey of 399 college-educated Black American men who were members of a Black fraternal organization. Regression analyses revealed that goal-striving stress was associated with decreased psychological well-being, controlling for demographics and various psychosocial factors. When asked to explain their failure to reach life goals, half of the men attributed setbacks to racial discrimination. The association of goal-striving stress with diminished well-being was stronger among those who did not attribute setbacks to race than among those who did. These findings suggest that even with material success, Black men face blocked opportunities that could be consequential to their well-being.

"I'LL DIE WITH THE HAMMER IN MY HAND": JOHN HENRYISM AS A PREDICTOR OF HAPPINESS

This paper examines the association between John Henryism - a behavioral predisposition to cope actively with psychosocial environmental stressors - and happiness. On the basis of previous research on aspiration and goal regulation, we predicted that John Henryism would be negatively associated with happiness when controlling for demographic factors and attainment in various domains of life. We tested the prediction in a sample of hypertensive participants (n=758) drawn from an inner-city, mainly African-American, safety-net hospital in Jefferson County, Alabama. Bivariate analysis revealed no association between John Henryism and attainment in six domains of life: marriage, children, education, employment, income, and health. However, a significant negative association between John Henryism and happiness was found both in bivariate analysis (Spearman's ρ= -0.335; p<.001) and when controlling for demographic factors and attainment using ordinal logistic regression analysis. There was a significant interaction effect between John Henryism and gender: being male was positively associated with happiness among participants with low John Henryism, but negatively associated with happiness among participants with high John Henryism. While further study would be required in order to establish the extent to which these findings can be generalized as well as their causal underpinnings, the results indicate that John Henryism is negatively associated with happiness, especially among men, and underscore the limitations of using self-reported measures of happiness as proxies for well-being for purposes of public policy.

Male gender role strain as a barrier to African American men's physical activity

Despite the potential health consequences, African American men tend to treat their roles as providers, fathers, spouses, and community members as more important than engaging in health behaviors such as physical activity. We conducted 14 exploratory focus groups with 105 urban, middle-aged African American men from the Midwest to examine factors that influence their health behaviors. Thematic content analysis revealed three interrelated barriers to physical activity: (a) work, family, and community commitments and priorities limited time and motivation for engaging in physical activity; (b) physical activity was not a normative individual or social activity and contributed to men prioritizing work and family responsibilities over physical activity; and (c) the effort men exerted in seeking to fulfill the provider role limited their motivation and energy to engage in physical activity. These findings highlight the need for physical activity interventions that consider how health fits in the overall context of men's lives.

Cancer pain: an age-based analysis

OBJECTIVE

Although cancer pain (consistent and breakthrough pain [BTP; pain flares interrupting well-controlled baseline pain]) is common among cancer patients, its characteristics, etiology, and impact on health-related quality of life (HRQOL) across the lifespan are poorly understood.

DESIGN

This longitudinal study examines age-based differences and pain-related interference in young and old patients with cancer-related pain over 6 months. Patients in the community with stage III or IV breast, prostate, colorectal, or lung cancer, or stage II-IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL using previously validated measures.

RESULTS

Respondents (N= 96) were 70% white and 66% female, with a mean age of 57±10 years. There were no significant differences in pain severity based upon age. However, the younger group experienced more pain flares with greater frequency (P=0.05). The oldest group had better emotional functioning at baseline but worse physical functioning at 6 months. Younger groups also had worse cognitive functioning at 6 months (P=0.03). Pain interference was independent of age.

CONCLUSIONS

These data provide evidence for the significant toll of cancer pain on overall health and well-being of young and old adults alike but demonstrate an increased toll for younger adults (especially financially). Beyond race and gender disparities, further health care disparities in the cancer and cancer pain were identified by age, illustrating the need for additional research across the lifespan in diverse cancer survivors.

Mind-Body Interventions to Reduce Risk for Health Disparities Related to Stress and Strength Among African American Women: The Potential of Mindfulness-Based Stress Reduction, Loving-Kindness, and the NTU Therapeutic Framework

In the current article, the authors examine the potential role of mind-body interventions for preventing or reducing health disparities in a specific group-African American women. The authors first discuss how health disparities affect this group, including empirical evidence regarding the influence of biopsychosocial processes (e.g., psychological stress and social context) on disparate health outcomes. They also detail how African American women's unique stress experiences as a result of distinct sociohistorical and cultural experiences related to race and gender potentially widen exposure to stressors and influence stress responses and coping behaviors. Using two independent, but related, frameworks (Superwoman Schema [SWS] and the Strong Black Woman Script [SBW-S]), they discuss how, for African American women, stress is affected by "strength" (vis-à-vis resilience, fortitude, and self-sufficiency) and the emergent health-compromising behaviors related to strength (e.g., emotional suppression, extraordinary caregiving, and self-care postponement). The authors then describe the potential utility of three mind-body interventions-mindfulness-based stress reduction (MBSR), loving-kindness meditation (LKM), and NTU psychotherapy-for specifically targeting the stress-, strength-, and contextually related factors that are thought to influence disparate outcomes for African American women. Self-awareness, self-care, inter- and intrapersonal restorative healing and a redefinition of inner strength may manifest through developing a mindfulness practice to decrease stress-related responses; using LKM to cultivate compassion and forgiveness for self and others; and the balance of independence and interdependence as a grounding NTU principle for redefining strength. The authors conclude with a discussion of potential benefits for integrating key aspects of the interventions with recommendations for future research.

The four Cs of HIV prevention with African Americans: crisis, condoms, culture, and community

HIV/AIDS continues to be a devastating epidemic with African American communities carrying the brunt of the impact. Despite extensive biobehavioral research, current strategies have not resulted in significantly decreasing HIV/AIDS cases among African Americans. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability. Successful interventions targeting African Americans must optimize strategies that integrate socio-cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors. Community-based participatory research to decrease the HIV/AIDS disparity by building community capacity and infrastructure and advocating for and distributing equitably, power and resources, must be promoted. Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent interventions may be tested and implemented at the community level.

Heavy drinking in early adulthood and outcomes at mid life

BACKGROUND

Heavy drinking in early adulthood among Blacks, but not Whites, has been found to be associated with more deleterious health outcomes, lower labor market success and lower educational attainment at mid-life. This study analysed psychosocial pathways underlying racial differences in the impact of early heavy alcohol use on occupational and educational attainment at mid-life.

METHODS

Outcomes in labor market participation, occupational prestige and educational attainment were measured in early and mid-adulthood. A mixture model was used to identify psychosocial classes that explain how race-specific differences in the relationship between drinking in early adulthood and occupational outcomes in mid-life operate. Data came from Coronary Artery Risk Development in Young Adults, a longitudinal epidemiologic study.

RESULTS

Especially for Blacks, heavy drinking in early adulthood was associated with a lower probability of being employed in mid-life. Among employed persons, there was a link between heavy drinking for both Whites and Blacks and decreased occupational attainment at mid-life. We grouped individuals into three distinct distress classes based on external stressors and indicators of internally generated stress. Blacks were more likely to belong to the higher distressed classes as were heavy drinkers in early adulthood. Stratifying the data by distress class, relationships between heavy drinking, race and heavy drinking-race interactions were overall weaker than in the pooled analysis.

CONCLUSIONS

Disproportionate intensification of life stresses in Blacks renders them more vulnerable to long-term effects of heavy drinking.

Levels of maternal serum corticotropin-releasing hormone (CRH) at midpregnancy in relation to maternal characteristics

BACKGROUND

Corticotropin-releasing hormone (CRH) in maternal blood originates primarily from gestational tissues and elevated levels in midpregnancy have been linked to adverse pregnancy outcomes. Investigators have hypothesized that high levels of maternal stress might lead to elevated CRH levels in pregnancy. Yet a few studies have measured maternal CRH levels among subgroups of women who experience disproportionate socioeconomic disadvantage, such as African-American and Hispanic women, and found that these groups have lower CRH levels in pregnancy. Our goal was to identify maternal characteristics related to CRH levels in midpregnancy and examine which if any of these factors help to explain race differences in CRH levels.

METHODS

The Pregnancy Outcomes and Community Health (POUCH) Study prospectively enrolled women at 15-27 weeks' gestation from 52 clinics in five Michigan communities (1998-2004). Data from the POUCH Study were used to examine maternal demographics, anthropometrics, health behaviors, and psychosocial factors (independent variables) in relation to midpregnancy blood CRH levels modeled as logCRHpg/ml (dependent variable). Analyses were conducted within a sub-cohort from the POUCH Study (671 non-Hispanic Whites, 545 African-Americans) and repeated in the sub-cohort subset with uncomplicated pregnancies (n=746). Blood levels of CRH and independent variables were ascertained at the time of enrollment. All regression models included week of enrollment as a covariate. In addition, final multivariate regression models alternately incorporated different psychosocial measures along with maternal demographics and weight. Psychosocial variables included measures of current depressive symptoms, perceived stress, coping style, hostility, mastery, anomie, and a chronic stressor (history of abuse as a child and adult).

RESULTS

In sub-cohort models, the adjusted mean log CRH level was significantly lower in African-Americans vs. non-Hispanic Whites; the difference was -0.48pg/ml (P<0.01). This difference was reduced by 21% (-0.38pg/ml, P<0.01) after inclusion of other relevant covariates. Adjusted mean log CRH levels were also lower among women with <12 years vs. >or=12 years of education (minimal difference=-0.19pg/ml, P<0.05), and among women with high levels of depressive symptoms who did not use antidepressants vs. women with lower levels of depressive symptoms and no antidepressant use (minimal difference=-0.13pg/ml, P<0.01). Log CRH levels were inversely associated with maternal weight (-0.03pg/ml per 10 pound increase, P<.05) but unrelated to smoking and all other psychosocial measures. Results were similar in the subset of women with uncomplicated pregnancies, except that lower CRH levels were also linked to higher perceived stress.

CONCLUSION

African-American women have lower blood CRH levels at midpregnancy and the race difference in CRH levels is reduced modestly after adjustment for other maternal characteristics. CRH levels were not elevated among women with high levels of perceived stress or more chronic stressors. The inverse association between CRH levels and maternal weight is likely due to a hemodilution effect. Relations among maternal CRH levels and maternal race, educational level, and depressive symptoms are difficult to explain and invite further investigation. Our results highlight a group of covariates that merit consideration in studies that address CRH in the context of pregnancy and/or post-partum complications.

Superwoman schema: African American women's views on stress, strength, and health

Researchers have suggested that health disparities in African American women, including adverse birth outcomes, lupus, obesity, and untreated depression, can be explained by stress and coping. The Strong Black Woman/Superwoman role has been highlighted as a phenomenon influencing African American women's experiences and reports of stress. The purpose of this study was to develop a preliminary conceptual framework for Superwoman Schema (SWS) by exploring women's descriptions of the Superwoman role; perceptions of contextual factors, benefits, and liabilities; and beliefs regarding how it influences health. Analysis of eight focus group discussions with demographically diverse African American women yielded themes characterizing the Superwoman role and personal or sociohistorical contextual factors. Participants reported that the Superwoman role had benefits (preservation of self and family or community) and liabilities (relationship strain, stress-related health behaviors, and stress embodiment). The SWS framework might be used to enhance future research on stress and African American women's health.

Does coping mediate the relationship between personality and cardiovascular health in African Americans?

Few studies have examined traits or behaviors that may predispose some African Americans to poor cardiovascular health outcomes. While several models of personality exist, the 5-factor model (FFM) is arguably the best representation of personality and provides a useful framework for the study of personality and health. Among personality characteristics associated with health risks among African Americans, a high-effort coping style called John Henryism is among the most thoroughly examined. It is not clear if personality coping and health are connected in a meaningful way. The present study utilized data from the Baltimore Study of Black Aging (BSBA) to examine whether personality was linked to John Henryism, how personality might be linked to cardiovascular health, and how John Henryism might mediate the relationship between personality and cardiovascular health. The sample consisted of 234 older African Americans (mean age, 67 years), 28% of which were men. Regressions were used to examine the questions. The results indicated that those who are more neurotic report more cardiovascular health problems, and that openness and conscientiousness were significant predictors of active coping. The mediation analysis results suggest that coping style did not mediate the relationship between personality and reports of cardiovascular health problems. These findings highlight the importance of personality in accounting for cardiovascular health in African Americans.