"Won't Kill Me, Won't Kill Me, Throw the Hammer Down and We'll be Free": How John Henryism Shapes Chronic Health Conditions Among African American and Caribbean Black Women

Background/Purpose: Black women report disproportionate rates of chronic health conditions (CHC), largely due to experiencing various forms of systemic oppression. John Henryism, or high-effort coping, is a culturally-relevant coping style that reflects the context shaping the lived experiences of Black populations navigating racism and capitalism in the U.S. Yet, there has been limited consideration of how this coping style shapes Black women’s health or the role of ethnicity in these processes. Therefore, the present study (1) assessed the association between John Henryism and CHC, accounting for sociodemographic characteristics and stressors; and (2) evaluated the interactive association between stressors, and John Henryism (i.e., does John Henryism buffer the impact of stress) on CHC.

Methods: This was a secondary analysis of the National Survey of American Life (NSAL 2001-2003), the most comprehensive study of mental disorders and health in Black Americans. Data and Sample: The analytic sample included 1,580 Black women, including 1,209 African American and 371 Caribbean Black women. 80% of the Caribbean Black women were US-born. Measures: Key variables for this study included John Henryism (α=0.82), categorized on the 25^th and 75^th percentiles (low, moderate and high); chronic health conditions (CHC), assessed via a count of health conditions; chronic stress and everyday discrimination (α=0.88), both measured via 10-item scales and summed; and goal-striving stress, measured from 4-items and categorized based on the 25^th and 75^th percentiles (low, moderate, and high). Age and SES (index of education and income) were measured continuously.

Analysis: Negative binomial logistic regression was used to estimate incidence rate ratios and 95% confidence intervals. Analysis was conducted among African American and Caribbean Black women collectively, and among Caribbean Black women separately, using STATA 17.0. The following modeling strategy was used: Model 1: CHC regressed on John Henryism; Model 2: CHC regressed on John Henryism, chronic stress, everyday discrimination, goal-striving stress, age, and SES; Model 3: interaction term between John Henryism and SES; Model 4: interaction term between John Henryism and chronic stress; Model 5: interaction term between John Henryism and everyday discrimination; and Model 6: interaction term between John Henryism and goal-striving stress. Appropriate survey weights were used.

Results: Overall, women reported moderate John Henryism, 2 chronic health conditions, a mean age of 43 years, low to moderate stress exposure, and low SES. John Henryism was not significantly associated with CHC among the collective group. Nevertheless, among Caribbean Black women who endorsed moderate John Henryism, for every one-unit increase in chronic stress, this group reported 1.48 times the rate of CHC, all else equal. In other words, among Caribbean Black women who endorsed moderate John Henryism, as chronic stress levels increased, the number of CHC also increased.

Conclusions and Implications: These findings collectively indicate that among Caribbean Black women who experience chronic stress, the protective threshold of John Henryism may be lower than expected and distinct from other Black women. This study underscores the necessity of evaluating intragroup variability among Black women to clarify health trends, which can inform the development of subsequent culturally-relevant health interventions.