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Population health scientists have largely overlooked anticipatory stressors and how different groups of people experience and cope with anticipatory stress. I address these gaps by examining black-white differences in the associations between an important anticipatory stressor—goal-striving stress (GSS)—and several measures of psychophysiology. Hypotheses focusing on racial differences in GSS and psychophysiology are tested using self-report and biomarker data from the Nashville Stress and Health Study (2011-2014), a cross-sectional probability survey of black and white working-age adults from Davidson County, Tennessee (n=1,252). Compared to their white peers, blacks with higher GSS report greater self-esteem and fewer symptoms of depression and anxiety. However, increased GSS also predicts elevated levels of high-effort coping (i.e., John Henryism), neuroendocrine stress hormones, and blood pressure for blacks but not whites. I discuss the implications of these findings for scholars interested in the stress process and broader black-white health inequalities in the United States.
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Journal of Health and Social Behavior
1 –19
© American Sociological Association 2020
DOI: 10.1177/0022146520901695
Original Article
The stress process paradigm conceives of individ-
ual health outcomes as resulting from a dynamic
interplay between a person’s various social sta-
tuses, stress exposures, and coping resources and
strategies (Pearlin et al. 1981). Stressors refer to
circumstances that require people to respond in
ways that deplete their adaptive capacities and are
typically conceptualized as being either acute (e.g.,
major life events) or chronic (e.g., financial hard-
ship) in nature (Turner, Wheaton, and Lloyd 1995).
Effective coping is also thought to mitigate the
adverse health effects of stressors. The conven-
tional wisdom in the coping literature is that people
who enlist proactive coping strategies tend to expe-
rience better health than their peers with more pas-
sive or avoidant coping styles (Pearlin and Bierman
Despite considerable progress in our understand-
ing of the stress process, important issues in this
area of study remain unresolved. For one, the
consequences of anticipatory stressors have been
mostly overlooked. Unlike concrete events and
strains, anticipatory stressors “do not exist as reali-
ties but are viewed as having the potential to become
so” (Pearlin and Bierman 2013:328). The neglect of
anticipatory stressors is troubling given that human
beings appear to be uniquely susceptible to anticipa-
tory distress when compared to other nonhuman
animals. Indeed, the human brain has evolved highly
complex cortical structures capable of anticipating
and responding to a wide variety of environmental
901695HSBXXX10.1177/0022146520901695Journal of Health and Social BehaviorDeAngelis
1University of North Carolina at Chapel Hill and
Carolina Population Center, Chapel Hill, NC, USA
Corresponding Author:
Reed T. DeAngelis, Department of Sociology, University
of North Carolina at Chapel Hill, 155 Hamilton Hall,
CB #3210, Chapel Hill, NC 27599, USA.
Striving While Black: Race
and the Psychophysiology of
Goal Pursuit
Reed T. DeAngelis1
Population health scientists have largely overlooked anticipatory stressors and how different groups
of people experience and cope with anticipatory stress. I address these gaps by examining black-
white differences in the associations between an important anticipatory stressor—goal-striving stress
(GSS)—and several measures of psychophysiology. Hypotheses focusing on racial differences in GSS and
psychophysiology are tested using self-report and biomarker data from the Nashville Stress and Health
Study (2011–2014), a cross-sectional probability survey of black and white working-age adults from
Davidson County, Tennessee (n = 1,252). Compared to their white peers, blacks with higher GSS report
greater self-esteem and fewer symptoms of depression and anxiety. However, increased GSS also predicts
elevated levels of high-effort coping (i.e., John Henryism), neuroendocrine stress hormones, and blood
pressure for blacks but not whites. I discuss the implications of these findings for scholars interested in the
stress process and broader black-white health inequalities in the United States.
anticipatory stress, black-white paradox, goal-striving stress, high-effort coping, John Henryism, skin-deep
2 Journal of Health and Social Behavior 00(0)
stimuli (Barrett 2017; Massey 2001). Although
adaptive in the short term, our brain’s ability to
anticipate calamities can also become hyperactive
and problematic for health over time (O’Donovan
et al. 2012; Sapolsky 1998). This appears to be espe-
cially true for people occupying precarious socio-
economic positions who must remain hypervigilant
to cues of impending adversity (Pearlin and Bierman
2013; Wilson and Mossakowski 2009).
Another shortcoming of the stress process litera-
ture is that researchers rarely consider how different
social groups experience and attribute various mean-
ings to the same psychosocial stressor (McLeod
2012; Pearlin and Bierman 2013). As McLeod
(2012:176) points out, the vast majority of stress
process research has focused on “objective social
origins of distress,” or how macrolevel social arrange-
ments influence group differences in stress exposures,
available coping resources, and health outcomes.
This methodological focus is narrow, however,
because it assumes the same stressor will entail
identical meanings and experiences for different
groups of people.
The “black-white health paradox” in the United
States serves as an illustrative case study of these
unresolved ambiguities of stress and coping (see
Hummer and Hamilton 2019; Louie and Wheaton
2019). Population health scientists have noted for
decades that white Americans, despite enjoying con-
siderable structural and material advantages, tend to
experience greater emotional distress than their black
peers when faced with the same psychosocial
stressor (Kessler 1979; Malat, Mayorga-Gallo, and
Williams 2018). At the population level, whites also
exhibit higher rates of psychiatric disorders such as
major depression, anxiety, suicide, and substance
dependence. Nevertheless, blacks are still signifi-
cantly more likely than whites to die prematurely
from cardiometabolic disease, cancer, and other
chronic health conditions. Although several explana-
tions have been offered, the jury is still out concern-
ing the underlying mechanisms responsible for this
paradox (Hummer and Hamilton 2019:151–54).
The present study addresses these gaps in our
knowledge of the stress process and black-white
health inequalities in the United States. Drawing
from literatures on anticipatory stress and racial dif-
ferences in coping, I contend that the black-white
health paradox at least partially stems from how
black and white Americans are socialized to antici-
pate failure. Most white Americans are socialized to
perceive themselves as atomized individuals acting
within a fully meritocratic society (Bonilla-Silva
2017; Kraus et al. 2012) and thus tend to experience
severe distress whenever they confront unfair treat-
ment or structural barriers to their aspirations
(Hicken, Lee, and Hing 2018; Malat et al. 2018).
Black Americans, on the other hand, are socialized
to develop contextualized self-concepts that are
better attuned to external environments and con-
straints (Bentley, Adams, and Stevenson 2008;
Brown 2008; Coard and Sellers 2005; Kraus et al.
2012). While this unique socialization process can
bolster psychosocial resilience in the face of barri-
ers to attainment (Barbarin 1993; Brown 2008;
Fischer and Shaw 1999), it can also promote high-
effort coping strategies that tax physiological stress
responses and eventually lead to poor physical
health (Gaydosh et al. 2018; James 1994).
In what follows, I first introduce a neglected
survey measure of anticipatory stress: the goal-
striving stress (GSS) scale. I then develop hypothe-
ses for why black and white Americans should
experience GSS in fundamentally different ways
and thereby express distinct stress and coping pro-
cesses. Next, I test my study hypotheses with rich
self-report and biomarker data from the Nashville
Stress and Health Study (2011–2014), a probability
survey of non-Hispanic black and white working-
age adults from Davidson County, Tennessee (n =
1,252). My analyses reveal substantial black-white
disparities in the associations between GSS and
self-esteem, high-effort coping, psychological dis-
tress, neuroendocrine stress hormones, and blood
pressure. I close by discussing the implications of
my findings for scholars concerned with the stress
process and black-white health inequalities in the
United States.
Goal-striving Stress
The GSS scale measures the perceived gap between
a person’s current achievements and aspirations and
weights this gap by their desire for and anticipation
of future success. Someone with high GSS per-
ceives a sizable achievement-aspiration gap, would
be highly disappointed by failure, but anticipates a
low probability of future success. Sociologists
Seymour Parker and Robert Kleiner (1966) origi-
nally developed the GSS scale to measure the psy-
chosocial strains experienced by black Americans
striving for upward mobility in the wake of desegre-
gation and the civil rights movement. Fundamentally,
Parker and Kleiner appeared to be responding to
what W.E.B. Du Bois intimated decades earlier in
The Philadelphia Negro, which was that ongoing
DeAngelis 3
experiences with “unrewarded merit and reasonable
but unsatisfied ambition” were unique social causes
of distress for emancipated black Americans (Du
Bois 1899:351).
The GSS scale is an augmented version of
Hadley Cantril’s (1965) self-anchored striving
scale. The basic method is to show respondents an
image of a 10-rung ladder and instruct them to
imagine that the bottom and top rungs represent
their “worst” and “best” possible ways of life,
respectively. Respondents are then asked to report
where on the ladder they perceive themselves to be
now and where they expect to be in the future. The
idea, in Cantril’s words, was to construct a measure
of social status “anchored within an individual’s
own reality world” (Cantril 1965:25). Akin to other
validated and widely implemented scales of subjec-
tive well-being (e.g., Scheier and Carver 1985),
self-anchored striving scales measure a person’s
cognitive averaging of their current achievements
and aspirations relative to broader sociocultural ref-
erents for success (Andersson 2015).
Although they share fundamental characteristics,
the GSS scale diverges from Cantril’s (1965) scale in
notable ways. First, the GSS scale also measures the
emotional valence respondents attach to their goals
by asking them how disappointed they would be by
failure. This added component is informative because
merely asking respondents to rank their achievements
and aspirations does not directly account for feelings
of relative deprivation or how strongly respondents
desire to bridge their achievement-aspiration gap (see
Smith et al. 2012). For instance, someone could very
well acknowledge that their current social ranking is
inferior to an idealized reference group (e.g., million-
aires) and may even entertain pipe dreams about one
day joining this group themselves, but they could still
feel content with their lot and therefore lack any real
motivation to achieve higher status in the coming
Second, the GSS scale also accounts for the
anticipation of failure by asking respondents to
report their subjective likelihood of future success.
This added item is what makes the GSS scale a dis-
tinctly sociological measure of individual goal pur-
suit vis-à-vis perceived opportunity structures. Emile
Durkheim ([1897] 1951) was perhaps the first soci-
ologist to identify dysregulated goal pursuits as
unique social determinants of population well-being.
Durkheim suggested that one role of society is to
regulate individual ambitions by preserving a har-
mony between culturally prescribed goals and the
socially structured means of attainment. Whenever a
given society loses its ability to effectively channel
individual aspirations toward desired social out-
comes, many people will begin to suffer from pro-
found feelings of normlessness and despair (see also
Agnew 1997).
Robert Merton (1938, 1968) advanced Durkheim’s
work by describing the individual effects of thwarted
goals in more detail. Merton (1938:38) suggested, in
a nutshell, that many behaviors and emotions we
label as deviant are predictable responses to the
“dissociation between culturally defined aspirations
and socially structured means.” In subsequent work,
Merton (1968) then elaborated on why the sociocul-
tural environment of the United States is a breeding
ground for strained ambitions and failure. The
United States is peculiar, Merton noted, because our
dominant success ethos—namely, the “American
Dream” ideology—universally prescribes all citizens
to strive for material gain while negating the reality that
opportunity structures block many hardworking people
from achieving success based on their ascribed sta-
tuses of race, gender, and familial social class.
According to Merton, these socio cultural contradic-
tions should create psychosocial strains for many
people and ultimately push them toward maladap-
tive coping behaviors (see also McNamee and
Miller 2014; Messner and Rosenfeld 2001).
Despite its clear affinities with sociological the-
ory, sociologists entirely ignored the GSS scale
until only very recently. Within the past decade, a
small group of sociologists and epidemiologists
have reinvigorated research into GSS, linking high
levels of GSS to increased psychological distress
(DeAngelis and Ellison 2018; Neighbors et al.
2011; Sellers and Neighbors 2008), weakened
self-concept (DeAngelis 2018), subjective social
isolation (DeAngelis and Ellison 2018), and physi-
ological dysregulation (Cain et al. 2019; Sellers
et al. 2012). However, we still know very little
about black-white differences in the effects of GSS.
One study found that GSS predicted worse mental
health for whites than blacks (Neighbors et al.
2011), but this study could not resolve whether GSS
also predicted black-white differences in physiol-
ogy. A second study found that GSS was associated
with more self-reported physical health problems
for Caribbean blacks than whites and African
Americans (Sellers et al. 2012), but this study found
no racial differences in the associations between
GSS and blood pressure or body mass index (BMI).
These unresolved issues are important to rectify
because, as I demonstrate in the following section,
there are good reasons to believe GSS will predict
4 Journal of Health and Social Behavior 00(0)
worse psychological functioning for whites but
worse physiological functioning for blacks.
Race and the Psychophysiology of Goal
Before continuing, I should note that my study is not
concerned with whether average levels of exposure
to GSS vary for blacks and whites. In this sense, I
expect blacks to exhibit higher average levels of
GSS than whites given blacks are exposed to more
barriers to attainment. Rather, the present study is
focused on how blacks and whites differ in their
experiences and styles of coping with equal levels of
GSS and how such differences might surface as
unique psychophysiological profiles (see Kessler
GSS is intimately linked to the self-concept
(DeAngelis 2018). According to the self-attribution
principle, people derive their sense of competence
and self-worth through repeated opportunities to
materialize life goals (Rosenberg 1986). That is,
personal experiences over the life course condition
people to attribute their successes and failures
either to their own agency or to powerful external
forces (Pearlin and Schooler 1978). But individual
self-attributions do not occur within a vacuum—
people also take cues from the larger society and
learn how to interpret their strivings in accordance
with broader cultural schemas about who succeeds
and why (Rosenberg 1986:76; Skaff and Gardiner
2003). This latter point is important to remember
because the dominant success myths in the United
States admonish individuals to assume sole respon-
sibility for their life outcomes, thereby glossing
over the presence of structural barriers to attain-
ment (Hochschild 1995; McNamee and Miller
2014; Merton 1968).
Although dominant success narratives in the
United States often undergird white supremacism—
indeed, the same meritocratic principles underlying
the American Dream have been used for centuries
to demonstrate the supposed inferiority of racial
minorities (Bobo, Kluegel, and Smith 1997; Feagin
1975)—these same narratives can also become
oppressive for whites who feel they are failing.
Ironically, many whites buy into meritocratic ideals
with such strong conviction that they become
blinded to broader class-based structures impinging
on their aspirations (Malat et al. 2018; Metzl 2019).
This is because whites historically have enjoyed the
luxury of being able to perceive themselves as
unfettered individuals in a free society rather than
as members of an oppressed group, a structural
advantage that makes meritocratic principles appear
all the more compelling to them (Bonilla-Silva 2017;
Kraus et al. 2012). Consequently, whites who are
failing to achieve their goals should be more
inclined to attribute their failures to their own short-
comings, which could lead to feelings of lowliness
and incompetence (DeAngelis 2018). For strug-
gling whites who do eventually accept that their
aspirations are beyond their control, this grudging
acceptance may usher in a profound sense of help-
lessness and despair (DeAngelis and Ellison 2018).
Experiences with GSS should be markedly dif-
ferent for black Americans. Opportunity structures
in the United States have been systematically engi-
neered to favor whites at the expense of blacks
(Rothstein 2017). Blacks are therefore poorly posi-
tioned in the stratification hierarchy to recover from
thwarted goals, which means the stakes of failure
tend to be much higher for blacks than whites
(Malat et al. 2018). Moreover, even blacks who do
manage to achieve success still have to contend
with the added burden of cultural racism, or the
“instillation of the ideology of [black] inferiority
in the values, language, imagery, symbols, and
unstated assumptions of the larger society”
(Williams, Lawrence, and Davis 2019:110). All this
is to say that unlike whites, blacks must navigate a
toxic sociocultural environment in which GSS is a
permanent fixture of their lives (Feagin and Sikes
1994; Parker and Kleiner 1966).
For these reasons, blacks have adapted a unique
coping orientation to navigate U.S. society in the
wake of emancipation and desegregation. Sherman
James (1994:178) referred to this coping style as
“John Henryism,” which he defined as the “strong,
explicit emphasis on hard work and self-reliance,
and [an] equally strong but more implicit emphasis
on resistance to environmental forces that arbi-
trarily constrain personal freedom.” Many blacks
are therefore socialized from an early age to antici-
pate hostility from the larger society and to stick
close to the black community for support (Brown
2008; Daly et al. 1995). Through this racial social-
ization process, blacks are also exposed to counter
narratives about what it takes to “make it” in the
United States, which typically account for the pres-
ence of powerful external barriers to their aspira-
tions (Bentley et al. 2008; Coard and Sellers 2005).
Because blacks are often taught from an early
age to anticipate setbacks due to forces beyond their
control, they should be less likely than whites to
internalize their failures or suffer emotional shock
from GSS. As already mentioned, one study did
indeed find that GSS predicted significantly less
DeAngelis 5
psychological distress for blacks than whites
(Neighbors et al. 2011). Other studies have found
that people who attribute their life outcomes to
external forces beyond their control—be they cor-
rupt opportunity structures or divine agency—tend
to enjoy enhanced self-esteem and less psychologi-
cal distress from GSS (DeAngelis 2018; DeAngelis
and Ellison 2018; Sellers, Neighbors, and Bonham
2011). The takeaway from these studies appears to
be that relinquishing personal responsibility for
failures can help people with high GSS preserve
their self-esteem (DeAngelis 2018), which can be
especially helpful for marginalized groups and indi-
viduals with heavily constricted social agency
(DeAngelis and Ellison 2018).
While blacks may enjoy a relative psychosocial
advantage over their white peers, the concomitant
physiological effects of GSS could be more sinister
for blacks. An emerging literature on the “skin-deep
resilience” of upwardly mobile blacks has revealed
substantial physiological costs associated with
enlisting proactive and high-effort coping strategies
in the face of structural barriers to attainment.
Studies in this field have shown that blacks who
strive for upward mobility against a backdrop of
socioeconomic marginalization report considerable
mental acuity and resilience even as they endure
physiological deterioration (see Gaydosh et al.
2018). Although such chronic and high-effort cop-
ing can affect the body in various ways (McEwen
1998), the hypothalamic-pituitary-adrenal (HPA)
axis has been identified as a key system responsible
for mediating physiological responses to anticipa-
tory social stressors and is thus a central focus of
my study (Goosby, Cheadle, and Mitchell 2018;
Sapolsky 1998).
The HPA axis functions as a series of feedback
loops that activate after the body’s initial fight-or-
flight response to an acute stressor (see Spencer and
Deak 2017). A cluster of neurons in the hypothala-
mus section of the brain first secretes corticotropin-
releasing hormone (CRH), which travels to the
pituitary gland where it initiates the release of adre-
nocorticotropic hormone (ACTH). ACTH then
travels through the bloodstream to the adrenal gland
where it initiates the release of cortisol. The func-
tion of cortisol is to then (a) suppress long-term
bodily functions related to digestion, growth, repro-
duction, and inflammation; (b) redirect stores of
glucose, proteins, and fatty acids back into the
bloodstream; and (c) restrict blood vessels to signal
the heart to pump blood harder and faster. Within a
period of minutes or hours, cortisol serves the
highly adaptive function of providing the body with
energy to surmount stressors. Nonetheless, people
who must constantly anticipate and respond to
stressors over periods of weeks, months, or even
years can succumb to hypercortisolism whereby the
body loses its ability to effectively inhibit cortisol
secretion (Saplosky 1998).
The collective realization among black Americans
that their aspirations are often at the mercy of forces
beyond their control could therefore be a double-
edged sword. While this awareness can help buffer
negative self-attributions of failures and thereby pre-
serve critical psychosocial resources, it could also
motivate high-effort coping strategies that tax physi-
ological stress responses. Such dogged goal striving
in the face of barriers to attainment could ultimately
put blacks at higher risk of hypercortisolism and ele-
vated blood pressure, both of which have been linked
with chronic anticipatory distress and HPA axis dys-
regulation (Eddy et al. 2018; James 1994; Sapolsky
Summary of Hypotheses
According to my theoretical perspective, high levels
of GSS should be associated with feelings of worth-
lessness and despair for whites more so than for
blacks. At the same time, high levels of GSS should
lead to high-effort coping and elevated physiologi-
cal stress responses for blacks more so than for
whites. I therefore expect to observe the following
empirical patterns:
Hypothesis 1: Compared to their white peers,
blacks with high GSS will exhibit enhanced self-
esteem, more high-effort coping, and fewer
symptoms of depression and anxiety.
Hypothesis 2: Compared to their white peers,
blacks with high GSS will exhibit elevated HPA
axis activity and blood pressure.
Nashville Stress and Health Study
I tested my hypotheses with self-report and bio-
marker data from Vanderbilt University’s Nashville
Stress and Health Study (NSAHS), a cross-sectional
probability survey of non-Hispanic black and
white working-age adults from Davidson County,
Tennessee (n = 1,252). The NSAHS was designed
for the very purpose of analyzing black-white dif-
ferences in stress, coping, and health. As NSAHS
researchers noted, Nashville was an excellent loca-
tion to conduct this study given its relatively high
6 Journal of Health and Social Behavior 00(0)
concentration of affluent blacks who are affiliated
with the local historically black universities and
medical schools. Sampling from Nashville there-
fore increased the likelihood of obtaining an ade-
quate sample of affluent blacks, which was “crucial
for disaggregating the health significance of race
and [socioeconomic status]” (Turner, Brown, and
Hale 2017:25).
The NSAHS sample was collected using mul-
tistage stratified sampling techniques. Vanderbilt
researchers first used simple random sampling to
choose 199 block groups from within Davidson
County. Survey Sampling International then gen-
erated a random list of 7,000 home addresses
from this sample of block groups in proportion to
population size. Vanderbilt researchers then drew
four random samples (n = 600 per sample) of
individuals between 25 and 65 years of age. Each
sample was stratified by race and gender such
that half of the sample was black and half white,
with equal numbers of men and women repre-
sented in each racial group. Fifty-nine percent of
contacted persons from this sampling frame ulti-
mately agreed to participate in the study. All
analyses were weighted for the probability of
noncontact during the household screening phase
and for nonresponse during the interviewing
phase. Poststratification weights were also incor-
porated into the final design weight to permit
generalizability to Davidson County’s population
of black and white working-age adults. The find-
ings reported in the following were comparable
regardless of weighting.
Each survey interview lasted approximately
three hours. All interviews were computer-assisted
and conducted either in the respondent’s home or
on the Vanderbilt campus. Interviewers were pro-
fessionally trained and matched with each respon-
dent based on race. All respondents received $50
for participating in the survey phase of the inter-
view. Respondents were also given instructions and
materials during the survey interview for subse-
quent biomarker collection. A trained clinician vis-
ited the respondent’s home the morning following
the interview to collect a urine sample, intravenous
blood sample, blood pressure measurements (three
measures spaced by two-minute intervals), and
anthropometric measures of height, weight, and hip
and waist circumferences. Respondents received an
additional $50 for participating in the biomarker
phase of the study. Fewer than 2% of respondents
refused to participate in biomarker collection. Due
to the complex design of the NSAHS, data collec-
tion lasted from April 2011 to January 2014—or
roughly three years. For complete information on
sampling and data collection for the NSAHS, see
Turner et al. (2017).
Psychological functioning. Self-esteem was measured
with Rosenberg’s (1965) scale (α = .81). Sample
items included “You feel that you are a person of
worth at least equal to others,” “You are able to do
things as well as most other people,” and “All in all,
you are inclined to feel that you are a failure”
(reverse-scored). I assessed high-effort coping with
Sherman James’s (1994) 12-item John Henryism
scale (α = .78). Sample items included “Once I
make up my mind to do something, I stay with it
until the job is done”; “When things don’t go the
way I want them to, that just makes me work even
harder”; and “I don’t let my personal feelings get in
the way of doing a job.”
Past-month depressive symptoms were mea-
sured with the 20-item Center for Epidemiological
Studies Depression (CESD) scale (α = .92). Sample
items included “You felt sad,” “You felt that you
could not shake off the blues,” and “You felt every-
thing you did was an effort” (see Radloff 1977).
Past-month anxiety was measured with a five-item
adaptation of the Spielberger State-trait Anxiety
Inventory (α = .87). Sample items included “I felt
worried over possible misfortunes,” “I felt tense,”
and “I felt anxious” (e.g., Marteau and Bekker
1992). Response choices for all items were ordinal
and were averaged or summed to create indices.
Physiological functioning. I assessed physiological
functioning with biomarkers for HPA axis activity
and blood pressure. HPA axis activity was measured
with three biomarkers: 12-hour urinary levels of
cortisol (ug/L), blood concentrations of dehydroepi-
androsterone sulfate (DHEAS; ug/dL), and the ratio
of cortisol to DHEAS. DHEAS is another HPA axis
hormone released from the adrenal gland and is an
antagonist to cortisol, meaning it functions to restore
bodily homeostasis in the wake of prolonged corti-
sol secretion. Exhibiting a simultaneous increase in
cortisol and decrease in DHEAS levels could indi-
cate hormonal instability and increasing vulnerabil-
ity to the toxic effects of cortisol. Exhibiting higher
increases in cortisol relative to DHEAS could also
indicate that the body is preferentially producing
cortisol at the expense of cortisol antagonists (see
Kamin and Kertes 2017).
I also examined the average of three systolic and
diastolic blood pressure readings. Systolic blood
DeAngelis 7
pressure gauges the pressure in the arteries while
the heart is beating, and diastolic blood pressure
measures the pressure in the arteries between heart-
beats. All blood pressure readings were recorded in
millimeters of mercury (mmHg). Blood pressure
was important to consider in conjunction with HPA
axis activity because, as mentioned earlier, chronic
anticipatory distress and hypercortisolism also tend
to be associated with cardiovascular abnormalities
(Sapolsky 1998).
Goal-striving stress. Interviewers showed respon-
dents an image of a ladder with rungs numbered
from zero to nine. Respondents were told that “the
steps on the ladder stand for 10 possible steps in
your life. Level 9 stands for the best possible way of
life for you and the first step stands for the worst
possible way of life for you.” Interviewers then
asked respondents, “Which step number describes
where you are now?” Respondents who answered
that they were currently at the top rung were not
asked any follow-up questions and were given a
score of zero on GSS (n = 108). All other respon-
dents were then asked, “Will you please tell me the
step number that best describes where you would
like to be a few years from now?” Respondents who
answered that they did not desire to reach a higher
rung were not asked any follow-up questions and
were also given a score of zero on GSS (n = 32).1
The next follow-up question then asked, “How
likely is it that you will actually reach this [desired]
step?” Response choices included highly likely (=
1), somewhat likely (= 2), somewhat unlikely (= 3),
and highly unlikely (= 4). The final question asked,
“How disappointed would you be if you found out
that you could never reach [your desired step]?”
Response choices included not at all (= 1), slightly
(= 2), fairly (= 3), and very (= 4).
Following prior work, I calculated GSS scores
by taking the difference between a respondent’s
achieved and aspired rungs and weighting this dif-
ference by the respondent’s subjective likelihood
and level of disappointment (Neighbors et al. 2011;
Sellers and Neighbors 2008). To be specific, I cal-
culated scores with the following formula: GSS =
(aspired rung – achieved rung) × (high disappoint-
ment × low likelihood). To understand how this
scale operates, imagine two respondents with the
same achievement-aspiration gap but with diver-
gent expectations for the future. Respondent A
anchors their achievements on rung five and desires
to reach rung eight but says they would be not at all
disappointed (= 1) by failure and believes it is
highly likely (= 1) they will succeed. Respondent
A’s GSS score would be (8 – 5) × (1 × 1) = 3 × 1 =
3. Respondent B also anchors their achievements
on rung five and desires to reach rung eight but
feels it is highly unlikely (= 4) they will succeed and
would be very disappointed (= 4) by failure.
Respondent B would score (8 – 5) × (4 × 4) = 3 × 16 =
48 on GSS.
Race. Categories for self-identified race included
non-Hispanic black and white.
Covariates. All regression estimates adjusted for
numerous potentially confounding variables. First, I
controlled for basic sociodemographic characteris-
tics of age (in years) and gender (1 = female, 0 =
male). Second, I controlled for childhood and other
antecedent conditions, including childhood financial
hardship (ordinal; 1 = family could easily afford
food, clothing, shelter, and lots of extras; 5 = could
not afford to pay for food, clothing, and shelter),
parental education (ordinal; 0 = no formal educa-
tion; 11 = doctorate degree), a 37-item checklist of
major life events during childhood and adulthood,
and a diagnostic checklist of lifetime psychiatric dis-
orders. The measure of parental education referred
only to the caregiver who “provided the major finan-
cial support of the family or household.” The check-
list of lifetime psychiatric disorders was based on the
Composite International Diagnostic Interview
(Lloyd and Turner 2008) and was measured by sum-
ming indicators of whether respondents met criteria
(1 = yes) for lifelong major depression, generalized
anxiety, posttraumatic stress disorder, substance
dependence, and social anxiety.
Third, I controlled for adulthood achieved sta-
tuses. These included marital status (1 = married,
0 = not married), education (in years), financial
resources (standardized ordinal measures of house-
hold income, liquid assets, and value of home; α =
.80), and employment status (unemployed = refer-
ence, full-time, part-time, retired, other). Fourth, I
controlled for health behaviors, including obesity
status as indicated by a BMI greater than or equal to
30 (1 = obese, 0 = not obese), smoker status (1 =
current smoker, 0 = former/nonsmoker), and heavy
drinking (1 = heavy drinker, 0 = not a heavy
drinker). Respondents were delineated as heavy
drinkers if they indicated that they drank four or
more drinks on average in the past year, whenever
they did drink.
Fifth, I controlled for major and daily discri-
mination experiences (Kessler, Mickelson, and
Williams 1999). Major discrimination was consti-
tuted by a checklist of questions asking whether
8 Journal of Health and Social Behavior 00(0)
respondents personally experienced seven major
episodes of discrimination at any point in their lives
(1 = yes). These episodes included being unfairly
treated by the police, being discouraged by a
teacher or advisor from continuing their education,
and being unfairly fired or denied a promotion at
work. Daily discrimination included nine items
gauging how often (on a Likert scale) respondents
experienced discrimination in their daily lives, such
as receiving worse service than other people at res-
taurants or stores and being called names, insulted,
threatened, or harassed by other people. I took the
average of all nine responses to create a mean index
(α = .85).
Finally, my analyses of biomarker outcomes
adjusted for whether respondents took blood pres-
sure medications (1 = yes) and fasted before collec-
tion (1 = did not fast, 0 = fasted) as well as blood
collection time (in HH:MM) and 12-hour urine col-
lection end time (in HH:MM). Blood samples were
collected once and at various times of the day, and
respondents also initiated their 12-hour urine sam-
ples at various times of the day. Because HPA axis
hormones generally peak shortly after awakening
and then decrease into the evening (Kamin and
Kertes 2017), my regression estimates of cortisol
and DHEAS levels had to account for the time of
specimen collection. I hypothesized that GSS will
be associated with elevated physiological stress
responses for blacks, which implies that blacks with
high GSS should exhibit hormonal imbalances
regardless of collection time.
Analytic Strategies
I first analyzed weighted descriptive statistics of
study variables split by racial group along with
ANOVA and chi-square tests of black-white
differences in means/proportions (Table 1). Next, I
conducted a series of robust ordinary least squares
(OLS) regression estimates of my dependent
variables (Tables 2–5). Cortisol, DHEAS, and
cortisol:DHEAS ratio were converted into natural
logarithmic form to permit the use of linear regres-
sion techniques. Cortisol:DHEAS ratios can be
interpreted as the (logged) number of ug/L of
urinary cortisol for every ug/dL of serum DHEAS.
For example, a cortisol:DHEAS ratio of 2 would
mean a respondent exhibited 2 ug/L of cortisol for
every 1 ug/dL of DHEAS (see Sollberger and Ehlert
2016:392). The distributional properties of cortisol,
DHEAS, and cortisol:DHEAS ratio before and after
logging their distributions are provided in Table S10
in the online version of the article.
For all regression tables, the first set of esti-
mates regressed the outcome variable on scaled
GSS scores (mean-centered), race, and their inter-
action. The second set of estimates then tested for
threshold effects of GSS by regressing the outcome
on dummy variables of GSS tertiles (low = omitted,
middle, high), race, and their interactions. Thus, the
GSS coefficients reflect the associations between
GSS and the dependent variable for whites, who are
the omitted group, and the interaction term coeffi-
cients represent the differences in GSS coefficients
between blacks and whites. All regression estimates
adjusted for covariates, poststratification weight-
ing, and clustering at the census block group level. I
omitted covariate coefficients to conserve space
and because the focal variable coefficients were
largely unaffected by covariates. Complete regres-
sion tables before and after adjusting for covariates
(Tables S1–S9) are available in the online version
of the article.
Evidence for my hypotheses will be found if the
following conditions are met: (1) GSS coefficients
predicting self-esteem and John Henryism are neg-
ative and the interaction term coefficients are posi-
tive; (2) GSS coefficients predicting depressive
symptoms and anxiety are positive and the interac-
tion term coefficients are negative; (3) GSS coeffi-
cients predicting cortisol, blood pressure, and
cortisol:DHEAS ratio show no association (or are
negative) and the interaction term coefficients are
positive; and (4) GSS coefficients predicting
DHEAS show no association (or are positive) and
the interaction term coefficients are negative. To
verify that the moderation patterns conformed to
my study hypotheses, visual confirmation of three
representative interactions as linear prediction plots
with 95% confidence bands are shown in Figures 1
through 3.
Missing data were replaced with 25 iterations of
multiple imputation by chained equation (Johnson
and Young 2011). The following variables had miss-
ing data: self-esteem (n = 5), John Henryism
(n = 3), depressive symptoms (n = 9), anxiety (n = 1),
cortisol (n = 93), DHEAS (n = 112), systolic/ diastolic
blood pressure (n = 60), childhood financial hardship
(n = 1), parental education (n = 122), major life
events (n = 51), financial resources (n = 44), obesity
status (n = 38), heavy drinking (n = 2), daily discrim-
ination (n = 8), fasting before biomarker collection
(n = 30), blood collection time (n = 73), and 12-hour
urine collection end time (n = 55). The findings
reported in the following were substantively identical
before and after imputation. All statistical analyses
were conducted in Stata 15.
DeAngelis 9
Table 1. Weighted Descriptive Statistics of Study Variables: Nashville Stress and Health Study
Black (n = 627) White (n = 625)
Mean SD Minimum Maximum Mean SD Minimum Maximum b wa
Focal variables
Self-esteem 4.65 .44 1.83 5 4.54 .62 1.17 5 **
John Henryism 49.24 5.89 24 60 47.56 5.75 22 59 ***
Depressive symptoms 1.72 .47 1 3.35 1.65 .51 1 3.70 *
Anxiety 1.83 .69 1 4 1.91 .70 1 4
Cortisol 2.09 .91 −.28 5.27 2.00 .81 −.07 4.65
DHEAS 4.63 .74 2.56 6.52 4.79 .74 2.66 6.77 **
Cortisol:DHEAS ratio −2.51 1.04 −5.40 .97 −2.79 1.03 −5.88 .88 ***
Systolic blood pressure 125.95 14.61 84.00 198.33 119.78 13.31 79.73 176.67 ***
Diastolic blood pressure 80.34 9.62 52.10 119.33 76.47 8.91 47.79 109.42 ***
Goal-striving stress 11.11 11.29 0 112 9.61 11.13 0 96 *
Low .20 .40 0 1 .29 .45 0 1 **
Middle .40 .49 0 1 .39 .49 0 1
High .40 .49 0 1 .32 .47 0 1 *
Age 43.57 11.43 22 69 44.61 11.83 23 68
Female .55 .50 0 1 .50 .50 0 1
Childhood financial
2.72 .95 1 5 2.42 .89 1 5 ***
Parental education 4.54 2.35 0 11 5.69 2.81 0 11 ***
Major life events 9.55 5.22 0 31 8.10 5.12 0 28 ***
Lifetime psychiatric
.53 .78 0 4 .91 1.06 0 5 ***
Married .35 .48 0 1 .66 .47 0 1 ***
Education 13.40 2.76 0 25 14.92 3.01 3 28 ***
Financial resources −.34 .66 −1.88 1.72 .37 .82 −1.58 2.19 ***
Employment status
Unemployed .17 .38 0 1 .12 .33 0 1 *
Full-time .61 .49 0 1 .64 .48 0 1
Part-time .09 .29 0 1 .14 .35 0 1 *
Retired .05 .22 0 1 .05 .22 0 1
Other .07 .25 0 1 .04 .20 0 1
Obese .58 .49 0 1 .36 .48 0 1 ***
Current smoker .47 .50 0 1 .48 .50 0 1
Heavy drinker .09 .29 0 1 .09 .28 0 1
Major discrimination 1.19 1.45 0 7 .76 1.07 0 6 ***
Daily discrimination 2.16 .63 1 4.78 1.93 .52 1 4.11 ***
Biomarker controls
Takes blood pressure
.38 .48 0 1 .22 .42 0 1 ***
Did not fast before
.03 .17 0 1 .02 .12 0 1
12-hour urine collection
end time
6:38 1:44 1:00 12:01 6:48 1:29 1:00 12:00
Time of blood collection 7:55 1:58 3:32 18:50 7:58 1:46 3:13 18:27
Note: DHEAS = dehydroepiandrosterone sulfate.
at-tests and chi-square tests of black-white differences in means/proportions.
*p < .05, **p < .01, ***p < .001 difference between black and white respondents (two-tailed).
10 Journal of Health and Social Behavior 00(0)
Table 2. Robust Linear Regression Estimates of Self-Esteem and John Henryism (n = 1,252), Nashville
Stress and Health Study (2011–2014).
Self-Esteem John Henryism
(a) (b) (a) (b)
Focal variables
Black .180 (.036)*** .100 (.056) 1.209 (.397)** .170 (.821)
GSS (scale) −.014 (.003)*** −.097 (.030)**
Low ――――
Middle −.132 (.053)* −.658 (.566)
High −.323 (.070)*** −2.654 (.753)**
Interactions (Black × . . . )
GSS (scale) .011 (.004)** .093 (.043)*
Low ――――
Middle .051 (.076) 1.276 (1.104)
High .179 (.083)* 1.517 (1.080)
Intercept 4.659 (.202)*** 4.841 (.211)*** 50.330 (2.041)*** 51.438 (2.172)***
Adjusted R2.198 .187 .094 .098
Note: Unstandardized coefficients are reported with robust standard errors in parentheses. All estimates adjust for
covariates, poststratification weighting, and clustering at the census block group level. Scaled GSS scores are mean-
centered. GSS = goal-striving stress.
*p < .05, **p < .01, ***p < .001 (two-tailed).
Table 3. Robust Linear Regression Estimates of Depressive Symptoms and Anxiety (n = 1,252),
Nashville Stress and Health Study (2011–2014).
Depressive Symptoms Anxiety
(a) (b) (a) (b)
Focal variables
Black −.007 (.034) .066 (.048) −.103 (.050)* .075 (.075)
GSS (scale) .016 (.002)*** .019 (.003)***
Low ――――
Middle .143 (.040)*** .255 (.055)***
High .362 (.053)*** .460 (.069)***
Interactions (Black × . . . )
GSS (scale) −.010 (.002)*** −.013 (.003)***
Low ――――
Middle −.074 (.062) −.195 (.100)
High −.135 (.065)* −.288 (.107)**
Intercept 1.012 (.143)*** .816 (.150)*** .997 (.217)*** .702 (.220)**
Adjusted R2.448 .428 .334 .322
Note: Unstandardized coefficients are reported with robust standard errors in parentheses. All estimates adjust for
covariates, poststratification weighting, and clustering at the census block group level. Scaled GSS scores are mean-
centered. GSS = goal-striving stress.
*p < .05, **p < .01, ***p < .001 (two-tailed).
Table 4. Robust Linear Regression Estimates of HPA Axis Biomarkers (n = 1,252), Nashville Stress and Health Study (2011–2014).
Cortisol DHEAS Cortisol:DHEAS ratio
(a) (b) (a) (b) (a) (b)
Focal variables
Black .159 (.076)* −.085 (.141) −.170 (.044)*** −.021 (.069) .332 (.077)*** −.051 (.150)
GSS (scale) −.002 (.004) .000 (.002) −.001 (.004)
Low ― ――――
Middle −.014 (.085) .028 (.066) −.036 (.112)
High .027 (.093) −.024 (.076) .052 (.123)
Interactions (Black × . . . )
GSS (scale) .013 (.004)** −.002 (.003) .015 (.005)**
Low ― ――――
Middle .256 (.164) −.197 (.097)* .434 (.167)*
High .379 (.129)** −.179 (.089)* .552 (.171)**
Intercept 1.916 (.307)*** 1.924 (.304)*** 6.083 (.270)*** 6.064 (.292)*** −4.254 (.376)*** −4.232 (.395)***
Adjusted R2.096 .097 .403 .405 .154 .160
Note: Unstandardized coefficients are reported with robust standard errors in parentheses. All estimates adjust for covariates, biomarker controls, poststratification weighting, and
clustering at the census block group level. Cortisol, DHEAS, and cortisol:DHEAS ratio are in natural logarithmic form. Scaled GSS scores are mean-centered. GSS = goal-striving
stress; HPA = hypothalamic-pituitary-adrenal; DHEAS = dehydroepiandrosterone sulfate.
*p < .05, **p < .01, ***p < .001 (two-tailed).
12 Journal of Health and Social Behavior 00(0)
Figure 1. Self-esteem by Race and Goal-striving Stress, Nashville Stress and Health Study (2011–2014).
Table 5. Robust Linear Regression Estimates of Systolic and Diastolic Blood Pressure (n = 1,252),
Nashville Stress and Health Study (2011–2014).
Systolic Blood Pressure Diastolic Blood Pressure
(a) (b) (a) (b)
Focal variables
Black 3.234 (1.098)** .138 (2.029) 2.020 (.835)* .024 (1.194)
GSS (scale) .041 (.056) .018 (.039)
Low ――――
Middle −1.854 (1.398) .213 (.993)
High −.509 (1.587) .069 (1.022)
Interactions (Black × . . . )
GSS (scale) −.024 (.073) .035 (.054)
Low ――――
Middle 3.540 (2.233) 1.953 (1.601)
High 4.254 (2.428)3.145 (1.521)*
Intercept 115.534 (4.635)*** 116.950 (4.774)*** 78.411 (3.078)*** 78.408 (3.184)***
Adjusted R2.234 .237 .194 .196
Note: Unstandardized coefficients are reported with robust standard errors in parentheses. All estimates adjust for
covariates, blood pressure medication, fasting, poststratification weighting, and clustering at the census block group
level. Scaled GSS scores are mean-centered. GSS = goal-striving stress.
p < .10, *p < .05, **p < .01, ***p < .001 (two-tailed).
Table 1 provides weighted descriptive statistics of
study variables. In terms of psychophysiology,
blacks reported higher average levels of self-esteem
and John Henryism but also slightly higher levels of
past-month depressive symptoms. Compared to
whites, blacks also exhibited lower average levels
of DHEAS, higher cortisol:DHEAS ratios, and
higher systolic and diastolic blood pressure. Blacks
also reported higher average levels of GSS.
In terms of covariates, blacks tended to report
greater childhood financial hardship than whites
and had less educated parents, were less educated
themselves, and possessed fewer financial resources
as adults. Blacks also reported significantly more
major life events and discrimination experiences
and were more likely to be single, unemployed,
obese, and taking blood pressure medications.
Consistent with the black-white health paradox,
whites still conveyed nearly twice as many lifetime
DeAngelis 13
psychiatric disorders than blacks despite blacks
expressing greater socioeconomic and physical
health disadvantages. Additional descriptive statis-
tics are available in Table 1.
Table 2 reports unstandardized coefficients from
robust linear regression estimates of self-esteem
and John Henryism. The results from Table 2 were
fully consistent with Hypothesis 1. Higher GSS
scores were associated with significantly lower
self-esteem and John Henryism among whites,
whereas blacks exhibited essentially no associa-
tions between GSS and either outcome. For
instance, every one-unit increase in scaled GSS
scores predicted a .014-unit decrease in self-esteem
for whites (b = –.014; p < .001) but only a .003-unit
decrease for blacks (–.014 + .011 = –.003). Figure 1
confirms that the slope predicting change in self-
esteem as a function of increasing GSS is essen-
tially flat for blacks but steep and decreasing for
whites. The black-white gap in GSS slopes predict-
ing self-esteem also reached two-tailed significance
at the p < .01 threshold. This moderation pattern
also looked more-or-less identical when predicting
John Henryism. There was also evidence of a
threshold effect of GSS on self-esteem. To be spe-
cific, blacks in the high (vs. low) GSS category
reported significantly higher self-esteem than their
white counterparts.
Table 3 also provides consistent support for
Hypothesis 1. For instance, a one-unit increase in
GSS predicted a .016-unit increase in depressive
symptoms for whites (b = .016; p < .001), whereas
Figure 2. Depressive Symptoms by Race and Goal-striving Stress, Nashville Stress and Health Study
Figure 3. Cortisol by Race and Goal-striving Stress, Nashville Stress and Health Study (2011–2014).
14 Journal of Health and Social Behavior 00(0)
the same increase in GSS predicted only a .006-unit
increase in depressive symptoms for blacks (.016 –
.010 = .006). Figure 2 provides visual confirmation
of this moderation pattern. The same patterns sur-
faced for anxiety. Black-white differences in slopes
predicting depressive symptoms and anxiety as a
function of GSS also reached two-tailed signifi-
cance at the p < .001 threshold. There was also evi-
dence of threshold effects of GSS, with blacks in
the high (vs. low) category of GSS reporting sig-
nificantly fewer symptoms of depression and anxi-
ety than their white counterparts.
Table 4 reports coefficients for HPA axis bio-
markers. The coefficients in Table 4 provided con-
sistent support for Hypothesis 2. For example, a
one-unit increase in GSS predicted a .011-unit
increase in logged cortisol levels for blacks (.013
– .002 = .011), whereas GSS was not associated
with cortisol for whites. This pattern can be seen
clearly in Figure 3. Blacks in the middle and high
(vs. low) GSS categories also reported signifi-
cantly lower logged DHEAS levels than their
white counterparts. GSS also predicted signifi-
cantly higher cortisol:DHEAS ratios for blacks
but no difference for whites.
To place these findings in more concrete terms, I
examined exponentiated marginal predictions of
average cortisol, DHEAS, and cortisol:DHEAS ratio
levels by race and GSS grouping. These values are
presented in Table S11, available in the online ver-
sion of the article. The following patterns emerged
for blacks as they moved from the low to high GSS
group: (1) cortisol levels rose from 6.63 ug/L to 9.96
ug/L (50% increase), (2) serum DHEAS levels
diminished from 116.58 ug/dL to 95.47 ug/dL (18%
decrease), and (3) cortisol:DHEAS ratios rose from
.06 to .10 (67% increase). Whites, on the other hand,
exhibited the following patterns as they moved from
low to high GSS: (1) cortisol levels barely rose from
7.22 ug/L to 7.42 ug/L (<3% increase), (2) DHEAS
levels declined only slightly from 120.09 ug/dL to
117.88 ug/dL (<2% decrease), and (3) ratios of corti-
sol to DHEAS remained stable at .06.2
Table 5 shows similar patterns for systolic and
diastolic blood pressure. Blacks in the high (vs.
low) GSS category presented average systolic
blood pressure readings that were 4.25 mmHg
higher than their white counterparts. However, this
difference in averages only reached one-tailed sig-
nificance (t = 1.75). High-GSS blacks also had sig-
nificantly higher average diastolic blood pressure
readings than high-GSS whites (b = 3.145; p < .05).
Finally, it is worth noting that there were no
black-white differences in psychophysiology when
GSS was low. This can be seen by examining the
black coefficients in all the (b) estimates, which
represent predicted black-white differences in each
outcome for respondents who scored in the bottom
tertile of the GSS distribution. This finding indi-
cates that black-white disparities in psychophysiol-
ogy emerged only as both groups began to confront
increasing levels of GSS.
My analyses revealed substantial black-white dif-
ferences in the associations between GSS and psy-
chophysiology. For blacks, GSS was associated
with little to no differences in self-esteem, high-
effort coping, or psychological distress but signifi-
cant increases in blood pressure and cortisol and
decreases in DHEAS (a cortisol antagonist). For
whites, however, GSS was associated with consid-
erably lower levels of self-esteem and high-effort
coping and higher levels of psychological distress
but no differences in blood pressure, cortisol, or
DHEAS. These patterns were also robust to differ-
ent model specifications and adjustments for numer-
ous covariates.
My study makes several key contributions to our
understanding of the stress process and black-white
health inequalities in the United States. First, I
advance stress process research by refocusing atten-
tion on a neglected class of stressors: anticipatory
stressors. Anticipatory stressors are distinct from
acute stressors and chronic strains because they do
not exist as concrete realities but can affect people
just the same (Pearlin and Bierman 2013). This is
because human beings have evolved advanced brain
structures capable of drawing complex inferences
about potential futures from past experiences
(Barrett 2017; Massey 2001). Consequently, our
mental images of anticipated stressors (e.g., failing
to achieve a major life goal) can trigger physiologi-
cal responses similar to those that occur when our
bodies are adapting to existing stressors (e.g., dis-
criminatory treatment). In many ways, then, antici-
patory stressors can be more enduring and
pernicious than existing stressors given that no
direct environmental stimulus is needed to trigger a
stress response (O’Donovan et al. 2012; Sapolksy
1998). In my analyses, GSS remained a robust pre-
dictor of psychophysiology even after accounting
for objective socioeconomic conditions and various
other prior and existing stressors.
The current study also highlights the GSS scale
as an important but underutilized survey measure of
anticipatory stress. The theoretical roots of GSS
DeAngelis 15
stretch back to the origins of sociology when
Durkheim ([1897] 1951) offered the first system-
atic analysis of social structure and anomie. In
keeping with Merton’s (1938, 1968) retooling of
anomie theory, Parker and Kleiner (1966) devel-
oped the GSS scale to observe the individual-level
consequences of structural anomie, particularly
among black Americans striving for upward mobil-
ity during the civil rights era. In their original study
of GSS among blacks in Philadelphia, Parker and
Kleiner (1966:12) hypothesized that blacks in their
sample would internalize experiences with failure
and suffer “severe loss of self-esteem” and poor
mental health. What they discovered, instead, was
that the links between GSS and psychological func-
tioning for blacks were highly complex and defied
simple explanation.
The second contribution of my study is that I
draw from more recent scholarship on the racial
socialization of black and white Americans to show
that experiences with GSS can be quite distinct
across racial groups. What Parker and Kleiner’s
(1966) early work in this area did not account for is
that blacks might experience GSS in fundamentally
different ways than whites. For example, the
authors proposed the following rationale for study-
ing GSS among blacks:
Like his fellow Americans, the Negro internalizes
the common success values and assumes . . . that
his chances of achieving his aspirations are
good. . . . He, too, is led to believe in the ethos of
the open social system which permits a high rate
of social mobility. Given the objective fact of the
limited opportunity structure for the Negro, this
estimate of reality is not feasible and frequently
leads to frustration. (Parker and Kleiner 1966:12)
My findings suggest, instead, that blacks are well
aware they must “work twice as hard to get half as
much.” Indeed, many blacks learn from a young age
not to attribute their setbacks and failures to per-
sonal incompetence but rather to identify racist
sociopolitical structures as central causes of their
struggles (Bentley et al. 2008; Coard and Sellers
2005; Sellers et al. 2011). Still, my findings imply
that this awareness functions as a double-edged
sword for black Americans. The unrelenting specter
of racialized barriers to attainment places a heavy
burden on blacks of always having to be prepared to
overcome barriers with extreme effort (James
1994). As my analyses revealed, blacks with high
GSS still expressed unwavering levels of John
Henryism, a self-reported index of persistent and
high-effort coping in the face of overwhelming bar-
riers to success.
The third contribution of my study is to demon-
strate that proactive coping and psychosocial resil-
ience can sometimes pair with physiological
dysfunction. In my analyses, blacks with high GSS
also exhibited elevated blood pressure and HPA
axis activity. This finding dovetails with an emerg-
ing literature on the “skin-deep resilience” of
upwardly mobile black Americans. Studies in this
field have found that ambitious and upwardly
mobile blacks from disadvantaged backgrounds
tend to express remarkable psychosocial resilience
even as they show signs of physiological deteriora-
tion. An intriguing hypothesis in this area is that
high-effort coping with barriers to mobility are
responsible for these associations (see Gaydosh
et al. 2018). By explicitly linking GSS to John
Henryism in addition to stress biomarkers, my
study offers compelling evidence in support of the
high-effort coping hypothesis.
Why should proactive coping with strained
goals lead to physiological wear and tear for black
Americans? At first glance, this finding seems to fly
in the face of conventional wisdom regarding stress
adaptation. In his now classic formulation of allo-
static load theory, for example, McEwen (1998:37)
contended that physiological stress responses are
“closely coupled to the psychological make-up of
the individual, in that those people who are fearful
and reactive will have more reactive physiological
responses, whereas those individuals who have pro-
active planning skills and psychological buffers
will have less reactive responses and more stability
in their physiology.” According to this logic, we
should have expected whites with high GSS to also
exhibit higher levels of cortisol and blood pressure
relative to their black peers.
This paradox resolves itself after acknowledg-
ing that the same stressor can entail drastically dif-
ferent meanings and experiences for different
groups of people (McLeod 2012). I suggested ear-
lier that racial differences in experiences with GSS
can be attributed to the dissimilar social contexts in
which blacks and whites must contend with barriers
to their goals. Because opportunity structures in the
United States have been systematically engineered
to thwart blacks (Rothstein 2017), whites enjoy
cumulative advantages over blacks that can help
them recover quicker from thwarted goals at all
stages of the life course (Malat et al. 2018). Blacks,
on the other hand, can never fully outrun prospects
of discrimination and failure regardless of their
achieved statuses or material resources (Feagin and
16 Journal of Health and Social Behavior 00(0)
Sikes 1994; Turner et al. 2017). For blacks, then,
the anticipation of failure seems to represent a
chronic looming threat that demands constant men-
tal acuity and physiological adaptation. For whites,
however, prospects of failure appear to be psycho-
logically distressing but nonetheless transitory
experiences that ultimately do not require much
physiological adaptation.
The very act of maintaining unflinching self-
control and positive emotions in the face of strained
goals could also be creating added physiological
burdens for blacks. Experimental studies have
found that people who express stoic levels of emo-
tional restraint and self-control often do report bet-
ter mental health, yet they also tend to exhibit
overactive physiological stress responses as
indexed by higher cortisol and blood pressure (Dorr
et al. 2007; Sapolsky 1998:283–86; see also Steffen
et al. 2003). A key takeaway from this literature is
that blacks who always “stay with it” and refuse to
“let feelings get in the way” of strained goals could
be suffering an extra physiological burden of con-
stantly having to monitor themselves to combat
negative emotions and behaviors deemed to be self-
defeating or counterproductive (e.g., Lambert,
Robinson, and Ialongo 2014).
The findings from my study could have broader
implications for black-white health inequalities in
the United States. For one, blacks are more likely
than whites to die prematurely from chronic health
conditions such as heart disease, kidney disease,
stroke, cancer, and diabetes (Hummer and Hamilton
2019:133–37). A recent study found that old-age
blacks also tend to display blunted cortisol responses
relative to their white peers, which is another indica-
tion of physiological dysregulation due to lifelong
stress exposure (Allen et al. 2019). The current
study suggests that prolonged coping with barriers
to attainment during working-age years may help
explain why black Americans suffer early morbidity
and mortality, given that such high-effort coping
appears to strain the HPA axis and cardiovascular
system. Indeed, studies have shown that HPA axis
dysregulation and elevated blood pressure can lead
to the very same chronic conditions mentioned pre-
viously (Goosby et al. 2018; Sapolsky 1998).
GSS may also be implicated in the apparent rise
in “deaths of despair” among white Americans
(Case and Deaton 2015). Historically, dominant
success narratives in the United States have cast
working- and middle-class whites as the main pro-
tagonists and beneficiaries of the American Dream
(Hochschild 1995:26). Because generations of
white Americans have grown accustomed to the
perquisites of living in a white supremacist society,
many whites are woefully unequipped to cope with
economic crises or any other circumstance that
undermines their relative social standing (e.g.,
Kraus et al. 2012) and thus tend to be exceptionally
vulnerable to mental illness whenever such circum-
stances do occur (Malat et al. 2018). My study sug-
gests that GSS can be a useful way to conceptualize
and measure the psychosocial strains experienced
by downwardly mobile white populations. For
many white Americans, the realization that their
dreams are at the throes of powerful external forces
may shatter their faith in meritocracy and lead to
profound feelings of normlessness and despair.
The current study has limitations that could be
overcome in the future. One limitation is that I ana-
lyzed cross-sectional data from a single urban
locale rather than longitudinal data from a nation-
ally representative cohort. I therefore cannot estab-
lish temporal ordering between variables or rule out
the possibility that there is something unique about
the black and white working-age adult population
of Nashville. Notwithstanding, the NSAHS pro-
vided an unusually rich collection of self-report and
biological data from a reasonably large probability
sample of adults, which would have been onerous
and costly to collect on a national and long-term
scale. The findings generated in my study were also
consistent with longstanding sociological theories
and nationally observed patterns and were robust to
various model specifications and adjustments for
numerous covariates. I can therefore see little rea-
son to believe my findings were spurious or some-
how idiosyncratic to Nashville.
Despite some limitations, my study advances our
understanding of the stress process and black-white
health disparities in the United States. First, I help
reinvigorate discussion of anticipatory stressors and
demonstrate that the GSS scale is useful for measur-
ing this unique class of stressors. Second, I develop
and test hypotheses to explain why experiences with
GSS should be markedly different for black and
white Americans. Third, I provide evidence that
black-white differences in coping with GSS lead to
distinct psychophysiological outcomes that are con-
sistent with the broader black-white health paradox.
My hope is that the current study sparks continued
interdisciplinary research aimed at addressing these
urgent population health dilemmas.
Tables S1 through S11 are available in the online version
of the article.
DeAngelis 17
I thank Bob Hummer for providing helpful feedback on
earlier drafts of this article.
The author disclosed receipt of the following financial
support for the research, authorship, and/or publication of
this article: The author is grateful to the Carolina Population
Center and its NIH center grant (T32-HD091058) for
general support.
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logical age, with levels steadily declining over
the life course (Lane et al. 1997). Respondent age
accounted for 13% of unique variance in serum
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Reed DeAngelis is a doctoral student in sociology at the
University of North Carolina-Chapel Hill and a biosocial
predoctoral trainee at the Carolina Population Center. His
research is focused on social stratification and health in the
United States with an emphasis on stress and coping. His
current projects highlight religious involvement, racial and
gendered self-perceptions, and family ties as important
social determinants of health. Reed is currently supported
by the National Institutes of Health and has published his
research in Journal of Health and Social Behavior, Society
and Mental Health, Sleep Health, Population Research
and Policy Review, Journal for the Scientific Study of
Religion, and Journal of Religion and Health, among other
... In contrast, some young people who encounter chronic challenges "put their heads down" and persist in pursuit of life goals with even greater determination to succeed. This high effort coping style that promotes success in many life pursuits and deters depressive symptoms appears to tax the physiological systems that respond to stress, leading to a greater risk of elevations in markers for metabolic problems (DeAngelis, 2020). ...
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Research on skin-deep resilience suggests that for youth and young adults from disadvantaged backgrounds, high levels of planful self-control may promote positive psychosocial outcomes while simultaneously conferring vulnerabilities to chronic diseases related to aging. In this study, we investigated the divergent effects of planful self-control on young Black American men’s psychosocial well-being and their metabolic risk. We expected that high levels of planful self-control in emerging adulthood would predict positive outcomes in young adulthood (educational attainment, low depressive symptoms, job satisfaction); however, the combination of high levels of planful self-control and the experience of contextual adversity either in emerging adulthood or in childhood would forecast poor metabolic health. Hypotheses were tested with prospective data from 504 Black American men followed from age 20 to age 26. Planful self-control in emerging adulthood directly forecasted low levels of depressive symptoms, one’s likelihood of obtaining a bachelor’s degree, increased job satisfaction, and increases in metabolic risk. Exposure to childhood deprivation moderated the influence of planful self-control on metabolic risk. Men with high levels of deprivation and high levels of planful self-control exhibited the worst metabolic profiles in the sample. In contrast, men with high levels of childhood deprivation and low levels of planful self-control exhibited the best metabolic profiles. Documenting the health consequences associated with planful self-control provides a foundation from which to identify modifiable psychosocial factors that affect the course of psychosocial problems and health.
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Affective polarization—the tendency for individuals to exhibit animosity toward those on the opposite side of the partisan divide—has increased in the United States in recent years. This article presents evidence that this trend may have consequences for Americans’ health. Structural equation model analyses of nationally representative survey data from Pew Research Center’s American Trends Panel (n = 4,685) showed heterogeneous relationships between affectively polarized attitudes and self-rated health. On one hand, such attitudes were directly negatively associated with health such that the polarized political environment was proposed to operate as a sociopolitical stressor. Simultaneously, affective polarization was positively associated with political participation, which in turn was positively associated with health, although the direct negative effect was substantially larger than the indirect positive one. These results suggest that today’s increasingly hostile and pervasive form of partisanship may undermine Americans’ health even as it induces greater political engagement.
A central paradox in the mental health literature is the tendency for black Americans to report similar or better mental health than white Americans despite experiencing greater stress exposure. However, black Americans’ higher levels of certain coping resources may explain this finding. Using data from the Nashville Stress and Health Study (n = 1,186), we examine whether black Americans have higher levels of self-esteem, social support, religious attendance, and divine control than white Americans and whether these resources, in turn, explain the black–white paradox in mental health. In adjusted models, the black–white paradox holds for depressive symptoms and any DSM-IV disorder. Findings indicate that black Americans have higher levels of self-esteem, family social support, and religiosity than white Americans. Causal mediation techniques reveal that self-esteem has the largest effect in explaining black–white differences in depressive symptoms, whereas divine control has the largest effect in explaining differences in disorder.
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The Black-white Depression paradox, the lower prevalence of major depression among non-Hispanic Black (relative to non-Hispanic white) individuals despite their greater exposure to major life stressors, is a phenomenon that remains unexplained. Despite a decade plus of research, there is little clarity as to whether the paradoxical observations are an invalid finding, spuriously produced by selection bias, information bias, or confounding, or are a valid finding, representative of a true racial patterning of depression in the population. Though both artefactual and etiologic mechanisms have been tested, a lack of synthesis of the extant evidence has contributed towards an unclear picture of the validity of the paradox and produced challenges for researchers in determining which proposed mechanisms show promise, which have been debunked, and which require further study. The objective of this critical review is to assess the state of the literature regarding explanations for the Black-white depression paradox by examining some of the more prominent hypothesized explanatory mechanisms that have been proposed and assessing the state of the evidence in support of them. Included mechanisms were selected for their perceived dominance in the literature and the existence of at least one, direct empirical test using DSM major depression as the outcome. This review highlights the very limited evidence in support of any of the extant putative mechanisms, suggesting that investigators should redirect efforts towards identifying novel mechanisms, and/or empirically testing those which show promise but to date have been relatively understudied. We conclude with a discussion of the broader implications of the evidence for well-accepted social theories and raise questions regarding the use of DSM major depression to assess mental health burden in Black communities.
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Beliefs about the probability of educational success tend to be very optimistic in the United States. However, scholars are beginning to uncover mental health consequences associated with quixotic hope—the unrealistic outstripping of expectation by aspiration. Using longitudinal data from Waves 1 and 3 of the National Study of Youth and Religion, this study asks, (1) does religiosity promote or diminish the likelihood of quixotic hope? and (2) does religious attendance and closeness to God mitigate long-term mental health consequences of quixotic hope? Results show that weekly religious attendance had a modest negative relationship with the likelihood of experiencing quixotic hope, while increasing religious attendance over time attenuated the negative mental health consequences of quixotic hope on increases in depression. Closeness to God neither predicted quixotic hope nor played a moderating role for depression. As educational expectations rise, regular religious practice may help protect the emotional well-being of youth.
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In the United States, Black men have poorer overall health and shorter life spans than most other racial/ethnic groups of men, largely attributable to chronic health conditions. Dysregulated patterns of daily cortisol, an indicator of hypothalamic–pituitary–adrenal (HPA) axis stress–response functioning, are linked to poor health outcomes. Questions remain regarding whether and how cortisol contributes to Black–White differences in men’s health. This exploratory study compared early day changes in cortisol levels (diurnal cortisol slopes from peak to pre-lunch levels) and their associations with medical morbidity (number of chronic medical conditions) and psychological distress (Negative Affect Scale) among 695 Black and White male participants in the National Survey of Midlife in the United States (MIDUS II, 2004–2009). Black men exhibited blunted cortisol slopes relative to White men (−.15 vs. −.21, t = −2.97, p = .004). Cortisol slopes were associated with medical morbidity among Black men ( b = .050, t = 3.85, p < .001), but not White men, and were unrelated to psychological distress in both groups. Findings indicate cortisol may contribute to racial health disparities among men through two pathways, including the novel finding that Black men may be more vulnerable to some negative health outcomes linked to cortisol. Further, results suggest that while cortisol may be a mechanism of physical health outcomes and disparities among older men, it may be less important for their emotional health. This study increases understanding of how race and male sex intersect to affect not only men’s lived experiences but also their biological processes to contribute to racial health disparities among men in later life.
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In recent decades, there has been remarkable growth in scientific research examining the multiple ways in which racism can adversely affect health. This interest has been driven in part by the striking persistence of racial/ethnic inequities in health and the empirical evidence that indicates that socioeconomic factors alone do not account for racial/ethnic inequities in health. Racism is considered a fundamental cause of adverse health outcomes for racial/ethnic minorities and racial/ethnic inequities in health. This article provides an overview of the evidence linking the primary domains of racism - structural racism, cultural racism, and individual-level discrimination - to mental and physical health outcomes. For each mechanism, we describe key findings and identify priorities for future research. We also discuss evidence for interventions to reduce racism and describe research needed to advance knowledge in this area.
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Objective: Research that assesses the relationship between psychosocial factors and chronic kidney disease (CKD) among African Americans (AAs) is limited. Using the Jackson Heart Study (JHS) cohort data, we investigated the association of goal-striving stress (GSS)-the stress experienced from not reaching goals-with prevalent CKD among AAs. Design: This was a cross-sectional analysis of JHS exam 1 data that assessed the relationship between GSS and CKD. Setting and participants: We utilized a sample from the JHS (n = 4967), an AA sample of women and men, 35-84 years old from the Jackson, MS metro area. Main outcome measures: The baseline relationship between GSS levels (low, moderate, and high) and CKD (eGFR < 60 mL/min/1.73m2) was evaluated using a logistic regression model to estimate odds ratios (OR) on a 95% confidence interval (CI). The final model was adjusted for sex, age, socioeconomic status, health behaviors, risk factors, and total stress. Results: After full adjustment, the odds of prevalent CKD increased by 52% (OR 1.52; 95% CI 1.04, 2.24) for those reporting high (versus low) GSS. Conclusions: Deficiencies between goal aspiration and achievement were associated with prevalent CKD. Potential interventions might consider the impact GSS contributes to prevalent CKD.
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This study examines whether dimensions of religious involvement (i.e., perceived divine control, private religious practices, and religious social integration) buffer associations between aspiration strain and mental health outcomes (i.e., psychological distress, loneliness, and optimism). We also test three-way interactions to determine whether the stress-buffering effects of religious involvement are amplified among undereducated persons. We test our hypotheses with cross-sectional survey data from Vanderbilt University’s Nashville Stress and Health Study (2011-2014), a probability sample of non-Hispanic white and black adults from Davidson County, Tennessee (n = 1,252). Results from multivariate regression models confirmed: (1) aspiration strain was positively associated with psychological distress and loneliness, and negatively associated with optimism; and (2) religious involvement attenuated these associations, but only among respondents with less than or equal to a high school education. We discuss the implications and limitations of our findings and outline avenues for future research.
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This review describes stress-related biological mechanisms linking interpersonal racism to life course health trajectories among African Americans. Interpersonal racism, a form of social exclusion enacted via discrimination, remains a salient issue in the lives of African Americans, and it triggers a cascade of biological processes originating as perceived social exclusion and registering as social pain. Exposure to discrimination increases sympathetic nervous system activation and upregulates the HPA axis, increasing physiological wear and tear and elevating the risks of cardiometabolic conditions. Consequently, discrimination is associated with morbidities including low birth weight, hypertension, abdominal obesity, and cardiovascular disease. Biological measures can provide important analytic tools to study the interactions between social experiences such as racial discrimination and health outcomes over the life course. We make future recommendations for the study of discrimination and health outcomes, including the integration of neuroscience, genomics, and new health technologies; interdisciplinary engagement; and the diversification of scholars engaged in biosocial inequities research.
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Individuals with higher educational attainment live healthier and longer lives. However, not everyone benefits equally from higher education. In particular, the black-white gap in life expectancy is greater at higher levels of educational attainment. Furthermore, recent research suggests that disadvantaged African Americans in the rural Southeast who attend college have worse physical health than their similarly disadvantaged peers who do not attend college. The extent to which this pattern generalizes to a nationally representative, mixed-race sample is unknown. Using data from the National Longitudinal Study of Adolescent to Adult Health, we test whether the health benefits associated with college completion vary by level of childhood disadvantage for depression and metabolic syndrome in young adulthood, across race/ethnicity. We find uniform lower depression associated with college completion regardless of childhood disadvantage, and across non-Hispanic white, non-Hispanic black, and Hispanic young adults. College completion is associated with lower metabolic syndrome for whites across all levels of childhood disadvantage. In contrast, college completion is associated with higher metabolic syndrome among black and Hispanic young adults from disadvantaged childhood environments. Our findings suggest that, for minorities from disadvantaged backgrounds, finishing college pays substantial dividends for mental health but simultaneously exacts costs with regard to physical health. This pattern contrasts starkly with whites and minorities from more privileged backgrounds, for whom college completion is associated with benefits to both mental and physical health. These results suggest that racial disparities in health may persist in part because the health of upwardly mobile minorities is compromised in young adulthood.
The tendency for blacks to report similar or better mental health than whites has served as an enduring paradox in the mental health literature for the past three decades. However, a debate persists about the mechanisms that underlie this paradox. Drawing on the stress process framework, we consider the counterbalancing roles of self-esteem and traumatic stress exposure in understanding the “black-white paradox” among U.S. adolescents. Using nationally representative data, we observe that blacks have higher levels of self-esteem than whites but also encounter higher levels of traumatic stress exposure. Adjusting for self-esteem reveals a net higher rate of mood disorders and distress among blacks relative to whites, and differences in traumatic stress exposure mediate this association. In the full model, we show that self-esteem and stress exposure offset each other, resulting in a null association between race and mood disorders and a reduced association between race and distress.
Objective: The association between effort reward imbalance (ERI) and various health outcomes has been well-documented over the past 20 years, but the mechanisms responsible for this association remain unclear. The present meta-analysis assessed the associations of ERI and over-commitment (OC) in the workplace with hypothalamic-pituitary-adrenal (HPA) axis measures. Methods: Electronic databases were searched with the phrase 'effort*reward*imbalance' which yielded 319 studies leading to 56 full text studies being screened. Thirty-two studies within 14 papers met inclusion criteria and were meta-analysed using mixed and random effects models. Results: Greater ERI was associated with increased HPA axis activity (r = .09, p < .001, k = 14, N = 2,541). The cortisol awakening response (r = .14, p < .001, k = 9, N = 584), and cortisol waking concentrations (r = .12, p = .01, k = 6, N = 493) were the only HPA measures associated with ERI. Over-commitment was also associated with greater HPA axis activity (r = .06, p < .01, k = 10, N = 1,918). Cortisol (p.m.) (r = .13, p = .02, k = 3, N = 295) was the only HPA measure associated with OC. Conclusions: ERI and OC were similarly related with HPA responsivity. However, as OC moderated the relationship between ERI and HPA axis markers, the importance of OC should not be overlooked. As OC is likely more malleable than ERI to intervention, this may be a promising avenue for future research.