Systemic racism and its uniquely

stressful impact on the health of Black

Americans: Where to next?

• Major goals / Agenda

• Historical aspects of racism for Black Americans?

o Key definitions

❖ Historical trauma

❖ Racism

• What is stress?

• How does racism stress impact Black Americans?

• How does (COVID-19) stress impact Black Americans?

• Open discussion forum: What do you think works to reduce or avoid the stress of systemic racism? In the outbreak?

• Recap session: Putting it all together

Marcellus M. Merritt, Ph.D.

Associate Professor of Psychology

University of Wisconsin Milwaukee

Garland Hall 216, P.O. Box 413

Milwaukee, WI 53201

(414) 229-6145 office

merrittm@uwm.edu

MAJOR GOALS OF WORKSHOP

❑ (Better) recognize the historical aspects

of systemic racism for Black Americans.

❑ Get a general idea of what stress is.

❑ Recognize how systemic racism is

affecting the health of Black Americans

by way of added stress.

❑ Appreciate how the COVID-19 outbreak

adds more stress for Black Americans.

❑ Discuss ways to cope with racism stress.

SYSTEMIC RACISM AND ITS UNIQUELY

STRESSFUL IMPACT ON THE HEALTH

OF BLACK AMERICANS:

WHERE TO NEXT?

How systemic racism may affect health

disparities for Black Americans

SYSTEMIC

RACISM

(‘usual’)

STRESS

BLACK

AMERICAN

HEALTH

COPING

RESOURCES

-

-

-

-

-

-

HISTORICAL ASPECTS OF RACISM

FOR BLACK AMERICANS?

HISTORICAL TRAUMA

• The Meriam Report is a guide to the “historically traumatic events” that have influenced the health of Native Americans

• As said by Evans-Campbell (2008), historical trauma is defined as “a collective complex trauma inflicted on a group of people, who share a specific group identity or affiliation-ethnicity, nationality, and religious”…

(Evans-Campbell, 2008)

MAJOR STAGES OF BLACK

AMERICAN HISTORICAL

DEVELOPMENT

• The changing status of “Blacks” in

U. S. history

o There were three primary eras:

– Chattel slavery (1640 – 1863)

– Reconstruction and Jim Crow

(1863 – 1965)

– Post-Civil Rights (1965 to present)

– Post “Obama” / “George Floyd”

Black Lives Matter (2016 - ??)

SYSTEMIC

RACISM

AMERICAN SLAVE LIFE: TALK ABOUT

STRESS! (SEMMES; PPS. 176-77)

• Europeans introduced contagious diseases, alcohol, tobacco, sugar, firearms and other risk factors for disease into the slave trade. (p. 175)

• These items were used to pacify slaves & sustain American slavery

• Tragically, African slaves’ use of these substances promoted their premature risk for disease and death…and have symbolized key barriers to the health of African-Americans to this very day

• “In short, the disruption of African culture to serve the economic needs of Europeans caused profound and negative changes in the health of Africans in Africa and in the New World.” (p. 176)

• The list of health risks for slaves is a long painful one; for instance:

– Infectious and parasitic diseases linked with inadequate housing accommodations and inadequate clothing (e g., no shoes provided)

– Nutritional deficiencies resulting from contaminated water and poorly prepared and limited food options (e g., scraps of fat pork and corn meal)

– Respiratory and digestive ailments linked with excess exposure to extreme weather conditions

RECONSTRUCTION AND JIM

CROW (1863 – 1965)

• Reconstruction and Jim Crow (1863-1965) represent the periods where Blacks were considered “free” but not full American citizens (e g., not able to vote or attend highly privileged and predominately White schools/colleges).

• Segregation (separate but unequal) was legally enforced in most public places

• Blacks were excluded from access to mainstream medical settings and had to go to segregated hospitals which were usually poor economically and limited in resources

• When Blacks did interact with the White medical system, they found overt and disrespectful treatment that further limited their access to treatment

POST-CIVIL RIGHTS

(1965 TO PRESENT)

• The post-Civil Rights era (1965 to present) has seen remedies to these inequalities (legally and socially)

• Racially segregated hospitals are a thing of the past, at least legally

• Along with this trend, has been some improvements in various health indicators for racial/ethnic minorities, although many of the disparities in health remain

• However, racial/ethnic minorities are stilldiscriminated against in terms of access or referrals for state-of-the-art treatments (e g., new drugs, surgical procedures) and some worsening disparities are a product of larger societal trends (e g., diabetes and obesity among Black and Native American children)

• These dynamics among other events (e.g., outing of the Tuskegee Syphilis Study) fueled mistrust of the medical care system and created wider disparities in access to and use of health care services among members of racial/ethnic minority groups.

POST “OBAMA” /“GEORGE FLOYD”

AND BLACK LIVES MATTER (2016 -?)

Age of persisting discrimination in

an apparently “post-racial” world,

albeit subtle in most cases.

Violations seen as irrelevant

departures from a new norm.

INTRO TO RACISM: GENERAL POINTS AND

ARGUMENTS

Jane Elliot in her “brown eye/blue eye” study argued that humans experience negative social outcomes because of the larger social worth of superficial features. However, for members of racial and ethnic minority groups these arbitrary factors have permanence and strong psychological meaning

◦ (e.g., “Living while Black” - based on accumulated personal experiences and socialization http://www.npr.org/templates/story/story.php?storyId=111388878

◦ http://www.guardian.co.uk/world/2006/nov/27/usa.julianborger)

*As with the term “race”, the definition of “racism” is varied, contradictory, and slippery

◦ Racism (as defined by Clark p. 150): “beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation.”

◦ It usually includes facets of unequal power, oppression, or dominant vs. deprived group status

THURSDAY APRIL 26, 2007 LECTURE

OUTLINE Comments –1) Graded In class EXAM #2 returned on Tuesday/ Take Home Exam #2 due Tuesday May 1.2) The corrected and updated class and reading schedule (see handout).3) Research papers were due by 11:59pm on Tuesday by hard copy or by submission to D2L - late papers will be penalized five points per day

Recap Lecture on Introduction to concept of racism and link to health (5)◦ Determinants of health model (Ch. 7) as a framework◦ Definition and “logic” (plus key terms)◦ Videos: “Imus issue”, Doll studies, “The Calgary experience”

Discussion groups- discuss meaning of racism and stereotypes in terms of Imus comments and Calgary video (Is this racism? How would you respond to it?) (8)

Continue with coverage of different aspects of racism (42)◦ Psychological (cognitive, emotional, racial identity) (15)◦ Behavioral (example of experience with housing discrimination; “Kill Bill!”) (20)◦ Social (5)

Impact of modern racism – the invisibility syndrome (from Franklin, 2001) (5)

Preview Tuesday 5/1 lecture (Cover racism and health)◦ Homework for Tuesday: Read Blascovich, 2001 & Merritt, 2006 papers. Submit five DQ’s for each reading by Tuesday 5/1.

AUTOMATIC NATURE OF

STEREOTYPES

Racial prejudice and stereotypes can be:

◦ Automatic

more unconscious, emotional and reflexive

e.g., as indexed by the Implicit Association Test (see next slide) and measures of brain wave activity

usually occurs when person is provoked emotionally and situation appears non-threatening

◦ Controlled (more implicit or subtle)

more conscious and guarded

tempered by the social context that person is in (i.e., social desirability)

usually occurs in more ambiguoussituations where “proper” response is unclear or “improper” responses may not be approved

Both types of responses have been linked with behavioral and physiological reactivity (see caption)

IMPLICIT ASSOCIATION TEST (IAT; GREENWALD, ET AL., 2003)

The Implicit Association Test is a flexible online task

designed to measure automatic associations between

concepts (e.g., math and arts) and attributes (e.g., good or

bad, male or female, self or other).

https://implicit.harvard.edu/implicit/ https://www.youtube.com/watch?v=n5Q5FQfXZag&t=91s

Methods

◦ Take Demo test –

◦ Select a test (e.g., Race IAT) –

◦ You will complete three tasks: two brief questionnaires and an

IAT in which you will sort words and pictures into categories as

quickly as possible. You should be able to complete the tasks in

less than 10 minutes total. When you finish, you will receive

your results as well as more information about the test and the

performance of others.

General findings –

◦ our unconscious associations of negative traits with specific

groups may or may not match our “conscious” reported

attitudes about those groups (those who do not match tend to

be more reactive; e.g., a high race stereotyper who reports

being non-prejudiced but responds negatively to a Hispanic

interviewee) (see caption)

GREEN AR, CARNEY DR, …, RAYMOND KL, IEZZONI LI, & BANAJI MR.

(2007). IMPLICIT BIAS AMONG PHYSICIANS AND ITS PREDICTION OF

THROMBOLYSIS DECISIONS FOR BLACK AND WHITE PATIENTS. JOURNAL OF GENERAL INTERNAL MEDICINE. VOLUME 22(9):1231-8.

Doctors with stronger anti-Black attitudes and stereotypes

(as assessed by the IAT) were less likely to prescribe

thrombolysis for myocardial infarction to black American

patients diagnosed with the same condition as equivalent

white Americans.

As unaware physicians’ bias on

the composite IAT variable

increased, their likelihood of

recommending thrombolysis

to black patients decreased,

as described above. In contrast,

increase in bias among aware

physicians was associated with

more thrombolysis for

black patients.

SOCIAL CONTEXTS FOR RACISM

The various social situations, settings, institutions where

racism can be manifested

◦ Micro-level (Individual or personally mediated, microaggressions)

one-to-one interpersonal interactions or small group

encounters (What did you call me?!?)

◦ Macro-level

larger and more formal social interactions such as

organizational meetings, conferences, religious events,

large classes; somewhere between interpersonal and

institutional (“aura in a room”)

◦ Institutional (Systemic)

even larger social structures or arrangements such as

housing segregation, biased educational policies, unfair

employment hiring and advancement practices, partial

banking/lending practices, etc.) Key & Peele: East/West College Bowl http://www.youtube.com/watch?v=gODZzSOelss

◦ People with “black-sounding“ names get less callbacks

for jobs (Levitt and Dubner, 2006; see next slide).

Internalized (racism)

Accepting or denying the reality of racially based

microaggressions and institutional disparities

(“Those people of color who don’t make it are just lazy

and unprepared…and need to pull themselves up by

their own bootstraps.”)

Other examples of social contexts are work settings,

public settings such as banks, train stations, or retail

establishments, educational settings, or media images

20 "Whitest" Boy NamesJakeConnor Tanner

20 "Blackest" Boy NamesDeShawn DeAndre Marquis

ABC News - Sept. 21, 2006 — Studies of resumes have found that

people with black-sounding names are less likely to get callbacks.

"20/20" put 22 pairs of names to the test, posting identical

resumes except for the names at the top.

The resumes with the white-sounding names were actually

downloaded 17 percent more often by job recruiters than the

resumes with black-sounding names.

What are some of those names? Here's a list from the book

"Freakonomics," by Steven D. Levitt and Stephen J. Dubner,

showing the top 20 whitest- and blackest-sounding girl and boy

names.

20 "Whitest" Girl

Names

Molly

Amy

Claire

Emily

Katie

Madeline

Katelyn

Emma

Abigail

Carly

Jenna

Heather

Katherine

Caitlin

Kaitlin

Holly

Allison

Kaitlyn

Hannah

Kathryn

20 "Blackest"

Girl Names

Imani

Ebony

Shanice

Aaliyah

Precious

Nia

Deja

Diamond

Asia

Aliyah

Jada

Tierra

Tiara

Kiara

Jazmine

Jasmin

Jazmin

Jasmine

Alexus

Raven

20 "Whitest" Boy

Names

Jake

Connor

Tanner

Wyatt

Cody

Dustin

Luke

Jack

Scott

Logan

Cole

Lucas

Bradley

Jacob

Garrett

Dylan

Maxwell

Hunter

Brett

Colin

20 "Blackest"

Boy Names

DeShawn

DeAndre

Marquis

Darnell

Terrell

Malik

Trevon

Tyrone

Willie

Dominique

Demetrius

Reginald

Jamal

Maurice

Jalen

Darius

Xavier

Terrance

Andre

Darryl

HAVE YOU EXPERIENCED ANYTHING

SIMILAR TO THIS (THAT YOU CAN

DIVULGE)?

3 TYPES OF MICROAGGRESSIONS

Microassaults: Conscious and intentional

actions or slurs.

Like using racial epithets, or purposely serving a

white person before a person of color in a bank.

Microinsults: Verbal and nonverbal messages

that subtly convey rudeness and insensitivity

and demean a person's racial identity.

Like a professor who asks a student of color how

she got into college, implying she may have gotten

in by way of affirmative action or quota system.

Microinvalidations: Messages that subtly

exclude or negate or the thoughts, feelings or

experiential reality of a person of color.

For instance, non-Asians often ask Asian-Americans

where they were born, sending the message that

they are perpetual foreigners in their own land.

Why can microaggressions be distressing for

the targets?

APPLICATION: WHAT IS STRESS?

In your chat box, type in 2-3 relevant events or things

that you find stressful in your daily life (e.g., paying

bills or work conflicts).

Then, go back and rank order those events or things

in terms of their perceived psychological and

physical health impacts.

WHAT IS STRESS(OR)?

Def. The psychological, behavioral,

and physiological aspects of being

in a situation that is perceived as

harmful to one’s well-being or ideal

comfort level (quoting the great

philosopher Marcellus M. Merritt, circa 2007)

Psychological (includes social)

◦ Thinking about an impending speech

(e g., feelings of anxiety)

Behavioral

◦ Giving a speech before an auditorium

full of people (e g., stammering)

Physiological (biological)

◦ Elevated physiological response during

the speech (e.g., increased blood

pressure and racing heart)

Stimulus = Stressor ResponseTraumatic event, Life event, Daily hassle Person factors

THINGS THAT MAKE STRESS HARD

TO STUDY / UNDERSTAND

complex

multidimensional

pervasive

frequent

unpredictable

intense

undesirable

uncontrollable

ambiguous

unconscious

“healthy”

treatable

SYSTEMIC RACISM AND ITS UNIQUELY

STRESSFUL IMPACT ON THE HEALTH

OF BLACK AMERICANS:

WHERE TO NEXT?

How systemic racism may affect health

disparities for Black Americans

SYSTEMIC

RACISM

(“usual”)

STRESS

BLACK

AMERICAN

HEALTH

COPING

RESOURCES

-

-

-

-

-

-

HOW DOES RACISM STRESS IMPACT

THE HEALTH OF BLACK

AMERICANS?

AFRICAN AMERICAN STRESS

EXPERIENCE?

First, what do we know about how

African Americans experience

stress?

Williams’ (2018) national survey of

racial disparities in stress

experience (Black vs. White)

More stressors

Stressors are seen as more intense

and prolonged

Thus, higher stress is more likely to

predict premature illness and death

So, race is a go-between for the

link between stress and disease

THE WEATHERING HYPOTHESIS

AND PREGNANCY OUTCOMES

• Recent studies show that as African American women age they are more likely to have low birth weight infants than White women of similar ages.

• The weathering hypothesis (Geronimus, 1992) in this context argues that the health status of African American women starts to prematurely decline in young adulthood.

– elevated blood pressure, early signs of vascular disease (e.g., stroke), depressive symptomology, impaired hormonal response, less exercise

• The key mechanisms for this weathering are chronic exposure to psychosocial and economic stress and sustained active coping with demanding stressors.

– family conflicts or responsibilities, limited socioeconomic opportunities, harassment or discrimination at work (Dominguez, et al., 2008), dating conflicts, academic stress, inadequate social support mechanisms, neighborhood stress (“role overload”).

• Premature aging and related health risks can have adverse effects on pregnancy outcomes (e.g., low birth weight).

CAN ANYONE THINK HOW

WEATHERING HAS UNDULY

AFFECTED YOUR AGING PROCESS?

HEALTH (PHYSIOLOGICAL)

EFFECTS OF RACISM

• Recent studies show that discrimination works like

other mental stressors (Dion et al., 1992; Krieger & Sidney

1996; Thompson, 1991; Williams et al., 2000) and is a major

contributor to mental distress for people of color.

– Indeed, one study of minority group members by Kessler et al. (1999)

ranks it with major negative life events such as the death of a loved

one, divorce and job loss.

• As shown in Clark (2002, see the next slide), exposure

to and perceptions of racism can lead to objective

health risks.

CLARK MODEL: RACISM TO HEALTH

Summary: It is NOT SIMPLY exposure

but also how one appraises and copes

with stressors (and the moderating

role of related biological, social and

behavioral factors) that molds health.

"Race has always been my biggest burden. Having to live as minority in America. Even now it continues to feel like an extra weight tied around me" (Ashe & Rampersad, 1995, p. 306).

LaVeist, TA (2006). Minority Populations

and Health: An introduction to health

disparities in the United States.

HEALTH EFFECTS OF RACISM

• Recent studies show that discrimination works like

other mental stressors (Dion et al., 1992; Krieger & Sidney

1996; Thompson, 1991; Williams et al., 2000) and is a major

contributor to mental distress for people of color.

– Indeed, one study of minority group members by Kessler et al. (1999)

ranks it with major negative life events such as the death of a loved

one, divorce and job loss.

• As shown in Clark (2002, see the next slide), exposure

to and perceptions of racism can lead to the following

objective health risks:

– Physiological reactivity (e.g., blood pressure reactivity to racist

statements and less nighttime BP dipping, Tomfohr et al, 2010)

– Health behaviors (e.g., For African American and Black Caribbean

respondents in the National Survey of American Life Study (NSAL),

every 1 unit rise in everyday discrimination positively predicted (DSM-

IV) alcohol and drug use disorders (Hunte & Barry, 2012)

– Mental health (e.g., African American and Black Caribbean

respondents in the NSALwho were high on “Chronic Discrimination”

(vs. those who were high on Low Discrimination, Disrespect and

Condescension, or General Discrimination) were much more likely to

meet DSM-IV criteria for generalized anxiety disorder and major

depressive disorder, Clark et al., 2015)

– Biomedical health status (e.g., higher mortality rates in segregated

areas and census tracts where there are higher mean scores on

disrespect of African Americans; Kennedy, 1997) (See next slide)

Hypotheses (originally linear in nature)

• The specific aims were to determine if:

(1) exposure to an overtly racist (vs. “non-racist”) stressor is

linked with increased blood pressure (BP) reactivity to active

speech, anger recall and ensuing rest periods and

(2) if perceived racism (PR) is linked to BP reactivity to racist

stressors

Sample

▪ 58 Black healthy and employed men (aged 23-47)

Procedure

▪ Collect blood pressure (BP) and heart rate (HR) during:

➢ a one-minute neutral reading task

➢ a ten-minute active speech task with racist or “non-racist” content in an audiotaped shopping scenario (five-minute speech preparation and five-minute presentation)

➢ a five-minute anger recall task

How subtle racism can increase riskMerritt, M. M., Bennett, G. G., Williams, R. B., Edwards, C. L., & Sollers, J. J. (2006).

Perceived racism and cardiovascular reactivity and recovery to personally-relevant

stress. Health Psychology, 25(3), 364-369.

82

84

86

88

90

92

94

96

98

100

102

Rest Speech Prep Present Recovery Anger Recall Rest

Period x Stressor effects on diastolic BP responses

Non-racist RacistF(7, 476) = 2.21; p < .07

Play Audio Racism Question

Dia

stoli

c B

loo

d P

ress

ure

(m

mH

g)

How much racism did you see in the shopping scenario?

0 = None 1 = A little bit

2 = A moderate amount 3 = A great deal

4 = An extreme amount

0

5

10

15

20

25

0* 1 2 3 4

Freq

uency

*Levels: 0= none; 1= a little bit; 2= a moderate amount;

3= a great deal; 4= an extreme amount

Frequency of perceived racism (PR) in shopping scenario

by stressor condition Racist Non-racist

• NRC- no PR (n= 15)

• NRC- hi PR (n= 8) – “a great

deal” or more

• Blatantly Racist Condition only

(BRC, n=36)

Period by Stressor by Perceived Racism

effects on diastolic BP levelsNRC-no PRF(7, 47) = 2.08; p < .05

Play Audio Racism Question

NRC-hi PR

BRC

Base Read Rest1 Prep Present Rest2 Anger RecallRest3

74

78

82

86

90

94

98

102

106

110

Dia

sto

lic

BP

mea

n l

evel

(m

mH

g)

* *

Summary & Conclusions

◼ Contrary to prediction, we found that the “non-racist” (NRC; compared to racist) stressor was linked with larger increases in diastolic BP during anger recall

◼ However, when we examined perceived racism (PR) scores, those in the NRC group who reported more PR showed notably larger BP responses after the presentation and anger recall tasks

◼ That the increased BP was only seen after the presentation suggests a rumination effect of the “non-racist” condition here (e.g., stereotype threat or attributional ambiguity; Blascovich et al., 2001) – subjects were trying fill in the attributional blanks

◼ The residual arousal for delayed recovery is usually not good for responses to later stressors

◼ MECHANISMS??? (anger coping, past exposure)

MUJAHID (2010). NEIGHBORHOOD STRESSORS AND

RACE/ETHNIC DIFFERENCES IN HYPERTENSION

PREVALENCE (THE MULTI-ETHNIC STUDY OF

ATHEROSCLEROSIS). IN AMERICAN JOURNAL OF HYPERTENSION.

Studied whether individual-

and neighborhood-level

chronic stressors add to

hypertension (HTN)

disparities.

Participants (45-84 years)

living in Baltimore, New York,

and North Carolina.

HTN assessed as systolic or

diastolic blood pressure

≥140 or 90 mm Hg, or taking

antihypertensive

medications.

Individual-level chronic stress

assessed by self-reported

chronic burden and

perceived major and

everyday discrimination.

An index of neighborhood

(census tract) chronic

stressors (i.e., physical

disorder, violence) created

using results from a

telephone survey.

The prevalence of HTN was

59.5% in African Americans

(AAs), 43.9% in Hispanics,

and 42.0% in whites.

TAKE HOME: Neighborhood

chronic stressors may add to

race/ethnic disparities in

HTN prevalence in the U. S.

IS PERCEIVED RACISM

IN THE GENES? [GREGOSKI,

ET AL. 2013]

Everyday discrimination scores are

linked with higher ambulatory blood

pressure (BP) and reduced nighttime

dipping, and the endothelin-1 (ET-

1)/Lys198Asn polymorphism is linked

with higher resting BP and elevated

BP reactivity for African Americans

versus White Americans.

However, the joint effects of these

factors on BP control are unknown.

The everyday discrimination scale

done by 352 (175 African American)

young adult normotensives, after that

24-hour ambulatory BP monitoring.

Among African American ET-1 T-allele

carriers, increases in everyday

discrimination predicted lesser

nighttime dipping.

Fig. 2 a, b Nightly dipping based on

ethnicity, Lys198Asn T-allele carrier

status by everyday discrimination. EA

White Americans, AA African Americans,

LowEDS (a left) everyday discrimination

below median, HighEDS (b right)

everyday discrimination on/above

median. Lower scores indicate

less dipping.

HOW DOES STRESS OF COVID-19

IMPACT AFRICAN AMERICANS?

In recent months, strong evidence has

arisen that COVID-19 is deadlier for

people who are:

elderly

those with chronic health ailments

those whose living or working situations

make social distancing tougher

These issues mean that the disease

has chiefly hurt many minority (non-

White) communities badly, in large part

by interrupting long-standing traditions.

Of note is the unique stress linked with

the pandemic for African Americans.

UNIQUE STRESS OF COVID-19 FOR

AFRICAN AMERICANS

Disparities in preexisting medical

conditions exacerbate health

effects of COVID-19 diagnosis

Lack of access to quality health

care and health information leads

to inadequate prevention efforts

Poor living conditions (e.g., over-

crowding or structural deficits)

means more exposure

Low job status and lack of work-at-

home resources means higher

exposure in public or work settings

SYSTEMIC RACISM AND ITS UNIQUELY

STRESSFUL IMPACT ON THE HEALTH

OF BLACK AMERICANS:

WHERE TO NEXT?

How high-effort coping with daily stress

affects health disparities for Black

Americans

SYSTEMIC

RACISM

(‘usual’)

STRESS

BLACK

AMERICAN

HEALTH

COPING

RESOURCES

-John Henryism

active coping?

-

-

-

-

PERCEIVED LACK OF CONTROL MAY

IMPACT THE RACISM AND STRESS

LINK FOR BLACK AMERICANS

❑ Black Americans work hard to provide for themselves,

their families, live in harmony with their own beliefs and

social expectations and expect fair treatment, support,

and gratitude in return for this hard work.

❑ This effort at controlling one's milieu by way of hard

work and behaving in step with society's expectations has

been termed as "John Henryism“ (James, 1984).

❑ John Henryism is formally defined as the value of hard

work and determination in the face of extreme and great

odds (e.g., racial exclusion; James et al., 1983).

❑ Facing many instances of racism can create a feeling of

not being valued or being viewed as a person of little or

no worth for both Black men and women.

❑ This sense of invisibility can promote feelings and

beliefs, as Black Americans, that we cannot control

whether our talents, abilities, character, and right to

safety are acknowledged by others in society.

HEALTH DISPARITIES:

JOHN HENRYISM?

The origin of health disparities is likely an interaction of social, psychological, and biological factors

The historical struggles of newly freed African Americans to realize the American Dream and the vast institutional racism and social barriers against successful outcomes

Some followed a coping style akin to the Protestant work ethic to deal with these barriers (“self-reliance”)

The legend of John Henry typifies this orientation among some African Americans

Ballad of John Henry's Hammer http://www.youtube.com/watch?v=xxReOxRwS-g

Coosa Tunnel, Columbus &

Western Railroad - 15 miles

east of Birmingham, Alabama

(Stovall & Havens, 1895)

JOHN HENRYISM

(JAMES, 1983)

▪ “metaphor of John Henry’s struggle to beat

the machine (and his eventual death) was

adapted into a psychological theory…”

▪ Definition: “the individual's self-perception

that he can meet the demands of his

environment through hard work and

determination”

▪ John Henryism Active Coping Scale

➢Persevering engagement with hard work

➢A focused resolve to achieve one’s goals

➢Exceptional mental and physical energy

▪ What is John Henryism associated with?

➢Healthy behaviors

➢High religiosity and life satisfaction

➢Decision latitude at work

➢Genetic factors?? (Whitfield, et al., 2006)

JHAC-12

The questions below concern how you see yourself, today, as a person living and doing things in

the real world. Read each question carefully and then write the number of the response which best

describes how you feel on the line next to the question. Each person is different, so there are not

“Right” or “Wrong” answers. We would simply like an honest appraisal of how you generally see

yourself.

FOR EACH OF THE FOLLOWING STATEMENTS, PLEASE SELECT ONE OF THESE

RESPONSES:

Completely True = 1 Somewhat False = 4

Somewhat True = 2 Completely False = 5

Don’t Know = 3

1. I’ve always felt that I could make of my life pretty much what I

wanted to make of it.

2. Once I make up my mind to do something, I stay with it until the

job is completely done.

3. I like doing things that other people thought could not be done.

4. When things don’t go the way I want them to, that just makes me

work even harder.

5. Sometimes I feel if anything is going to be done right, I have to do

it myself.

6. It’s not always easy, but I manage to find a way to do the things I

really need to get done.

7. Very seldom have I been disappointed by the results of my hard

work.

8. I feel that I am the kind of individual who stands up for what he

believes in, regardless of the consequences.

9. In the past, even when things got really tough, I never lost sight of

my goals.

10. It’s important for me to be able to do things the way I want to do

them rather than the way other people want me to do them.

11. I don’t let my personal feelings get in the way of doing a job.

12. Hard work has really helped me to get ahead in life.

THE JOHN HENRYISM ACTIVE

COPING HYPOTHESIS

Coping

Resources

Coping

StyleHealth

Outcome

More + (high effort) predicts Better

Less + (high effort) predicts Worse

What we know:

Overall logic – Sustained high-effort coping given low

odds for success leads to elevated and sustained

levels of sympathetic activity that over time produces

structural alterations in the physiology.

o “broken spirit…broken flexibility”

WHAT ARE COPING

RESOURCES?

“Big Three” socioeconomic status (SES)

◦ education, income, job status

Wealth

assets, inheritance

Support mechanisms

◦ church networks

◦ career networks, job security

◦ Extended family system

Neighborhood / social capital

◦ (lack of) socioecologic stress

◦ access to health-promoting institutions

◦ (lack of) financial demands

◦ respite or breaks from caregiving duties

Positive psychological status (“stress busters”)

◦ e.g., optimism, forgiveness, self-efficacy, grit

• Healthy distractions / behaviors (“doing you”)

• music listening, relaxation, exercise/fitness regime

Coping resources have a large and inverse link

with future chronic disease (Williams, 2002)

OUR RECENT RESEARCH ON THE

JHAC HYPOTHESIS

10

15

20

25

30

Tra

it -

An

ger

co

ntr

ol

sco

re

Lo JHAC Hi JHAC

Low Education

Lo JHAC Hi JHAC

High Education

Mean scores for trait-anger control by

JHAC and education subgroup - Could poor

emotion regulation be a precursor of the JHAC

hypothesis?

*

+

SO THEN, WHAT ABOUT ALTERED

HORMONAL REGULATION AS A

CONDUIT FOR THE JHAC

HYPOTHESIS?

JHAC by Job Demands (JD) on Cortisol Awakening Response

1.5

2

2.5

3

3.5

4

4.5

5

5.5

AM 30M

Period

Cort

isol (n

mol /

L)

Low JH Low JD

Low JH Hi JD

Hi JH Low JD

Hi JH Hi JD

…among Whites

1

1.5

2

2.5

3

AM 30M

Period

Cortis

ol (nm

ol / L)

Low JH Low JD

Low JH Hi JD

Hi JH Low JD

Hi JH Hi JD

…among Blacks

Bennett, G. G*., Merritt, M. M., Sollers, J .J. III, Edwards, C. L., Whitfield, K.

E., et al.. (2004). Stress, coping, and health outcomes among African-

Americans: A review of the John Henryism hypothesis. Psychology and

Health, 19(3), 369-383.

MERRITT, M. M., MCCALLUM, T. J., & FRITSCH, T. (2011). HOW

MUCH STRIVING IS TOO MUCH? JOHN HENRYISM ACTIVE COPING

PREDICTS WORSE DAILY CORTISOL RESPONSES FOR AFRICAN

AMERICAN BUT NOT WHITE FEMALE DEMENTIA FAMILY

CAREGIVERS. AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY,

19(5), 451-460.

Data were obtained through in-home

interviews. Caregiver participants:

completed the JHAC-12 Scale, Activities of

Daily Living (ADL) scale and Revised

Memory and Behavior Problem checklist

(RMBPC)

collected five saliva samples daily (at

awakening, 9am, 12pm, 5pm, and 9pm)

for two successive days.

The interviewer arranged to come back

in 3 to 7 days for the saliva samples.

Salivary cortisol samples were tested in

a GCRC wet lab by immunoassay

employing microtiter plates.

JHAC by recipient

Activities of Daily Living

(ADL) effects on daily

cortisol slope for Black

caregivers. Note.

Higher scores on the

ADL show that the care

recipient has less

ability to complete

basic tasks of daily

functioning alone.

JHAC by recipient

Revised Memory and

Behavior Problems

Checklist (RMBPC)

effects on daily cortisol

slope for Black

caregivers. Note.

Higher scores on the

RMBPC show that the

care recipient has had

many problems related

to memory, depression,

and agitation over the

past week that have

bothered the caregiver.

Sojourner

syndrome?

SUMMARY: OUR NEW FRONTIERS

FOR JOHN HENRYISM RESEARCH?

More religious coping predicts more blood

pressure (BP) recovery to anger recall stress

for high JHAC and low educated Black men

(Ayazi et al., 2018; see the next slide).

Self-selected leisure activities (SSLAs) as

coping resources for high effort copers!?

More reported positive mental state, distraction,

and less focus on negative life events when doing

SSLA is linked with better reported sleep quality

and lesser depressive symptoms among high (BUT

NOT LOW) JHAC young adults.

Higher JHAC scores are associated with more

nighttime BP dipping among young adults who do a

more difficult SSLA on the evening of a sleep study.

Less BP recovery if ruminate (vs. distract)

after anger recall for high JHAC and low SES

young adults

For high-JHAC young women who are depressed, higher

father’s education predicts better estimated fitness

levels. Yet, higher father’s education predicts worse

fitness for non-depressed low-JHAC women (Merritt &

Dillon, 2012).

Speech Prep Present Rest Anger Recall Final Rest-10

-5

0

5

10

15

20

25

30

Dia

stol

ic B

lood

Pre

ssur

e ch

ange

sco

re (

mm

Hg)

Low JHAC High JHAC

Speech Prep Present Rest Anger Recall Final Rest-10

-5

0

5

10

15

20

25

30

Dia

stolic

Blo

od P

ress

ure

change s

core

(m

mH

g)

Low JHAC High JHAC

AT LOW PRAYER

AT HIGH PRAYER

Ayazi, M., Johnson, K., Merritt, M. M., Edwards, C. L., Koenig, H. G.,

Bennett, G. G., et al. (2018). Religiosity, education, John Henryism active

coping, and cardiovascular responses to anger recall for African American

men. Journal of Black Psychology, 44, 295-321. doi: 10.1177/0095798418765859

WHAT ARE SOME USEFUL WAYS

FOR AFRICAN AMERICANS TO

MANAGE RACISM STRESS?

WHAT ARE SOME USEFUL WAYS

FOR AFRICAN AMERICANS TO

MANAGE RACISM STRESS?

Slides #61–70 offer some proven

ways of (racism) stress coping

Valued-Living – be true to yourself!

Attending to our emotions – self-

awareness is vital

Self-Compassion – forgiveness is a

must in a race-based reality

THANK YOU !

Any questions?

WHAT ARE USEFUL WAYS FOR

AFRICAN AMERICANS TO MANAGE

RACISM STRESS?

Routine coping strategies

Problem focused coping (PFC) –

deal with issue more directly

Emotion focused coping (EFC) –

if you cannot resolve issue directly,

then these are short term solutions

Dysfunctional coping (DFC ) – avoid

these tactics as they are barriers to

resolving the problem

Calming coping strategies

New more patient-centered tactics

Usual psychological interventions

PROBLEM FOCUSED COPING

Defin. deal with stress more

directly to resolve conflict

Example (family caregiver strain)

tangible social support seeking like

hiring a nurse to care once weekly

attend church with care recipient

read holy book with care recipient

sing hymns with care recipient

Use time-management strategies

when you feel overwhelmed with

care recipient

Use conflict-resolution strategies like

assertiveness training to mitigate the

stress in relationship

EMOTION FOCUSED COPING

Defin. if you cannot resolve issue

directly, then try short term

solutions

Example (family caregiver strain)

belonging social support seeking like

joining a caregiver support group

Reframe the situation

Retain a sense of humor and develop

optimism about it

Pray for support and forgiveness

Journal about your emotions

Cry about it

Take a nap when you get a break

Music listening

CALMING COPING STRATEGIES

Defin. It’s beneficial to calm your

bodily processes so you reverse

your stress response.

When your stress response is

activated, you process information

inefficiently and you can feel

physically and emotionally drained.

If this state is extended, it can

accelerate to chronic stress.

Hence, usual or alternative stress

reduction methods may be handy.

MINDFULNESS

MEDITATION

The practice bringing one's attention to the

internal and external experiences occurring in

the present moment

Key steps

1. Close your eyes and try to relax just as if you were at home. Set

aside all thoughts of the past and the future and stay in the

present.

2. Become aware of your own breathing, focusing on the feeling

of air moving in and out of the body as one breathes. Feel your

belly rise and fall, the air enter your nostrils and leave your

mouth. Pay attention to the way each breath changes and is

different.

3. Watch every thought come and go, whether it be a worry, fear,

anxiety or hope. When thoughts come up in your mind, don't

ignore or suppress them but simply note them, remain calm and

use your breathing as an anchor.

4. If you find yourself getting carried away in your thoughts,

observe where your mind went off to, without judging, and simply

return to your breathing. Remember not to be hard on yourself if

this happens.

5. Now sit back with your eyes closed for about five minutes and

try to set aside all negative thoughts of the past or future.

CALMING COPING STRATEGIES

Example (family caregiver strain)

One useful tip to calm yourself when

things get heavy is to go to a quiet

place and take deep, long breaths.

Breathe in, hold for five seconds, then

exhale slowly. Repeat several times.

This exercise can help soothe your

nerves and slow a racing heart.

Meditation (see the next slide)

Guided imagery and visualization

Aromatherapy

Exercise

Progressive muscle relaxation (see

the next slide)

PROGRESSIVE

MUSCLE

RELAXATION

Teaches you how to relax your muscles

through a two-step process.

First, you steadily tense specific muscle

groups in your body, like your neck and

shoulders.

Then you release the tension and observe how

your muscles feel when you relax them.

This activity will help you to reduce your overall

tension and stress levels, and help you relax

when you are feeling anxious.

It can also help improve physical problems like

stomach-aches and headaches, as well as

better your sleep.

NEW MORE

PERSON-CENTERED

APPROACHES

self-improvement apps or online

classes (e.g., cooking, gardening)

Arts therapy

“creativity engenders good moods

and positive outlook”

Self-selected leisure activities

“finding your own happy place” https://uwm.edu/news/the-power-to-de-stress-yourself/

USUAL PSYCHOLOGICAL

INTERVENTIONS

If these routine activities don’t

work and your stress persists, then

consider referring to your physician

or a mental health professional

Standard psychological therapies

may include:

cognitive behavioral therapy

behavioral modification

assertiveness training

exposure therapy

With COVID-19 limitations, tele-

therapy or virtual sessions are

viable options