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John Henryism and Superwoman Schema (SWS) are dispositional characteristics adopted to overcome the challenges of chronic psychosocial stress, and have particular salience for African American women. Both show protective and harmful effects on health and share conceptual similarities and distinctions, yet there is no empirical evidence of the potential overlap resulting in uncertainty about the unique roles they may each play concerning the health of African American women. We examined: 1) whether and to what extent John Henryism and SWS represent similar or distinct constructs relevant to the unique sociohistorical and sociopolitical position of African American women, and 2) whether the two differentially predict health outcomes. Data are from a purposive and socioeconomically diverse sample of 208 African American women in the San Francisco Bay Area. First, we conducted a progressive series of tests to systematically examine the conceptual and empirical overlap between John Henryism and SWS: correlation analysis, exploratory factor analysis (EFA), principal component analysis and k-modes cluster analysis. Next, we used multivariable regression to examine associations with psychological distress and hypertension. John Henryism and SWS were moderately correlated with one another (r s = 0.30–0.48). In both EFA and cluster analyses, John Henryism items were distinct from SWS subscale items. For SWS, feeling an obligation to present an image of strength and an obligation to help others predicted higher odds of hypertension (p < 0.05); having an intense motivation to succeed predicted lower odds (p = 0.048). John Henryism did not predict hypertension. Feeling an obligation to help others and an obligation to suppress emotions predicted lower levels of psychological distress (p < 0.05) whereas John Henryism predicted higher distress (p = 0.002). We discuss the implications of these findings for the measurement of culturally specific phenomena and their role in contributing to the unequal burden of ill health among African American women. • John Henryism and Superwoman Schema are statistically distinct constructs. • The two constructs represent unique forms of coping in African American women. • The two measures differentially predict psychological distress and pre/hypertension. • Understanding culturally-specific coping may inform how racism gets under the skin. • The findings have implications for understanding intersectional stress-coping dynamics. [ABSTRACT FROM AUTHOR]

In this article, we ask how city planners can reorient urban governance to focus on health equity? We explore health equity planning in the City of Richmond, California, where planners are leading an integrated strategy to promote equity by addressing structural racism and many place-based “toxic stressors.” We explore the evolution of Richmond’s health equity planning from integrating health into a general plan, to neighborhood-based interventions, violence reduction programs, and drafting a Health in All Policies (HiAP) equity-focused strategy and ordinance. We suggest that making health equity planning work demands an explicitly relational approach to urban governance. [ABSTRACT FROM AUTHOR]

Racial discrimination, a psychosocial stressor, may contribute to disproportionate rates of hypertension among African American women. Coping moderates the effects of psychosocial stress on health. Coping dispositions describe stable personality characteristics, whereas contextual frameworks emphasize flexible coping behaviors in response to specific stressful encounters. Using data from the African American Women's Heart and Health Study-a non-probability cross-section of 208 midlife African American women in Northern California-we estimated the association between everyday racial discrimination (Everyday Discrimination Scale, EDS) and prevalence of hypertension (HTN), and evaluated moderation by coping disposition (John Henryism Active Coping scale, JH) versus context-specific active coping behavior (Active Coping with Racism scale, ACR). There were no main associations between EDS, JH, or ACR on HTN prevalence. There was evidence of statistical interaction between EDS and ACR (p-int = 0.05), but not JH (p-int = 0.90). Among those with high levels of ACR, reporting monthly (prevalence ratio (PR) = 2.35, 95% confidence interval (CI) = 1.13, 4.87), weekly (PR = 2.15, 95% CI = 1.01, 4.61), or daily (PR = 2.36, 95% CI = 1.14, 4.88) EDS was associated with higher HTN prevalence, versus reporting racial discrimination yearly or less. In contrast, among those with low levels of ACR, reporting more chronic racial discrimination was associated with lower hypertension prevalence, although results were less precise. Findings suggest that ongoing active coping with chronic racial discrimination may contribute to hypertension risk among African American women., Competing Interests: The authors declare no conflict of interest.

Objectives. We conducted qualitative interviews with breast cancer survivors to identify themes related to institutional, personally mediated, and internalized discrimination in the medical setting. Methods. We conducted 7 focus groups and 23 one-on-one interviews with a multiethnic sample of breast cancer survivors randomly selected from a population-based registry covering the Greater San Francisco Bay Area, California. Results. Participants reported experiencing different forms of medical discrimination related to class, race, and language. Among African Americans, participants reported experiencing internalized discrimination and personal or group discrimination discrepancy--perceiving discrimination against them as a racial/ethnic group, yet not perceiving or discussing personal experiences of discrimination. Among Asian immigrants, participants reported experiencing institutional and personally mediated overt types of discrimination, including lack of access to quality and readily available translation services. Our results also indicated well-established coping mechanisms in response to discrimination experiences in both groups. Conclusions. Participants reported experiencing medical discrimination at all 3 levels, which may have deleterious health effects through the biopsychosocial stress pathway and through active coping mechanisms that could lead to delayed- or underutilization of the health care system to avoid discrimination. [ABSTRACT FROM AUTHOR]

Background: Little is known about the relation between perceptions of health care discrimination and use of health services.Objectives: To determine the prevalence of perceived discrimination in health care, its association with use of preventive services, and the contribution of perceived discrimination to disparities in these services by race/ethnicity, gender, and insurance status.Design, Setting, and Participants: Cross-sectional study of 54,968 respondents to the 2001 California Health Interview Survey.Measurements: Subjects were asked about experience with discrimination in receiving health care and use of 6 preventive health services, all within the previous 12 months.Methods: We used multivariate logistic regression with propensity-score methods to examine the adjusted relationship between perceived discrimination and receipt of preventive care.Results: Discrimination was reported by 4.7% of respondents, and among these respondents the most commonly reported reasons were related to type of insurance (27.6%), race or ethnicity (13.7%), and income (6.7%). In adjusted analyses, persons who reported discrimination were less likely to receive 4 preventive services (cholesterol testing for cardiovascular disease, hemoglobin A1c testing and eye exams for diabetes, and flu shots), but not 2 other services (aspirin for cardiovascular disease, prostate specific antigen testing). Adjusting for perceived discrimination did not significantly change the relative likelihood of receipt of preventive care by race/ethnicity, gender, and insurance status.Conclusions: Persons who report discrimination may be less likely to receive some preventive health services. However, perceived discrimination is unlikely to account for a large portion of observed disparities in receipt of preventive care. [ABSTRACT FROM AUTHOR]

The authors propose that perceived discrimination has an effect on self-reported health statuses, which are known to affect future morbidity and mortality. A sample of 3,012 Mexican-origin adults from the Mexican American Prevalence and Services Study in California is utilized to test this hypothesis. Dependent variables include a self-rating of health and a count of self-reported chronic conditions; the key independent variable is a scale of overall discrimination specific to one's Mexican origin. Results indicate that discrimination is related to poor physical health—net of controls for acculturation stress, national heritage, sociodemographic variables, and social support. Depression is identified as a major mechanism through which discrimination may affect physical health. Notably, job market stress/discrimination has a very strong association with poorer physical health, net of depression. Individual-level effects of discrimination found in this study, as well as institutional-level conditions and contextual effects, should be treated as crucial to future studies of individual-level physical health differentials. [ABSTRACT FROM AUTHOR]

Presents a study which investigated the association between racial discrimination and alcohol-related behavior in a sample of urban transit operators in San Francisco, California. Data and methods; Results; Conclusions.