Blood pressure and skin color

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.

Skin-Tone Trauma: Historical and Contemporary Influences on the Health and Interpersonal Outcomes of African Americans

Empirical evidence demonstrates that racism is a source of traumatic stress for racial/ethnic minorities, particularly African Americans. Like race and racism, skin tone and experiences of colorism—an often overlooked form of discrimination that privileges lighter skinned over darker skinned individuals, although not uniformly, may also result in traumatic stress. This article proposes a new conceptual model of skin-tone trauma. The model depicts how historical and contemporary underpinnings of colorism lead to colorist incidents that may directly and indirectly, by eliciting traumatic stress reactions, lead to negative effects on the health and interpersonal relationships of African Americans. Key tenets of critical race and intersectionality theories are used to highlight the complexities of skin-tone trauma as a result of intersectional identities on the basis of existing social hierarchies. Last, we present suggestions for researchers, as well as recommendations and strategies for practitioners, to unmask “skin-tone wounds” and promote healing for individuals, families, and communities that suffer from skin-tone trauma. Skin-tone trauma should be acknowledged by researchers, scholars, and practitioners to better understand and assess the widespread scope of trauma in the African American community.

Measuring racial microaggression in medical practice

The purpose of this study was to validate the already existing Racial Microaggression in Counseling Scale (RMCS) when the term 'therapist' was replaced with 'physician', thus constituting the modification as the Racial Microaggression in Medical Practice Scale (RMMPS). Racial microaggressions work at reinforcing inferior social status on a cognitive level. Unlike overt racism, messages behind microaggression are subtler and more every day. A lack of acceptance, respect, and regard emerges from interactions in medical contexts as there are layers of in-group and out-group statuses at play (e.g. physician-patient, Black-White, expert-lay, and Westernized-alternative). The layer focused on in this study was that of race or skin color. A sample of racial minorities in the Northeast (n = 91) was investigated both quantitatively and qualitatively to validate the modification and future use of a RMMPS. The scale was related to the racial incongruence between patient and provider. Qualitative findings support the original concepts and themes used when developing the 10-item measure in a counseling setting. Psychometric findings for the scale also supported its factorial structure using generalizability theory estimates. Future implications of this research relate to health behavior, trustworthiness, and health outcomes of minority patients. Its potential for use among various practitioners, educators, and researchers is also discussed.

African Ancestry, Social Factors, and Hypertension Among Non-Hispanic Blacks in the Health and Retirement Study

The biomedical literature contains much speculation about possible genetic explanations for the large and persistent black-white disparities in hypertension, but profound social inequalities are also hypothesized to contribute to this outcome. Our goal is to evaluate whether socioeconomic status (SES) differences provide a plausible mechanism for associations between African ancestry and hypertension in a U.S. cohort of older non-Hispanic blacks. We included only non-Hispanic black participants (N = 998) from the Health and Retirement Study who provided genetic data. We estimated percent African ancestry based on 84,075 independent single nucleotide polymorphisms using ADMIXTURE V1.23, imposing K = 4 ancestral populations, and categorized into quartiles. Hypertension status was self-reported in the year 2000. We used linear probability models (adjusted for age, sex, and southern birth) to predict prevalent hypertension with African ancestry quartile, before and after accounting for a small set of SES measures. Respondents with the highest quartile of African ancestry had 8 percentage points' (RD = 0.081; 95% CI: -0.001, 0.164) higher prevalence of hypertension compared to the lowest quartile. Adjustment for childhood disadvantage, education, income, and wealth explained over one-third (RD = 0.050; 95% CI: -0.034, 0.135) of the disparity. Explanations for the residual disparity remain unspecified and may include other indicators of SES or diet, lifestyle, and psychosocial mechanisms.

Genetic ancestry, social classification, and racial inequalities in blood pressure in Southeastern Puerto Rico

BACKGROUND

The role of race in human genetics and biomedical research is among the most contested issues in science. Much debate centers on the relative importance of genetic versus sociocultural factors in explaining racial inequalities in health. However, few studies integrate genetic and sociocultural data to test competing explanations directly.

METHODOLOGY/PRINCIPAL FINDINGS

We draw on ethnographic, epidemiologic, and genetic data collected in Southeastern Puerto Rico to isolate two distinct variables for which race is often used as a proxy: genetic ancestry versus social classification. We show that color, an aspect of social classification based on the culturally defined meaning of race in Puerto Rico, better predicts blood pressure than does a genetic-based estimate of continental ancestry. We also find that incorporating sociocultural variables reveals a new and significant association between a candidate gene polymorphism for hypertension (alpha(2C) adrenergic receptor deletion) and blood pressure.

CONCLUSIONS/SIGNIFICANCE

This study addresses the recognized need to measure both genetic and sociocultural factors in research on racial inequalities in health. Our preliminary results provide the most direct evidence to date that previously reported associations between genetic ancestry and health may be attributable to sociocultural factors related to race and racism, rather than to functional genetic differences between racially defined groups. Our results also imply that including sociocultural variables in future research may improve our ability to detect significant allele-phenotype associations. Thus, measuring sociocultural factors related to race may both empower future genetic association studies and help to clarify the biological consequences of social inequalities.

Phenotypic Bias and Ethnic Identity in Filipino Americans

OBJECTIVE: Links between phenotypes (skin tone, physical features) and a range of outcomes (income, physical health, psychological distress) were examined. Ethnic identity was examined as a protective moderator of phenotypic bias. METHOD: Data were from a community sample of 2,092 Filipino adults in San Francisco and Honolulu. RESULTS: After controlling for age, nativity, marital status, and education, darker skin was associated with lower income and lower physical health for females and males. For females, more ethnic features were associated with lower income. For males, darker skin was related to lower psychological distress. One interaction was found such that females with more ethnic features exhibited lower distress; however, ethnic identity moderated distress levels of those with less ethnic features. CONCLUSIONS: Phenotypic bias appears prevalent in Filipino Americans though specific effects vary by gender and skin color versus physical features. Discussion centers on the social importance of appearance and potential strengths gained from ethnic identification.

Relationships between skin color, income, and blood pressure among African Americans in the CARDIA Study

OBJECTIVES

We explored how income and skin color interact to influence the blood pressure of African American adults enrolled in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) Study.

METHODS

Data were derived from 1893 African American CARDIA year-15 participants who had undergone skin reflectance assessments at year 7. We adjusted for age, gender, body mass index, smoking status, and use of antihypertensive medication to examine whether year-15 self-reported family incomes, in interaction with skin reflectance, predicted blood pressure levels.

RESULTS

Mean systolic and diastolic blood pressure levels were 117.1 (+/-16.07) and 76.9 (+/-12.5) mm Hg, respectively. After adjustment, the interaction between skin reflectance and income was significantly associated with systolic blood pressure (P< .01). Among lighter-skinned African Americans, systolic pressure decreased as income increased (b= -1.15, P<.001); among those with darker skin, systolic blood pressure increased with increasing income (b=0.10, P=.75).

CONCLUSIONS

The protective gradient of income on systolic blood pressure seen among African Americans with lighter skin is not observed to the same degree among those with darker skin. Psychosocial stressors, including racial discrimination, may play a role in this relationship.

Skin color, social classification, and blood pressure in southeastern Puerto Rico

OBJECTIVES

We tested competing hypotheses for the skin color-blood pressure relationship by analyzing the association between blood pressure and 2 skin color variables: skin pigmentation and social classification.

METHODS

We measured skin pigmentation by reflectance spectrophotometry and social classification by linking respondents to ethnographic data on the cultural model of "color" in southeastern Puerto Rico. We used multiple regression analysis to test the associations between these variables and blood pressure in a community-based sample of Puerto Rican adults aged 25-55 years (n=100). Regression models included age, gender, body mass index (BMI), self-reported use of antihypertensive medication, and socioeconomic status (SES).

RESULTS

Social classification, but not skin pigmentation, is associated with systolic and diastolic blood pressure through a statistical interaction with SES, independent of age, gender, BMI, self-reported use of antihypertensive medication, and skin reflectance.

CONCLUSION

Our findings suggest that sociocultural processes mediate the relationship between skin color and blood pressure. They also help to clarify the meaning and measurement of skin color and "race" as social variables in health research.

Skin pigmentation, self-perceived color, and arterial blood pressure in Puerto Rico

Darker skin color has been associated with higher average blood pressure in several African-derived populations in the Americas. This pattern has been interpreted as evidence of genetic, physiologic, or sociocultural mechanisms, but existing evidence does not provide an adequate means of evaluating these alternatives. This paper introduces a measurement strategy to isolate the cultural and biological dimensions of skin color, and it develops a specific hypothesis regarding the cultural significance of skin color in Puerto Rico and its relationship to arterial blood pressure. Data come from a face-to-face survey in southeastern Puerto Rico (N = 100). There is no association between blood pressure and skin pigmentation, as measured by reflectance spectrophotometry. However, the discrepancy between self-perceived color and skin pigmentation, a measure we call "color incongruity," is associated with systolic blood pressure (SBP) through an interaction with socioeconomic status (SES) (P = 0.009). For low-SES respondents, darker self-ratings of color relative to skin pigmentation are associated with higher mean SBP. For high-SES respondents, however, darker self-ratings of color relative to pigmentation are associated with lower mean SBP. We interpret this pattern as evidence that the relationship between skin color and blood pressure is mediated by sociocultural processes, and we highlight the need for testable hypotheses and appropriate measurement operations in research on racial inequalities in health.

[Reasons for banishing the concept of race from Brazilian medicine]

As part of medicine's canonical framework, the concept of race has been associated with the idea that color and/or biological ancestry are relevant indicators of a predisposition to a certain disease or reaction to drugs. This stance derives from a typological view of human races. The low level of genetic variability and of structuring of the human species is incompatible with the existence of races as biological entities and tells us that color and/or geographical ancestry have little or nothing useful to contribute to medical practice, particularly when it comes to caring for an individual patient. We show that even so-called racial diseases like sickle cell anemia are really the product of evolutionary strategies used by populations exposed to specific infectious agents, whose territories have no unequivocal relation with either color or continental origin. Furthermore, in the words of sociologist Paul Gilroy, the social concept of race is "toxic," contaminating society as a whole, and it has been used to oppress and to foster injustice, even within a medical context.

Perceived stress following race-based discrimination at work is associated with hypertension in African-Americans. The metro Atlanta heart disease study, 1999-2001

There is increasing evidence of an association between stress related to job strain and hypertension. However little data exist on stress from racism and race-based discrimination at work (RBDW). The objective of this study was to investigate whether blood pressure (BP) outcomes are positively associated with stressful racism towards African-Americans from non-African-Americans as well as RBDW from other African-Americans. The metro Atlanta heart disease study was a population-based study which included 356 African-American men and women, aged >/=21 years, residing in metropolitan Atlanta, Georgia during 1999-2001. Perceived stress was self-reported by 197 participants for racism from non-African-Americans and 95 for RBDW from other African-Americans. Sitting systolic (SBP) and diastolic (DBP) BP were taken at a clinic visit and was the average of the last two of three BP measures. Hypertension was self-reported as physician-diagnosed high BP on 2 or more visits. Logistic and least-squares linear regression models were fit accordingly and separately for each type of stress, adjusting for age, gender, body mass index, and coping abilities. The likelihood of hypertension significantly increased with higher levels of perceived stress following racism from non-African-Americans, but not from RBDW from other African-Americans; adjusted odd ratios (95% CI) were 1.4 (1.0, 1.9) and 1.2 (0.8, 1.5) per unit increment of stress. The adjusted magnitude of SBP and DBP increase between low and very high level of stress, conversely, was greater when RBDW originated from African-Americans than racism from non-African-Americans. Stressful racism and RBDW encounters are associated with increased SBP and DBP and increased likelihood of hypertension in African-Americans. Future studies with a larger sample size are warranted to further explore these findings for mechanistic understanding and occupational policy consideration regarding stress risk reduction.

John Henry Active Coping, education, and blood pressure among urban blacks

The John Henryism hypothesis posits that individuals who actively cope with psychosocial stressors in the face of low socioeconomic resources are more likely to exhibit higher blood pressure levels than those with greater socioeconomic resources. It has been proposed that John Henryism may contribute to the disproportionately high rates of hypertension among blacks. Previous studies which support the John Henryism hypothesis have been conducted among blacks who reside in primarily southern rural settings. However, more recent studies conducted among urban blacks, have yielded contrasting results. This study examined the John Henryism hypothesis in a middle-aged urban sample of blacks in south Florida. The results of the study confirmed that there is indeed a relationship among John Henry Active Coping, years of education, and blood pressure among urban blacks in south Florida. Upon closer examination, higher John Henry Active Coping scores were associated with higher systolic and diastolic blood pressure among higher educated men, and John Henry Active Coping scores were associated with higher systolic and diastolic blood pressure among women with lower levels of education. The findings are discussed in terms of sociocultural factors that may influence the coping styles of black men and women in different communities and environments.

Perceptions of interethnic group racism predict increased vascular reactivity to a laboratory challenge in college women

African-Americans have disproportionately higher rates of hypertension than any other U.S. ethnic group. Researchers have postulated that the psychosocial-stress association with racism may help explain these higher rates in African-Americans, as well as blood pressure variability among African-Americans. Using a quasi-experimental design, this study examined the relationship between perceived interethnic group racism (racism) and blood pressure responses in 39 African-American females. Measurements of blood pressure were obtained before, during, and after a laboratory challenge where participants spoke about their personal views and feelings concerning animal rights. Perceptions of racism, as well as psychological and coping responses to racism, were assessed via the Perceived Racism Scale. The results revealed that on average, participants perceived racism 75.25 times/year. Racist statements were perceived most often, and speaking up was the most frequently reported coping response. The overwhelming majority of participants (76.47%) used active and passive coping responses to deal with racism. Among the psychological responses to racism, the magnitude of emotional responding was greatest for anger. Multivariate regression analyses indicated that perceived racism was significantly and positively related to diastolic blood pressure changes during the speech (p = .01), early recovery (p < .003), and late recovery (p = .01) periods. Potential confounders did not mitigate these effects. The findings highlight the importance of delineating the role of more real-world behavioral challenges in future research exploring blood pressure variability and hypertension risk in African-Americans.

Racial discrimination and skin color in the CARDIA study: implications for public health research. Coronary Artery Risk Development in Young Adults

OBJECTIVES

This study assessed whether skin color and ways of handling anger can serve as markers for experiences of racial discrimination and responses to unfair treatment in public health research.

METHODS

Survey data on 1844 Black women and Black men (24 to 42 years old), collected in the year 5 (1990-1991) and year 7 (1992-1993) examinations of the Coronary Artery Risk Development in Young Adults (CARDIA) study, were examined.

RESULTS

Skin color was not associated with self-reported experiences of racial discrimination in 5 of 7 specified situations (getting a job, at work, getting housing, getting medical care, in a public setting). Only moderate associations existed between darker skin color and being working class, having low income or low education, and being male (risk ratios under 2). Comparably moderate associations existed between internalizing anger and typically responding to unfair treatment as a fact of life or keeping such treatment to oneself.

CONCLUSIONS

Self-reported experiences of racial discrimination and responses to unfair treatment should be measured directly in public health research; data on skin color and ways of handling anger are not sufficient.

Blood pressure in young blacks and whites: relevance of obesity and lifestyle factors in determining differences. The CARDIA Study. Coronary Artery Risk Development in Young Adults

BACKGROUND

Middle-aged black men and women have higher blood pressure, on average, than whites. However, this pattern is inconsistent in children and adolescents. This study explores how differences in lifestyle factors in young adulthood may influence blood pressure patterns in the two races.

METHODS AND RESULTS

The Coronary Artery Risk Development in Young Adults (CARDIA) study is an ongoing collaborative investigation of lifestyle and the evolution of cardiovascular disease risk factors in a random sample of young adults ages 18 to 30 years at baseline (1985 to 1986). Data from four examinations over 7 years were analyzed with the use of a method that simultaneously examined cross-sectional and longitudinal relationships of lifestyle factors and blood pressure. This study included 1154 black women, 853 black men, 1126 white women, and 1013 white men. Blacks had higher systolic blood pressure and diastolic blood pressure than whites at every examination. Racial differences were much greater in women than in men and increased over time. Within each sex-race group, average diastolic blood pressure over four examinations was positively associated with baseline age, body mass index, and alcohol intake and negatively associated with physical activity, cigarette use, and intake of potassium and protein. Longitudinal change in diastolic blood pressure was positively associated with changes in body mass index and alcohol intake. After adjustment for obesity and other lifestyle factors, black-white diastolic blood pressure differences were reduced substantially: 21% to 75% for men and 49% to 129% for women. Results for systolic blood pressure were similar.

CONCLUSIONS

Differences in obesity and other lifestyle factors in young adults largely explain the higher baseline blood pressure and greater increase over time of blacks relative to whites.

Skin color and cancer mortality among black men in the Charleston Heart Study

The association between skin color and 30-year cancer mortality in a random sample of black men and a peer-nominated group of high socioeconomic status (SES) black men was evaluated in the Charleston Heart Study, a prospective study, begun in 1960, designed to investigate the epidemiology of coronary heart disease in a biracial cohort. Skin color was used as a continuous variable and as a categorical variable, by tertiles, in a Cox proportional hazards regression model. In the high SES group, there was a statistically significant decreasing relationship between skin color and cancer mortality, with those having the lightest skin having the lowest cancer mortality. In the random sample of black men, the relationship between skin color and cancer mortality was not statistically significant; however, the data indicated a slight protective effect among those with the lightest skin color. Because degree of skin reflectance is a measure of black-white admixture, these results may indicate a genetic mechanism underlying the differences in cancer mortality across skin color groups. Skin color is also recognized as a marker for psychosocial factors. Therefore, poor prognosis among those with darker skin color as a result of failure of early detection, inadequate treatment, and a variety of psychosocial stressors represents an alternative explanation of the study findings.

Skin colour, measures of socioeconomic status, and blood pressure among blacks in Erie County, NY

This study examined (1) the construct validity of an observational skin colour measure and (2) the interrelationships of skin colour, measures of socioeconomic status (SES), and blood pressure (BP) in a random survey of black male (n = 354) and black female (n = 641) household residents aged 18-86 in Erie County, NY. Significant associations between lighter skin colour and older age (p < 0.05), and being female (p < 0.01) were observed, confirming known findings. Lighter skin colour was also marginally associated with higher SES (p = 0.06) in females only. Darker skin colour was associated with higher diastolic BP (p < 0.05). The association of skin colour and BP may be explained by considering skin colour as: (1) a marker for socioenvironmental events (i.e. discrimination) and its consequences (i.e. impact on self-esteem), (2) a marker for genes of West African origin, or (3) related directly to BP through a biochemical pathway as yet unknown.

Hypertension in blacks: socioeconomic stress and sympathetic nervous system activity

Primary hypertension is almost twice as prevalent among American blacks as among whites. Causes of this increased prevalence of hypertension remain elusive. Elevation of sympathetic nervous system activity, in part secondary to increased levels of socioeconomic stress, is hypothesized as playing a role. Increased sympathetic nervous system activity may increase peripheral vascular resistance directly or through increased vascular reactivity. Microneurography allows direct measurement of peripheral sympathetic nervous system activity. Application of this technique will allow comparison of sympathetic nervous system activity in black and white subjects and provide additional insight into the role of the sympathetic nervous system in the development of hypertension in blacks.

Eye color and hypertension

We searched for predictors of essential hypertension in 1,031 persons aged 30-49 who were observed to progress from normotension to hypertension, as compared to an equal number of matched subjects who remained normotensive. Blood pressure status was well documented in both multiphasic screenings and clinical records. Compared to persons with each lighter eye color, those with brown eyes were more prone to develop hypertension, with relative risk of 1.5 (95% confidence interval 1.18-1.96) compared to all persons with nonbrown eyes. The association persisted after control for race, sex, body mass index, alcohol use, educational level, parental history of hypertension, and among whites, for ethnic origin as crudely estimated by last name. Partial confirmation was obtained in three largely independent study groups: 1) 25 pairs of eye-color-discordant dizygotic twins; 2) 894 pairs of incident hypertensives and controls selected only with multiphasic screening blood pressure measurements; and 3) cross-sectional analysis of 152,018 multiphasic screenees. The weak association of eye color with hypertension clearly requires further confirmation. Although it has little potential for use in screening or clinical care, it may have implications regarding etiology. Areas for further exploration include the close metabolic relation of melanins to catecholamines, both derived from the amino acid tyrosine, and the possibility that dark-eyed persons react more quickly and strongly to stimuli than light-eyed persons.

Race and sex differences in the correlates of blood pressure change

Potential predictors of systolic and diastolic blood pressure change between 1960 and 1967 in the biracial population of Evans County, Georgia, were investigated. An all possible regressions multiple linear regression analysis was used. For systolic blood pressure change, the level of systolic blood pressure, age, and change in Quetelet index were significant (p less than 0.05) correlates in white men. The level of systolic blood pressure, the level and change of socioeconomic status, change in Quetelet index, and change in cholesterol were significant correlates for white women. The level of Quetelet index was of borderline significance (p less than 0.055) when the other significant variables were included in the model for white women. The change in Quetelet index was the only significant correlate of systolic blood pressure change in blacks. For diastolic blood pressure change, age, change in hematocrit, and change in Quetelet index were significant correlates for white men. Age, level and change of socioeconomic status, level and change of Quetelet index, and change in hematocrit were the significant correlates in white women. In black men, change in Quetelet index and age were significant. In black women, only age was a significant correlate of diastolic blood pressure change. These results indicate that there may be important differences in these correlates between race-sex groups and thus in the mechanism of blood pressure change for different race-sex groups. groups.

Hypertension in blacks

Hypertension represents a problem of special importance in the black patient primarily because of frequency and increased severity. Differences between hypertension in blacks and whites in the United States seem to be mostly epidemiological, pathophysiological, and in responsiveness to drug therapy. Black hypertensives seem to have more of a salt-sensitive, volume-dependent type of hypertension and, therefore, diuretic therapy appears to be particularly useful. Agents that seem to depend more on a stimulated renin-angiotensin-aldosterone system are generally less effective as monotherapy in this group of patients. However, proper combinations of low dose diuretics, with almost any other therapeutic agent, seems to produce a responsiveness in the black hypertensive that is equal to comparable white patients.

Duffy antigens and hypertension in a black population

Skin color and social class have been suggested as reasons to explain the greater prevalence of hypertension in Blacks as compared to Whites. The presence of Duffy red blood cell proteins, a measure of "whiteness" in Blacks, was unrelated to the presence of elevated blood pressure in 722 Black hospital patients. The finding suggests that social class rather than skin color is associated with the greater prevalence of hypertension in Blacks.

The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival

This article presents a detailed account of the incidence, prevalence, and survival experience of people with end-stage renal disease (ESRD) covered by Medicare. The number of new entrants into the ESRD program has risen since its inception. This increase is greatest for people whose cause of renal failure is primary hypertensive disease or diabetic nephropathy. The program incidence rates for black people is 2.8 times that of white people. Incidence is highest for persons 65 to 69 years of age. Total patient survival is 44 percent 5 years after renal failure onset. Total Medicare enrollment for ESRD quadrupled between the years 1974 and 1981.

John Henryism and blood pressure differences among black men

A community probability sample of southern working-class, black men (N = 132) between 17 and 60 years of age was administered a scale to measure the degree to which they felt they could control their environment through hard work and determination. Since the legend of John Henry--the famous, black steeldriver of American folklore--can be understood as a cultural statement about how black Americans must often attempt to control behavioral stressors through hard work and determination, items for the scale were developed to reflect the theme of John Henryism. It was hypothesized that men scoring below the median on education but above the median on John Henryism would have higher blood pressures than any other group. The data were in line with the prediction, in that men who scored low on education and high on John Henryism had significantly higher diastolic blood pressures than men who scored above the median on both measures. Study findings are discussed in terms of the meaning that education and John Henryism may have for raising or lowering autonomic arousal when individuals encounter behavioral stressors in everyday life.

The relationship between income, education and hypertension

A sample survey was conducted in South Carolina to determine how income and education relate to hypertension, independently of age, race and sex. The results indicated that there was a significant inverse relationship between income and hypertension for Whites (P < 0·0001), but not for Blacks. There was also a statistically significant inverse relationship between education and hypertension for Whites (P < 0·0001) and for Blacks (P < 0·001).

Social factors in the etiology of multiple outcomes: the case of blood pressure and alcohol consumption patterns

The literature addressing the relationships between biological and social factors in the etiology of multiple chronic diseases occurring simultaneously is presented. The rationale for studying such multiple outcomes is presented in terms of providing a realistic appraisal of the development of chronic diseases from a clinical perspective; i.e. persons with chronic illnesses often have more than one illness at the same time. Social processes related to the development of one joint disease outcome, namely clinically elevated blood pressure and heavy alcohol consumption patterns, are discussed, and emphasis is given to elaborating the role of stress and social support in the etiologic process. Several alternative models are presented to account for the etiology of the joint outcome, and a research agenda is suggested.

Coronary heart disease risk factors in men with light and dark skin in Puerto Rico

The association of skin color with coronary heart disease risk factors was studied in 4,000 urban Puerto Rican men. Skin color on the inner upper arm was classified according to the von Luschan color tiles. Using this grading, men were separated into two groups of light or dark skin color. The dark group had a lower socioeconomic status (SES) based on income, education, and occupation. Dark men had slightly higher mean systolic blood pressures (SBP) and lower mean serum cholesterol levels than the light, but the relative weights and cigarette smoking habits of both groups were similar. After controlling for the differences in SES, skin color showed a small but statistically significant association with SBP. Whether this association with skin color represents genetic or environmental influences on SBP could not be determined from this study.

Apolipoprotein A-I, A-II and C-II in black and white residents of Evans County

Plasma levels of lipids, lipoprotein-cholesterol and three major apolipoproteins (ApoA-I, A-II and C-II) were studied in 318 black and white males and females randomly sampled in Evans County, Georgia. Black-white differences in lipid and lipoprotein-cholesterol concentrations were observed, with low-density fractions higher in whites and high-density fractions higher in blacks. Plasma levels of ApoA-I but not ApoA-II were higher in blacks than in whites and in females than in males. ApoC-II concentrations were lower in black than in white men and women. Black-white differences in atherogenic lipoprotein fractions were statistically explained (in the sense of association, not necessarily of causal process) by the differences in ApoC-II concentrations between the race groups. Black-white differences in anti etherogenic high-density lipoprotein-cholesterol were greater than statistically predicted by differences in ApoA lipoprotein levels. The findings are indicative of black-white differences in lipoprotein composition.

Pathophysiology of hypertension in blacks and whites. A review of the basis of racial blood pressure differences

Differences in blood pressure between blacks and whites in the United States are now well documented. The causes of these differences remain speculative. Genetic factors, personal characteristics, renal physiology, endocrine factors, autonomic nervous system function, cardiac function and various environmental factors are examined in the present review as potential determinants of racial blood pressure differences. Racial differences in renal physiology and environmental influences such as socioeconomic status seem to be likely candidates for important contributions to blood pressure differences. Further research aimed specifically at black-white blood pressure differences is of great importance to a fundamental understanding of the etiology and prevention of essential hypertension.