Previous studies by the HCHDS used an innovative approach to explore race-related health disparities by studying variations in risk factors and poor health outcomes in an integrated community of lower-SES whites and blacks (specifically EHDIC-SWB). This approach addresses two important limitations in current health disparities research: the confounding of race and residential segregation and the confounding of race and SES. This integrated community study design allows for substantive control of often overlooked and/or unmeasured confounding variables. In this study we seek to expand on the Exploring Health Disparities in Integrated Communities Prince Georges (EHDIC-PG) Study. We will examine the role of John Henryism (a strategy for coping with prolonged exposure to stress;James, et al., 1994;1983) to determine the physical, mental and physiological health impacts of stress and discrimination on high-SES African Americans. We will call upon a complementary set of physical and mental health indicators including a novel Biomapping Method that allows for continuous ambulatory measures of physiological characteristics potentially linked to health disparities. Much of the research on health disparities has been limited to poor and underserved populations, but this study expands on current research and uses cutting edge methodology and novel applications of existing conceptual frameworks to understand health disparities among higher SES blacks and whites. The three specific aims of this study follow:
Specific Aim 1) To estimate the relationship between John Henryism and poorer health outcomes, including elevated blood pressure, self-reported physical and mental health problems, as well as increased rates of obesity, and lower cardio vascular fitness among affluent African Americans and whites.
Specific Aim 2) To estimate the relationship between discrimination and health among affluent African Americans and whites.
Specific Aim 3) To identify racial variation in ambulatory physiological measures of health and stress using an innovative biomapping protocol.

Public Health Relevance

This study will be the first to ascertain objective, real-world measures of physiological state and physiological fluctuations to explore disparities in health and well-being. This speaks to both the innovation and significance of this research. If, in fact, African Americans have elevated physiological markers of stress, these markers become potential targets for future preventive interventions that high-risk individuals can be trained to down regulate using a biofeedback model.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Comprehensive Center (P60)
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Special Emphasis Panel (ZMD1-RN)
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Johns Hopkins University
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Bell, Caryn N; Thorpe Jr, Roland J; LaVeist, Thomas A (2018) The Role of Social Context in Racial Disparities in Self-Rated Health. J Urban Health 95:13-20
Gaskin, Darrell J; Zare, Hossein; Vazin, Roza et al. (2018) Racial and Ethnic Composition of Hospitals' Service Areas and the Likelihood of Being Penalized for Excess Readmissions by the Medicare Program. Med Care 56:934-943
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