Race, Stress, and Coping Mechanisms: Addressing the Cardiovascular Health Disparity Between Black and White Americans

Abstract

Cardiovascular disease, the number one cause of mortality in the United States (Yang et al., 2015), has become increasingly polarized with respect to race. In 1990, Black Americans had an 8 percent greater risk of mortality from cardiovascular disease than their White counterparts; today, this figure has more than tripled (Orsi et al., 2010). Several researchers have postulated that Black Americans have more genetic mutations and poorer lifestyles than White Americans, which predispose them to develop cardiovascular disease (Ackerman et al., 2003; Nakajima et al., 2004, Allen et al., 2010; Mozaffarian et al., 2015). Although lifestyle and genetic differences between Black and White Americans are well documented in the literature, recent evidence suggests that stress significantly contributes to the cardiovascular health disparity between White and Black Americans as well (Troxel et al., 2003; Sims et al. 2012). Black Americans are not only exposed to more stress than White Americans (Myers, 2009; Lee & Paxman, 1997; Tangney & Fischer, 2005), but recent evidence suggests that Black Americans are more at risk for cardiovascular disease because they perceive and cope with stress differently (Lepore et al., 2006; El-Khoury et al., 2004). The purpose of this thesis is to better understand the White-Black cardiovascular health disparity by examining how White and Black Americans perceive and cope with stress. In the present study, it was hypothesized that Black Americans are at a greater risk for cardiovascular disease because they perceive more stress in their environment and use less protective coping strategies compared to White Americans. The results only partially supported these hypotheses. Interestingly, Black participants reported higher risk than White Americans on only one risk factor, family history of heart attacks. Consistent with my hypothesis, Black participants reported that they experienced more stress and used more disengagement coping strategies (e.g. avoiding problems, wishful thinking, socially withdrawal, and self-criticism) than White participants; however, Black participants also used more engagement coping strategies (e.g. problem solving, cognitive restructuring, express emotions) than White participants. High perceptions of stress and disengagement coping predicted the presence of five risk factors for cardiovascular disease: high blood pressure, taking medication for high blood pressure, high levels of LDL cholesterol, low levels of HDL cholesterol, and smoking. The results of this study indicate that perceived stress and maladaptive coping strategies predict cardiovascular disease risk. Key words: cardiovascular disease, stress perceptions, coping, racial health disparities