The Relationship Between High Effort Active Coping and Risk Factors for Cardiovascular Disease in Resource Constrained Neighborhoods in Chicago

Rational: People living in poverty are at higher risk for cardiovascular disease then their high income counterparts. This trend may be due, in part, to increased exposure to chronic stressors, such as neighborhood disadvantage, and the strategies used to cope. The John Henryism hypothesis proposes that the use of high effort active coping in disadvantaged environments increases an individual’s risk for cardiovascular disease.  Despite the hypothesized interaction between John Henryism Active Coping (JHAC) and neighborhood disadvantage, studies to date have been limited by the use of individual level socioeconomic status as a proxy for disadvantaged environments. To address this gap we examined the relationship between JHAC, neighborhood disadvantage and their interaction on important risk factors for cardiovascular disease, hypertension and elevated body mass index (BMI).

Methods: This study tested the John Henryism hypothesis using data collected as part of the Chicago Community Adult Health Study (CCAHS) (N= 3105). In addition to individual surveys, systematic social observations (SSO) took place in virtually all (1664 of 1672) blocks in which survey respondents were sampled. In the current study neighborhood disadvantage was measured using indictors of poverty (2000 census), neighborhood stability (2000 census), land use (SSO), signs of disorganization (SSO) and select resources (SSO). To identify neighborhood typologies a latent class analysis was conducted at the neighborhood cluster level (N=343). The LCA results indicated that a two class solution was the best fitting model with a high entropy value (.96).  Classes were identified as low disadvantage and high disadvantage. John Henryism was measured with four items from the John Henryism Active Coping scale. Body mass index (BMI) was calculated using the respondents height (H) in meters and weight (W) in kilogram using the following equation: BMI= W/(H*H).  Hypertension was measured using systolic blood pressure (SBP) and diastolic blood pressure (DBP). Respondents were considered hypertensive if they had an average SBP of 140 mmHg or higher, an average DBP of 90 mmHg or higher or reported that they had taken antihypertensive medications in the last 12 months. To test the interaction between JHAC and neighborhood disadvantage multilevel regression models were estimated. All models controlled for age, sex, education and race.

Results: In multilevel regression models predicting BMI and hypertension neither the main effect of JHAC nor neighborhood disadvantage were significantly associated with BMI or hypertension; however, there were significant JHAC by disadvantage interaction effects on BMI (B(SE)=-1.99(.46), p<.001) and hypertension (B(SE)= -.42(.17), p<.01) where high JHAC was associated with low BMI/hypertension in the low disadvantage neighborhood but high BMI/hypertension in the high disadvantage neighborhoods.

Implications: Individuals using high effort coping strategies while living in high disadvantage/low resource neighborhoods have the highest risk for hypertension and elevated BMI, key risk factors for cardiovascular disease.  This study suggests that a person’s effort to improve their circumstances when living in a disadvantage neighborhood can negatively impact health; highlighting a fundamental injustice.  These structural barriers to optimal heath are necessary targets of health policy and social work interventions that aim to address health disparities.