Dwayne T. Brandon

Social context as an explanation for race disparities in hypertension: Findings from the Exploring Health Disparities in Integrated Communities (EHDIC) Study

Disparities in hypertension between African Americans and non-Hispanic whites have been well-documented, yet an explanation for this persistent disparity remains elusive. Since African Americans and non-Hispanic white Americans tend to live in very different social environments, it is not known whether race disparities in hypertension would persist if non-Hispanic whites and African Americans were exposed to similar social environments. We compared data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) Study with the National Health and Nutrition Examination Survey (NHANES) 1999-2004 to determine if race disparities in hypertension in the USA were attenuated in EHDIC-SWB, which is based in a racially integrated community without race differences in income. Hypertension was defined as systolic blood pressure (BP) > or = 140 mmHg (millimeters of mercury) and/or diastolic BP > or = 90 mmHg or respondents report of taking antihypertensive medications. Of the 1408 study participants, 835 (59.3%) were African American, 628 (44.6%) were men, and the mean age was 40.6 years. After adjustment for potential confounders, various analytic models from EHDIC-SWB and NHANES 1999-2004 data, we found the race odds ratio was between 29.0% and 34% smaller in the EHDIC-SWB sample. We conclude that social and environmental exposures explained a substantial proportion of the race difference in hypertension.

Stress, coping, and health outcomes among African-Americans: a review of the John Henryism hypothesis

The John Henryism (JH) hypothesis argues that prolonged high-effort coping with chronic psychosocial stressors may be associated with elevated risk for negative health outcomes among those without sufficient socioeconomic resources. Early JH studies found a significant association between high JH, low socioeconomic status, and hypertension among African-Americans. More recently, these findings have been extended to a wide array of health status outcomes, including cardiovascular reactivity, neurohormonal secretion, and negative health behaviors. The present review provides a comprehensive overview of JHs conceptual bases and empirical support. Limitations of the construct are discussed and recommendations are made to guide future theoretical and research efforts in the area.

Segregation and Disparities in Health Services Use

We compared race disparities in health services use in a national sample of adults from the 2002 Medical Expenditure Panel Survey and data from the Exploring Health Disparities in Integrated Communities Project, a 2003 survey of adult residents from a low-income integrated urban community in Maryland. In the Medical Expenditure Panel Survey data, African Americans were less likely to have a health care visit compared with Whites. However, in the Exploring Health Disparities in Integrated Communities Project, the integrated community, African Americans were more likely to have a health care visit than Whites. The race disparities in the incidence rate of health care use among persons who had at least one visit were similar in both samples. Our findings suggest that disparities in health care utilization may differ across communities and that residential segregation may be a confounding factor.

Does Intact Pair Status Matter in the Study of African American Twins? The Carolina African American Twin Study of Aging

In twin research, typically both members of a pair must participate. Survivorship of members of intact pairs compared to surviving members of nonintact twin pairs may reflect differences in psychosocial and health factors, and represent a potential selection bias relative to the general population. The purpose of the present study is to examine health, cognition, and well-being among members of African American intact twin pairs compared to individuals from nonintact twin pairs. Data from the Carolina African American Twin Study of Aging (CAATSA) were used for analyses. Subjects ranged in age from 25 to 89 years of age (mean=59.78 years, SD=12.84 years). CAATSA implements a 3-h protocol to collect data on demographics, health, cognition, and well-being. Data from one randomly selected member of each twin pair (N=78) was compared to data from surviving members of nonintact twin pairs (N=52). The results indicated significant differences on 11 of the 39 measures (i.e., age, education, forced expiratory volume, mean standing and sitting systolic and diastolic blood pressures, cognitive impairment score, alpha span, digit symbol, and logical memory). In each case, members of intact twin pairs performed better than surviving members of nonintact twin pairs. After controlling demographic variables, only blood pressures differed between the groups. It appears that using only pairs in research on older African American twins may represent a selection bias in estimating origins of individual variability in cognitive functioning and health but not psychological well-being.

Does coping mediate the relationship between personality and cardiovascular health in African Americans

Few studies have examined traits or behaviors that may predispose some African Americans to poor cardiovascular health outcomes. While several models of personality exist, the 5-factor model (FFM) is arguably the best representation of personality and provides a useful framework for the study of personality and health. Among personality characteristics associated with health risks among African Americans, a high-effort coping style called John Henryism is among the most thoroughly examined. It is not clear if personality coping and health are connected in a meaningful way. The present study utilized data from the Baltimore Study of Black Aging (BSBA) to examine whether personality was linked to John Henryism, how personality might be linked to cardiovascular health, and how John Henryism might mediate the relationship between personality and cardiovascular health. The sample consisted of 234 older African Americans (mean age, 67 years), 28% of which were men. Regressions were used to examine the questions. The results indicated that those who are more neurotic report more cardiovascular health problems, and that openness and conscientiousness were significant predictors of active coping. The mediation analysis results suggest that coping style did not mediate the relationship between personality and reports of cardiovascular health problems. These findings highlight the importance of personality in accounting for cardiovascular health in African Americans.

Genetic and environmental influences on depressive symptoms by age and gender in African American twins.

Depression is typically considered relative to individuals and thought to originate from both biological and environmental factors. However, the environmental constraints and insults that African Americans experience likely influence the concordance by age and gender for depression scores among adult African American twins. Monozygotic (MZ) (n = 102) and Dizygotic (DZ) (n = 110) twins, age 25–88 years in the Carolina African American Twin Study of Aging were examined using an 11-item version of the CES-D measure of depressive symptomatology. Those participants with scores above nine were considered depressed. Overall, the MZ pairs had a higher concordance than the DZ pairs implying genetic influence. Both MZ and DZ males had higher concordances than either female zygosity groups. The difference between the concordance rates for MZ and DZ twin pairs was greater in males than females. By age group, the difference between the concordance rates for younger MZ and DZ twin pairs was much larger than for older pairs. The results suggest that, even though African Americans may be at risk for depression due to contextual/environmental factors, genetic influences remain important.

Sociocultural Influences in Genetic Designs of Aging: Unexplored Perspectives

As the aging population continues to become more diverse, there is growing interest in understanding the similar and unique aspects of aging within and across people of different ethnic groups. The impact of culture on the sources of variation identified in quantitative genetic approaches has not been well discussed in the literature. The purpose of this paper is to review previous research pertinent to the cultural aspects of quantitative genetic approaches and methodologies, and provide conceptual and statistical approaches for advancing the science. To meet this objective, results from previously published studies as well as preliminary data analyses from the Carolina African American Twin Study of Aging will be presented. There are three themes to draw from the issues discussed in this paper: (1) avoiding genetic reductionism, (2) interpreting differential heritabilities, and (3) modeling cultural influences.

Feeling No Ways Tired: A Resurgence of Activism in the African American Community

A considerable amount of the literature on African American activism has been focused on the mainstream political participation and the civil rights and Black Power movements. Subsequent research in this era has primarily focused on the church and post–civil war reconstruction efforts. Few contemporary studies have assessed activist efforts among African Americans and the factors that may influence their involvement. The current study investigates what factors are related to activism among African American church members. To better understand the factors that influence activism, 187 African American church members from two Midwestern cities were sampled. Employing Pearson correlations and hierarchical regression analysis revealed that racial centrality, psychological empowerment, and activism each significantly influence activist behavior among African Americans. Given the zeitgeist of the times (i.e., Ferguson, Eric Garner, and the Black Lives Matter movement), further research is needed to understand what factors may encourage African Americans to become involved and effectuate change in their respective communities.