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. Author manuscript; available in PMC: 2025 Jan 1.
Published in final edited form as: Soc Sci Med. 2023 Nov 26;340:116445. doi: 10.1016/j.socscimed.2023.116445

Superwoman Schema and self-rated health in black women: Is socioeconomic status a moderator?

Christy L Erving a,*, Izraelle I McKinnon b, Miriam E Van Dyke b, Raphiel Murden c, Shivika Udaipuria b, Viola Vaccarino b, Reneé H Moore d, Bianca Booker b, Tené T Lewis b
PMCID: PMC10959495  NIHMSID: NIHMS1972332  PMID: 38043442

Abstract

Background:

The Superwoman Schema (SWS) construct elucidates Black women’s socialization to be strong, suppress their emotions, resist vulnerability, succeed despite limited resources, and help others at their own expense. Drawing from intersectionality and social psychological research on self-schemas, this study examined the extent to which SWS was associated with Black women’s self-rated health. We also investigated whether socioeconomic status (SES) moderated the association between SWS, its five dimensions, and self-rated health.

Methods:

Data were from the Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women’s Health Study, a cohort of African American self-identified women. SWS was assessed using Giscombé’s 35-item Superwoman Schema Scale. Socioeconomic status was measured by household income and educational attainment. Ordered logistic regression models were used and statistical interactions were run to test for moderation (N = 408).

Results:

First, SWS dimension “obligation to help others” was associated with worse self-rated health (p < .05). Second, household income, but not education, moderated the association between SWS and self-rated health (p < .05): SWS overall was associated with worse self-rated health among higher income women but better self-rated health among lower income women. Third, income moderated the association between SWS dimension “obligation to present an image of strength” and self-rated health (p < .05): presenting strength was associated with better self-rated health for lower income women only. Fourth, moderation results revealed that SWS dimension “obligation to help others” was inversely associated with self-rated health particularly among higher income women.

Conclusions:

Findings speak to the complex interplay between SES and SWS dimensions as they relate to Black women’s perceived health.

Keywords: Superwoman schema, African American women, Stress, Coping, Social class

1. Introduction

Research confirms the relatively poor physical health of Black women vis-à-vis other race-gender groups (Geronimus et al., 2010; Hargrove, 2018; Read and Gorman, 2006). These patterns are especially pronounced in mid-life through older adulthood (Brown and Hargrove, 2013; Richardson and Brown, 2016). For example, Black women between the ages of 51 and 65 years have lower self-rated health compared to their White male, White female, and Black male counterparts (Brown et al., 2016). Though some research has sought to identify the extent to which social factors such as stress exposure (e.g., discrimination and financial hardship), childhood adversity, and relationship strain contribute to Black women’s health (Erving et al., 2021a,b; Lewis et al., 2006; Simons et al., 2016; Umberson et al., 2014), the possibility of race-gender specific social mechanisms undergirding these disparities remain underexplored. In addition, though race-gender physical health disparities in mid-to-late life are well-documented, further exploration of social mechanisms underlying Black women’s physical health in early mid-life may provide insight on how their health unfolds later in the life course. The disadvantages Black women experience begin early in the life course, accumulating over time to culminate into poor health in mid-to-late life. Geronimus and colleagues’ (2010) research on biological weathering showed that at 49–55 years of age, Black women were already biologically 7.5 years older than White women. Thus, an examination of Black women’s health in earlier life course stages is essential to comprehensively understanding their health in later life. The current study seeks to address these gaps by exploring the extent to which endorsement of the Superwoman Schema is associated with the self-rated health of Black women in early mid-life (30–46 years of age).

Developed by Woods-Giscombé (2010), the Superwoman Schema (SWS) captures a collective response of Black women to racialized and gendered oppression by highlighting their socialization to be strong, suppress their emotions, resist vulnerability, succeed despite limited resources, and help others at their own expense. As noted by Woods-Giscombé (2010), “the operationalization and measurement of stress must be culturally relevant, taking into consideration the context of African American women’s lives” (670). The intersectional degradation Black women experience because of their racial and gendered identities places them at unique risks for negative health outcomes (Crenshaw, 1989, 1991; Collins, 2000; Erving et al., 2021a; Lewis and Van Dyke, 2018). While quantitative intersectional research has primarily taken an inter-categorical methodological approach (i.e., across-group analyses, e.g., see Bauer and Scheim, 2019; Harnois and Bastos, 2019), the development of the SWS scale is a methodological innovation linking the intersectionality framework with intra-categorical (i.e., within-group) quantitative approaches to understanding Black women’s health. Accordingly, SWS could potentially serve as a missing psychosocial mechanism underlying Black women’s physical health.

In addition to relying on intersectionality and Black feminist thought as theoretical pillars, the development of SWS was also informed by conceptual frameworks such as “weathering” (Geronimus, 2001) and allostatic load (McEwen, 1998). In essence, SWS emanates from the accumulation of stress Black women experience over the life course owing to their subordinated racial and gender positionality, necessitating their strength to overcome structural inequalities (e.g., Black men’s disproportionately high incarceration rates, which has removed them from Black communities en masse). Indeed, Woods-Giscombé (2010) envisioned the Superwoman Schema as a means to understand mechanisms and pathways linking stress and health among Black women (p. 669).

The current study examined the association between SWS and self-rated health, a powerful subjective health measure found to be a reliable predictor of morbidity and mortality (Ferraro et al., 1997; Idler and Benyamini, 1997; Zajacova et al., 2017). We draw data from a cohort of Black women living in the Atlanta, GA metropolitan area. However, the literature examining the health implications of strong Black womanhood remains in its infancy, leaving mechanisms underlying the association poorly understood. Therefore, a second aim is to ascertain the extent to which socioeconomic status (SES) (i.e., household income and educational attainment) moderates the association between SWS and self-rated health.

We hypothesize that socioeconomic status may nuance the expression and endorsement of SWS as well as the SWS-health association. On one hand, high SES women may have more economic resources to facilitate strong endorsement of SWS ideals (e.g., intense motivation to succeed, obligation to help others), and thus, SWS may be less harmful for their health. On the other hand, high SWS endorsement among women with low SES may be harmful for health as they may be unable to fully embrace aspects of Superwoman Schema that require access to economic resources and social capital. By investigating SES as a potential moderator of the SWS-self-rated health association, we contribute to a small, but growing literature recognizing socioeconomic diversity in Black women’s health (Brown et al., 2016; Erving and Smith, 2022).

2. Theoretical framework

This study is theoretically informed by the intersectionality framework as well as social psychological research on identity and self-schemas. The intersectionality framework illuminates the processes by which Black women’s health may be comprised in early mid-life. An intersectional interpretation of Black women’s health recognizes that their marginalized gendered and racialized identities expose them to oppressive systems of sexism and racism that, in turn, compromises their health (Crenshaw, 1989, 1991; Collins, 2000; Homan et al., 2021). Intersectional inter-categorical (across-group) quantitative research reveals the physical health disadvantages of Black women (e.g., see Brown et al., 2016; Cummings and Jackson, 2008) vis-à-vis more privileged groups (e.g., White men). Nevertheless, comparative analyses do little to address the unique social and structural factors, rooted in gendered racism, that impinge on Black women’s ability to maintain a healthy state.

Social psychological research confirms complex interrelationships among self-schemas, identity, and well-being (Thoits, 2013). Self-schemas refer to “cognitive generalizations about the self, derived from past experience, that organize and guide the processing of the self-related information contained in an individual’s social experience” (Markus, 1977: 63). Facilitating the processing of information about the self, schemas are powerful predictors of social outcomes like academic achievement, self-esteem, and mental health (Oyserman et al., 2003; Rosenfield et al., 2005). Self-schemas reflecting social identities (e.g., race, gender) tend to be particularly salient for members of historically marginalized social groups, having both positive and negative implications for psychological health (Hughes et al., 2015; Oyserman et al., 2003; Monk, 2020).

Though a robust literature has examined how racial identity and centrality influence the mental health of Black Americans (e.g., Hughes et al., 2015), a limited volume of quantitative work has investigated how racialized-gendered self-schemas influence the physical health of Black women. Because Black women occupy a unique racial and gender positionality that differs from their Black male and non-Black female counterparts, it is critical to identify self-schemas unique to this population. A rich body of qualitative and theoretical research from various disciplines has articulated how Black women’s necessity to be strong can serve as both an asset and liability (Thomas et al., 2022). For instance, Gillespie (1984), Wallace (1990), Harris (2001) and Beauboeuf-Lafontant (2007) emphasize the perils and precarity of Black women’s portrayal as strong and invincible in the context of literature, political participation, within the Black community, as well as the private sphere.

Bridging the intersectionality framework with social psychological research on self-schemas, this study examines the association between Black women’s endorsement of the “strong Black woman” self-schema (Beauboeuf-Lafontant, 2007) and their self-rated health. Accordingly, we fill a gap in the literature as it pertains to quantifying the extent to which strong Black womanhood may influence a subjective measure of health. Despite exposure to structural racism and sexism, self-described “strength” is a central component of Black women’s gendered-racialized identity (Settles, 2006). The Superwoman Schema, a recently validated scale capturing Black women’s expectations to exude strength, conveys a social psychological process unique to Black women’s experiences that is informed by their historical and contemporary gendered-racialized marginalization. As opposed to assuming homogenous experience among Black women, this study examines the degree to which SWS is endorsed across the economic spectrum, and whether the association between SWS and health differs for high versus low SES Black women. Status variation among Black women remains relatively understudied in the growing SWS literature (Knighton et al., 2022; Perez et al., 2022). Here we recognize social class as a status dimension that could differentiate the experiences of Black women. In this way, we include another system of oppression that may impinge on the health of Black women, infusing greater intersectional nuance into research on the psychosocial determinants of Black women’s health.

3. Background

3.1. Superwoman Schema and black Women’s health

Grounded in Black feminist epistemology and intersectionality, Woods-Giscombé and colleagues (2010, 2019) operationalized the Superwoman Schema (SWS) construct to capture a cognitive schema, or set of beliefs and values, that many Black women have been socialized to embrace. The SWS scale highlights five dimensions: expectations to exude strength, suppression of emotions, resistance to vulnerability, motivation to succeed despite limited resources, and assistance to others at one’s own expense (Woods-Giscombé, 2010; Woods-Giscombé et al., 2019).

A small literature is beginning to establish a linkage between SWS and health, with most studies focusing on psychological health. For instance, Black women’s perceptions that they must exude strength, be self-reliant, and selflessly care for others are associated with elevated depression and anxiety symptoms (Jones et al., 2021; Liao et al., 2020; Watson-Singleton, 2017). In addition, specific dimensions of SWS may have positive associations with mental health, while others have negative implications for mental health (Leath et al., 2022; Nelson et al., 2022; Perez et al., 2022).

Moving beyond psychological health, McLaurin-Jones et al. (2021) reported that SWS endorsement was associated with poor sleep among Black college women. No direct association between SWS and allostatic load was found in a study of Black women in the San Francisco/Bay area (Allen et al., 2019). Using the same cohort of Black women, Perez et al. (2022) found that specific dimensions were associated with greater risk for hypertension: feeling an obligation to present an image of strength and obligation to help others. Having an intense motivation to succeed, however, was associated with lower risk for hypertension (Perez et al., 2022). In another study, resistance to vulnerability was protective against cellular aging (Thomas et al., 2022). Thus, findings remain mixed, with some showing null independent associations between SWS and health (Allen et al., 2019), others showing negative health effects (McLaurin-Jones et al., 2021), and even others demonstrating complex patterns dependent on the specific aspect of Superwoman Schema endorsed (Perez et al., 2022; Thomas et al., 2022).

We build on this literature in three ways. First, we assess whether SWS is associated with self-rated health, a measure of overall health related to morbidity and mortality (Idler and Benyamini, 1997; Jylhä, 2009; Zajacova et al., 2017). Though previous research has been inconsistent, given the novelty of the SWS measure, it is important to ascertain whether SWS is related to various health outcomes which will enhance understanding of the conditions under which SWS is adaptive or maladaptive with regards to physical well-being (Perez et al., 2022; Woods-Giscombé et al., 2019). Second, the relative associations between each SWS dimension and health remain underexplored; thus, we examine how SWS as a composite measure, as well as the specific sub-components or dimensions of SWS (e.g., motivation to succeed; suppress emotions), are related to self-rated health. Third, we assess whether SES moderates the association between SWS and self-rated health. Extant literature on the intersections of race, socioeconomic status, and health indicate that these interrelationships are not always straightforward, given that the Black middle class does not always enjoy the same health benefits of higher SES as their White counterparts (Boen, 2016; Colen et al., 2018; Turner et al., 2017). With regards to SWS, there is a possibility that socioeconomic position could be patterned by SWS and, in turn, moderate the association between SWS and subjective well-being.

3.2. Socioeconomic status and SWS

In addition to their racial and gender marginalization, economic oppression impinges on life chances and restricts opportunities for the economic advancement of low SES Black women. Within a classist stratification system, Black women living in poverty are disproportionately exposed to social stress and poor mental and physical health (Keith and Brown, 2017; Smith, 2021). It is unclear, however, whether SES influences the extent to which Black women endorse SWS. Black women of varying SES backgrounds may endorse certain components of Superwoman ideals to different degrees (Allen et al., 2019; Woods-Giscombé, 2010). For instance, SWS nuances in the “obligation to help others” dimension was identified by Woods-Giscombé (2010) in a qualitative focus group study of Black women: those who had completed some college education described desires to provide financially for their families despite not having enough for themselves. In addition, college-educated women were more likely to feel an obligation to helping their family members financially (Woods-Giscombé, 2010). In a sample of Black women living in the San Francisco Bay area, Allen et al. (2019) reported a weak but significant bivariate correlation between lower educational attainment and higher scores on the SWS subscale of emotion suppression. Another study, however, did not find SWS endorsement distinctions by education or income (Platt and Fanning, 2023). Further investigation of SES distinctions in SWS overall and each SWS dimension can clarify whether SWS endorsement is universal to all Black women or if SWS endorsement is more salient for specific subpopulations.

3.3. Black Women’s SES and implications for SWS endorsement and health

Though SES is often referred to as a “fundamental cause” of health (Clouston and Link, 2021; Link and Phelan, 1995), evidence of the SES-health gradient among Black Americans overall and Black women, in particular, is mixed (Smith, 2021). On one hand, Black women’s physical health profiles are differentiated by SES, with college-educated Black women experiencing better self-rated health compared to their counterparts with a high school diploma or less (Brown et al., 2016; Cummings and Jackson, 2008). On the other hand, the Black middle-class does not enjoy the same economic benefits from their class status as their similarly positioned White peers (Colen et al., 2018; Houle and Addo, 2019; Pattillo, 2013; Thomas, 2015; Williams et al., 2016); accordingly, the diminishing health returns hypothesis suggests that Black Americans do not accrue the same health gains of higher SES as their White counterparts (Boen, 2016; Hudson et al., 2013; Turner et al., 2017; Wilson et al., 2017). Extending beyond a SES-health research paradigm that focuses on comparison across race-gender groups, this study explores potential within-group SES disparities among Black women who are often studied as if they are a homogeneous group. Taken together, this research will examine SWS nuances in Black women’s health as well as the extent to which they endorse SWS ideals.

We propose that specific SWS dimensions may operate to uniquely compromise the health of low SES Black women. Because they lack access to economic resources (e.g., income, wealth), providing financial aid to network members may be untenable which can, in turn, be distressing and elicit poor health. Even middle-class Black women, despite often reporting a perceived obligation to help family members financially, may harbor complex emotions regarding helping others in their lives, as the middle-class status of Black women is often precarious due to high levels of debt and under-compensation for their work (Knighton et al., 2022; Sacks et al., 2020). Moreover, suppressing emotions may be particularly harmful for the health of Black women with fewer economic resources because of their limited means to seek professional help (e.g., therapy) as a safe space in which to emote, vent frustrations, and develop health-promoting coping mechanisms. Last, a motivation to succeed, while laudable, may be particularly demoralizing for Black women who have restricted opportunity to pursue upward economic mobility. A motivation to succeed without access to education and income to facilitate economic advancement can activate a physiological stress response that, over time, compromises physical health. In sum, the current study assesses the extent to which SWS endorsement differentially influences the physical health of Black women from various socioeconomic backgrounds. In doing so, we recognize status (i.e., socioeconomic) heterogeneity in SWS and physical health among Black women which, in turn, may provide insight on the extent to which SWS may be health-protective for certain segments of the Black female population while having deleterious health effects for others.

In sum, the current study addresses the following research questions: What is the association between SWS, its subcomponents, and self-rated health? Does SES moderate the association between SWS and self-rated health? Because Black women of lower socioeconomic position reported higher endorsement of SWS (specifically, emotion suppression) in a previous study (Allen et al., 2019), there is the possibility that the association between SWS and self-rated health could be stronger for those with lower SES. On the other hand, high SES women may more strongly endorse SWS dimensions like “obligation to help others” (Woods-Giscombé, 2010), in turn, making this dimension especially detrimental to their well-being.

4. Methods

Data were from the Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women’s Health Study, a cohort of 422 Black or African American self-identified women. MUSE was designed to determine the impact of psychosocial stressors (e.g., discrimination) on cardiovascular disease risk (for more information on the cohort, see Spikes et al., 2022). Because prior studies have found that African American women do not receive substantive health gains from higher versus lower socioeconomic status (e.g., Lewis et al., 2006), by design, 50% of the participants were above and 50% were below the median income of $50,000 in Georgia at recruitment. This categorization was made to understand determinants of risk across the socioeconomic spectrum among Black women. Baseline data were collected December 2016 to March 2019. National Opinion Research Center (NORC) services were acquired to identify participants representing a wide range of socioeconomic backgrounds and census tracts in the Atlanta, Georgia metropolitan area. NORC used consumer residential and voter registration lists to identify Black women in the target age range (30–45 years of age). Potential respondents were sent a flyer introducing the study, followed by a phone call. A total of 1,989 persons who expressed interest in the study were pre-screened via telephone to determine eligibility. Inclusion criteria were self-identifying as a Black woman, being aged 30–45, and premenopausal with at least one ovary. Exclusion criteria included history of clinical cardiovascular disease, being pregnant or lactating, any chronic illness known to influence atherosclerosis (e.g., HIV/AIDS, autoimmune or chronic inflammatory diseases such as lupus/rheumatoid arthritis, renal disease, liver disease), current treatment for psychiatric disorders, current illicit drug use (i.e., marijuana, cocaine), or alcohol abuse. Women working overnight shifts were excluded because of the impact of shift-work on diurnal rhythms and ambulatory blood pressure (Yamasaki et al., 1998).

Based on these inclusion and exclusion criteria, 831 were eligible to participate in the study. Eligible participants were contacted by study staff and scheduled for an in-person visit. A total of 422 respondents completed the in-person interview. Compared to women who participated in the study, women who were eligible but did not participate were slightly younger (Mean Age = 36.69; SD = 4.31), had lower educational attainment (39% were college graduates), and lower household incomes (only 39% had a household income of $50,000 or more). Enrolled respondents represented approximately 200 unique census tracts in the Atlanta metropolitan area. Interviews were conducted in English by interviewers who identified as Black women. All procedures were approved by the IRB and all participants provided written, informed consent.

Of the 422 women enrolled in the study, 407 (96% of the cohort) had complete data on Superwoman Schema (SWS). The remaining 4% (N = 15) had a missing response to at least one question on the 35-item SWS scale. Among this group, if a given participant responded to at least 80% of the items on the SWS scale (e.g., answered at least 29 of the 35 questions), we used person-mean-substitution (Huisman, 2000) to impute the remaining 1–6 items. Person-mean substitution was only performed for N = 12 women. Women who skipped 7 or more questions on the 35-item SWS scale (N = 3) were excluded from all analyses. Of the remaining 419 women, an additional 11 were missing covariate data (e.g., for household income, 6 responded “Don’t Know”, 2 refused, and 2 were missing; 1 respondent was missing on educational attainment) resulting in a final sample of N = 408 for this analysis. Sensitivity analyses were conducted comparing the results for N = 408 to a complete case analysis (N = 397) and multiple imputation with chained equations (N = 422). These regression analysis results are reported in Appendix Tables. Overall, results were similar across the different analytic approaches, so we opted to present the analysis of N = 408.

Dependent Measure.

For self-rated health, respondents rated their health in general on a five-point scale ranging from “poor” to “excellent”. Because only four respondents rated their health as “poor”, the “fair” and “poor” categories were collapsed, resulting in a four-point scale: Poor/Fair (=1), Good (=2), Very Good (=3), and Excellent (=4). As one of the most widely used general health measures, self-rated health is a reliable predictor of morbidity (Ferraro et al., 1997; Zajacova et al., 2017) and mortality (Idler and Benyamini, 1997; Jylhä, 2009). This version of the self-rated health measure is used in various large survey datasets such as National Survey of American Life and the National Health Interview Survey (also, see studies such as Hudson et al., 2013; Zajacova et al., 2017).

Independent Measures.

The Superwoman Schema Scale (SWS) was comprised of 35-items that captured five dimensions: 1) obligation to present an image of strength (6 items, e.g., “I have to be strong”), 2) obligation to suppress emotions (7 items, e.g., “I keep my feelings to myself”), 3) resistance to being vulnerable (7 items, e.g., “Asking for help is difficult for me”), 4) intense motivation to succeed (6 items, e.g., “No matter how hard I work, I feel like I should do more”), and 5) obligation to help others (9 items, e.g., “There is no time for me, because I am always taking care of others”) (Woods-Giscombé et al., 2019). Response options entailed: Not true for me (0), true for me rarely (1), true for me sometimes (2), and true for me all the time (3). In alignment with prior research (Allen et al., 2019; Leath et al., 2022), items were summed and averaged to generate a composite score for each respondent (possible range: 0–3). To create the SWS aggregate score, we summed and averaged all 35 items to create a composite score for each respondent (possible range: 0–3). Relevant items were reverse coded for consistent valence, and higher values reflect greater SWS endorsement. The full SWS scale (hereafter, SWS overall) had high reliability (alpha = .94) as well as the five SWS subscales (alpha = .81 for “strength”, 0.86 for “suppress”, 0.86 for “vulnerability”, 0.75 for “motivation”, and 0.88 for “obligation to help others”).

Moderators.

Two SES indicators were included in the analysis. First, annual household income distinguished between respondents with a household income of less than $50,000 (reference) and those earning $50,000 or more. This cut-off is consistent with median household income in Atlanta in 2016 (U.S. Census Bureau, 2019). Second, educational attainment compared respondents without a Bachelor’s degree (reference) to those with a Bachelor’s degree or higher. The tetrachoric correlation between annual household income and educational attainment was 0.51 (p < .001), suggesting that these indicators of SES are related yet distinct measures.

Controls.

All models adjusted for age, depressive symptoms, parental status, marital status, and employment status, as these factors are associated with physical health. Age ranged from 30 to 46 years. To account for the potential influence of mental health on self-rated health assessment, models adjusted for depressive symptoms using a 21-item version of the Beck Depression Inventory (Beck et al., 1988). Parental and marital statuses were included as covariates in the analysis. Parents referred to individuals who reported being a parent (=1). Marital status distinguished between those currently married or “living as married” (=1) compared to those who were not (=0). Employment status distinguished between those who were employed (=1) versus not employed (=0). In addition, we adjusted models for the number of children residing in the household (range: 0–9), as the presence of children in the household could influence the associations being tested.

4.1. Analytic strategy

First, descriptive statistics were reported for the full sample (Table 1). To assess SES differences in key study measures, the Wilcoxon Mann-Whitney rank-sum test was used because the measures were not normally distributed (Harris and Hardin, 2013, Table 2). Ordinal logistic regression analysis was utilized to examine the association between SWS and self-rated health after adjustments for SES and the study controls (Table 3). To assess whether SES moderated the association between SWS and self-rated health, statistical interactions between each SES measure and SWS were run. To assess how each SES measure was independently associated as a potential moderator, statistical interaction terms for each SES measure were entered into the regression model one at a time. Significant statistical interactions are reported in Table 4. To facilitate interpretation, predicted probabilities are included in figures for statistically significant interactions. Statistical analyses were conducted in Stata version 17.0 (StataCorp, 2021) and all statistical assumptions for each test were assessed.

Table 1.

Descriptive statistics (N = 408).

Mean (SD) Min. Max.
Dependent Measure
Self-Rated Health (Poor/Fair = 1) 2.41 (83) 1.00 4.00
Self-Rated Categories
 Poor/Fair .14
 Good .39
 Very Good .38
 Excellent .08
Independent Measures
Superwoman Schema (SWS) 1.92 (.51) .00 2.86
SWS Subscales
 Obligation to Present Strength 2.25 (.64) .00 3.00
 Suppress Emotions 1.64 (.68) .00 3.00
 Resistance to Vulnerability 1.91 (.69) .00 3.00
 Motivation to Succeed 2.23 (.52) .00 3.00
 Obligation to Help Others 1.72 (.68) .00 3.00
Socioeconomic Status
 Household Income
  Less than $50,000 .46
  $50,000 or more (ref.) .54
 Educational Attainment
  Less than Bachelor’s degree .52
  Bachelor’s degree or higher (ref.) .48
Controls
 Age 37.44 (4.28) 30.00 46.00
 Depressive Symptoms 5.91 (6.72) .00 39.00
 Parental Status (Parent = 1) .74
 Married/Living as Married (=1) .36
 Employment Status (Employed = 1) .87
 Number of Children in Household 1.54 (1.43) 0.00 9.00
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Source: Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women’s Health Study, 2016–2019

Table 2.

Self-rated health and superwoman schema endorsement means by socioeconomic status.

Household Income
 Educational Attainment
Less than $50,000 $50,000 or more Less than Bachelor’s Degree Bachelor’ s Degree or higher
Self-Rated Health 2.25 (.86) 2.55 (.78)a 2.30 (.86) 2.53 (.78)a
Superwoman Schema (SWS) 1.93 (.54) 1.91 (.48) 1.98 (.53) 1.85 (.48)a
SWS Subscales Obligation to Present Strength 2.26 (.67) 2.24 (.61) 2.28 (.64) 2.22 (.63)
 Suppress Emotions 1.66 (.70) 1.62 (.67) 1.73 (.69) 1.54 (.66)a
 Resistance to Vulnerability 1.93 (.71) 1.88 (.67) 1.99 (.72) 1.82 (.65)a
 Motivation to Succeed 2.22 (.56) 2.24 (.49) 2.26 (.53) 2.20 (.51)
 Obligation to Help Others 1.74 (.73) 1.70 (.64) 1.79 (.72) 1.64 (.64)a
N (Sample Size) 188 220 213 195
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Standard Deviations in parentheses.

a

Indicates significant differences (p-value <.05) by household income or educational attainment based on Wilcoxon Mann-Whitney rank-sum tests. Source: Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women’s Health Study, 2016–2019

Table 3.

Odds ratios from ordinal logistic regression of the association between superwoman schema and self-rated health (N = 408).

Model 1 Model 2 Model 3 Model 4 Model 5 Model 6
SWS Overall .98 (.66,1.45)
SWS Subscales
Obligation to Present Strength 1.34 (1.00,1.79)
Suppress Emotions .91 (.68,1.21)
Resistance to Vulnerability 1.06 (.79,1.42)
Motivation to Succeed 1.26 (.88,1.80)
Obligation to Help Others .72* (.53,.97)
SES
Income $50,000 or more 1.65* (1.07,2.54) 1.62* (1.05,2.49) 1.66* (1.07,2.55) 1.64* (1.06,2.52) 1.62* (1.05,2.49) 1.65* (1.07,2.54)
Bachelor’s degree or higher 1.24 (.82,1.86) 1.24 (.82,1.87) 1.23 (.82,1.86) 1.24 (.82,1.87) 1.25 (.83,1.88) 1.22 (.81,1.84)
Controls
Age 1.01 (.97,1.06) 1.01 (.97,1.06) 1.01 (.97,1.06) 1.01 (.97,1.06) 1.01 (.97,1.06) 1.02 (.97,1.06)
Depressive Symptoms .94*** (.91,.97) .93*** (.90,.96) .94*** (.91,.97) .94*** (.91,.97) .94*** (.91,.96) .95** (.92,.98)
Parent .76 (.43,1.34) .70 (.40,1.24) .77 (.44,1.35) .75 (.42,1.31) .73 (.42,1.290 .81 (.46,1.42)
Married .92 (.60,1.43) .96 (.62,1.50) .93 (.60,1.44) .94 (.60,1.46) .93 (.60,1.45) .96 (.62,1.50)
Employed 1.67 (.93,3.01) 1.70 (.95,3.07) 1.69 (.94,3.04) 1.67 (.93,3.00) 1.73 (.96,3.13) 1.74 (.96,3.13)
Number Children in Household 1.10 (.92,1.32) 1.11 (.92,1.32) 1.10 (.92,1.31) 1.11 (.93,1.32) 1.11 (.93,1.32) 1.11 (.93,1.33)
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Odds ratio followed by 95% confidence intervals in parentheses are reported.

*

p < .05,

**

p < .01,

***

p < .001.

Source: Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women’s Health Study, 2016–2019

Table 4.

Models with significant interactions between household income and SWS (N = 408).

Model 1 Model 2 Model 3
SWS
Superwoman Schema (SWS) 1.46 (.86, 2.47) - -
Obligation to Present Strength - 1.79** (1.20, 2.68) -
Obligation to Help Others - - .97 (.65, 1.44)
SES
Income $50,000 or more 8.04** (1.87, 34.53) 6.28** (1.61, 24.43) 4.56** (1.64, 12.69)
Bachelor’s degree or more 1.22 (.81, 1.84) 1.22 (.80,1.84) 1.24 (.82, 1.86)
Significant Statistical Interactions
SWS x Income $50,000 or more .44* (.21, 90) - -
Strength x Income $50,000 or more - .55* (.31,.97) -
Help Others x Income $50,000 or more - - .55* (.32, .95)
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Confidence internals in parentheses.

All models control for age, depressive symptoms (Beck Depression Inventory), parental status, marital status, employment status, and number of children living in the household.

*

p < .05,

**

p < .01,

***

p < .001.

Source: Mechanisms Underlying Stress and Emotions (MUSE) in African- American Women’s Health Study, 2016–2019

5. Results

Descriptive statistics for the study measures are reported in Table 1. Self-rated health fell between the “Good” and “Very Good” categories, at 2.41 (SD = 0.83). In terms of each self-rated health category, 14% reported “fair” or “poor” health, 39% had “good” health, 38% reported “very good” health, and 8% reported excellent health. Mean Superwoman Schema endorsement was 1.92 (SD = 0.51), approaching the “true for me sometimes” category. When subscale means were considered, “obligation to present strength” (Mean = 2.25; SD = 0.64) and “motivation to succeed” (M = 2.23; SD = 0.52) were the most highly endorsed, falling between the “true for me sometimes” and “true for me all the time” responses. The next highest subscale endorsement was “resistance to vulnerability” (M = 1.91; SD = 0.69) followed by “obligation to help others” (Mean = 1.71; SD = 0.68), and, last, “suppress emotions” (M = 1.64; SD = 0.68).

The sample was socioeconomically heterogeneous. Fifty-four percent had a household income of $50,000 or more. With regard to education, 48 percent had a bachelor’s degree or higher. The mean age was 37.44 years (SD = 4.28). Depressive symptoms were relatively low (M = 5.91; SD = 6.72). Nearly three-quarters were parents and 36 percent were married or living as married. Eighty-seven percent of respondents were employed. The mean number of 1.54 (SD = 1.43) children resided in the same household as respondents.

Means for self-rated health and SWS are reported by SES (i.e., household income and educational attainment) in Table 2. Significant differences by SES were calculated using the Wilcoxon rank sum test. For household income, self-rated health was higher among women with a household income of $50,000 or more (M = 2.55; SD = 0.78) relative to those with a household income of less than $50,000 (M = 2.25; SD = 0.86). There were no income differences in SWS overall SWS nor its subscales. With regard to educational attainment, college-educated women had a higher self-rated health (M = 2.53; SD = 0.78), on average, relative to those with lower educational attainment (M = 2.30; SD = 0.86). Several educational attainment differences in SWS were observed. College-educated women reported lower SWS overall (M = 1.85; SD = 0.48) compared to those without a college degree (M = 1.98; SD = 0.53). In addition, college-educated women reported relatively lower endorsement of three SWS dimensions: suppress emotions, resistance to vulnerability, and obligation to help others. On the other hand, there were no educational differences in obligation to present strength and motivation to succeed.

5.1. Is SWS associated with self-rated health?

Results from ordinal logistic regression models assessing the association between SWS, its subcomponents, and self-rated health are shown in Table 3. Results from the Brant test revealed that the parallel regression assumption was not violated in any of the models, making ordinal logistic regression an ideal analytic approach (Harrell, 2001; Long and Freese, 2014). Model 1 showed no significant association between SWS overall and self-rated health when adjusting for controls. Nevertheless, for those with higher household income (i.e., $50,000 or more), the odds of having higher self-rated health was 1.65 times than that of those with lower household income, holding constant all other variables. This suggests that higher household income, but not educational attainment, is health-protective in this cohort of Black women. With respect to study covariates, only one measure was significant: depressive symptoms (OR = 0.94, p < .001) were associated with lower self-rated health.

5.2. What specific SWS dimensions are associated with self-rated health?

In Models 2 through 6, the association between each dimension of SWS and self-rated health was assessed in separate models. Study results revealed that “Obligation to Present Strength” (Model 2), “Suppress Emotions” (Model 3), “Resistance to Vulnerability” (Model 4), and “Motivation to Succeed” (Model 5) were not associated with self-rated health. One SWS dimension emerged as significant: In Model 6, “Obligation to Help Others” was associated with lower self-rated health (OR = .72, p < .05). Household income remained inversely associated with self-rated health across Models 2, 3, 4, 5, and 6. In addition, depressive symptoms remained significant in each model. Ultimately, the only sub-dimension of SWS related to self-rated health was obligation to help others.

5.3. Does socioeconomic status moderate the association between SWS and self-rated health?

To test for socioeconomic status (SES) as a potential moderator of the SWS-self-rated health association, statistical interactions were first run between household income and SWS overall as well as the subscales. Models with statistically significant interactions are reported in Table 4. The interaction between SWS and household income was statistically significant (OR = .44, p < .05), as shown in Model 1. As presented in Model 2, the interaction between the SWS subscale of Obligation to Present Strength and household income (OR = 0.55, p < .05) was also statistically significant. Last, as shown in Model 3, the interaction between the SWS subscale of Obligation to Help Others and household income (OR = 0.55, p < .05) was statistically significant. Given the large confidence intervals for the main effects of household income in the interaction models, results should be interpreted with caution. Nevertheless, our results could encourage future research on the moderating effects of income on the SWS-health association. There were no statistically significant interactions between SWS and educational attainment. We conducted supplemental analysis operationalizing educational attainment as number of years, and there was no evidence of moderation.

To facilitate interpretation of income as a moderator of the SWS-self-rated health association, significant statistical interactions were modeled visually in Figs. 1–3. Fig. 1 reports predicted probabilities of poor/fair (1a) and excellent (1b) self-rated health categories by household income and SWS endorsement. We focus on these two categories of self-rated health, as they represent the most extreme values of the outcome measure. We also focus on predicted probabilities of these two self-rated health categories to ease interpretation. In both figures, SWS endorsement values were set at the mean as well as one standard deviation below (low) and above (high) the mean. Predicted probabilities were produced based on Model 1 in Table 4. All covariates were set at their means. As shown in Fig. 1a, greater SWS endorsement was associated with a higher predicted probability of reporting fair/poor health among higher income women. On the other hand, greater endorsement of SWS was associated with lower predicted probabilities of reporting fair/poor health among lower income women. Regarding “Excellent” self-rated health results reported in Fig. 1b, among high income women, greater SWS endorsement was associated with lower predicted probability of excellent self-rated health. Among low income women, SWS endorsement was associated with a higher predicted probability of excellent self-rated health.

Fig. 1.

Fig. 1.

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a–bPredicted probabilities of poor/fair and excellent self-rated health based on statistical interaction between superwoman schema and household income.

Fig. 3.

Fig. 3.

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a–bPredicted probabilities of poor/fair and excellent self-rated health based on statistical interaction between obligation to help others and household income.

Fig. 2 reports predicted probabilities of poor/fair (2a), and excellent (2b) self-rated health by household income and endorsement of the “obligation to present strength” SWS dimension. “Obligation to present strength” values were set at the mean as well as one standard deviation below (low) and above (high) the mean. Predicted probabilities were produced based on Model 2 from Table 4. There was no association between “strength” and self-rated health among high income women. On the other hand, among lower income women, higher “strength” endorsement was associated with lower predicted probabilities of fair/poor (2a) health yet higher predicted probabilities of excellent (2b) health. This result suggests a health protective effect of “obligation to present strength” on self-rated health, but only among those with an annual household income of less than $50,000.

Fig. 2.

Fig. 2.

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a–bPredicted probabilities of poor/fair and excellent self-rated health based on statistical interaction between obligation to present strength and household income.

Fig. 3 reports predicted probabilities of poor/fair (3a), and excellent (3b) self-rated health by household income and endorsement of the “obligation to help others” SWS dimension. “Obligation to help others” values were set at the mean as well as one standard deviation below (low) and above (high) the mean. Predicted probabilities were produced based on Model 3 from Table 4. There was no association between “help others” and self-rated health among low income women. On the other hand, among higher income women, higher “help others” endorsement was associated with higher predicted probabilities of fair/poor (3a) health yet lower predicted probabilities of excellent (3b) health. This result suggests that “obligation to help others” is particularly harmful for self-rated health of women with an annual household income of $50,000 or more. In sum, the association between SWS and self-rated health was moderated by income, but not education.

6. Discussion

Using data from a cohort of Black women in early mid-life (30–46 years), this study had two aims: 1) To assess the association between Superwoman Schema (SWS), its subcomponents, and self-rated health. 2) To investigate whether SES (i.e., annual household income and educational attainment) moderated the association between SWS and self-rated health. The proposed study, to our knowledge, is the first to examine the influence of SWS on self-rated health, a subjective yet powerful measure of well-being associated with morbidity and mortality (Idler and Benyamini, 1997; Jylhä, 2009).

In terms of the association between SWS and self-rated health, results initially revealed that SWS, as a composite measure, was unrelated to health. When examining specific SWS dimensions, frequent “obligation to help others” was associated with worse self-rated health. As distinct from the idea of Black women taking pride in being “strong”, it is informative that obligation to help others, rooted in burdens and strains others place on them, was associated with lower self-rated health. Previous research confirms that Black women often serve as caregivers in the context of their immediate and extended family, but also in the workplace and in the broader community (Beauboeuf-Lafontant, 2007; Erving et al., 2021; Hirshfield and Joseph, 2012; Jones and Shorter-Gooden, 2003). Nonetheless, our results suggest that the mantle of heightened responsibility to others is potentially detrimental to health.

Household income moderated the association between SWS and self-rated health. Specifically, SWS was positively associated with self-rated health among lower income women, but negatively associated with higher income women’s self-rated health. In addition, the specific SWS dimension “obligation to help others” was associated with lower self-rated health but only among higher income Black women. Consistent with research identifying the diminishing health returns of higher economic status for Black Americans (Hudson et al., 2013; Turner et al., 2017; Wilson et al., 2017), the self-rated health of Black women with higher income decreased as SWS endorsement increased. Several intersectional social processes could operate to disadvantage higher income Black women. For instance, research shows economically upwardly mobile Black women feel a sense of indebtedness to family members to a greater extent than similarly economically privileged White women (Higginbotham and Weber, 1992). Though benevolence is a desirable characteristic in a general sense, financial obligation to network members can have negative consequences especially among upper income Black Americans (Hill, 2022; O’Brien, 2012). Moreover, middle-class Black women may respond to others’ needs in their personal and professional lives, with many serving as primary caregivers to young children while also meeting time-intensive employer demands in pursuit of professional advancement (Maddox, 2013; Jones and Shorter-Gooden, 2003). With the looming expectations to excel as “supermoms” and “career women” (Dow, 2015), the obligation to meet others’ needs could be operant in the personal and professional relationships higher income Black women cannot easily escape (Barnes, 2016; Wingfield, 2007, 2010). In attempts to provide emotional, financial, and social support, middle-class Black women may experience compromised health due to their inability to meet such obligations without simultaneously sacrificing their own socioemotional and economic needs. Given critical health disparities experienced by middle-class Black women (i.e., unexpectedly heightened maternal and infant mortality risk; Rosenthal and Lobel, 2011), the influence of SWS (especially the “obligation to help others” dimension) on other physical health outcomes should be explored among middle- and upper middle-class Black women.

The moderating effects of the Obligation to Show Strength SWS dimension revealed additional complexity. Specifically, endorsing “strength” was health-protective, but only among women with lower household income. In the literature on Black women’s well-being, the notion of strength attached to Black womanhood has been characterized as “a costly performance”, “draining”, and “burdensome” (Beauboeuf-Lafontant, 2007; Settles, 2006; Woods-Giscombé, 2010). Nevertheless, lower SES Black women’s embracing of strength could also reflect high levels of mastery and self-efficacy, psychosocial resources that aid in coping with social stress (Erving et al., 2021a; Keith et al., 2010). Although past research has identified gendered racism and financial strain as stressors that prevent low SES Black women from thriving psychologically and physically (Keith and Brown, 2017; Perry et al., 2013), our findings suggest that the internalization of the “strength mandate” associated with Black womanhood may be an empowering and affirming asset for lower income Black women who, on average, have limited access to societally valued resources. Exuding strength may serve as an effective coping mechanism to counteract the pernicious influence of structural inequalities on low SES Black women’s health. This conjecture, nevertheless, awaits empirical investigation.

In sum, study results convey that not all elements of SWS may compromise perceived health. Instead, Black women’s embodiment of certain Superwoman characteristics (i.e., strength) can serve as a health-preserving psychological resource for lower income Black women, on one hand. On the other hand, the characteristic that reflects others’ impositions on Black women’s time, energy, and attention (i.e., obligation to help others) is detrimental for higher income Black women.

It is noteworthy that household income moderated the association between SWS and self-rated health, but education did not. In essence, our study findings confirm the non-equivalence of socioeconomic indicators. For Black people in general (Meschede et al., 2017) and Black women in particular (Addo and Zhang, 2022), obtaining a college degree often does not translate into greater access to economic resources such as income, occupational prestige, or wealth accumulation. In fact, despite being lauded as the “most highly educated” demographic in the U.S. (Davis, 2020), Black women have the highest levels of educational debt (Addo and Zhang, 2022) and often feel obligated to provide aid to family and network members even to their own financial detriment (Sacks et al., 2020). Hence, high income may impose additional societal, workplace, and familial expectations on Black women that are harmful for health under the condition of them highly endorsing SWS.

6.1. Limitations

Despite the study strengths, there were some limitations. First, our data are cross-sectional. Future research should assess these associations longitudinally. Second, these findings could be specific to Black women living in the Atlanta metropolitan area. Nonetheless, Atlanta is an ideal setting in which to conduct such an investigation, as it is a high-density urban area in which Black Americans comprise 51 percent of the population and have diverse SES ranges (U.S. Census Bureau, 2019); moreover, Black Americans are disproportionately represented in urban cities and their surrounding suburbs (U. S. Department of Agriculture, 2021). Future research should assess the extent to which SWS endorsement is harmful to the health of Black women living in other urban centers as well as rural locales. Third, in addition to current SES, early life SES could provide even greater insight (Hudson et al., 2013). For example, assessing life course SES could allow for a more nuanced understanding of queries such as how upward, stable, or downward economic mobility influence Black women’s endorsement of SWS. Such an investigation can provide a more comprehensive assessment of SES that takes a life course perspective and helps to identify critical stages of lifespan development wherein SWS and its health consequences take shape. Fourth, our estimates may be conservative, as respondents with a history of severe health conditions were excluded from the MUSE cohort by design. Of note, women who had hypertension, diabetes, and/or obesity were not excluded from the study. Thus, the sample consisted of Black women with varying levels of health based on objective measures. Another limitation is the possibility that selection bias could have influenced our results, particularly because individuals who were eligible for the study but did not participate were socio-demographically distinct from those who completed the study (e.g., in terms of age, educational attainment, and household income). Nevertheless, our study results are suggestive and invite future research examining the role of socioeconomic position in the linkage between Superwoman Schema endorsement and health. Last, our assessment of self-rated health, though commonly used in the literature, may skew results towards better health since options such as “neither good nor poor” and “very poor” are not available using this standard measure of self-rated health.

7. Conclusions

This study re-infuses Black feminism into intersectionality research by focusing on Black women’s unique racialized-gendered experiences and status distinctions (i.e., socioeconomic status) therein (Aguayo-Romero, 2021). As noted by Crenshaw (1989, 1991), the intersectionality framework is rooted in a long tradition of Black feminist scholarship; yet quantitative intersectional scholarship tends to primarily adopt an inter-categorical (across-group) approach. Our study investigates intra-categorical complexity (McCall, 2005) by re-centering Black women’s experiences, leading to the discovery that some aspects of “superwoman-hood” are advantageous for some Black women (i.e., low-income and presenting an image of strength) while others are disadvantageous (i.e., obligation to help others) for other (i.e., high income) Black women. By revealing the health-related “kryptonite” in Superwoman Schema dimensions (Harris et al., 2022), this study advances our understanding of how complex characteristics of Black womanhood can be potentially modified to improve the health, and ultimately the life chances, of Black women and girls in U.S. society.

Supplementary Material

Appendix Tables

Acknowledgments

The authors acknowledge funding from the following sources: R01HL130471, R01HL158141 and K24HL163696 (Funding Agency: NHLBI; awarded to Lewis); T32 HL130025 (Funding Agency: NHLBI; awarded to McKinnon and Vaccarino); Ford Foundation Postdoctoral Fellowship (awarded to Erving). This study was also supported by a grant from the National Institutes of Health, P30 AG015281, the Michigan Center for Urban African American Aging Research (awarded to Erving). This research was also supported by grant, P2CHD042849, Population Research Center, awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.socscimed.2023.116445.

Data availability

Data will be made available on request.

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Supplementary Materials

Appendix Tables
NIHMS1972332-supplement-Appendix_Tables.docx (16.1KB, docx)

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