The Role of Disadvantaged Neighborhood Environments in the Association of John Henryism With Hypertension and Obesity.

Abstract

The John Henryism hypothesis proposes that high-effort, active coping in impoverished, low-resource environments is associated with an increased risk of cardiovascular disease, but a lower risk of disease in a high-resource environment. To test this hypothesis, we examined the association of John Henryism Active Coping (JHAC) with objectively measured neighborhood disadvantages and the relationship to hypertension (including systolic [SBP] and diastolic [DBP] blood pressure) and elevated body mass index (BMI). The study included 3105 participants- 39.93% non-Hispanic blacks, 31.66% non-Hispanic whites, and 25.83% Hispanic and 2.58% non-Hispanic other. All participants aged 18 to 92 years were surveyed and underwent a baseline clinical examination as part of the Chicago Community Adult Health Study, from 2001 to 2003. Coping was measured using four items from the JHAC scale, and neighborhood disadvantage was assessed using rater assessments and the US Census data. In multilevel regression models clustered by neighborhood, neither JHAC nor neighborhood disadvantage was significantly associated with hypertension (SBP and DBP) or BMI. However, significant interaction effects of neighborhood disadvantage and JHAC on hypertension (odds ratio [standard error {SE}] = 0.66 [0.11], p = .018), SBP (B [SE] = -2.63 [1.33], p = .048), DBP (B [SE] = -2.08 [0.87], p = .017), and BMI (B [SE] = -1.86 [0.46], p < .001) were found, such that JHAC was related to increases in disadvantaged neighborhoods and decreases in advantaged neighborhoods. In a large study that modeled objective measures of neighborhood disadvantage, JHAC was associated with increased risk for cardiovascular disease among individuals living in highly disadvantaged neighborhoods which lack resources and opportunities for upward social mobility. This is consistent with the John Henryism hypothesis.