Stress, coping, and health outcomes among African-Americans: a review of the John Henryism hypothesis

Experiencing Burnout: John Henryism, Gender Role Conflict, and Anxiety Among Incarcerated Black Men

At the intersection of race and gender, Black men encounter conflicting and often stress-inducing gender norms. Research suggests Black men may utilize John Henryism Active Coping (JHAC), a culturally-relevant strategy to manage stress. However, little is known about how incarcerated Black men cope with gender role conflict (GRC) and resulting psychological distress. To better understand stressors and coping strategies among Black male prisoners, the current study examined the relationships between GRC, anxiety, and JHAC among N = 193 incarcerated Black men nearing community reentry. Hierarchical linear regression results showed length of incarceration, GRC, and anxiety were all negatively associated with JHAC. Full-time employment prior to incarceration was positively associated with JHAC. Moderation analyses indicated anxiety increased the strength of the negative association between GRC and JHAC. Implications highlight incarcerated Black men may benefit from interventions that encourage active coping strategies to manage gender-related stress and anxiety.

Rationale, design, and participant characteristics of the FAITH! Heart Health+ study: An exploration of the influence of the social determinants of health, stress, and structural racism on African American cardiovascular health

BACKGROUND

African Americans (AAs) face cardiovascular health (CVH) disparities linked to systemic racism. The 2020 police killing of Mr. George Floyd in Minneapolis, Minnesota, alongside the COVID-19 pandemic, exacerbated adverse psychosocial factors affecting CVH outcomes among AAs. This manuscript describes the study protocol and participant characteristics in an ancillary study exploring the relationship between biopsychosocial factors and CVH among AAs.

METHODS

Using a community-based participatory approach, a mixed-methods ancillary study of 58 AA participants from an overarching randomized control trial (RCT) was conducted. Baseline RCT health assessments (November 2020) provided sociodemographic, medical, and clinical data. Subsequent health assessments (February-December 2022) measured sleep quality, psychosocial factors (e.g., high-effort coping), biomarkers (e.g., cortisol), and cardiovascular diagnostics (e.g., cardio-ankle vascular index). CVH was assessed using the American Heart Association Life's Simple 7 (LS7) (range 0 to 14, poor to ideal) and Life's Essential 8 (LE8) scores (range 0 to 100, low to high). Correlations between these scores will be examined. Focus group discussions via videoconferencing (March to April 2022) assessed psychosocial and structural barriers, along with the impact of COVID-19 and George Floyd's killing on daily life.

RESULTS

Participants were predominantly female (67%), with a mean age of 54.6 [11.9] years, high cardiometabolic risk (93% had overweight/obesity and 70% hypertension), and moderate LE8 scores (mean 57.4, SD 11.5).

CONCLUSION

This study will enhance understanding of the associations between biopsychosocial factors and CVH among AAs in Minnesota. Findings may inform risk estimation, patient care, and healthcare policies to address CVD disparities in marginalized populations.

Racial Discrimination and Risk for Internalizing and Externalizing Symptoms Among Black Youths

Importance

Racial discrimination is a psychosocial stressor associated with youths' risk for psychiatric symptoms. Scarce data exist on the moderating role of amygdalar activation patterns among Black youths in the US.

Objective

To investigate the association between racial discrimination and risk for psychopathology moderated by neuroaffective processing.

Design, Setting, and Participants

This cohort study used longitudinal self-report and functional magnetic resonance imaging (fMRI) data from Black youth participants in the US from the Adolescent Brain Cognitive Development (ABCD) study. Data were analyzed from January 2023 to May 2024.

Exposures

At time 1 of the current study (12 months after baseline), youths self-reported on their experiences of interpersonal racial discrimination and their feelings of marginalization. Amygdalar response was measured during an emotionally valenced task that included blocks of faces expressing either neutral or negative emotion.

Main Outcomes and Measures

At 24 and 36 months after baseline, youths reported their internalizing (anxiety and depressive symptoms) and externalizing symptoms (aggression and rule-breaking symptoms).

Results

A total of 1596 youths were a mean (SD) age of 10.92 (0.63) years, and 803 were female (50.3%). Families in the study had a mean annual income range of $25 000 to $34 999. Two factors were derived from factor analysis: interpersonal racial discrimination and feelings of marginalization (FoM). Using structural equation modeling in a linear regression, standardized β coefficients were obtained. Neural response to faces expressing negative emotion within the right amygdala significantly moderated the association between FoM and changes in internalizing symptoms (β = -0.20; 95% CI, -0.32 to -0.07; P < .001). The response to negative facial emotion within the right amygdala significantly moderated the association between FoM and changes in externalizing symptoms (β = 0.24; 95% CI, 0.04 to 0.43; P = .02). Left amygdala response to negative emotion significantly moderated the association between FoM and changes in externalizing symptoms (β = -0.16; 95% CI, -0.32 to -0.01; P = .04).

Conclusions and Relevance

In this cohort study of Black adolescents in the US, findings suggest that amygdala function in response to emotional stimuli can both protect and intensify the affective outcomes of feeling marginalized on risk for psychopathology, informing preventive interventions aimed at reducing the adverse effects of racism on internalizing and externalizing symptoms among Black youths.

Eyes Wide Open: Sleep as a Potential Contributor to Racial and Ethnic Disparities in Cancer

U.S. racial and ethnic minoritized groups face disproportionate cancer burdens compared to White Americans. Investigating modifiable factors, such as sleep, that are socially patterned and inequitably distributed by race and ethnicity may advance understanding of cancer disparities and provide intervention opportunities. Emerging data suggest poor sleep health is associated with cancer. Yet, its contribution to racial and ethnic cancer disparities is understudied. In this narrative review, we explored the sleep-cancer relation through a disparities lens. We (i) summarized literature reporting on associations between sleep and cancer among racial and ethnic minority populations; (ii) examined potential sleep-cancer mechanisms; and (iii) discussed future directions. We identified five studies reporting on sleep-cancer associations among minoritized groups. Poor sleep health was associated with aggressive breast cancer among Black women, increased breast cancer risk among Asian women, and increased risk of breast and total cancer among Hispanic/Latinx Americans. Sleep and cancer disparities have similar socioeconomic and behavioral determinants, suggesting racial and ethnic minoritized groups may be vulnerable to poor sleep health and its adverse health impacts. Evidence indicates that the sleep-cancer disparities relation is an emerging, but important area of research that warrants further investigation, as sleep may be an avenue for reducing cancer disparities.

Cumulative Lifetime Violence and Bacterial Vaginosis Infection in Sexually Transmitted Infections: Findings From a Retrospective Cohort Study Among Black Women at Risk for HIV

Introduction

Bacterial vaginosis is the most common vaginal condition among women of reproductive age and has been associated with sexually transmitted infections. This study examines the association between cumulative lifetime violence exposure, bacterial vaginosis, and sexually transmitted infections among Black women at risk for HIV.

Methods

HIV-negative Black women in a retrospective cohort study (N=230) completed survey questions on cumulative violence (exposure to sexual or physical abuse before age 18 years and exposure to intimate partner violence or sexual violence [partner or other] after age 18 years and past year), bacterial vaginosis (lifetime and past year), and sexually transmitted infection diagnosis (lifetime and past year). Logistic regression models estimated the associations between cumulative violence, bacterial vaginosis, and sexually transmitted infections. Bacterial vaginosis was examined as a moderator in the association between cumulative violence and sexually transmitted infections.

Results

Many women reported cumulative violence exposure (40%), lifetime bacterial vaginosis diagnosis (53%), and lifetime sexually transmitted infection diagnosis (73%). Cumulative violence experience was significantly associated with increased adjusted odds of lifetime bacterial vaginosis diagnosis (AOR=1.98; 95% CI=1.10, 3.54). Lifetime bacterial vaginosis diagnosis (AOR=2.76; 95% CI=1.45, 5.22) and past-year bacterial vaginosis diagnosis (AOR=2.16; 95% CI=1.14, 4.10) were significantly associated with increased odds of lifetime sexually transmitted infection diagnosis. Lifetime bacterial vaginosis diagnosis (AOR=2.10; 95% CI=1.19, 3.70) and past-year bacterial vaginosis diagnosis (AOR=3.00; 95% CI=1.70, 5.31) were significantly associated with past-year sexually transmitted infection diagnosis. Lifetime bacterial vaginosis infection significantly increased the odds of lifetime sexually transmitted infection diagnosis with increasing cumulative violence exposure.

Conclusions

Our findings support educating and screening Black women who experience cumulative violence for bacterial vaginosis to reduce the risk of untreated bacterial vaginosis and sexually transmitted infections.

Structural and Psychosocial Syndemic Conditions and Condomless Anal Intercourse Among Transgender Women - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020

Psychosocial and structural syndemic conditions, including polydrug use and experiencing homelessness, frequently co-occur and might jointly increase HIV risk. Limited studies have assessed racial and ethnic differences in exposure to syndemic conditions and behaviors associated with HIV transmission among transgender women. This report examines the relation between syndemic conditions and condomless anal intercourse (CAI) among transgender women in seven urban areas in the United States to develop HIV prevention interventions for transgender women. During 2019-2020, transgender women in seven urban areas were recruited using respondent-driven sampling for a biobehavioral survey. Reported syndemic conditions (psychosocial: polydrug use, sexual violence, and psychological distress; structural: homelessness, incarceration, and exchange sex) were summed to create a syndemic score. Using modified Poisson regression to account for RDS, the study assessed whether the strength of the association between syndemic score and CAI differed by race and ethnicity. To assess additive interaction, the relative excess prevalence owing to interaction (REPI) and 95% CIs for selected pairs of syndemic conditions on CAI prevalence stratified by race and ethnicity were estimated. Of 1,348 transgender women (Black = 546, White = 176, and Hispanic = 626), 55% reported CAI; and 24% reported ≥3 syndemic conditions. Reporting additional syndemic conditions was associated with CAI for White, Hispanic, and Black participants. The association was significantly stronger for White than Black and Hispanic participants. Limited significant superadditive interactions were found, although the majority were between structural syndemic conditions. Racial and ethnic differences in REPI estimates were observed. Reporting more syndemic conditions was associated with increased CAI across racial and ethnic groups, demonstrating that HIV prevention efforts for transgender women should address structural and psychosocial syndemic conditions. Results differed by race and ethnicity, indicating that syndemic-focused interventions for transgender women should be tailored to racial and ethnic groups.

The promotive and protective effects of parents' perceived changes during the COVID-19 pandemic on emotional well-being among U.S. households with young children: an investigation of family resilience processes

Introduction

The COVID-19 pandemic may constitute a traumatic event for families with young children due to its acute onset, the unpredictable and ubiquitous nature, and the highly distressing disruptions it caused in family lives. Despite the prevalent challenges such as material hardships, child care disruptions, and social isolation, some families evinced remarkable resilience in the face of this potentially traumatic event. This study examined domains of changes perceived by parents of young children that were consistent with the post-traumatic growth (PTG) model as factors that facilitate family resilience processes.

Methods

This study drew data from the RAPID project, a large ongoing national study that used frequent online surveys to examine the pandemic impact on U.S. households with young children. A subsample of 669 families was leveraged for the current investigation, including 8.07% Black, 9.57% Latino(a), 74.44% non-Latino(a) White families, and 7.92% households of other racial/ethnic backgrounds. In this subsample, 26.36% were below 200% federal poverty level.

Results

Approximately half of the parents reported moderate-to-large degrees of changes during the pandemic, and the most prevalent domain of change was appreciation of life, followed by personal strengths, new possibilities, improved relationships, and spiritual growth. Black and Latino(a) parents reported more changes in all five domains than White parents and more spiritual growth than parents of the other racial/ethnic groups. Moreover, parent-reported improved relationships were found to indirectly reduce young children's overall fussiness/defiance and fear/anxiety symptoms through reducing parents' emotional distress. Perceived changes in the new possibilities, personal strengths, and appreciation of life domains were found to serve as protective factors that buffered the indirect impacts of material hardship mean levels on child behavioral symptoms via mitigating parents' emotional distress.

Discussion

These findings shed light on resilience processes of a family system in a large-scale, disruptive, and stressful socio-historical event such as the COVID-19 pandemic. The five PTG domains could inform therapeutic and intervention practices in the face of future similar events. Importantly, these findings and the evinced family resilience should not negate the urgent needs of policy and program efforts to address material hardships, financial instabilities, and race/ethnicity-based structural inequalities for families of young children.

Residential segregation and Black-White differences in physical and mental health: Evidence of a health paradox?

Ample research finds that residential segregation is detrimental to Black Americans' physical health and exacerbates Black-White physical health disparities. However, less is known about how residential segregation may influence Black Americans' mental health and Black-White differences in mental health. Drawing on U.S. census data and a state representative study of Indiana residents (N = 2,685), I examine associations between residential segregation and multiple dimensions of physical and mental health. Consistent with past research, I find that residential segregation has an adverse association with physical health among Black respondents. In contrast, I find residential segregation to have a salubrious association with Black respondents' mental health, producing a Black mental health advantage at higher levels of segregation. I conclude by discussing the implications of these findings for research on residential segregation and health and the Black-White mental health paradox.

Self-Employment, Working Hours, and Hypertension by Race/Ethnicity in the USA

There is a large literature on work-related characteristics and hypertension, but studies on self-employment, longer working hours, and hypertension are mixed. Assessments of self-employment should be extended to account for people with part-time self-employment (i.e., employees also earning income from self-employment). The aim of this study was to determine the association of different types of self-employment with hypertension among adults by race/ethnicity and to assess whether longer working hours moderated these associations. Using data from the 2007-2018 National Health and Nutrition Examination Survey, measured hypertension (blood pressure ≥ 140/90 mm Hg) was assessed and employment categories included employees, part-time self-employment (i.e., employee with self-employment income), or full-time self-employment. Modified Poisson regressions and multiplicative interaction terms were used. Having full-time self-employment was associated with lower relative risk (RR) of hypertension compared to employees among Black (RR = 0.77, 95% confidence interval (CI) = 0.61-0.96) and White men (RR = 0.77, 0.65-0.93) compared to employees. Full-time self-employment was associated with higher risk of hypertension (RR = 1.36, 95% CI = 1.01-1.82) compared to employees among Hispanic women, while part-time self-employment was associated with lower risk (RR = 0.69, 95% CI = 0.48-0.98). Among White women, part-time self-employment was associated with higher relative risk of hypertension (RR = 1.27, 95% CI = 1.05-1.53) compared to employees. There were significant interactions between employment categories and longer working hours among Hispanic women as well as Black women and men. The results suggest that self-employment categories and longer working hours impact hypertension by race/ethnicity and sex. Because the number of full-time and part-time self-employed adults has increased, the health of this particular subgroup of workers should be further addressed.

The Water Surrounding the Iceberg: Cultural Racism and Health Inequities

Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity.

CONTEXT

Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism.

METHODS

We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities.

FINDINGS

Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course.

CONCLUSIONS

More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.

Depression impairment among young adult college students: exploring the racial paradox

BACKGROUND

Studies suggest Black Americans have a lower prevalence of depression than White Americans despite greater exposure to risk factors for depression across the life course. We examined whether this paradox exists among students in higher education, and whether the paradox may be partly explained by racial differences in reports of impairment from depression, which is a required criterion for clinical diagnosis.

METHODS

We analyzed data from the Healthy Minds Study (2020-2021), restricting the sample to young adults (18-29) who identified as either Black or White. Using modified Poisson regression models to estimate risk ratios, we examined associations between race and depression impairment across five levels of depression severity, adjusting for age and gender.

RESULTS

Approximately 23% of Black students reported depression impairment, which is significantly lower than the 28% of White students who reported depression impairment. For all students, greater depression severity was associated with greater probability of impairment; however, the relationship was more modest among Black students. At severe, moderately severe, and moderate depression levels, Black students had lower risk of depression impairment compared with White students.

CONCLUSION

White students may be more likely than Black students to report significant impairment at high levels of depression. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some the racial depression paradox.

A Systematic Review of Black People Coping With Racism: Approaches, Analysis, and Empowerment

This article reviews the current research literature concerning Black people in Western societies to better understand how they regulate their emotions when coping with racism, which coping strategies they use, and which strategies are functional for well-being. A systematic review of the literature was conducted, and 26 studies were identified on the basis of a comprehensive search of multiple databases and reference sections of relevant articles. Studies were quantitative and qualitative, and all articles located were from the United States or Canada. Findings demonstrate that Black people tend to cope with racism through social support (friends, family, support groups), religion (prayer, church, spirituality), avoidance (attempting to avoid stressors), and problem-focused coping (confronting the situation directly). Findings suggest gender differences in coping strategies. We also explore the relationship between coping with physical versus emotional pain and contrast functional versus dysfunctional coping approaches, underscoring the importance of encouraging personal empowerment to promote psychological well-being. Findings may help inform mental-health interventions. Limitations include the high number of American-based samples and exclusion of other Black ethnic and national groups, which is an important area for further exploration.

Black women social workers: Workplace stress experiences

Black women social workers (BWSWs) represent essential workforce members who are burdened by ongoing COVID-19 circumstances. Strategies to deal with highly stressful situations on the job, such as those experienced in 2020, were absent from the research literature leaving intervention strategies to support highly stressed BWSWs unknown. This study aimed to uncover the various ways BWSWs experienced their organizations as they performed work duties. Atlas.ti. 9 was used to analyze verbatim transcripts from 17 semi-structured qualitative interviews given by BWSWs across the United States in February 2021. Hermeneutic phenomenology was implemented to interpret interview data. The convenience sample was drawn from professional organizations where BWSWs claimed membership and volunteered to be electronically interviewed for 2 hours generating themes such as stress perceptions, institutional barriers to efficient work productivity and recommendations for workplace support. BWSWs reported high stress work environments in the past year. Some believed that their health and mental health declined because of the inability to find work-home life balance. Findings suggest BWSWs persevere regardless of high levels of stress and being unsupported in the workplace in order to maintain a livelihood. BWSWs play a crucial role in the lives of vulnerable populations, but need to attend to ways to be healthier given the polarization associated with racism, classism, and sexism experienced. Thematically, the data revealed stressful situations in the workplace and how organizations have failed to implement strategies in order to improve social worker health. Suggestions for workplace supports were also identified.

Writing about justice and injustice: Complex effects on affect, performance, threat, and biological responses to acute social stress among african American women and men

OBJECTIVE

Brief, culturally-tailored, and scalable stress coping interventions are needed to address a broad range of stress-related health disparities, including among African Americans. In this study, we develop two brief justice writing interventions and demonstrate a methodological approach for evaluating how prompting African Americans to think about justice and injustice can alter responses to acute social stress.

METHODS

African American women and men were randomized to a neutral writing condition or one of two justice-based writing interventions, which prompted them to recall past experiences of personal justice - with (adjunctive injustice) or without (personal justice-only) recalling and writing about injustice. Participants then completed a modified Trier Social Stress Test, during which they received feedback on poor performance. We measured cognitive performance, affect, and perceived threat in response to task feedback. We also measured blood pressure and salivary cortisol stress responses.

RESULTS

Men experienced more positive emotion, performed better on the stressor task, and were less threatened by poor performance feedback in the personal justice-only condition. Men also had lower systolic blood pressure reactivity in the justice writing conditions compared to control. Women experienced less positive emotion, performed worse on the stressor task, and were more threatened by feedback in the personal justice-only condition. Women also had lower cortisol recovery after the stressor task in the adjunctive injustice condition.

CONCLUSION

Thinking about justice and injustice may alter performance, affect, threat, and biological responses to acute social stress. Still, gender differences highlight that justice thinking is likely to produce heterogeneous and complex stress coping responses among African Americans.

Superwoman Schema and John Henryism among African American women: An intersectional perspective on coping with racism

RATIONALE

John Henryism and Superwoman Schema (SWS) are dispositional characteristics adopted to overcome the challenges of chronic psychosocial stress, and have particular salience for African American women. Both show protective and harmful effects on health and share conceptual similarities and distinctions, yet there is no empirical evidence of the potential overlap resulting in uncertainty about the unique roles they may each play concerning the health of African American women.

OBJECTIVE

We examined: 1) whether and to what extent John Henryism and SWS represent similar or distinct constructs relevant to the unique sociohistorical and sociopolitical position of African American women, and 2) whether the two differentially predict health outcomes.

METHODS

Data are from a purposive and socioeconomically diverse sample of 208 African American women in the San Francisco Bay Area. First, we conducted a progressive series of tests to systematically examine the conceptual and empirical overlap between John Henryism and SWS: correlation analysis, exploratory factor analysis (EFA), principal component analysis and k-modes cluster analysis. Next, we used multivariable regression to examine associations with psychological distress and hypertension.

RESULTS

John Henryism and SWS were moderately correlated with one another (rs = 0.30-0.48). In both EFA and cluster analyses, John Henryism items were distinct from SWS subscale items. For SWS, feeling an obligation to present an image of strength and an obligation to help others predicted higher odds of hypertension (p < 0.05); having an intense motivation to succeed predicted lower odds (p = 0.048). John Henryism did not predict hypertension. Feeling an obligation to help others and an obligation to suppress emotions predicted lower levels of psychological distress (p < 0.05) whereas John Henryism predicted higher distress (p = 0.002).

CONCLUSIONS

We discuss the implications of these findings for the measurement of culturally specific phenomena and their role in contributing to the unequal burden of ill health among African American women.

Coping with online racism: Patterns of online social support seeking and anti-racism advocacy associated with online racism, and correlates of ethnic-racial socialization, perceived health, and alcohol use severity

Given the emerging public health concerns of online racism, we examined potential coping approaches for racial/ethnic minority adults. Using a latent class regression model (N = 407), we examined patterns of online social support seeking and anti-racism advocacy engagements that were associated with online racism among racial/ethnic minority adults. We also examined whether these patterns were associated with ethnic-racial socialization messages (cultural socialization, promotion of mistrust, preparation for racial bias), perceived health, and alcohol use severity. Three distinct latent groups were identified with meaningful group differences: triggered/reactive (alcohol use risk, higher promotion of mistrust), moderate engagement (no risk), disengaged/non-reactive (higher promotion of mistrust, higher cultural socialization, alcohol use risk) groups. Online social support seeking and advocacy engagement may have both benefits and costs in coping with online racism. Those who engage at optimal/balanced levels appear to report better well-being. Implications for research and practice are discussed.

The Association Between John Henryism and Depression and Suicidal Ideation Among African-American and Caribbean Black Adolescents in the United States

PURPOSE

The aim of this study is to investigate the relationship between John Henryism (JH), a psychological construct indexing repeated high effort coping, and depression and SI among Black adolescents, and to explore whether these relationships vary by sex.

METHODS

Data came from the National Survey of American Life-Adolescent Supplement, a cross-sectional, multistage probability sample of African-American and Caribbean Black adolescents aged 13-17 (N = 1,170). JH was measured using a 12-item scale (alpha = 0.71) and dichotomized at the median. Lifetime history of major depression (MD) and SI were assessed using the Composite International Diagnostic Inventory and self-report, respectively. Logistic regression was used to assess the relationship between JH and likelihood of MD and SI, adjusting for demographic and psychosocial characteristics and accounting for the complex survey design. Moderation by sex was assessed using interaction terms.

RESULTS

Lifetime prevalence of MD was 6.3% (N = 87) and lifetime history of SI was 7.6% (N = 91). In unadjusted models, high JH was inversely associated with MD (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.34-0.90) and SI (OR: 0.45, 95% CI: 0.23-0.91). In adjusted models, the relationship between JH and MD was attenuated (OR: 0.68, 95% CI = 0.39-1.18, p = .16) and remained marginally significant for SI (OR: 0.55, 95% CI: 0.28-1.06, p = .07). These relationships were similar by sex.

DISCUSSION

Consistent with prior work in adults, JH was inversely associated with MD and SI among Black adolescents. Findings illustrate the importance of considering culturally salient protective factors for mental health among Black adolescents.

Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults

Background

Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the intersection of autism and race/ethnicity in association with psychiatric and medical diagnoses.

Methods

The study population included adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. We ascertained 1507 adults who had an autism diagnosis documented in their electronic medical records. We sampled a matched control group of adults without an autism diagnosis (N = 15,070) at a 10:1 ratio. Our sample was 46% White, 17% Hispanic, 16% Asian, 7% Black, and 14% other race/ethnicity. We compared health diagnoses (a) between autistic and non-autistic adults within strata of race/ethnicity and (b) across race/ethnicity within strata of autistic and non-autistic adults. Lastly, we examined the interaction between autism and race/ethnicity on both multiplicative and additive scales.

Results

Autistic adults were more likely to be diagnosed with most medical and psychiatric conditions compared with their non-autistic counterparts of the same race/ethnicity. Among autistic adults, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions and Black and Hispanic autistic adults were more likely to be diagnosed with obesity than their White counterparts. In interaction models, we found that adults who were Black and autistic were disproportionately less likely to be diagnosed with psychiatric conditions and autoimmune disease and more likely to be diagnosed with hypertension than expected.

Conclusion

Health vulnerabilities may be compounded at the intersection of autism and race/ethnicity. Future research should continue to apply an intersectional lens toward understanding and addressing these disparities. Our findings likely underestimate the health disparities that exist in uninsured autistic adults and those living in other parts of the United States.

How Racism "Gets Under the Skin": An Examination of the Physical- and Mental-Health Costs of Culturally Compelled Coping

Historically and contemporarily, Black Americans have been compelled to use effortful coping styles characterized by high behavioral and emotional restraint in the face of systematic racism. Lynch and colleagues have previously conceptualized a class of regulatory strategies-overcontrolled coping-characterized by emotional suppression, hypervigilance for threat, and high distress tolerance, which bear close analogy to coping styles frequently used among individuals facing chronic racial stress. However, given the inherent culture of racism in the United States, engaging in highly controlled coping strategies is often necessitated and adaptive, at least in the short term. Thus, for Black Americans this class of coping strategies is conceptualized as culturally compelled coping rather than overcontrolled coping. In the current article, I offer a critical examination of the literature and introduce a novel theoretical model-culturally compelled coping-that culturally translates selected components of Lynch's model. Cultural translation refers to considering how the meaning, function, and consequences of using overcontrolled coping strategies changes when considering how Black Americans exist and cope within a culture of systematic racism. Importantly, this model may offer broad implications for future research and treatment by contextualizing emotion regulation as a central mechanism, partially answering how racism "gets under the skin" and affects the health of Black Americans.

Self-employment, educational attainment, and hypertension among Black women and men

Background

Self-employment is generally associated with better health outcomes and educational attainment can shape self-employment. Yet, Black Americans are less likely to be self-employed and analyses of self-employment and health among Black Americans are few. The aim of this study was to determine how educational attainment moderates the associations between self-employment and hypertension among Black adults.

Methods

Using data from the 2007-2018 National Health and Nutrition Examination Survey, participants who self-identified as non-Hispanic Black (n = 2,855) were categorized as (1) employees with no self-employment income, (2) employees with self-employment income, or (3) having full-time self-employment. Modified Poisson regressions and multiplicative interaction terms were used to determine whether educational attainment moderated the associations between self-employment and measured hypertension (i.e., 140/90 mm Hg or anti-hypertensive medication).

Results

Most participants were employees with no self-employment income (81.9%), but 11.8% were employees reporting some self-employment income and 6.3% were self-employed full-time. About two in five (40.9%) had hypertension. Having full-time self-employment was associated with lower risk of hypertension compared to those who were employees (risk ratio = 0.82, 95% confidence interval = 0.67-0.98), and educational attainment moderated the associations among Black men such that part-time self-employment was associated with high rates of hypertension among Black men who had not completed high school.

Conclusions

These results suggest that full-time self-employment is associated with lower risk of hypertension among Black adults, but that being an employee with some self-employment income may elevate rates of hypertension among Black men depending on educational attainment. Future studies should assess pathways between self-employment and hypertension by educational attainment among Black women and men.

The Relationship of John Henryism With Cognitive Function and Decline in Older Black Adults

OBJECTIVE

This study aimed to investigate the relationship between John Henryism, a psychological trait typified by high-effort active coping that has been associated with adverse health outcomes among Blacks, and cognitive decline.

METHODS

In a cohort of community-dwelling older Black adults ( N = 611), we investigated the relationship between John Henryism and cognitive decline. John Henryism was measured using the John Henryism Active Coping Scale (JHACS), a nine-item validated measure of self-reported high-effort coping (mean [standard deviation] = 16.9 [4.8]; range, 4-27). We implemented a three-step modeling process using mixed-effects models to assess the relationship between the JHACS and global cognitive function as well as five cognitive domains. We adjusted for demographics and for factors known to be associated with cognitive function and decline including vascular risk factors, discrimination, and income.

RESULTS

The trait of high-effort active coping was associated with lower-average cognitive function ( β = -0.07, 95% confidence interval = -0.10 to -0.03), but not with decline. The results remained after further adjustment for experiences of discrimination, income, and vascular risk factors. In domain-specific analyses, we found that the JHACS was associated with baseline levels of working memory, semantic memory, and visuospatial ability, but not decline.

CONCLUSIONS

These results highlight the importance of using culturally specific measures in considering the heterogeneity of cognitive health outcomes in minoritized populations. Understanding how stress responses relate to late-life cognition among older Black adults could help promote aspects of behavioral resilience along with healthful coping responses.

Positive affect decreases the negative association between social mobility belief and physical health among Chinese rural-to-urban migrant adolescents

OBJECTIVE

The belief in upward social mobility promotes the mental health and social adaptation of disadvantaged adolescents. However, efforts for upward mobility may facilitate psychosocial adaptation while undermining physical health for minority youth from disadvantaged backgrounds. Therefore, we aimed to examine how social mobility belief is associated with mental and physical health among Chinese rural-to-urban migrant adolescents and explore whether positive affect acts as a protective factor moderating these relationships.

METHOD

A total of 158 rural-to-urban migrant adolescents aged 10-14 completed a self-report questionnaire and underwent medical examination.

RESULTS

Social mobility belief and positive affect were positively related to mental health (general self-efficacy). Positive affect interacted with social mobility belief in predicting physical health (self-rated health and allostatic load). For migrant adolescents with low levels of positive affect, strong belief in social mobility was associated with poor self-rated health and high allostatic load. For migrant adolescents with high levels of positive affect, their physical health was better and not associated with social mobility belief.

CONCLUSIONS

Social mobility belief showed a double-edged sword effect; it was positively associated with mental adaptation while negatively associated with physical health among Chinese rural-to-urban migrant adolescents. Positive affect acted as a protective factor for decreasing the negative association between social mobility belief and physical health.

Planful Self-Control, Metabolic Risk, and Psychosocial Outcomes Among Young, Black Men: A Test of Skin-Deep Resilience Theory

Research on skin-deep resilience suggests that for youth and young adults from disadvantaged backgrounds, high levels of planful self-control may promote positive psychosocial outcomes while simultaneously conferring vulnerabilities to chronic diseases related to aging. In this study, we investigated the divergent effects of planful self-control on young Black American men’s psychosocial well-being and their metabolic risk. We expected that high levels of planful self-control in emerging adulthood would predict positive outcomes in young adulthood (educational attainment, low depressive symptoms, job satisfaction); however, the combination of high levels of planful self-control and the experience of contextual adversity either in emerging adulthood or in childhood would forecast poor metabolic health. Hypotheses were tested with prospective data from 504 Black American men followed from age 20 to age 26. Planful self-control in emerging adulthood directly forecasted low levels of depressive symptoms, one’s likelihood of obtaining a bachelor’s degree, increased job satisfaction, and increases in metabolic risk. Exposure to childhood deprivation moderated the influence of planful self-control on metabolic risk. Men with high levels of deprivation and high levels of planful self-control exhibited the worst metabolic profiles in the sample. In contrast, men with high levels of childhood deprivation and low levels of planful self-control exhibited the best metabolic profiles. Documenting the health consequences associated with planful self-control provides a foundation from which to identify modifiable psychosocial factors that affect the course of psychosocial problems and health.

Differences in All-Cause Mortality Among Transgender and Non-Transgender People Enrolled in Private Insurance

Few studies have analyzed mortality rates among transgender (trans) populations in the United States and compared them to the rates of non-trans populations. Using private insurance data from 2011 to 2019, we estimated age-specific all-cause mortality rates among a subset of trans people enrolled in private insurance and compared them to a 10% randomly selected non-trans cohort. Overall, we found that trans people were nearly twice as likely to die over the period as their non-trans counterparts. When stratifying by gender, we found key disparities within trans populations, with people on the trans feminine to nonbinary spectrum being at the greatest risk of mortality compared to non-trans males and females. While we found that people on the trans masculine to nonbinary spectrum were at a similar risk of overall mortality compared to non-trans females, their overall mortality rate was statistically smaller than that of non-trans males. These findings provide evidence that some trans and non-trans populations experience substantially different mortality conditions across the life course and necessitate further study.

When Resilience Becomes Risk: A Latent Class Analysis of Psychosocial Resources and Allostatic Load Among African American Men

There is a well-established link between psychosocial risks and psychological health among African American (AA) men. Yet, the psychosocial sources and physical health consequences of resilience (i.e., the ability to maintain good health despite adversity) remain underexplored. Using data from 283 AA men in the Nashville Stress and Health Study, the present study investigated the links between psychosocial resilience and allostatic load (AL), a biological indicator of physiological dysregulation. Latent class analysis (LCA) identified distinct resilience profiles comprising eight psychosocial resources across four categories: coping strategies, sense of control, racial identity, and social support. Analysis of variance (ANOVA) tests determined significant class differences in men’s AL scores. LCA results confirm a four-class model was the best fit: Class 1 (high resources, 32%), Class 2 (high coping but low control, 13%), Class 3 (low resources but high racial identity, 20%), and Class 4 (low resources but high mastery, 34%). Results reveal lower AL (better health) among Classes 1 (m = 0.35) and 4 (m = 0.31) and higher AL (worse health) among Classes 2 (m = 0.44) and 3 (m = 0.44). Findings indicate that the “quality” rather than the “quantity” of psychosocial resources matters for physical health among AA men, as positive health outcomes were observed among both low- and high-resource classes. Results suggest different resource combinations produce distinct patterns of resilience among AA men and underscore the need to further elucidate complex resilience processes among this population.

Resilience and Family Socialization Processes in Ethnic Minority Youth: Illuminating the Achievement-Health Paradox

Youth in marginalized communities who "strive" to rise above adversity, including systemic racism and poverty, are considered "resilient." African-American, Latinx, and Asian-American youth often achieve admirable academic success despite limited social capital and high early life stress by adopting a "striving persistent behavioral style" (SPBS). SPBS may be supported by family socialization processes that facilitate reliance on self-regulation processes. Unfortunately, a young person's resilience in one domain (i.e., academic) can come at a cost in other domains, including physical and mental health morbidities that are under-identified and under-treated. Indeed, research suggests a link between SPBS in the face of adversity and later health morbidities among ethnic minority youth. Herein, we describe SPBS as an adaptation to minority stress that not only promotes social mobility but may also stoke physical and mental health disparities. We review how family processes related to academic, emotional, and ethnic-racial socialization can facilitate the striving persistent behavioral style. We emphasize the double bind that ethnic minority families are caught in and discuss directions for future research and clinical implications for individual and family-level interventions. While needed, we argue that individual and family-level interventions represent a near-term work around. Solutions and factors that shape the need for SPBS and its cost must be addressed structurally.

Working Harder than Others to Prove Yourself: High-Effort Coping as a Buffer between Teacher-Perpetrated Racial Discrimination and Mental Health among Black American Adolescents

High-effort coping (feeling like one must work harder than others to succeed due to anticipated discrimination) is an understudied concept in adolescence. The current study examined among Black American adolescents surveyed in eighth and 11^th grade (N = 630, 49% female) how high-effort coping moderated the relations between teacher-perpetrated racial discrimination and psychological distress across time, and whether the buffering role of high-effort coping varied by adolescent gender and socioeconomic status. Experiencing racial discrimination from teachers in eighth grade was positively related with depressive symptoms, anger, and suicidal ideation in 11^th grade. High-effort coping buffered against teacher discrimination for suicidal ideation among low socioeconomic status youth, as well as for anger among high socioeconomic status youth. Findings underscore the harmful influence of racial discrimination on Black American adolescents' mental health, as well as suggest that among certain subpopulations, high-effort coping may be one psychologically protective resource through which Black American youth retain positive feelings that are undermined by racial discrimination, and thus promote mental well-being.

Multidimensional conceptualization of identity and psychopathology: Assessing mental health disparities from an intersectional and dimensional framework

Black, Indigenous, and People of Color (BIPOC) currently constitute 40% of the US population and will become the majority by 2045. Current mental health systems have not sufficiently accounted for disparities, inequities, and social determinants impacting BIPOC lives. We outline several advances that could improve mental health disparities research. Research on BIPOC requires mental health assessment accurately capturing multiple facets of one's identity, taking into account the complexities of multifaceted historical oppression. Assessing (personality) psychopathology in a dimensional and hierarchical manner could provide greater insight into mental health disparities between diverse identity individuals. We encourage studying moderators that are protective assets for BIPOC-such as resiliency and community factors-as opposed to deficit-dominant, category-based, and majority-dominant assessments.

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

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. Furthermore, most of the previous work has been conducted among young and middle-aged adults. This 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 older adults.

METHODS

One hundred 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 (ie, demographic information, chronic conditions, medication use, and health behaviors). Blood pressure, waist circumference, and blood were also collected. Triglycerides, high-density lipoprotein cholesterol, hemoglobin A1C, and C-reactive protein levels were measured from the blood samples.

RESULTS

JH was positively associated with metabolic syndrome 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.

Hardiness and attitudes toward professional healthcare services: Implications for healthcare service utilization among Black American adults

This study (N = 780) examines the indirect effects of hardiness—health locus of control (HLOC), health competence (HC), health value (HV)—on past-year healthcare provider visit via attitudes toward seeking and receiving professional healthcare services (ATSRPHS). Across four health domains (dental, general health, mental, vision), ATSRPHS mediated the indirect effect of (1) HV and (2) internal HLoC on past-year healthcare provider visit. ATSRPHS also mediated the indirect effect of external HLoC on past-year visit to healthcare provider visit for general medical, mental, and vision health. ATSRPHS did not mediate any indirect effect of HC on past-year healthcare provider visit. This research contributes to understanding determinants of healthcare service utilization among Black American adults.

Cross-Sectional Examination of Musculoskeletal Pain and Physical Function in a Racially and Socioeconomically Diverse Sample of Adults

BACKGROUND

Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics.

METHODS

This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable.

RESULTS

Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (β = -0.07, p = .031), in mid midlife (β = -0.04, p = .041; age 40-54) and late midlife (β = -0.05, p = .027; age 55-64).

CONCLUSIONS

This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life.

Resilience-promoting policies and contexts for children of color in the United States: Existing research and future priorities

The health status of children in the United States varies by racial and ethnic, shaped by an interrelated set of systems that disadvantage children of color in the United States. In this article, we argue for a broad view of resilience, in both research and policy, that views resilience not just as a property of individuals but also as a characteristic of social contexts and policies. Accordingly, we describe the empirical evidence for policies and contexts as factors that can improve health among children and families that are deprived of equal opportunities and resources due to structural racism. We discuss the evidence and opportunities for policies and interventions across a variety of societal systems, including programs to promote economic and food security, early education, health care, and the neighborhood and community context. Based on this evidence and other research on racism and resilience, we conclude by outlining some directions for future research.

Community-dwelling older adults who are low-income and disabled weathering financial challenges

Despite interventions aiming to improve outcomes among older adults experiencing financial challenges, the challenges and strategies employed to handle them are poorly understood. This study examined the experiences of financial challenges among low-income adults aged ≥65 years. Eleven semi-structured interviews were analyzed using thematic analyses. An overarching theme was "I guess it balances", capturing attempts to maintain hope and proactively address challenges despite stress, uncertainty and limitations. Balancing was demonstrated within four domains, including cognitive bandwidth ("think a lot" versus "I don't dwell on that"), emotional experience ("depressing" versus "be thankful"), learned resilience ("that was a shock" versus "there's always a way"), and meeting daily needs ("we learned to do without" versus "take a dollar and stretch it"). Participants described being weathered by challenges and using predominately high-effort coping strategies to weather the challenges. These findings call for strengthening the safety net for older adults facing financial challenges.

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.

Race Differences in Characteristics and Experiences of Black and White Caregivers of Older Americans

BACKGROUND AND OBJECTIVES

Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects.

RESEARCH DESIGN AND METHODS

Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study. Guided by Pearlin's Stress Process Model, hierarchical logistic regression models were constructed to examine race differences in caregiving-related effects after adjusting for caregiving context, stressors, and resources.

RESULTS

Relative to white caregivers, blacks more often provided in excess of 40 hr of care per week (54.3% vs 38.6%) and more often cared for an older adult with dementia (27.1% vs 20.7%) who was living below the federal poverty line (31.7% vs 11.9%) or was Medicaid-eligible (42.2% vs 11.8%). Black caregivers more often used supportive services (32.9% vs 24.8%). In fully adjusted regression models, black caregivers were more likely to report gains and less likely to report emotional difficulty than whites. Service utilization did not attenuate caregiving-related emotional difficulty or participation restrictions, regardless of race.

DISCUSSION AND IMPLICATIONS

Findings highlight caregiving disparities and counterintuitive differences in experiences and indicate the importance of identifying supports such as paid family leave and faith and community-based programming to better support community-dwelling low-income older adults and their family and unpaid caregivers.

Coping, Discrimination, and Physical Health Conditions Among Predominantly Poor, Urban African Americans: Implications for Community-Level Health Services

African Americans and ethnic minorities experience racial discrimination in a variety of settings. Racial discrimination is a potent stressor that has been linked to psychosocial stress and poor physical health. To cope with discriminatory experiences and daily life event stressors, African Americans frequently use the concept of John Henryism (a high effort coping strategy with prolonged exposure to stress). This cross-sectional analysis explored the relationship between racism/discrimination, John Henryism, and health problems in a predominately African American sample. Data were collected through health care screenings for hypertension, diabetes, and obesity and a self-report survey to assess experiences of discrimination and use of John Henryism. Logistic and linear regression models were used to assess the relationship between the John Henryism score, racism/discrimination score, and health problems among 352 participants. John Henryism was associated with a decrease in systolic blood pressure (b = - 12.50, 95% CI = - 23.05, - 1.95) among men, after adjusting for experiences of racism/discrimination and demographic characteristics. Experiences of racism/discrimination were associated with an increase in systolic blood pressure (b = 11.23, 95% CI = 0.38, 22.09) among men, after adjusting for John Henryism and demographic characteristics. Among women, there was no association found between John Henryism and experiences of racism/discrimination with systolic blood pressure. No association was found between John Henryism and experiences of racism/discrimination with being overweight/obese in women nor men. The study found that John Henryism was positively associated with the health of men, while experiences of racism/discrimination were negatively associated with their health. Limitations of the study are discussed, and recommendations are made to guide future research exploring the concept of John Henryism as a relevant factor between stress, racial discrimination and poor health.

Neural and sociocultural mediators of ethnic differences in pain

Understanding ethnic differences in pain is important for addressing disparities in pain care. A common belief is that African Americans are hyposensitive to pain compared to Whites, but African Americans show increased pain sensitivity in clinical and laboratory settings. The neurobiological mechanisms underlying these differences are unknown. We studied an ethnicity- and gender-balanced sample of African Americans, Hispanics and non-Hispanic Whites using functional magnetic resonance imaging during thermal pain. Higher pain report in African Americans was mediated by discrimination and increased frontostriatal circuit activations associated with pain rating, discrimination, experimenter trust and extranociceptive aspects of pain elsewhere. In contrast, the neurologic pain signature, a neuromarker sensitive and specific to nociceptive pain, mediated painful heat effects on pain report largely similarly in African American and other groups. Findings identify a brain basis for higher pain in African Americans related to interpersonal context and extranociceptive central pain mechanisms and suggest that nociceptive pain processing may be similar across ethnicities.

Stress hypothesis overload: 131 hypotheses exploring the role of stress in tradeoffs, transitions, and health

Stress is ubiquitous and thus, not surprisingly, many hypotheses and models have been created to better study the role stress plays in life. Stress spans fields and is found in the literature of biology, psychology, psychophysiology, sociology, economics, and medicine, just to name a few. Stress, and the hypothalamic-pituitaryadrenal/interrenal (HPA/I) axis and sympathetic nervous system (SNS), are involved in a multitude of behaviors and physiological processes, including life-history and ecological tradeoffs, developmental transitions, health, and survival. The goal of this review is to highlight and summarize the large number of available hypotheses and models, to aid in comparative and interdisciplinary thinking, and to increase reproducibility by a) discouraging hypothesizing after results are known (HARKing) and b) encouraging a priori hypothesis testing. For this review I collected 214 published hypotheses or models dealing broadly with stress. In the main paper, I summarized and categorized 131 of those hypotheses and models which made direct connections among stress and/or HPA/I and SNS, tradeoffs, transitions, and health. Of those 131, the majority made predictions about reproduction (n = 43), the transition from health to disease (n = 38), development (n = 23), and stress coping (n = 18). Additional hypotheses were classified as stage-spanning or models (n = 37). The additional 83 hypotheses found during searches were tangentially related, or pertained to immune function or oxidative stress, and these are listed separately. Many of the hypotheses share underlying rationale and suggest similar, if not identical, predictions, and are thus not mutually exclusive; some hypotheses spanned classification categories. Some of the hypotheses have been tested multiple times, whereas others have only been examined a few times. It is the hope that multi-disciplinary stress researchers will begin to harmonize their naming of hypotheses in the literature so as to build a clearer picture of how stress impacts various outcomes across fields. The paper concludes with some considerations and recommendations for robust testing of stress hypotheses.

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.

Neighborhood Profiles and Associations with Coping Behaviors among Low-Income Youth

Extant research has typically examined neighborhood characteristics in isolation using variable-centered approaches; however, there is reason to believe that perceptions of the neighborhood environment influence each other, requiring the use of person-centered approaches to study these relationships. The present study sought to determine profiles of youth that differ in their perceptions of their neighborhoods and objective neighborhood characteristics, and whether these profiles are associated with youth coping. Participants were low-income, African American youth (N= 733; 51.0% female, M age = 18.76 years, SD = 1.71) from a metropolitan city who were originally recruited for the Youth Opportunity program in Baltimore, Maryland. A latent profile analysis was conducted which included self-reported neighborhood social cohesion, collective efficacy, disorder, violence, and disadvantage derived from census data. Coping behaviors, specifically positive cognitive restructuring, problem-focused coping, distraction strategies, and avoidant behaviors were assessed via self-reported questionnaires. Four neighborhood profiles were identified: highest disorder (20.0%); highest violence/highest disadvantage (5.2%); high violence (26.6%); and highest cohesion/lowest disorder (48.2%). Individuals in the highest violence/highest disadvantage profile reported higher positive cognitive restructuring and problem-focused coping than the other profiles. These findings warrant an investigation into the individual assets and contextual resources that may contribute to more positive coping behaviors among youth in more violent and disadvantaged neighborhoods, which has the potential to improve resilient outcomes among youth in similar at-risk settings.

The Influence of Race-Related Stress on Eating Pathology: The Mediating Role of Depression and Moderating Role of Cultural Worldview Among Black American Women

The current study aimed to advance the eating pathology literature through investigating the association between a salient stressor for Black American women (race-related stress) and eating pathology, while also examining the potential mediating role of depressive symptoms on this association. In addition, the study aimed to examine the potential protective role of cultural worldview in this model. A community sample of 119 Black women between the ages of 18 and 60 years ( M = 36.34, SD = 12.51) were recruited for the study. Results supported a significant indirect effect of race-related stress on eating pathology through depressive symptoms. Moderated mediation analyses revealed a conditional effect of depression at various levels of worldview. Contrary to our hypotheses, participants with a more collectivistic and spiritual worldview often engaged in more eating pathology as a result of self-reported depressive symptoms stemming from experiences of race-related stress. Implications and future directions are discussed.

Racial discrimination, John Henryism coping, and behavioral health conditions among predominantly poor, urban African Americans: Implications for community-level opioid problems and mental health services

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.

Prospective Associations of Adolescent Conscientiousness With Psychological Resources and Metabolic Syndrome in Black and White Men

OBJECTIVE

Conscientiousness predicts better psychological resources as well as lower cardiovascular mortality and lower metabolic syndrome (MetS) risk. However, the benefits of conscientiousness might be amplified, disabled, or reversed in disadvantaged groups. This study is the first to test these competing hypotheses for prospective associations between adolescent conscientiousness and adult psychological resources and MetS.

METHOD

Participants were 220 men (54.6% black) from the Pittsburgh Youth Study. Adolescent conscientiousness (M [SD] age = 16 [1]) was rated by participants and their parents. Adult (M [SD] age = 32 [1]) socioeconomic status (SES; occupation and education), psychological resources (composite of positive affect, purpose in life, optimism, self-mastery, and self-esteem), and MetS scores (glucose, lipids, waist circumference, and blood pressure) were measured. Hierarchical regressions were used to evaluate the association of conscientiousness with adult psychological resources and MetS scores, with testing of moderation by race and SES.

RESULTS

Self- and parent-reported conscientiousness were associated with better psychological resources (βs = 0.23-0.29, ps ≤ .015), with no moderation by race or socioeconomic status. In the full sample, a three-way interaction of self-reported conscientiousness, race, and SES was obtained for MetS (β = 0.12, p = .093). Subgroup analysis indicated that self-reported conscientiousness was related to higher MetS scores in low SES black men (βint = -0.22, p = .022), but there was no comparable linear (βs ≤ 0.08, ps ≥ .50) or interaction (βs ≤ -0.13 ps ≥ .25) pattern in white men.

CONCLUSIONS

Adolescent conscientiousness was beneficial for adult psychological resources, regardless of race or SES. However, there may be physiological costs of conscientiousness for black men from disadvantaged backgrounds.

Placing prostate cancer disparities within a psychosocial context: challenges and opportunities for future research

Black men are more likely to be diagnosed with prostate cancer compared with White men. Despite advances in prevention and treatment strategies, disparities in prostate cancer among Black men persist. While research on the causes of higher incidence and mortality is ongoing, there is limited evidence in the existing literature that clearly speaks to the potential psychological or social factors that may contribute to disparities in prostate cancer incidence. Given the lack of attention to this issue, we review scientific evidence of the ways in which social factors, including socioeconomic status and racial segregation, as well as psychological factors, like depression and anxiety, are related to subsequent prostate cancer risk, which could occur through behavioral and biological processes. Our objective is to illuminate psychosocial factors and their context, using a racial disparity lens, which suggests opportunities for future research on the determinants of prostate cancer. Ultimately, we aim to contribute to a robust research agenda for the development of new prostate cancer prevention measures to reduce racial disparities.

High-Effort Coping and Cardiovascular Disease among Women: A Systematic Review of the John Henryism Hypothesis

African-American women living in the United States experience higher cardiovascular disease risk (CVD) mortality compared to White women. Unique mechanisms, including prolonged high-effort coping in the face of discriminatory stressors might contribute to these racial disparities. The John Henryism hypothesis is a conceptual framework used to explain poor health outcomes observed among individuals with low resources who repeatedly utilize active coping to overcome barriers. The aims of our study were to summarize the literature related to John Henryism and CVD-related factors with a particular focus on women and to identify gaps for areas of future inquiry. We searched MEDLINE, EMBASE, Scopus, and CINAHL to identify literature that used the John Henryism Active Coping scale. Reviewers independently reviewed eligible full-text study articles and conducted data extraction. We qualitatively summarized the literature related to John Henryism and cardiovascular disease (CVD)-related health behaviors (e.g., smoking or physical activity) and risk factors (e.g., hypertension) with a focus on study populations inclusive of women. Our review included 21 studies that used the John Henryism Active Coping scale, of which 10 explicitly reported on the interaction between John Henryism and socioeconomic status (SES) and CVD-related factors. With respect to the original hypothesis, three studies reported results in line with the hypothesis, four were null, and three reported findings in opposition to the hypothesis. The remaining studies included in the review examined the main effects of John Henryism, with similarly mixed results. The literature related to the interaction between John Henryism and SES on CVD-related factors among women is mixed. Additional studies of John Henryism that incorporate biological measures, varied indicators of resources, and larger study populations may illuminate the relationship between coping and deleterious health outcomes among women.

EMBRace: Developing a Racial Socialization Intervention to Reduce Racial Stress and Enhance Racial Coping among Black Parents and Adolescents

Researchers have illustrated the deleterious psychological effects that racial discrimination has exerted on Black Americans. The resulting racial stress and trauma (RST) from experiences with discrimination has been linked to negative wellness outcomes and trajectories for Black youth and families. Racial socialization (RS)-defined as the verbal and nonverbal messages that families use to communicate race to their children-can be a cultural strength and has been associated with positive outcomes in Black youth. Furthermore, the Racial Encounter Coping Appraisal and Socialization Theory (RECAST) encourages the frequent and competent use of RS between family members to cope with the negative impact of RST. Guided by RECAST, the purpose of this article is to describe the development of the Engaging, Managing, and Bonding through Race (EMBRace) intervention targeting the RS practices between Black adolescents and families. The authors explore current research on RST, discuss why traditional coping models for stress are inadequate for racially specific stressors, highlight RECAST as a burgeoning racial coping and socialization model, and describe how RS can be used as a tool to intervene within Black families. This is followed by a detailed description of the development and use of the EMBRace intervention which seeks to reduce RST through RS psychoeducation and practice, stress management, and the promotion of bonding in Black families. This article aims to serve as an example of a culturally relevant RS intervention for Black families who may benefit from clinical treatment for psychological distress from racially discriminatory encounters.

Parental Education Attainment and Educational Upward Mobility; Role of Race and Gender

Background. The Minorities' Diminished Return theory suggests that education attainment and other socioeconomic resources have smaller effects on the health and well-being of African Americans and other racial and ethnic minorities compared to Whites. Racial and ethnic differences in the processes involved with educational upward mobility may contribute to the diminished returns of education attainment for African Americans compared to Whites. Aim: This study compared African Americans and non-Hispanic Whites for the effect of parental education attainment on educational upward mobility and explored gender differences in these effects. Methods. The National Survey of American Life (NSAL 2003) is a nationally representative survey of American adults. Participants included 891 non-Hispanic White and 3570 African American adults. Gender, race/ethnicity, age, highest parental education attainment, and respondents' educational attainment were measured. Data were analyzed using linear regression models. Results. Overall, higher parental education attainment was associated with higher educational upward mobility (b = 0.34, p < 0.001), however, this boosting effect was significantly smaller for African Americans compared to Whites (b = -0.13, p = 0.003). Our further analysis showed that race by parental education attainment can be found for females (b = -0.14, p = 0.013) but not males (p > 0.05). Conclusion. African American females are at a disadvantage compared to White females regarding the effect of parental education attainment on their educational upward mobility, a phenomenon which could not be observed when comparing African American and White males. These results advocate for taking intersectionality frameworks to study the effects of race, gender, and class in the US.