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blood pressure


Population-based surveys indicate that black adults in the United States experience disproportionately higher rates of hypertension than their white counterparts, with 38.0% of black men compared to 28.9% of white men, and 41.0% of black women compared to 24.7% of white women suffering from hypertension. Consequently, a variety of hypotheses have been proposed to account for this disparity in hypertension prevalence, including biological and genetic factors, which have not consistently provided support for the disparity.

James and colleagues proposed a psychosocial construct, “John Henryism”, to explain the ethnic disparity in hypertension prevalence. These researchers developed the John Henry Scale for Active Coping (JHAC12) to assess an individual’s predisposition to cope actively with psychosocial stressors. The JHAC12 is a 12-item trait-based scale based upon the legend of John Henry that incorporates the following themes: 1) efficacious mental and physical vigor, 2) a strong commitment to hard work, and 3) a single-minded determination to succeed. official canadian pharmacy

John Henryism is an interactive construct which suggests that individuals of low socioeconomic status (SES) who frequently address psychosocial stress by actively coping have sustained high blood pressure levels. This idea is controversial because it opposes extensive literature which suggests that active coping is adaptive and health promoting. However, John Henryism is associated with negative health outcome, because it includes both an individual’s active coping style as well as limited economic resources to control a stressor. Thus, it should be kept in mind that John Henryism involves persistent active striving in the face of socioeconomic hardship or inequity, resulting in adverse health behaviors, status, and/or outcomes.

Early research on the John Henryism hypothesis focused exclusively on rural southern populations and supported a relationship among high JHAC12 scores, low SES (usually operationalized as education), and higher blood pressure levels. More recent studies conducted among urban and/or non-southern populations have been inconsistent. For example, James and colleagues examined a large sample of blacks in eastern North Carolina and did not find significant differences in between low and high SES groups with high JHAC12 scores. Instead, they found that for subjects scoring low on the JHAC12, hypertension prevalence was greatest among those in the high SES category relative to any other JHAC12 score by socioeconomic group. In a study conducted in the Raleigh-Durham-Chapel Hill area of North Carolina researchers found that black and white women who had high John Henry active coping and high-status jobs exhibited higher on-the-job and laboratory blood pressure than other women. They also observed that the majority of high-SES women exhibited the trait of John Henry active coping. The researchers, however, did not observe an inverse relationship between SES and blood pressure. The lack of an inverse relationship between SES and blood pressure may have contributed to their inability to replicate findings of other studies conducted among samples from a similar geographical area.

Reasons why other studies have failed to support the John Henryism may be due to a variety of factors, such as failure to include a socioeconomic indicator, failure to control for risk factors of hypertension, and inappropriate samples (i.e., subjects within an inappropriate age range). In the most recently published study on John Henryism and blood pressure among an urban sample of southern blacks, researchers did not find support for an association between the interaction of SES (utilizing education as a proxy for SES) and John Henry active coping on blood pressure (controlling for age and body mass index). However, they did find support for an interaction between gender and John Henry active coping on blood pressure, such that there was a positive correlation between John Henry active coping and blood pressure in men; whereas increases in John Henry active coping were associated with decreases in blood pressure in women. A reason for the failure of Dressier and colleagues to establish a relationship between John Henry active coping and education on blood pressure may have been their inclusion of subjects diagnosed with hypertension who were on hypertensive medication (mean systolic blood pressure of 134.5 mmHg and mean diastolic blood pressure of 87.7 mmHg). Including subjects whose blood pressure was controlled by antihypertensive medications may have restricted the range of blood pressure values examined—thus limiting their ability to find differences between groups.

This study sought to address whether healthy subjects with low levels of education and high JHAC12 scores would exhibit higher blood pressure levels than other JHAC12 scores by education groups in an urban sample of middle-aged black men and women from the urban area of south Florida. Focusing on an urban sample of middle-aged adults is most relevant to the John Henryism hypothesis, because it is often within the urban arena and during mid-life where one’s struggle to succeed within a social environment on a micro- as well as macro level is most felt and the opportunities and resources to succeed are most available. Thus, examining the John Henryism hypothesis within this population should provide a better understanding of the contextual framework under which John Henryism operates.

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