Courtney S. Thomas Tobin

The National Survey of American Life (NSAL) has been pivotal in advancing sociological and psychological understandings of Black life in the United States. By centering the lived experiences of Afr...

Objectives: Obesity is common among older Black adults, but its underlying drivers, such as neighborhood racial composition (NRC), remain understudied. This study examined the association between NRC and obesity among older Black adults, evaluating the role of individual-level socioeconomic status (SES). Methods: Data from the Nashville Stress and Health Study was linked to five-year estimates from the American Community Survey. Obesity was defined as body mass index ≥30 kg/m ² . NRC was measured with the Index of Concentration at the Extremes. Results: After adjusting for demographic characteristics and health behaviors, older Black adults living in more Black-concentrated neighborhoods had lower obesity prevalence (PR = 0.76, 95% CI: 0.63–0.93) compared to those in more White-concentrated neighborhoods. However, after controlling for individual-SES this association was not significant (PR = 0.82, 95% CI: 0.65–1.04). Conclusion: Individual-SES may account for the relationship between NRC and obesity among older Black adults.

Background and Objectives: Black Americans have the highest rates of hypertension worldwide, yet the social and psychological mechanisms driving this disparity in older adulthood are not well established. Discrimination is theorized as a salient chronic stressor with implications for cardiovascular health, though findings linking discrimination to hypertension remain mixed. This study examined the role of positive reappraisal, a coping strategy, as a moderator of the association between discrimination and hypertension among older Black adults. Research Design and Methods: Data were drawn from the Nashville Stress and Health Study, a population-based sample in Davidson County, TN. Analyses focused on 273 Black respondents aged 50 and older. Modified Poisson regression models with robust standard errors were used to estimate direct associations between discrimination and positive reappraisal with physician-diagnosed hypertension, adjusting for sociodemographic covariates. We then included a discrimination × positive reappraisal interaction to this model. Results: Greater discrimination was associated with lower hypertension risk (RR = 0.89, 95% CI: 0.79–0.99). Positive reappraisal was not directly associated with hypertension, but the discrimination x positive reappraisal interaction was significant (RR = 1.07, 95% CI: 1.02–1.12), indicating that the association between discrimination and hypertension varied by levels of positive reappraisal. Discussion and Implications: Findings highlight the complex, context-dependent ways that older Black adults cope with racism-related stress. While positive reappraisal may buffer hypertension risk when discrimination is low, alternative strategies may be more protective when discrimination is high. These results underscore the need for culturally grounded interventions that address both exposure and coping in promoting cardiovascular health equity.

The John Henryism hypothesis (JHH) suggests high John Henryism may adversely affect the health of individuals with low socioeconomic status (SES). Although prevalent among Black Americans, its impact on Black women’s mental health across ethnic subgroups remains understudied. Using National Survey of American Life data (2001–2003), a factor analysis and negative binomial regression examined John Henryism patterns and psychological distress among 1,209 African American and 371 Caribbean Black women. Distinct factor structures indicated the need for group-specific versions of John Henryism variables to capture its role within each population. The analysis found no direct link between John Henryism and distress for either group. However, after accounting for sociodemographic factors and stressors, high John Henryism was associated with lower distress among Caribbean Black women. Evidence supporting the JHH was found only among Caribbean Black women, where John Henryism was protective for those with low and moderate SES but unrelated to distress for high-SES individuals.

Despite overall improvements in the accessibility, quality, and outcomes of care in the U.S. health care system over the last 30 years, a large proportion of marginalized racial and ethnic minority (minoritized) groups continue to suffer from worse outcomes across most domains. Many of these health disparities are driven by inequities in access to and the scope of society’s health-affirming structural resources and opportunities commonly referred to as structural drivers or social determinants of health—SDoH. Persistently health-undermining factors in the social environment and the downstream effects of these inequities on neurocognitive and biological pathways exacerbate these disparities. The consequences of these circumstances manifest as behavioral, neurohormonal, immune, and inflammatory and oxidative stress responses, as well as epigenetic changes. We propose a theoretical model of the interdependent characteristics of inequities in the SDoH driven by race-based discriminatory laws, policies, and practices that eventually culminate in poor health outcomes. This model provides a framework for developing and validating multi-level interventions designed to target root causes, thereby lessening health disparities and accelerating improved health outcomes for minoritized groups.

Prior disparities in obesity research emphasize socioeconomic status as a potential driver of White-Black differences in obesity prevalence, but there is a paucity of research examining the influence of education on the observed racial difference among men. The objective of this study was to determine whether the relationship between race and obesity varies by education level among Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) men. We used 1999 to 2016 National Health and Nutrition Examination Survey data consisting of a sample of 13,583 men (9,459 NHW and 4,124 NHB). Race and Ethnicity were determined by self-reports of whether they were Hispanic or not and their racial group. Education was based on self-reporting of the highest grade level or level of school completed and categorized as: less than high school, high school diploma or General Equivalency Diploma, some college or associate degree, and college degree or above. Thirty-four percent of the men were obese (body mass index [BMI] > 30 kg/m ² ); a higher proportion of NHB men reported being obese than NHW men (36.0%, n = 1,508, vs. 33.8%, n = 3,140; p = .049). Adjusting for age, marital status, income, insurance status, smoking status, drinking status, self-rated health, physical inactivity, and the number of chronic conditions, NHB men with a college degree or above had a higher prevalence of obesity (prevalence ratio: 1.21, confidence interval [1.06, 1.39]) than NHW men. Findings suggest that among college-educated NHW and NHB men, there is a relationship between race/ethnicity and obesity prevalence.

High allostatic load (AL), a measure of physiological dysregulation, has been linked with premature morbidity and mortality. There is a paucity of research assessing AL among non-Hispanic Black (NHB) and non-Hispanic White (NHW) American men of various age groups. This study investigated racial differences in AL among NHB and NHW adult men and assessed whether racial differences in AL varied by age. Data were drawn from NHB ( n = 232) and NHW ( n = 246) men in the Nashville Stress and Health Study. AL was based on the sum of 10 biomarkers that was dichotomized as high AL (four or more high-risk biomarkers) or low AL (fewer than four high-risk biomarkers). Modified Poisson regression models were estimated to assess race differences in AL, adjusting for age, socioeconomic status (SES), and health behaviors. Interactions assessed whether racial differences in AL varied between young (22–49 years) and older (50–69) men. NHB men had a higher prevalence of being in the high AL group (prevalence ratio [PR] = 1.54, confidence interval [CI] = [1.09, 2.18]), relative to NHW men in the total sample. Among young men ages 22 to 49 years, NHB men had a higher prevalence of being in the high AL group (PR = 2.09, CI = [1.25, 3.49]), relative to NHW men. Among older men ages 50 to 69 years, there were no racial differences in AL. Findings underscore the importance of identifying factors that are associated with high AL, which is critical to mitigate premature morbidity and mortality, among NHB men.

Informed by Black feminist thought and intersectionality, Superwoman Schema (SWS) is a construct that captures a collective response of Black women to racial and gender marginalization by highlighting expectations that they exude strength, suppress emotions, resist vulnerability, succeed despite limitations, and help others to their own self-neglect. Using a sample of Black women (N = 390) in early-midlife (between 30 and 46 years old; M = 37.54 years; SD = 4.29), this study integrates the intersectionality framework and the stress process model to examine the independent and interactive effects of SWS endorsement as well as socioeconomic status (SES) and financial strain on Black women’s mental health. Study results reveal that SWS dimensions “emotion suppression” and “obligation to help others” are associated with elevated depressive symptoms. In addition, net worth and financial strain, but not traditional measures of socioeconomic status such as education and income, moderate the association between SWS endorsement and depressive symptoms. Specifically, the association between SWS and depressive symptoms is strongest among Black women reporting negative net worth or high financial strain (e.g., not being able to make ends meet). Broader implications and future research directions are discussed.

Awareness of racial health care inequities is one prerequisite to eliminating them. Although extant research has described awareness of racial health care inequities in the United States, the health impacts of such awareness on communities that are most impacted by these inequities remains unknown. Therefore, we examined associations between awareness of Black-White racial health care inequities and self-rated health for Black and White adults in the United States. We used survey data from non-Hispanic Black and White participants (N = 6,449) who responded to the national American Health Values Survey (2015-2016) to test associations between awareness of Black-White inequities in health care and self-rated health. Accurate awareness of health care inequities was associated with 47% higher odds of poorer self-rated health for Black individuals. Inaccurate awareness was associated with 36% higher odds of poorer self-rated health for White individuals. Accurate awareness may be adaptive, yet place an additional burden on Black individuals. Inaccurate awareness may harm White individuals' health. Health care system changes and alleviation of racism-related stress may be preventive supports for the health of Black individuals. Accurate awareness should be a goal for White individuals, not only to prevent health risks, but to also facilitate structural change for racial equity.