Socioeconomic position, John Henryism, and incidence of acute myocardial infarction in Finnish men

Abstract

a b s t r a c tPrevious cross-sectional studies examining whether John Henryism (JH), or high-effort coping with socioeconomic adversity, potentiates the inverse association between socioeconomic position (SEP) and cardiovascular health have focused mainly on hypertension in African Americans. We conducted the first longitudinal test of this hypothesis on incident acute myocardial infarction (AMI) using data from the Kuopio Ischemic Heart Disease Risk Factor Study in Finland (N ¼ 1405 men, 42e60 years). We hypothesized that the expected inverse gradient between SEP and AMI risk would be stronger for men scoring high on JH than for those scoring low. John Henryism was measured by a Finnish version of the JH Scale for Active Coping. Four different measures of SEP were used: childhood SEP, education, income, and occupation. AMI hazard ratios (HR) by SEP and JH were estimated using COX proportional hazard models, before and after adjustment for study covariates. 205 cases of AMI occurred over a median of 14.9 years. Men employed in lower rank (farmer, blue-collar) occupations who scored high on JH had significantly higher age-adjusted risks of AMI than men in higher rank (white-collar) occupations (HR ¼ 3.14, 95% CI: 1.65e5.98 for blue collar; HR ¼ 2.33, 95% CI: 1.04e5.22 for farmers) who also scored high on JH. No socioeconomic differences in AMI were observed for men who scored low on JH (HR ¼ 1.36, 95% CI: 0.74 e2.47 for blue collar; HR ¼ 0.93, 95% CI: 0.59e1.48 for farmers; p ¼ 0.002 for the SEP Â JH interaction). These findings persisted after adjustment for sociodemographic, behavioral, and biological factors. Results for other SEP measures were in the same direction, but did not reach statistical significance. Repetitive high-effort coping with adversity (John Henryism) was independently associated with increased risk for AMI in Finnish men, underscoring the potential relevance of the John Henryism hypothesis to CVD outcomes other than hypertension and to populations other than African Americans.

John Henryism, Gender and Self-reported Health Among Roma/Gypsies in Serbia

“…The now well validated JH Scale for Active Coping was translated from English to Serbian and was shown to have good internal reliability, as well as cultural relevance in this sample of low income Serbian Roma. Our study thus expands the cross-cultural scope of JH research and reinforces previous findings (James 1994;Bennett et al 2004;Haritatos et al 2007;Bronder et al 2014;Logan et al 2015;Mujahid et al 2016) that John Henryism is not inherently detrimental to health. Rather, there appear to be circumstances, as was the case for Roma women in the current study, where high JH seems to help foster a positive sense of wellbeing.…”

“…Mean levels of JH in the current sample of Roma are significantly lower than in other studies; these include African Americans (James et al 1987(James et al , 1992Dressler et al 1998), Europeans (Duijkers et al 1988;Mujahid et al 2016); Asian Americans (Haritatos et al 2007;Logan et al 2015) and Hispanic Americans (LeBron et al 2015). The low JH scores of the Serbian Roma could reflect a number of factors, including acquiescence in the face of their marginalized circumstances or a growing dependence on ''free'' government assistance.…”

“…Most Roma really liked the questions comprising the JHAC, providing additional support (see Duijkers et al 1988;Haritatos et al 2007;Logan et al 2015;LeBrón et al 2015;Mujahid et al 2016) for the utility of this concept beyond the experiences of African Americans. In the current study, the Roma were relatively healthy, or at least perceived themselves to be: only one third rated their health as ''poor'', the most common complaints being hypertension and diabetes.…”

“…Further, given the well-known high rates of hypertension-related morbidity and mortality in the African American population (Subramanyam et al 2013), some years ago James (1994) hypothesized that an unrelenting pursuit of success in the face of great odds, and importantly, in the absence of adequate resources, could exact a price on one's physical health even if the pursuit is ultimately successful. With a primary focus on cardiovascular disease, a growing number of studies has tested this hypothesis, with some studies finding strong support (e.g., James et al 1983James et al , 1987James et al , 1992Mujahid et al 2016), some finding mixed support (e.g., Duijkers et al 1988;Dressler et al 1998;Subramanyam et al 2013) and others finding no support (e.g., McKetney and Ragland 1996).…”

Health Disparities due to Diminished Return among Black Americans: Public Policy Solutions

“…Whether John Henryism promotes health or impairs health seems to depend on one's access to other resources such as SES and social support (Hudson et al, 2016). John Henryism may function as a resource or as a health hazard (Mujahid, James, Kaplan, & Salonen, 2017). John Henryism is most damaging when it covaries with low access to SES resources and social support (James, 1994).…”