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
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