JOHN HENRY ACTIVE COPING, EDUCATION, AND BLOOD PRESSURE: DISCUSSION
This study examined the John Henryism hypothesis on blood pressure in an urban population of middle-aged black men and women. The population in which James and colleagues first demonstrated the importance of John Henryism on blood pressure was located in the rural south, where it was demonstrated that less educated John Henry active copers had higher blood pressure levels than more educated John Henry active copers. The current study’s findings must be considered in light of the fact that early studies in support of the John Henryism hypothesis were almost exclusively conducted among southern, rural, relatively low SES men. The present study included a middle-aged sample drawn from the urban south Florida area. The present study revealed that high John Henry active coping is related to higher blood pressure levels in women with lower levels of education (consistent with the hypothesis); whereas for men, high John Henry active coping is related to elevated blood pressure levels only among those with higher levels of education (inconsistent with the initial proposed John Henryism hypothesis).
Why the differential effects of John Henryism by gender? It is noteworthy that in the current study, support for the John Henryism hypothesis was found among women for whom an inverse association between blood pressure and education was found, and not among men, for whom an inverse association among blood pressure and education was not found. The John Henryism hypothesis proposes to contribute to the delineation of disparity over and above other established risk factors in the rates of hypertension among blacks compared to whites. It has been well established that there is an inverse association between SES and blood pressure. That is, all other things being equal, those of a lower SES are more likely to have higher blood pressure levels than those of a higher SES. The current findings, in addition to Light et al., where an inverse association between blood pressure and SES was not found and, thus, support for the John Henryism hypothesis was not found, help to establish that John Henry active coping moderates the impact of SES (in this case, education) on blood pressure. canadian pharmacy viagra
Another explanation for the differential findings by gender is that the social realities of discrimination, negative representation in the media, and racism appear to impact black males more than black females and may be significant contributing factors to negative health behaviors and status (i.e., unemployment, stress, adaptation, substance abuse, and violence). Furthermore, it could be suggested that the higher a nonmajority individual’s social status, the more of a threat that individual presents to those within the majority. In addition, the assessment of and the expectations for behavior are rarely the same across gender. For example, a black male coping in an assertive or persistently active manner in a majority-dominated occupational or social setting may appear more threatening than a similarly behaved female counterpart, leading to more external and internal discord. Thus, the higher a black male’s level of education, perhaps the more detrimental the psychological and/or physical health consequences as a result of utilizing an active coping style in response to stressors. What has yet to be clearly delineated is what aspect(s) of active coping is (are) psychologically and/or physically detrimental for the black male with higher socioeconomic resources and in what environments.
Why did the present study’s findings not replicate earlier studies conducted on the John Henryism hypothesis? An explanation for the failure to replicate findings by Dressier and colleagues may be due to the sociocultural context from which the samples were drawn. Dressier and colleagues report that their sample was drawn from Tuscaloosa, AL, which is a typical southern community, whereas, urban south Florida is unique in that it is reflective of a multinational community with sociodemographics that appear to be atypical of many southern states. South Florida is a melting pot of a variety of cultures, including Caribbean, South American, Latin, and European. Furthermore, the community within south Florida appears to be considerably more socioeconomically advantaged and more technologically advanced than typical southern communities. The JHAC12 may tap differently into the coping techniques among urban versus rural blacks. The social, economic, and cultural patterns may be quite diverse between rural and urban black environments, requiring quite different coping patterns. We agree with James and colleagues’ proposition that stressors due to social differences between urban versus rural communities may explain inconsistent findings across regions and assert that the demands between urban and rural communities will always be different, with both communities consistently making relative adjustments as advances come along. Dressier and colleagues point out that cultural expectations dictate social behavior, which, in turn, attributes meaning to behaviors. The stressors and
pressures associated with fast-paced urban environments may cause individuals to tap into coping resources differently than those who live in rural communities. Schell notes that among the socioe-conomically disadvantaged in urban environments culture allocates risks disproportionately to some individuals and groups and in some urban environments culture may be seen as adding stressors to the environment. Williams points out that urbanization is predictive of increases in blood pressure levels, and that stressors are related to the social, political, and economic structures in one’s environment. Pearlin and Schooler state that:
“… social structural conditions not only discriminate in placing more strain on some groups of people than others, but they seem well to cause the very segments of society that are under the greatest strain to have less effective coping repertoires. It is a striking fact that groups most exposed to hardship are also least equipped to cope with it gives some urgency to understanding better the processes by which people are led toward or away from various coping resources and responses” (p. 18).
Limitations and Future Directions
The present study did not control for other known risk factors of hypertension, including alcohol use, physical activity level, family history of hypertension, and smoking status. In addition, a more rigid approach to blood pressure measurement would have contributed to the reliability of the study’s findings (i.e., several blood pressure assessments on separate occasions, control for gender and ethnicity of the assessor, etc.).
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Furthermore, the proxy variable of education as a primary SES indice may be limiting. Social class is not simply education, occupation, or income but incorporates many other social, cultural, and individual characteristics. A summary SES index that incorporates such factors (i.e., job status) may contribute to more consistent findings in the literature.
Another important issue is that of the cultural variation among the population of blacks in south Florida. Unfortunately, similar to other studies examining this construct among blacks in other regions across the United States, the study did not access the cultural diversity of the blacks represented in this community. It is possible that the sample studied included a widely heterogeneous group of not just blacks but was reflective of the population of blacks who reside in Miami-Dade County, FL. This population includes relatively large communities of Caribbean blacks (Jamaicans, Haitians, Bahamians, and other West Indian groups), South American, Latino, and European blacks who may have different cultural assumptions regarding how African Americans cope with stressors in society. Future studies will need to examine whether there is cultural variability in the way that the diverse population of blacks in America utilize coping skills.
Given that the hypothesis proposes that individuals who attempt to cope actively with behavioral stress for prolonged periods of time under circumstances that are especially unfavorable to them, an assessment of the frequency of experiencing unfavorable stressors (i.e., racism) is also needed. Future research in this area might also examine whether different coping strategies are a result of variations in acculturation and assimilation into urban environments and technologically advanced communities. The relationship between blood pressure and John Henryism may be found only in communities with specific hypertension-related risk factors, particular age groups, particular SES and cultural mores, and geographical areas.
Coping cannot be examined without attention given to psychological resources and appraisals, such as internal locus of control, mastery, self-esteem, and other personality states and/or traits. “Instead of seeking universal ways of dealing with stress, they must consider individual differences in personality traits that affect the choice of optimal ways of coping”. It would be enlightening to further examine how other person variables, like trait and state anger, hardiness, anxiety, optimism, and perceived social support, influence John Henry active coping. eriacta
Folkman and colleagues note that it is not reasonable to discuss various forms of coping as adaptive versus nonadaptive without reference to the context in which it is used. The JHAC 12 is a trait-based measure that assesses how individuals generally cope. It may be helpful to develop an ethnoculturally relevant measure that provides the opportunity to assess how people cope in a variety of stressful situations, including racially charged situations. Cooper states that racism structures social and economic relationships. Thus, examining how blacks cope with the experience of racism, discrimination, prejudice, and their combined influence on blood pressure status may help to add insight into the relationship among SES, coping, and blood pressure among blacks.
Given the current study’s limitations, the findings are noteworthy in that it has been commonly accepted that active coping and high SES are independent protective factors against negative health behaviors, status, and outcomes. Included among the study’s strengths are control for risk factor of BMI, inclusion of males and females, determination of the direction and strength of the association between blood pressure and educational level, and examination of the hypothesis among a sample of middle-aged blacks, an appropriately aged population for whom the hypothesis was originally developed. What appears to be clear from the present study is that gender moderates the impact of John Henryism on blood pressure among urban blacks in south Florida. Clearly, research is revealing that an individual’s sociocultural context is important in determining whether a coping style is efficacious.