High-Effort Coping and Cardiovascular Disease among Women: A Systematic Review of the John Henryism Hypothesis

Abstract

African-American women living in the United States experience higher cardiovascular disease risk (CVD) mortality compared to White women. Unique mechanisms, including prolonged high-effort coping in the face of discriminatory stressors might contribute to these racial disparities. The John Henryism hypothesis is a conceptual framework used to explain poor health outcomes observed among individuals with low resources who repeatedly utilize active coping to overcome barriers. The aims of our study were to summarize the literature related to John Henryism and CVD-related factors with a particular focus on women and to identify gaps for areas of future inquiry. We searched MEDLINE, EMBASE, Scopus, and CINAHL to identify literature that used the John Henryism Active Coping scale. Reviewers independently reviewed eligible full-text study articles and conducted data extraction. We qualitatively summarized the literature related to John Henryism and cardiovascular disease (CVD)-related health behaviors (e.g., smoking or physical activity) and risk factors (e.g., hypertension) with a focus on study populations inclusive of women. Our review included 21 studies that used the John Henryism Active Coping scale, of which 10 explicitly reported on the interaction between John Henryism and socioeconomic status (SES) and CVD-related factors. With respect to the original hypothesis, three studies reported results in line with the hypothesis, four were null, and three reported findings in opposition to the hypothesis. The remaining studies included in the review examined the main effects of John Henryism, with similarly mixed results. The literature related to the interaction between John Henryism and SES on CVD-related factors among women is mixed. Additional studies of John Henryism that incorporate biological measures, varied indicators of resources, and larger study populations may illuminate the relationship between coping and deleterious health outcomes among women.

Is John Henryism a Health Risk or Resource?: Exploring the Role of Culturally Relevant Coping for Physical and Mental Health among Black Americans

“…Moreover, Subramanyam and colleagues (2013) found partial support for the JHH with hypertension among black men but not among black women. A recent systematic review of the JHH among black women also demonstrated mixed findings (Felix et al 2019). More specifically, although some studies have found support for the JHH, others have yielded results that are opposite of what the JHH posits, and some have not found an association at all (Felix et al 2019).…”

“…A recent systematic review of the JHH among black women also demonstrated mixed findings (Felix et al 2019). More specifically, although some studies have found support for the JHH, others have yielded results that are opposite of what the JHH posits, and some have not found an association at all (Felix et al 2019). Given that the John Henryism construct was developed based on the experiences and characteristics of black men, most studies have focused on the ways it influences this population.…”

The Synergistic Influence of Life Experiences and Cultural Nuances on Development of Depression: A Cognitive Behavioral Perspective

“…While some levels of stress are normal and easily managed, a problem ensues when stress becomes chronic, intolerable, and toxic (Franke, 2014). Failure to address and manage stress, resulted in increased problems regarding normal mental and physical functioning (Felix et al, 2018). When stress occurs, cortisol levels initially rise but then stop working when stress becomes chronic (Boyd, 2018).…”

“…In addition, the provider is always continuing to learn more about the cultural nuances of their patients/clients (Warren, 2018). Most importantly, providers need to initially examine and assess their feelings, attitudes, and responses related to cultural perspectives that are different from what they are accustomed to and thus learn to feel a level of comfortableness when encountering these differences (Felix et al, 2018;Purnell, 2019;Warren, 2015). The implications for mental health education, practice, and research are numerous.…”

Prejudice, Discrimination, and Health

“…Other researchers have described this concept as "vigilance" ( Himmelstein, Young, Sanchez, & Jackson, 2015 ) with applicability to diverse racial/ethnic groups. Overall, the fi ndings on vigilant, high-eff ort coping are mixed, with evidence of limited eff ect or diff erential impact on health across populations by race, sex, and socioeconomic status ( Felix et al, 2019 ;Subramanyam et al, 2013 ).…”