Discrimination and Hypertension Among Older African Americans and Caribbean Blacks: The Moderating Effects of John Henryism

Abstract

Objectives

Discrimination is a major contributor to health disparities between Black and White older adults. Although the health effects of discrimination are well established, less is known about factors that may intervene in the discrimination–health connection, such as coping strategies. The study aim was to determine whether John Henryism (JH; high-effort coping) moderates the association between racial discrimination and hypertension in nationally representative samples of older African Americans and Caribbean Blacks.

Methods

The analytic sample was drawn from the National Survey of American Life—Reinterview, which was conducted 2001–2003, and included African Americans (N = 546) and Caribbean Blacks (N = 141) aged 55 and older. Study variables included racial discrimination, JH, and hypertension. Logistic regressions, which controlled key sociodemographic differences, were used to test the study aim.

Results

Among both Black ethnic groups, discrimination and JH were not associated with hypertension. For African Americans low and moderate in JH, discrimination was unrelated to hypertension; discrimination was positively associated with hypertension for African Americans high in JH. For Caribbean Blacks, discrimination was positively associated with hypertension among respondents low in JH. Among Caribbean Blacks moderate and high in JH, discrimination was not associated with hypertension.

Discussion

The findings indicate that JH, in the face of discrimination, is associated with hypertension of older African Americans but may be an effective coping strategy for older Caribbean Blacks due to cultural and sociodemographic differences between the 2 ethnic groups. Future research should investigate the differing mechanisms by which JH influences health in heterogeneous older Black populations.

Black elderly, Health, High blood pressure, Racism, Stress coping

Hypertension (HTN) is the most prevalent and potent risk factor for cardiovascular disease (CVD), which is the single leading cause of death in the United States, accounting for close to one in four deaths in the United States (Heron, 2019). The prevalence of HTN in adults aged 18 or older was 45.4% in 2017–2018, up from 41.7% in 2013–2014 (Heron, 2019). HTN disproportionately affects African Americans, compared to non-Hispanic Whites, with 2017–2018 data showing a prevalence of 57.2% in African American men and 56.7% in African American women (Ostchega et al., 2020). This higher prevalence has led to persistent CVD disparities, poorer HTN control, and increased burden of associated risk factors including diabetes, chronic kidney disease, physical inactivity, and overweight status and obesity among African Americans relative to non-Hispanic Whites (Carnethon et al., 2017). African Americans also have an earlier HTN onset and greater severity relative to other racial groups (Mozaffarian et al., 2015). Overall, half of the Black–White mortality disparity in the United States is attributable to HTN (Harper et al., 2014).

Modifiable risk factors for HTN include behavioral (e.g., poor diet, lack of physical activity) and environmental factors (e.g., neighborhood characteristics; Kershaw et al., 2017; Mensah et al., 2005). However, these factors do not account for all the disparity between African Americans and Whites (Redmond et al., 2011). Of significance is the role of racial discrimination in this disparity. Some studies on African Americans demonstrate that racial discrimination is predictive of increased blood pressure reactivity, and chronic exposure to racial discrimination over time can lead to HTN (Beatty Moody et al., 2016; Lewis et al., 2009, 2015; Mays et al., 2007; Williams & Mohammed, 2009). However, this body of literature is equivocal, as other studies find no associations between discrimination, blood pressure, and HTN. Some empirical inquiries find that although discrimination is not directly related to blood pressure and HTN, it was conditionally associated with these health outcomes. That is, discrimination is associated with blood pressure and HTN among some subgroups (Williams & Mohammed, 2009). Another limitation of research in this area is that studies tend to focus on adults across the life span rather than older adults, even though older adults are at the greatest risk for HTN and have endured the cumulative effects of discrimination over the life course. In fact, Beatty Moody et al.’s (2016) research finds that lifetime discrimination was associated with elevated blood pressure among older respondents but unassociated with blood pressure among younger respondents. Their finding underscores the cumulative health toll of experiencing discrimination over a lifetime among older adults. It is, therefore, pertinent to investigate factors that could moderate the association between racial discrimination and HTN for a comprehensive insight into HTN risk among older Black Americans. This study examines the moderating effects of high-effort coping (John Henryism [JH]) in the association between racial discrimination and HTN among older African American and Caribbean Black adults.

The JH Hypothesis

The JH hypothesis provides a framework through which examination of culturally and socially unique stress coping strategies and their effects on African Americans is investigated. James (1994) posits that JH, a stress coping strategy shaped by the historical and sociocultural contexts in which African Americans inhabit, increases the possibility of negative health outcomes such as HTN and CVD. JH is rooted in African American historical culture commonly delivered through a folklore or traditional oral presentations across generations. The folklore is that John Henry, “a steel-driving man,” was pitted against a steam locomotive. Through his sheer physical and mental abilities and capacities, John defeated the locomotive yet ultimately died due to the exhausting feat. Via this folklore, the JH hypothesis postulates that African Americans who, when facing discrimination, socioeconomic marginalization, and other psychosocial stressors requiring persistent and prolonged adaptation, utilize constant, high-effort coping to meet and, potentially, overcome these pernicious psychosocial stressors are more likely to experience HTN due to increased blood pressure reactivity. In other words, the use of active, yet exhausting coping strategies in combating prolonged exposure to toxic stressors may lead to declines in health, resulting in early morbidity and mortality.

JH and Blood Pressure

Although JH is associated with multiple mental and physical health outcomes among African Americans, extant research predominately investigates its effects on blood pressure, HTN risk, and other related indicators. The findings from these studies are mixed, demonstrating positive (Dressler et al., 1998; Fernander et al., 2004; LeBrón et al., 2015; Subramanyam et al., 2013), inverse (Barajas et al., 2019; Clark & Adams, 2004), and null associations (Bonham et al., 2004; Booth & Jonassaint, 2016; Jackson & Adams-Campbell, 1994). Moreover, the health effects of JH seem to vary by sociodemographic characteristics and by outcome (Dressler et al., 1998; Fernander et al., 2004). For example, LeBron et al. (2015) found a positive association between JH and systolic blood pressure, but no association with diastolic blood pressure. Conversely, in a study on cardiovascular reactivity to stress, Merritt et al. (2004) found that JH was associated with diastolic blood pressure during the recovery phase of the stress test among lower-educated African Americans. Thus, the presence and direction of the association between JH and blood pressure or HTN risk are unclear. Some of the heterogeneity in findings across studies may be due to the overwhelming use of convenience samples primarily from the southeastern and midwestern United States. These samples are not generalizable to the broader population of Black Americans in the United States and potentially limit our understanding of within-group differences in how JH operates based on ethnicity and/or nativity. Very few studies have examined differences in the JH hypothesis across subgroups of the Black diaspora (Neighbors et al., 2007), which highlights a gap in the research on JH that is in need of investigation.

JH, Discrimination, and Health

A growing area of interest with regard to the JH hypothesis has been its role as a moderator of the relationship between discrimination and health. One argument is that the high-effort coping characteristic of JH might heighten the physiological and emotional strain African Americans experience when faced with discrimination and lead to even worse health than the effect of discrimination alone. Conversely, JH, as a stress coping strategy, might mitigate and protect against the effects of discrimination, leading to relatively better health outcomes. Existing literature on the moderating effects of JH is limited and primarily focuses on blood pressure or depressive symptoms as outcomes and uses nonprobability samples, such as African American college students. For instance, among a sample of African American college students in the southeastern United States, Volpe et al. (2020) found that JH moderates the relationship between racial discrimination and diastolic blood pressure, but not systolic blood pressure, such that the effects of discrimination on diastolic blood pressure were more pronounced at higher levels of JH. In contrast, in a sample of African American college women, Clark and Adams (2004) found that perceived racism—a more comprehensive measure of racial discrimination and other racism-related experiences—was not associated with systolic or diastolic blood pressure reactivity at high levels of JH but had an inverse relationship with both measures at low levels of JH. Taken together, the studies by Volpe et al. and Clark and Adam, respectively, exemplify the two potential roles of JH in relation to discrimination and health—health-damaging coping response or protective coping resource. Other studies outside of a collegiate population are similarly mixed with one study on HTN risk documenting null findings for the interaction between JH and discrimination (Michaels et al., 2019) and another only documenting their main effects: an inverse relationship between JH and systolic blood pressure and a positive association between discrimination and systolic blood pressure among African American men, and no association between each factor and blood pressure among African American women (Barajas et al., 2019). Thus, findings pertaining to the relationships between JH, discrimination, and blood pressure are inconclusive and warrant further investigation.

Caribbean Blacks in the United States

Despite the sizeable Black immigrant population in the United States and growing ethnic diversity among Black Americans, social science and gerontological research rarely distinguish between Black ethnic groups. Instead, research tends to treat the Black diaspora in the United States as a homogenous population when, in reality, there are important cultural and sociodemographic distinctions between various Black ethnic groups. Of particular interest are Caribbean Blacks, who comprise a majority of the Black immigrant population in the United States (Acosta & de la Cruz, 2011; Rastogi et al., 2011). In fact, by 2017, the Caribbean immigrant population totaled 4.4 million and accounted for 10% of Black Americans (Acosta & de la Cruz, 2011). Although Caribbean Blacks and African Americans share the same racial identity, these two groups differ from each other in culture and several key sociodemographic factors. For example, Caribbean Blacks, as a group, have higher incomes and higher levels of formal education, especially college attendance, than African Americans (Anderson, 2015), which have important implications for differences in experiences of discrimination and the prevalence of HTN between these two ethnic groups. In fact, epidemiological evidence indicates that the prevalence of HTN is lower among Caribbean Blacks than African Americans (Commodore-Mensah et al., 2018). Research on discrimination finds that Caribbean Blacks, especially foreign-born persons, are less likely to perceive racial discrimination than African Americans (Hunter, 2008).

The racial experiences of Caribbean Blacks stand in stark contrast to the experiences of African Americans, which may contribute to differences in perceptions of discrimination between the two groups. Many Caribbean Blacks migrate from Caribbean countries in which they are the numerical racial majority, and blackness is less stigmatized in these countries than it is in the United States. Consequently, Caribbean Black immigrants, on average, are likely to have experienced less social, political, and economic marginalization in their home countries than African Americans in the United States, which can lead Caribbean Blacks to minimize attributions to racial discrimination. However, in the United States, Caribbean Blacks are subsumed under the same Black racial category as African Americans, and American society makes little distinction between these two Black ethnic groups. This means that although Caribbean Blacks are less likely to perceive racial discrimination than African Americans, they are likely to be exposed to similar levels of racial discrimination as their African American peers (Foner, 2001).

Focus of the Present Study

In our review of the relevant literature, we have identified several critical knowledge gaps in the research on racial discrimination, JH, and HTN among Black Americans, including (a) the dearth of research on these topics among older adults; (b) the paucity of studies using nationally representative samples that would permit population-level generalizations of the study findings; (c) inconsistent findings regarding the relationships between racial discrimination, JH, and HTN; and (d) the lack of focus on ethnic diversity within the Black American population, especially when empirical evidence indicates ethnic variations in HTN and experiences of discrimination within the Black population. In addressing these knowledge gaps, the purpose of the current investigation was to (a) examine the associations between racial discrimination, JH, and HTN in a nationally representative sample of older African Americans and Caribbean Blacks and (b) determine whether JH moderates the association between racial discrimination and HTN.

Method

Sample

Data for this study came from the National Survey of American Life: Coping with Stress in the twenty-first century—Reinterview (NSAL-RIW; Jackson et al., 2004). The original NSAL and NSAL-RIW were collected by the Program for Research on Black Americans (PRBA) at the University of Michigan’s Institute for Social Research using a national multistage probability design. The African American sample is the core sample of the NSAL. The core sample consists of 64 primary sampling units. Fifty-six of these primary areas overlap substantially with existing Survey Research Center National Sample primary areas. The remaining eight primary areas were chosen from the South for the sample to represent African Americans in the proportion in which they are distributed nationally. The African American sample is a nationally representative sample of households located in the 48 coterminous states, with at least one Black adult 18 years of age or older who did not identify ancestral ties in the Caribbean.

The fieldwork for the NSAL was conducted from 2001 to 2003. Most of the interviews were conducted face to face (86%) in respondents’ homes, while the remaining 14% were telephone interviews. Respondents were compensated for their time. The overall response rate was 72.3% with response rates of 70.7% for African Americans, 77.7% for Caribbean Blacks, and 69.7% for non-Hispanic Whites. A total of 6,082 interviews were conducted with persons aged 18 or older, including 3,570 African Americans, 891 non-Hispanic Whites, and 1,621 Caribbean Blacks. Both the African American and Caribbean Black samples required that respondents self-identify their race as Black. Those self-identifying as Black were included in the Caribbean Black sample if they indicated they were of West Indian or Caribbean descent, said they were from a country included on a list of Caribbean area countries presented by the interviewers, or indicated that their parents or grandparents were born in a Caribbean area country and who are English-speaking (but may also speak another language). Particularly important for this study, the NSAL includes the first major probability sample of Caribbean Blacks ever conducted. The Caribbean Black sample was selected from two area probability sample frames: the core NSAL sample and housing units from geographic areas with a relatively high density of persons of Caribbean descent. For a more detailed discussion of the NSAL sample and instrumentation see the work of Jackson et al. (2004).

At the completion of the initial NSAL interview, respondents were given a paper, self-administered questionnaire; this is referred to as the NSAL-RIW. The NSAL-RIW included measures that were not in the original survey, such as the JH measure. Respondents were instructed to complete the self-administered questionnaire and mail it back to the PRBA. Of the 3,570 African American respondents and 1,621 Caribbean Black respondents who completed the NSAL, a total of 2,137 African American respondents and 695 Caribbean Black respondents completed the NSAL-RIW. Like the NSAL sample, the NSAL-RIW sample is a nationally representative sample. The NSAL and NSAL-RIW data collections were approved by the University of Michigan Institutional Review Board. The analytic sample for this study featured 546 African American and 141 Caribbean Black respondents aged 55 or older.

Measures

Independent variables

Racial discrimination was measured with a summary score of the 10-item Everyday Discrimination Scale developed by Williams et al. (1997) that assesses episodes of unfair treatment experienced in daily life (Cronbach’s alpha = 0.90 for African Americans and 0.85 for Caribbean Blacks). Respondents were presented with a list of 10 scenarios of unfair treatment and asked, “In your day-to-day life how often have any of the following things happened to you?” Response categories ranged from 0 (never) to 5 (almost everyday). After each item, respondents were asked the reason for why they experienced the unfair treatment (e.g., ancestry/national origins, gender, race, age, skin tone). Respondents who attributed the unfair treatment to race, ancestry/national origins, or skin tone were classified as having experienced racial discrimination in that episode of unfair treatment. Higher scores indicated more frequent experiences of racial discrimination. Although the NSAL included a measure of major discrimination, we used the everyday discrimination measure in this study because of its stronger association with HTN (Dolezsar et al., 2014). Everyday discrimination taps into daily hassles and indignities and constitutes a form of chronic stressor. Chronic stressors are more strongly related to HTN than acute stressors, such as major discrimination, as they lead to prolonged activation of the sympathetic nervous system, which can result in the development of HTN (Spruill, 2010).

JH was assessed with an adapted 12-item version of the John Henryism Scale for Active Coping (James, 1994). This scale assessed respondents’ attitudes toward the use of high-effort active coping strategies when faced with difficult psychosocial stressors and barriers. Response categories ranged from 1 (completely false) to 4 (completely true). A JH score was derived from averaging all items of the scale, and higher scores indicated more high-effort coping when faced with difficult psychosocial stressors (Cronbach’s alpha = 0.84 for African Americans and 0.87 for Caribbean Blacks).

Dependent variable

HTN was assessed using a self-report measure. Respondents were asked to report the presence of HTN or high blood pressure that has been diagnosed by a doctor or a health professional.

Covariates

The multivariable analyses accounted for the influence of several sociodemographic and health variables in the relationships between racial discrimination, JH, and HTN. Age and family income were assessed continuously. Age was measured in years, and family income was measured in dollars. Due to its skewed distribution, family income was log-transformed for all multivariable analyses. Missing data for family income and education were imputed using an iterative regression-based multiple imputation approach incorporating information about age, gender, region, race, employment status, marital status, home ownership, and nativity of household residents. Gender was assessed dichotomously, and men were set as the reference group. Nativity, which was only assessed for Caribbean Black respondents, differentiated between respondents who were born in the United States (reference group) and respondents who were born outside of the United States. Health measures included body mass index (BMI) and diabetes. BMI was treated as a continuous measure and calculated as 703 × weight (lbs)/height (ins)². Diabetes was assessed with a self-report measure. Respondents were asked to report the presence of diabetes that has been diagnosed by a doctor or a health professional.

Analysis Strategy

Logistic regression was used to determine the relationships between discrimination, JH, and HTN. We used an interaction term between discrimination and JH to test the moderating effect of JH on the association between discrimination and HTN. These relationships were tested in stepwise regression models. In the first step, HTN was regressed on discrimination, JH, and covariates. In the second step, the discrimination × JH interaction term was added to the model. Separate regression analyses were conducted for the African American and Caribbean Black samples. To illustrate significant interactions, we plotted the estimated probability for HTN (Figures 1 and 2). For ease of interpretation, JH was depicted as low, moderate, and high in the interaction plots. Low and high JH were represented by respondents with JH scores of 1 SD below and above the mean, respectively. Moderate JH was represented by respondents with JH scores at the mean. All multivariable analyses took into account the complex multistage clustered design of the NSAL-RIW sample, unequal probabilities of selection, nonresponse, and poststratification.

Figure 1.

Predicted probability of hypertension by racial discrimination and John Henryism among older African Americans.

Figure 2.

Predicted probability of hypertension by racial discrimination and John Henryism among older Caribbean Blacks.

Results

Intercorrelations of the study variables are provided in Supplementary Tables 1–4. Table 1 presents the univariate distribution of the study variables for African American and Caribbean Black respondents and bivariate analyses between ethnicity and the study variables. The bivariate analyses indicated that African American and Caribbean Black respondents differed on family income, BMI, and rates of HTN. Compared to African American respondents, Caribbean Black respondents had higher family income. The mean family income for the Caribbean Black sample was $36,469, which was approximately $8,000 more than the mean family income for the African American sample. Caribbean Black respondents had lower BMI and rates of HTN than African American respondents. The mean BMI was 27.2 for the Caribbean Black sample and 29 for the African American sample. Slightly under half of Caribbean Black respondents reported HTN, and close to two thirds of African American respondents reported HTN.

Table 1.

Bivariate Relationships Between Ethnicity and Study Variables

	Total sample (N = 687)		African American (n = 546)		Caribbean Black (n = 141)		Test
	% or M (N or SD)	Range	% or M (N or SD)	Range	% or M (N or SD)	Range
Gender							χ 2 = 2.58
Men	41.06 (237)	—	40.00 (175)	—	54.02 (62)	—
Women	58.94 (450)	—	60.00 (371)	—	45.98 (79)	—
Diabetes							χ 2 = 0.19
Yes	25.80 (177)	—	26.01 (144)	—	23.1 (33)	—
No	74.20 (484)	—	73.99 (377)	—	76.9 (107)	—
Nativity							—
Born in the United States	—	—	—	—	31.49 (31)	—
Born outside of the United States	—	—	—	—	68.51 (110)	—
Hypertension							χ 2 = 6.67**
No	36.06 (237)	—	34.67 (168)	—	53.40 (69)	—
Yes	63.94 (424)	—	65.33 (353)	—	46.60 (71)	—
Age	66.14 (8.15)	55–90	66.19 (8.17)	55–90	65.97 (8.12)	55–88	t = 0.28
Family income	30,266.91 (31,366.90)	0–250,000	28,665.37 (30,967.23)	0–250,000	36,468.62 (32,202.25)	1,300–170,000	t = −2.65**
BMI	28.58 (5.52)	16.44–51.37	28.95 (5.70)	16.44–51.37	27.23 (4.60)	16.59–49.22	t = 3.28**
Racial discrimination	5.56 (8.40)	0–50	5.81 (8.63)	0–50	4.60 (7.37)	0–43	t = 1.48
John Henryism	3.33 (0.44)	1.4–4	3.32 (0.43)	2–4	3.37 (0.46)	1.4–4	t = –1.23

Notes: BMI = body mass index. Percentages and N, presented within parentheses, are presented for categorical variables. Means and standard deviations, presented within parentheses, are presented for continuous variables. Percentages are weighted and frequencies are unweighted.

**p < .01.

Model 1a indicated that among African American respondents, racial discrimination and JH were not associated with HTN (Table 2). In Model 1b, the significant interaction between racial discrimination and JH indicated that JH moderated the association between racial discrimination and HTN among African American respondents. Specifically, among respondents with low and moderate levels of JH, discrimination was not associated with HTN (Figure 1). Although the slope for respondents with moderate levels of JH appeared to be trending positively, ancillary analysis (not shown) indicated that this slope was not significant. In contrast, among respondents with high levels of JH, more frequent experiences of racial discrimination were associated with greater probabilities of HTN. At the lowest level of discrimination, the probability of HTN was similar between respondents with low and high levels of JH. However, at the highest level of discrimination, the probability for HTN was substantially greater among respondents with high levels of JH than among respondents with low levels of JH.

Table 2.

Logistic Regression Analyses of Racial Discrimination, John Henryism, and Hypertension Among Older African Americans and Caribbean Blacks

	OR (95% CI)
	African Americans		Caribbean Blacks
	Model 1a	Model 1b	Model 2a	Model 2b
Racial discrimination × John Henryism	—	1.05 (1.01, 1.11)*	—	0.82 (0.70, 0.97)*
Racial discrimination	1.02 (0.99, 1.05)	0.86 (0.73, 1.01)	1.01 (0.93, 1.10)	2.00 (1.10, 3.65)*
John Henryism	1.03 (0.50, 2.12)	0.77 (0.35, 1.67)	0.70 (0.16, 2.94)	2.68 (0.56, 12.80)
Age	1.03 (1.00, 1.07)	1.03 (1.00, 1.07)	1.00 (0.92, 1.09)	1.01 (0.94, 1.09)
Gender
Mena	—	—	—	—
Women	1.09 (0.72, 1.65)	1.11 (0.73, 1.68)	1.37 (0.55, 3.44)	1.33 (0.54, 3.29)
Family income	0.95 (0.72, 1.25)	0.94 (0.71, 1.24)	1.07 (0.51, 2.26)	0.90 (0.42, 1.91)
BMI	1.11 (1.04, 1.17)***	1.11 (1.04, 1.17)***	1.01 (0.89, 1.14)	1.00 (0.86, 1.16)
Diabetes
Noa	—	—	—	—
Yes	2.87 (1.46, 5.62)**	2.88 (1.45, 5.74)**	1.50 (0.35, 6.40)	2.05 (0.58, 7.25)
Nativity
Born in the United Statesa	—	—	—	—
Born outside of the United States	—	—	0.56 (0.17, 1.78)	0.60 (0.21, 1.76)

Note: OR = odds ratio; 95% CI = 95% confidence interval; BMI = body mass index.

^aReference category.

*p < .05, **p < .01, ***p < .001.

Model 2a demonstrated that neither racial discrimination nor JH was associated with HTN among Caribbean Black respondents (Table 2). The significant interaction in Model 2b revealed that JH moderated the association between discrimination and HTN among Caribbean Black respondents. Figure 2 shows that more frequent experiences of racial discrimination were associated with increasing probability for HTN among respondents with low levels of JH. Although the slope for high JH appeared to be trending negatively and the slope for moderate JH appeared to be trending positively, ancillary analyses (not shown) indicated that this slope was not significant. Thus, among respondents with moderate and high levels of JH, discrimination and HTN were not associated.

Discussion

There is a dearth of studies on the connection between discrimination and HTN among older adults, and only a few studies have examined the moderating effects of high-effort coping (i.e., JH) in this connection. Findings from these studies are equivocal, complicating our understanding of the roles of discrimination and JH in HTN. Of the studies that have investigated the moderating effect of JH in the relationship between discrimination and HTN among Black Americans, none have investigated how the moderating effect of JH may differ by ethnicity. As the first study to investigate the moderating effects of JH on the association between racial discrimination and HTN among older African American and Caribbean Black adults using nationally representative data, the current analysis extends the discrimination and health literature.

The data indicated that older African Americans and Caribbean Blacks did not differ in their levels of JH or frequency of racial discrimination experiences. On average, both ethnic groups reported relatively high levels of JH, which is in line with evidence demonstrating that high-effort coping is a common strategy for dealing with adversity among Black Americans (James & Thomas, 2000; Neighbors et al., 2007). Furthermore, both African American and Caribbean Black respondents reported relatively low levels of racial discrimination. This is concordant with findings from other studies of discrimination among older Black Americans (Mouzon et al., 2020; Nguyen, 2018; Qin et al., 2020). Racial discrimination was assessed with the Everyday Discrimination Scale (EDS) in this study, which assessed daily hassles and indignities rather than major experiences of discrimination, such as being unfairly denied a promotion or fired. It is possible that this cohort of respondents, many of whom came of age prior to the Civil Rights Movement and during the Jim Crow era and have experienced overt forms of racial discrimination, may not have identified the events described in the EDS as racial discrimination. Furthermore, Caribbean Black respondents, many of whom were born outside of the United States and migrated to the United States after the Civil Rights Movement, may have come from cultural and racial contexts that led them to minimize racial discrimination attributions. Nevertheless, research demonstrates that even at modest levels, discrimination can detrimentally affect Black Americans’ health and well-being (Krieger et al., 2011; Nguyen, 2018).

Our analysis indicated that racial discrimination and JH were not directly associated with HTN for both ethnic groups. While research on the health effects of discrimination demonstrates that racial discrimination is predictive of a range of health problems (Monk, 2015; Mouzon et al., 2016), findings for the relationship between discrimination and HTN are equivocal (Davis et al., 2005; Williams & Mohammed, 2009). Our null findings for discrimination align with a small number of studies that are unable to identify a direct association between discrimination and HTN (Williams & Mohammed, 2009). The research on JH and HTN is also inconsistent. Our null findings for JH are concordant with those of studies that did not identify a direct association between JH and HTN (Michaels et al., 2019) as well as other health outcomes, such as depressive symptoms (Neighbors et al., 2007).

The significant interaction between discrimination and JH among older African Americans revealed that discrimination and HTN were unrelated among those respondents who reported low or moderate levels of JH. However, among respondents who reported high levels of JH, more frequent experiences of discrimination were associated with increased risk for HTN. Consequently, at the highest levels of discrimination, respondents with high levels of JH were substantially more likely to have HTN than respondents with low levels of JH. Other studies have identified similar trends (Volpe et al., 2020). This finding indicates that high-effort coping is not an effective coping strategy for older African Americans dealing with racial discrimination. In fact, high-effort coping can be harmful in the face of adversities that are uncontrollable, such as racial discrimination. Consistent with the weathering hypothesis (Geronimus, 1992), chronic exposure to discrimination, a psychosocial stressor, combined with the persistent utilization of great amounts of psychological and physiological effort to overcome this seemingly unsurmountable stressor can lead to accelerated declines in health. This weathering effect can explain why at the highest levels of racial discrimination, African Americans with high levels of JH had substantially greater probabilities of HTN than African Americans with low levels of JH.

In contrast, the lack of an association between discrimination and HTN among older African Americans with low and moderate levels of JH may suggest that these groups could be utilizing other, more effective coping strategies that can mitigate the harmful effects of discrimination. Weathering can also erode one’s protective stress coping resources. Because these respondents were less likely to engage in high-effort coping than their counterparts in the high JH group, it is possible that their protective coping resources were more intact, and they were able to tap into these coping resources to effectively deal with the toll of racial discrimination.

Interestingly, the moderating effects of JH on the relationship between racial discrimination and HTN among older Caribbean Blacks indicated a pattern that was opposite of that identified among older African Americans. Among older Caribbean Blacks with moderate and high levels of JH, discrimination was not associated with HTN. In contrast, among older Caribbean Blacks with low levels of JH, discrimination was positively associated with HTN. This moderation pattern indicates that high-effort coping may be an effective coping strategy for this ethnic group. Some studies of JH among immigrant populations in the United States show that high-effort coping can protect against mental and physical morbidities (Haritatos et al., 2007; Logan et al., 2017). Haritatos et al.’s (2007) investigation of JH among Asian immigrants found that higher levels of JH were associated with better self-rated health and physical functioning and fewer somatic symptoms. They also found that perceived stress partially explained these associations. Specifically, respondents with high levels of JH had decreased perceptions of stress, which was associated with better health outcomes. Another study that examined JH among immigrants identified relationships between JH, acculturation, acculturative stress, and perceived stress among Korean immigrants (Logan et al., 2017). Findings from that study revealed that Korean immigrants with higher levels of JH were more acculturated and had decreased acculturative and perceived stress. Given this evidence, it is possible that Caribbean Black respondents who engaged in high-effort coping may have appraised discriminatory experiences as less stressful. This decreased stress appraisal may have attenuated the association between discrimination and HTN. Additionally, this group of respondents may have also experienced less acculturative stress, an additional form of chronic stress particularly relevant to Caribbean Blacks, which could have further decreased their risk for HTN. Conversely, it is possible that Caribbean Black respondents who had low or moderate levels of JH were less likely to experience decreased stress appraisal. Thus, these groups of respondents may have been more vulnerable to the sequelae of discrimination.

Despite our data indicating that JH might be a protective resource for older Caribbean Blacks, we would like to caution that the current evidence is based on cross-sectional data, which cannot elucidate the long-term effects of using high-effort coping in response to discrimination. Perhaps, over time, expending such an enormous amount of energy daily to manage an uncontrollable psychosocial stressor could lead to weathering and the erosion of other stress coping resources (e.g., self-efficacy, self-esteem). This can result in an increased risk for HTN as well as other health problems. Studies using longitudinal data are needed to fully understand how high-effort coping functions as a stress coping strategy over the long term and its relationship to discrimination and HTN over time.

Limitations and Strengths

The study findings should be interpreted within the context of its limitations. First, the data were cross-sectional, which poses challenges to disaggregating the temporal ordering of the study variables. Moreover, as we have detailed above, cross-sectional data limit our understanding of the long-term effects of high-effort coping. Another limitation of this analysis is the use of self-reported measures. Self-reported measures are susceptible to memory and social desirability biases. Additionally, the NSAL-RIW only surveyed community-dwelling adults. Institutionalized (e.g., residents of nursing homes) and homeless persons were excluded from the survey. Thus, the current findings can only be generalized to community-dwelling older African Americans and Caribbean Blacks. This study did not account for other sources of social stress that are relevant for Caribbean Blacks (e.g., acculturative stress) due to the lack of available data. Future studies should examine the roles of acculturation and acculturative stress in the relationships between JH, discrimination, and HTN. Finally, while our study focused on everyday discrimination, we did not examine the relationships between major discrimination, JH, and HTN. Future studies should investigate whether JH moderates the association between major discrimination and HTN. Major discrimination is an important type of discrimination to consider among older Black Americans, especially people who came of age before the Civil Rights Movement. These individuals are likely to have experienced more acute and overt forms of discrimination.

Despite these limitations, this study has several notable strengths. This is the first investigation of ethnic differences in the moderating effects of JH on the association between racial discrimination and HTN among African American and Caribbean Black older adults. This study extends the current scientific literature by bridging several knowledge gaps. There has been very little attention paid to the discrimination–health connection among older Black Americans, as research in this area tends to focus on adults across the life span. Research on discrimination specifically among older Black Americans is important because of their cumulative exposure to discrimination and other psychosocial stressors over the life course. According to the weathering hypothesis, this cumulative stress exposure can lead to accelerated health declines and explain the health disparities between older Black and White Americans. Moreover, our focus on within-group (ethnic) differences among older Black Americans provides a more complete understanding of how the functions of JH as a stress coping strategy for dealing with discrimination vary between older African Americans and Caribbean Blacks. Ethnic distinctions in this area of research are especially important, as African Americans and Caribbean Blacks come from differing social, cultural, and historical contexts that shape their perceptions and experiences of racial discrimination. The use of nationally representative data is an additional strength of the current investigation. In particular, nationally representative samples of Caribbean Blacks are exceedingly rare in survey research. Altogether, the findings from this investigation indicate that the association between racial discrimination and HTN for both older African American and Caribbean Black adults is conditional on the level of JH. Furthermore, these findings offer some insight into ethnic differences in the utility of high-effort coping in response to racial discrimination among older Black Americans, underscoring the importance of research focused on diversity within the Black population.

Implications

Our current findings have several implications for practice, public health, and research. This study underscores ethnic differences in the role of high-effort coping in the face of racial discrimination within the Black population. It is important for practitioners to understand the ethnic and cultural heterogeneity among Black Americans; practitioners should include assessments of patients’ cultural and ethnic backgrounds, practices, and values, as they can shape patients’ perceptions of stress and coping strategies, which can influence their health. Preventive interventions for HTN among older Black Americans should consider stress coping strategies that are most culturally appropriate for African Americans and Caribbean Blacks. Future research should explore the mechanisms by which JH differentially influences the relationship between discrimination and HTN among older African Americans and Caribbean Blacks. Additionally, research on JH has identified gender differences in the effects of JH on blood pressure. For example, Dressler et al. (1998) found a positive association between JH and blood pressure among men but a negative association between JH and blood pressure among women. Another study found that JH was positively associated with high blood pressure among women with lower levels of education. However, among men, they only identified a positive association between JH and high blood pressure among those with higher levels of education. Moreover, men report more frequent experiences of discrimination than women (Ifatunji & Harnois, 2016; Mouzon et al., 2020). Some studies indicate that men are more vulnerable to the effects of discrimination than women (Assari et al., 2017), while other studies indicate the opposite (Assari, 2018). Additionally, gender differences in the prevalence of HTN are well documented (Benjamin et al., 2019). Given these findings, future research should examine whether the moderating effect of JH on the association between discrimination and HTN varies by gender. Finally, evidence indicates that discriminatory experiences vary by nativity among Black Americans (Krieger et al., 2011). Prospective inquiries should explore whether the moderating effect of JH differs between U.S.-born and foreign-born Caribbean Blacks.

Funding

The preparation of this article was supported by grants from the National Heart, Lung, and Blood Institute to A. W. Nguyen (5R25HL105444-11) and O. M. Bubu (R25HL105444 [Pilot]), the National Institute on Aging to H. O. Taylor (5T32 AG000029-42, 1P30AG059298) and O. M. Bubu (K23AG068534, P30AG059303 [Pilot], P30AG066512 [Pilot], L30-AG064670) and a grant from the American Academy of Sleep Medicine Foundation to O. M. Bubu (BS-231-20). The funders had no role in the conception or preparation of this manuscript.

Conflict of Interest

None declared.

Author Contributions

A. W. Nguyen designed the study and conducted the data analysis. A. W. Nguyen, D. Miller, O. M. Bubu, H. O. Taylor, R. Cobb, A. R. Trammell, and U. A. Mitchell wrote the manuscript.