Black men have poorer health and shorter lifespans than other race and gender groups in the U.S., largely due to disparities in aging-related health conditions such as hypertension, heart disease and stroke, cancers, and diabetes. Physiological distress is increasingly examined as a key proximal outcome of stress and coping processes through which exposure to chronic stressors are posited to generate health disparities. The purpose of this dissertation was to document, better understand, and identify racial differences in physiological distress and relationships between physiological distress and antecedent stress and coping processes among midlife and older Black and White men. Our goal was to identify how proximal health factors and different coping strategies contributed to racial health disparities among men. We also explored the relationships between coping and two dimensions of distress, physiological and psychological distress, to determine if coping differences accounted for the paradox in which Black men experience more physical health problems but better mental health than their White counterparts. This research will be used to identify priorities and leverage points for intervention to improve health outcomes and reduce health disparities among men.We completed three empirical studies using linked data from 700 Black and White men who participated in the National Survey of Midlife Development in the United States (MIDUS II) and the National Study of Daily Experiences (NSDE II). Our primary outcome variable for all three studies was physiological distress, as indicated by blunted diurnal cortisol slopes. In Chapter 2, we documented more physiological distress among Black men than White men and most pronounced racial disparities in older age groups than in younger age groups. Having common medical conditions (e.g., hypertension, heart disease, diabetes) was associated with more physiological distress among Black men but was unrelated to White men’s physiological distress levels. Psychological distress and functional limitations were unrelated to both Black and White men’s physiological distress. In Chapter 3, we showed that Black and White men reported similar use of 12 different coping strategies, though Black men reported greater reliance on positive reinterpretation, denial, drug use, and physical inactivity. Religious and spiritual coping was protective for White men’s physiological distress, but not Black men’s. Black men who used drugs had less physiological distress than those who abstained. In Chapter 4, we found that none of the coping strategies tested demonstrated similar relationships for both physiological and psychological distress, providing further evidence that these dimensions of distress are distinct. Most coping strategies predicted psychological distress in anticipated ways but not physiological distress. Implications include: 1) physiological distress measures are useful in men’s health research; 2) many factors assumed to influence physiological distress (e.g., psychological distress, functional limitations, smoking, and coping) may not warrant attention in interventions to improve physical health outcomes among aging men, because they are not relevant for this sociodemographic group; 3) interventions that enhance midlife and older men’s coping skills and access to supportive resources may have no effect on their physiological health but may benefit their psychological health; and 4) interventions to improve physical health outcomes and reduce health disparities among men should prioritize evidence-based predictors of men’s physiological distress including eliminating stressors rooted in social inequities and reducing the harmful effects of common medical conditions on Black men’s lives.
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Coping and Psychological and Physiological Distress among Black and White Men in the U.S.
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