Understanding the “Paradox” in Black-White Alcohol Outcomes: Examining High-Effort Coping and Health Behaviors with a Focus on Black Populations and College Students

Despite experiencing more physical health disadvantages and psychosocial stressors, Black Americans consistently report better mental health outcomes compared to White Americans-a phenomenon commonly referred to as the Black-White health paradox. Alcohol research has identified another racial paradox suggesting Black Americans are at greater risk for alcohol-related problems despite drinking less than White Americans, which is known as the Black-White alcohol paradox. While both paradoxes are well-documented, few studies have examined their potential overlap or how insights from one might inform understanding of the other. Although the alcohol paradox is usually examined among older adults, it may be important to consider factors related to the health paradox among a younger population at-risk for problematic alcohol use: college students. This narrative review argues the importance of examining high-effort-coping (HEC; i.e., John Henryism), a culturally-relevant form of coping with social and economic adversity that has primarily been examined among Black populations. HEC is associated with poorer physical health yet better mental health, similar to the Black-White health paradox. Little is known on how HEC may play a role in health-harming behaviors, such as alcohol use. This paper aims to (1) review and highlight gaps in research using Black and White samples that have examined HEC in relation to health behaviors and college student health outcomes, (2) review studies on HEC and substance use and how it can be applicable to college students, and (3) offer recommendations for integrating HEC in future health behavior research using the Black-White alcohol paradox as an example.