When is Hope Enough? Hopefulness, Discrimination and Racial/Ethnic Disparities in Allostatic Load

Abstract

Hopefulness is associated with better health and may be integral for stress adaptation and resilience. Limited research has prospectively examined whether hopefulness protects against physiological dysregulation or does so similarly for U.S. whites, blacks and Hispanics. We examined the association between baseline hopefulness and future allostatic load using data from the Health and Retirement Study (n = 8,486) and assessed differences in this association by race/ethnicity and experiences of discrimination. Four items measured hopefulness and allostatic load was a count of seven biomarkers for which a respondent’s measured value was considered high-risk for disease. A dichotomous variable assessed whether respondents experienced at least one major act of discrimination in their lifetime. We used Poisson regression to examine the association between hopefulness and allostatic load and included an interaction term in our model to test racial/ethnic differences in this association. Subsequent analyses were stratified by race/ethnicity and tested the interaction between hopefulness and discrimination within each group. Hopefulness was associated with lower allostatic load scores (b=−0.043, SE=0.007) but its effects varied significantly by race/ethnicity. Race-stratified analyses suggested that hopefulness was protective among whites (b=−0.051, SE=0.008) and not associated with allostatic load among Hispanics (b=−0.013; SE=0.022) irrespective of experiencing discrimination. Hopefulness was associated with lower allostatic load among blacks reporting discrimination but associated with higher allostatic load among those who did not. Findings suggest that hopefulness plays differing roles for older whites, blacks and Hispanics and, for blacks, its protective effects on physiological dysregulation are intricately tied to their experiences of discrimination.

INTRODUCTION

There is growing interest in the role psychosocial factors play in promoting resilience and the context in which this process occurs among older adults. Nonetheless, a vast majority of health research focuses on identifying and addressing risk factors for poor health and disease. Far less has been done on internal, psychosocial resources that support healthy functioning, foster resilience and promote longevity. Hopefulness is an understudied resource that may be particularly beneficial in the face of persistent stressors and adversity across the life course. Individuals who are hopeful are goal-oriented, hold a positive outlook towards the future and a high sense of agency or control over one’s life and goals.¹ In other words, hopefulness conceptually combines goal-directed thinking with a positive outcome expectancy² and self-efficacy.^3,4 Although the constructs are not mutually exclusive, hopefulness can be differentiated from: 1) optimism⁵ which solely focuses on positive outcome expectancy without considering a person’s motivation and agency, and 2) an internal sense of control^1,6 which solely focuses on personal agency without considering a person’s outlook, expectations and motivation. Thus, the integration of these two constructs with goal-oriented thinking potentially makes hopefulness a more protective psychosocial factor compared to either of the two constructs alone.

Prior research has documented associations between hopefulness and composite measures of mental and physical health⁷, treatment adherence in primary care settings⁸, and cancer survivorship in adolescents and adults.⁹ The lack of hope, hopelessness, has been studied more extensively and has been shown to be associated with cardiovascular disease,^10–12 depressive symptoms,^13–16 suicidal behavior and ideation,^17–19 and mortality.^20,21

Multiple mechanisms plausibly link hopefulness and health. Hopefulness may promote healthy behaviors or minimize unhealthy behaviors²² because hopeful thinking is associated with the desire to prevent negative experiences, including poor health, the belief that those experiences can be avoided and the identification of pathways to avoid them.³ Hopefulness may also influence health via cognitive processes that effect the physiological stress response, specifically perceptions of fear and threat.²³ According to the allostatic load hypothesis, repeated or prolonged exposure to experiences considered threatening or challenging can hinder the body’s ability to adapt to stress.^24,25 Stress exposure triggers the release of “primary mediators” from the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic and parasympathetic nervous system. These mediators, including cortisol, epinephrine and norepinephrine, then trigger the release of “secondary mediators” from the immune, cardiovascular and metabolic systems. Over time, the frequent activation of the physiological stress response creates “wear-and-tear” on these body systems that leads to the dysregulation of or impairments in functioning that manifests as allostatic load.²⁴ Allostatic load is a known predictor of poor health^26–28 and mortality.^29,30 Thus, the extent to which hopefulness protects against increases in allostatic load has important implications for death, disease and disability.

Although extant research on the protective effects of psychosocial resources on allostatic load are mixed³¹, hopefulness has not been thoroughly examined and may be an integral part of healthy stress adaptation, resilience and the maintenance of normal physiological functioning. For example, hopefulness may lead to proactive coping—the accumulation of resources and skills prior to potentially stressful experiences to prevent or avoid exposure, which then prevents the physiologic stress response in the first place.³² Alternatively, in the face of an existing stressor, hope can diminish stress reactivity by minimizing perceptions of how threatening or severe a stressor may be,²³ thus limiting the activation of the stress response system.²³ Few studies have considered associations between hopefulness and the intermediary physiological processes underlying changes in health. One exception is a study that found a positive association between hope and allostatic load.³³ However, this study was specific to a small sample of newly admitted nursing home residents and not representative of the larger United States (U.S.) population. Other population-based studies have linked hopelessness to individual biomarkers^16,34,35 but were not representative of the U.S. and failed to examine racial and ethnic differences in this association.

Considering stark racial and ethnic disparities for multiple health outcomes,³⁶ the mechanisms through which hopefulness affects physiological functioning likely vary across race/ethnicity. Theoretical and empirical research suggest that racial and ethnic minorities and other marginalized populations are disproportionately exposed to social stressors,^37–40 including discrimination,^41,42 and tend to have higher levels of allostatic load than non-Hispanic whites.⁴³ Discrimination is associated with multiple health outcomes and multifaceted in its effects.^44,45 It influences socioeconomic status, residential location, health care quality and access, health behaviors and physiological functioning directly.^46–49 This latter pathway is substantiated by prior research showing that the stress of discrimination is associated with allostatic load and other measures of multi-system dysregulation^50–52 and individual biomarkers, including markers of immune function,^53–58 blood pressure,^59–62 and metabolism.⁶³ Individuals may utilize distinct coping mechanisms and psychosocial resources in the face of discrimination and other social stressors,^64,65 which may in turn influence the stress response.⁶⁶ The combined effects of discrimination and coping resources on the physiological functioning of racial and ethnic minorities may vary from whites due to differences in lived experiences, cognitive appraisal processes and cultural norms about coping strategies.⁶⁷ Moreover, a lifetime of exposure and adaptation to discrimination may, in fact, facilitate resilience in late life in these populations through the development of psychosocial resources,⁶⁸ such as hopefulness. Therefore, examination of racial and ethnic heterogeneity in the relationships between hopefulness, discrimination and allostatic load is warranted.

The current study is the first to prospectively examine the relationships between hopefulness, discrimination and allostatic load using data from a nationally representative sample of community-dwelling U.S. whites, blacks and Hispanics in mid-life and old age. It addresses the stated gaps and furthers our understanding of the role hopefulness and discrimination play in physiological functioning. We hypothesize that hopefulness will be inversely associated with allostatic load and that its effects will be more pronounced among older blacks and Hispanics—two populations that over time have experienced significant social and economic disadvantage⁶⁹ and, as a result, may be more dependent on internal psychosocial resources in later life when faced of adversity. Identifying modifiable psychosocial factors, such as hopefulness,⁷⁰ that protect against increases in allostatic load may inform future policies and programs focused on the treatment and prevention of disease, particularly among older racial and ethnic minorities. Even more consequential, however, is the potential impact of hopefulness and other resources on racial and ethnic health disparities. Thus, the current study is timely in elucidating how hopefulness facilitates resilience and prevents physiological dysregulation among a racially diverse population of U.S. adults.

METHODS

Study population and data source

The data come from the Health and Retirement Study (HRS), an ongoing national survey of the health and aging experiences of U.S. adults aged 51 and older residing in the community. This prospective cohort study is conducted by the University of Michigan with funding by the National Institute on Aging. Data on economic, social and physical well-being have been collected biennial since 1992 using face-to-face and phone interviews, and new cohorts are recruited every six years. Additional details on study design and protocol of HRS are available elsewhere.⁷¹ The Institutional Review Board of the University of Michigan approved this study.

In 2006, the HRS started administering supplemental psychosocial and biomarker assessments.^72,73 Separate written consent forms were completed for both assessments. Psychosocial data were collected after the core HRS interview using a leave-behind, self-administered questionnaire. The biomarker assessment included the collection of physical measures (e.g., blood pressure, height, weight, waist circumference, etc.), saliva for DNA sequencing and dried blood spots, for measuring cholesterol, hemoglobin A1c and C-reactive protein.

One half of the HRS cohort completed the assessments in 2006, while the other half-sample completed them in 2008. Both cohorts repeat each assessment every four years (i.e., in 2010 and 2012, respectively). We combined the 2006 and 2008 half-samples for each wave to increase the sample size and statistical power of the current study. At baseline (i.e., 2006/2008), there were 15,885 eligible respondents and 13,805 of them participated in the psychosocial assessment. At the four-year follow-up (i.e., 2010/2012), 8,933 of baseline participants were alive and eligible for the biomarker assessment and all of them completed the biomarker assessment. We excluded 188 respondents whose racial/ethnic background was classified as “other” due to small cell sizes and high racial/ethnic heterogeneity within this classification. Individuals missing on any study variable were also excluded (n = 259), resulting in a final analytic sample of 8,486.

Measures

Our measure of physiological dysregulation is allostatic load, which we assessed at follow-up using the following seven biomarkers: pulse pressure (i.e., the difference between systolic and diastolic blood pressure), heart rate, hemoglobin A1c, high-density lipoprotein (HDL) cholesterol, total cholesterol, C-reactive protein (CRP), and waist circumference. We followed previously established methods for measuring allostatic load by dichotomizing each biomarker at cut-points considered “high-risk” for cardiovascular and metabolic diseases (see Supplemental Table S1) and then counting the number of high-risk biomarkers⁷⁴. Values ranged from 0 to 7. Other constructions of allostatic load have been used that incorporate primary mediators such as epinephrine and norepinephrine, additional immune factors and systolic and diastolic blood pressure instead of pulse pressure. However, the HRS does not include epinephrine, norepinephrine or additional immune markers in the 2010/2012 biomarker assessment. Also, we used pulse pressure, a measure of arterial stiffness,⁷⁵ instead of systolic and diastolic blood pressure in our measure of allostatic load because pulse pressure has been shown to be a better predictor of cardiovascular functioning among older adults compared to its components.^76–78

Baseline hopefulness was assessed by reverse-coding and averaging the following four items: “I feel it is impossible for me to reach the goals that I would like to strive for”, “The future seems hopeless to me and I can’t believe that things are changing for the better”, “I don’t expect to get what I really want” and “There’s no use in really trying to get something I want because I probably won’t get it”. These items came from the Beck Hopelessness Scale⁷⁹ and the Kuopio Ischaemic Heart Disease Risk Factor Study²⁰, both of which have been shown to be valid in clinical and nonclinical samples. Possible response options for each item ranged from 0=strongly agree to 5=strongly disagree, such that higher levels of the scale represented higher levels of hopefulness. The internal reliability of the scale was high in the total sample and for each race/ethnic group (Cronbach’s α range: 0.80–0.88), and factor analyses identified a single factor from the four items (Eigenvalue = 2.70 in 2006 and 2.85 in 2008).

We focused on major acts of discrimination that unfairly and negatively impact status attainment; the items were adapted from the Lifetime Discrimination Scale.^41,80 At baseline, respondents were asked to indicate if any of the following six experiences had ever happened in their lifetime: unfairly dismissed from a job, not hired for unfair reasons, unfairly denied a promotion, unfairly prevented from moving into a neighborhood, unfairly denied a bank loan, and unfairly stopped, searched, threatened or abused by the police. For each respondent we counted the number of reported experiences. We then dichotomized the variable such that 0 = no, does not report experiencing major act of discrimination and 1 = yes, reports experiencing at least one major act of discrimination.

Depressive symptoms are correlated with feelings of hopefulness and allostatic load.^33,81 Thus, we included baseline depressive symptoms in our analyses as a potential confounder. Respondents were asked to indicate whether they experienced each of the following eight symptoms, which were derived from a modified version of the Center for Epidemiologic Studies Depression Scale:⁸² felt depressed, everything was an effort, sleep was restless, felt lonely, felt sad, could not get going, was happy, enjoyed life. The last two items were reverse-coded, and we counted the number of symptoms reported. Values ranged from 0 to 8.

Additional covariates were self-reported and assessed at baseline. For race/ethnicity, whites were compared to blacks and Hispanics. Age at baseline was measured in years. Males were compared to females and U.S.-born respondents were compared to foreign-born respondents. Education was assessed as years of school completed. Supplemental analyses added controls for prevalent cardiovascular and metabolic conditions including hypertension, stroke, heart disease, and diabetes.

Statistical Analysis

All analyses were conducted using Stata 15® and statistical procedures and weights that account for the complex HRS sample design. A Wald F-test was used to examine race/ethnic differences in all variables. Multivariate analyses used Poisson regression to determine whether baseline hopefulness was associated with allostatic load, a count variable, at the four-year follow-up, net of covariates (Model 1). An interaction term between hopefulness and race/ethnicity was added (Model 2) and its significance was tested with an omnibus F-test. We then stratified our models by race/ethnicity and included an interaction term between hopefulness and discrimination to determine whether the effect of hopefulness on allostatic load differed by experiences of discrimination within each racial/ethnic group.

Subsequent sensitivity analyses examined an alternative way of measuring allostatic load. Specifically, we included separate measures of systolic and diastolic blood pressure in our allostatic load measure instead of pulse pressure (i.e., the difference between one’s systolic and diastolic blood pressures). Substantive findings using this revised allostatic load measure did not differ from findings using pulse pressure in our measure of allostatic load. Additionally, we examined the interaction between gender and hopefulness and between gender, race and hopefulness (i.e., a 3-way interaction), because resiliency pathways may be gendered⁸³. However, none of these interactions were statistically significant (Supplemental Table S2); thus, the only interaction retained in non-stratified analyses was between race/ethnicity and hopefulness.

RESULTS

Characteristics of the sample by race/ethnicity are presented in Table 1. Differences by race/ethnicity existed for all variables except age. Blacks and Hispanics had higher allostatic load than whites at follow-up and whites had the highest levels of hopefulness at baseline. While 1 in 3 whites and Hispanics reported experiencing discrimination, 45% of blacks reported experiencing at least one major act of discrimination in their lifetime. The average age for the sample and all racial/ethnic groups was 66 years old. There was a significantly greater proportion of women among blacks (63.9%) and Hispanics (61.8%) compared to whites (55.4%), and nearly 52% of Hispanics were foreign born. Years of education were highest for whites (13.5 years) and lowest for older Hispanics (9.8 years); the reverse was true for depressive symptoms with Hispanics on average reporting two times the number of symptoms than whites.

Table 1.

Weighted Sample Characteristics by Race/Ethnicity: HRS (n=8,486)

	Total (n=8,486)	White (n=6,803)	Black (n=1,039)	Hispanic (n=644)	p-value
Variables	Mean (SE) or %	Mean (SE) or %	Mean (SE) or %	Mean (SE) or %
Allostatic Load, 2010/2012 (range: 0–7)	1.7 (0.02)	1.7 (0.02)	2.0 (0.04)	2.0 (0.05)	<0.001
Hopefulness, 2006/2008 (range: 0–5)	3.7 (0.02)	3.8 (0.02)	3.6 (0.07)	3.2 (0.07)	<0.001
Experienced Discrimination, 2006/2008 (%)	31.8	31.0	45.1	28.4	<0.001
Age, 2006/2008 (range: 52–96, years)	66.0 (0.21)	66.0 (0.24)	66.0 (0.44)	66.0 (0.61)	0.910
Female (%)	56.3	55.4	63.9	61.8	<0.001
Foreign (%)	6.3	3.8	4.9	51.5	<0.001
Education (range: 0–17, years)	13.2 (0.07)	13.5 (0.05)	12.1 (0.14)	9.8 (0.43)	<0.001
Depressive Symptoms, 2006/2008 (range: 0–8)	1.2 (0.03)	1.2 (0.03)	1.7 (0.09)	2.1 (0.13)	<0.001

p-value test significance of race difference for each variable

Table 2 shows the association between hopefulness and allostatic load (Model 1) and tests whether these associations differ by race/ethnicity (Model 2). Baseline hopefulness was inversely associated with allostatic load, such that higher levels of hopefulness at baseline were associated with lower allostatic load at follow-up. Blacks had higher allostatic load compared to whites and those who reported experiencing discrimination had higher allostatic load than those who did not. Model 2 adds the interaction between race/ethnicity and hopefulness and shows that the effects of hopefulness on allostatic load varies by race/ethnicity (adjusted Wald Test: F(2,55) = 6.65, p<0.01).

Table 2.

Poisson Regression of Allostatic Load (2010/2012) on Hopefulness (2006/2008): HRS (n=8,486)

	Model 1			Model 2
	b	SE		b	SE
Hopefulness, 2006/2008	−0.043***	0.007		−0.054***	0.008
Blacka	0.126***	0.022		−0.112	0.072
Hispanica	0.058	0.039		−0.129	0.079
Black-x-Hopefulness, 2006/2008				0.067***	0.019
Hispanic-x-Hopefulness, 2006/2008				0.057*	0.022
Experienced Discrimination, 2006/2008	0.059*	0.023		0.057*	0.023
Age, 2006/2008	0.001	0.001		0.001	0.001
Femaleb	0.042*	0.016		0.043**	0.016
Foreign-bornc	−0.072	0.045		−0.07	0.045
Education	−0.032***	0.003		−0.032***	0.003
Depressive Symptoms, 2006/2008	0.009	0.006		0.008	0.006
Constant	0.953***	0.104		1.000***	0.107

^*p<0.05,

^**p<0.01,

^***p<0.001;

^aref=whites,

^bref=males,

^cref=U.S.-born

The interaction between race/ethnicity and hopefulness is depicted in Figure 1, which shows the predicted allostatic load score by level of hopefulness for each race/ethnic group. While baseline hopefulness is inversely associated with allostatic load at follow-up for whites (slope: −0.09, p<.001), the association is positive but not significant for blacks and Hispanics.

Figure 1. Association between Hopefulness and Allostatic Load by Racial/Ethnic Group: HRS (n=8,486).

To better understand the differential effects of hopefulness on allostatic load for older whites, blacks and Hispanics, we tested the interaction between hopefulness and discrimination within race-stratified models (Table 3). For whites, hopefulness was negatively associated with allostatic load (Model 1) but the interaction between hopefulness and discrimination was not significant (Model 2). For blacks, the opposite was true: hopefulness was not associated with allostatic load in the main effects model (Model 3) but the interaction between hopefulness and discrimination was significant (Model 4). The association was null for Hispanics irrespective of the interaction (Models 5 and 6).

Table 3.

Race-stratified Regression of Allostatic Load (2010/2012) on the Interaction between Hopefulness (2006/2008) and Discrimination (2006/2008), HRS (n=8,486)

	White (n=6,803)				Black (n=1,039)				Hispanic (n=644)
	Model 1		Model 2		Model 3		Model 4		Model 5		Model 6
	b	SE	b	SE	b	SE	b	SE	b	SE	b	SE
Hopefulness 2006/2008	−0.051***	0.008	−0.042***	0.011	0.017	0.018	0.067**	0.024	−0.013	0.022	−0.005	0.027
Discrimination 2006/2008	0.067*	0.028	0.162	0.085	−0.019	0.053	0.362**	0.126	0.059	0.056	0.154	0.154
Hopefulness-x-Discrimination			−0.026	0.021			−0.107***	0.03			−0.03	0.049
Age 2006/2008	0.002	0.001	0.002	0.001	0.001	0.003	0.001	0.002	−0.001	0.003	−0.001	0.003
Femalea	0.028	0.018	0.028	0.018	0.207***	0.051	0.203***	0.049	0.017	0.06	0.019	0.06
Foreign-bornb	−0.069	0.064	−0.069	0.065	−0.234	0.143	−0.244	0.137	0.001	0.051	0.003	0.052
Education	−0.038***	0.004	−0.038***	0.004	−0.009	0.01	−0.008	0.009	−0.022**	0.007	−0.022**	0.008
Depressive Symptoms, 2006/2008	0.007	0.007	0.006	0.007	0.037**	0.012	0.038**	0.012	−0.004	0.014	−0.005	0.014
Constant	1.054***	0.117	1.017***	0.126	0.489*	0.243	0.286	0.233	1.003***	0.254	0.981***	0.264

^*p<0.05,

^**p<0.01,

^***p<0.001;

^aref=males,

^bref=U.S.-born

Figure 2 shows the interaction between hopefulness and discrimination for blacks. Among blacks who report experiencing major acts of discrimination, the association between hopefulness and allostatic load is negative (slope: −0.081; p=0.093); but, for blacks who report not experiencing any major acts of discrimination in their lifetime, the association is positive (slope: 0.138; p<0.01).

Figure 2. Association between Hopefulness and Allostatic Load among Older Blacks by Experienced Discrimination: HRS (n=1,039).

DISCUSSION

This study revealed significant associations between hopefulness and allostatic load among a racially diverse sample of adults in mid-life and old age. Our findings align with previous research suggesting hopefulness is beneficial for physiological functioning³³ and health.^9,84,85 However, we offer novel findings on racial and ethnic differences in this association, which contribute to our understanding of resilience in mid-life and old age.

Specifically, higher levels of hopefulness at baseline were associated with lower allostatic load scores four years later. This association, however, was not consistent across all groups. While greater hopefulness was associated with lower allostatic load scores among whites, it is not associated with allostatic load among Hispanics. For blacks, the association depended on their experiences of discrimination: hopefulness was inversely associated with allostatic load among blacks who reported experiencing at least one major act of discrimination in their lifetime, but positively associated with allostatic load among blacks who did not report experiencing discrimination. These associations persisted even after taking into account group differences in depressive symptoms and socioeconomic status. Supplemental analysis additionally controlled for prevalent cardiovascular health conditions and revealed similar findings.

A plausible explanation for the mixed results is that the mechanisms through which hopefulness affects physiological functioning are multifactorial, involving social, psychological and behavioral processes and, therefore, are neither universal nor uniform. For example, hopeful individuals may be more likely to actively engage in planning and problem-solving strategies that mitigate the degree of stress they are exposed to or foster greater resources for dealing with anticipated stressors. This is supported by research showing that hopeful individuals tend to have a positive problem orientation and rational problem-solving style compared to those characterized as hopeless.⁸⁶ Having a more hopeful perspective can also facilitate perceiving problems as challenges that are within one’s capacity to solve and the use of a deliberate and systematic approach to solving these problems.⁸⁷ This proactive coping style may minimize or prevent a physiological response to stressful encounters prior to exposure,³² thus leading to less wear-and-tear on the body over time.

Additionally, hopefulness may buffer the effects of a stressor vis-à-vis the influence on other psychological and social factors or health behaviors. One pathway for this relationship is through greater positive emotions,⁸⁵ which facilitate adaptation to stress.⁸⁸ Hopeful individuals are also less likely to have an external locus control⁶ and are more likely to engage in health-promoting behaviors when diagnosed with chronic conditions,⁸⁴ both of which are associated with lower allostatic load scores.^89–91 Collectively, these mechanisms protect the body from damage caused by constant activation of the physiological stress response, help maintain normal physiological functioning and adaptability, and promote resilience to future stressors.

A novel finding of our study is that the salience of the aforementioned mechanisms differs for older whites, blacks and Hispanics. While whites may directly benefit from hopefulness irrespective of experiencing discrimination, the protectiveness of being hopeful is intricately tied to experiences of discrimination among blacks. Our initial examination of race differences in the relationship between hopefulness and allostatic load suggested that baseline hopefulness was not associated with future allostatic load among blacks, which would be an erroneous conclusion because heterogeneity in how hopefulness affects the physiological functioning of blacks was not considered. Additional analyses revealed that, on the one hand, greater hopefulness was protective for blacks who report experiencing major acts of discrimination; on the other hand, it was associated with higher allostatic load scores and detrimental for the physiological functioning of blacks who did not report having these experiences. This latter finding was unexpected and is counter to our hypotheses. However, previous studies have documented worse health outcomes among individuals reporting few or no experiences of discrimination compared to those with higher rates of exposure.^92,93

The unexpected findings among blacks should be interpreted within the context of their lived experiences. Namely, our study focused on reports of discrimination among adults born between 1914 and 1960, during the Jim Crow Era and Civil Rights Movement, which was a politically-charged and racially-divisive period in the U.S. distinguished by pervasive acts of racism. Thus, one explanation for our findings is that older blacks who have experienced and overcome past instances of discrimination may be more hopeful in later life than those who did not. More specifically, for blacks in our sample, it could be that overcoming these earlier experiences of discrimination and “making it” to old age despite the adversity they faced helped foster hope and other internal resources that more effectively protect against stress and physiological dysregulation in later life. This aligns with the hypothesis that resilience—the capacity to adapt to a threat—is a multifactorial quality forged over time through a process of repeated success over obstacles and challenges.^94,95 Thus, older blacks who have experienced major acts of discrimination throughout their lives may be better able to hold on to hope in the face of new challenges than those who have not, which would provide greater protection against physiological dysregulation.

The idea that experiencing discrimination facilitates the development of psychosocial resources is counter to conventional stress theory positing that stressors erode internal resources and thereby provide a way through which stressors exerts their deleterious effects.⁹⁶ However, this hypothesis fails to consider the positive effects of stress adaptation over time.⁹⁷ The “shift-and-persist” hypothesis⁹⁸ suggests that the adverse effects of early life adversity, as measured by low socioeconomic status, on physiological functioning can be averted through a learned reappraisal process that involves accepting the stressor and adjusting oneself to the exposure (i.e., “shifting”), and finding meaning in the experience and maintaining optimism (i.e., “persisting”). Learning this strategy earlier in life may reduce the emotional and physiological response to stressful situations acutely, which, in turn, mitigates physiological dysregulation in later life. Previous research has documented differences in stress appraisal by race and ethnicity⁹⁹ but appraisal processes likely vary within racial/ethnic groups as well. Therefore, it is possible that blacks in our sample who have experienced discrimination have learned to reappraise their experiences and find a greater purpose or meaning in them that helps them maintain the protective effects of hope.

Conversely, another explanation for our findings is that older blacks who state that they have not experienced any major acts of discrimination in their lifetime may in fact be denying and/or internalizing their experiences. This failure to acknowledge one’s experiences of discrimination may interfere with stress adaptation and promote physiological dysregulation. Prior research suggests that racial and ethnic minorities perceive lower rates of personally-experienced discrimination compared to rates of discrimination they perceive members of their social group experience.¹⁰⁰ In other words, they tend to deny their own disadvantage while recognizing the disadvantage of their own social group.¹⁰¹ Minimizing or denying discrimination may be psychologically protective if it maintains a person’s sense of personal control and self-esteem.^68,102 However, discrimination is an uncontrollable stressor that directly threatens intrinsic characteristics of oneself.¹⁰³ Therefore, attempting to be hopeful when faced with discrimination while actively denying its existence may be more taxing on the body and detrimental to physiological functioning than being hopeful while acknowledging its presence. The importance of acknowledging and thoroughly comprehending the magnitude of the adversity one faces is echoed in research on John Henryism—a high-effort, active-coping style characterized by a determined perseverance to succeed despite limited resources¹⁰⁴ that, for blacks, paradoxically leads to adverse health including higher blood pressure^105–108 and worse physiological functioning.^109–111 As Brody and colleagues explain, this can be due to “outwardly undetectable wear and tear” that manifests as either premature mortality rates and/or cardiometabolic health impairments.¹¹¹ This phenomenon is attributed to the accelerated aging due to insufficient access to resources, most noticeably low socioeconomic status among blacks, as a result of sustained efforts for upward mobility. In this case, the combination of dealing with stressors associated with low socioeconomic status and coping in a goal-oriented manner adversely affects the health of black men and women and may stem from a failure to fully comprehend the enormity of the structural barriers perpetuated along racial lines. Future research in this area would benefit from examining how different cognitive approaches to coping with discrimination and other adversities impact internal resources and their effects on physiological functioning.

An important contribution of this study was the inclusion of a nationally representative sample of older Hispanics. Despite the fact that Hispanics are the largest racial and ethnic minority group in the country, constituting approximately one-fifth of the U.S. population, there is a noted dearth of empirical research on the relationships between psychosocial resources, discrimination and physiological functioning in this population.¹¹² Our study addressed this gap in the literature and yielded unexpected findings, specifically, the absence of an association between hopefulness and allostatic load irrespective of experiences of discrimination. These findings align with previous research demonstrating inconsistent associations between psychosocial resources and physiological outcomes in this population.^113,114 Together, these findings suggest that other psychosocial and sociocultural resources, besides hopefulness, may protect against physiological dysregulation among Hispanics. For instance, cultural values, such as valuing family and social harmony, have been identified as important sources of resilience among Hispanic communities.¹¹⁵ These values foster social support and capital across familial relationships and community networks that, in turn, protect against social disadvantage and stressors. Additionally, the life-course stressors that older Hispanics have faced may be qualitatively different from those of older U.S. blacks. Our sample of Hispanics is highly heterogeneous—more than half are foreign-born and Hispanics from multiple countries of origin have been aggregated due to sample size limitations. Thus, it is possible that resilience to physiological dysregulation among this sample of Hispanics may be more greatly influenced by immigration- and acculturation-related stressors than the experiences of discrimination assessed in this study (e.g., discrimination related to one’s job). Thus, to better understand resilience to physiological dysregulation among older Hispanics, future research should examine the relationships between cultural factors, immigration-related stress, acculturation and allostatic load in this population.

As with any study, there are limitations to the present analysis that should be considered when interpreting the results and addressed in future research. First, some of our measures were self-reported (e.g., hopefulness, discrimination, prevalent health conditions) and are subject to reporting bias. Hopefulness, in particular, may be influenced by social desirability bias and could itself be impacted by health and functioning. Moreover, there are multiple methods to construct the allostatic load measure,^28,116 including the count-based method used in the current study. However, counting the number of “high-risk” biomarkers assumes an equal influence (i.e., equal weight) of each biomarker on multisystem dysregulation, which may not be a valid assumption. Weighing methods have been proposed to address this limitation, however, these methods are less straightforward and sample dependent which limits replication in other samples. Moreover, the definition of “high-risk” may vary across population subgroups. Where available, we took into consideration known subgroup differences in high-risk cut-points (i.e., gender differences in high-risk waist circumference) to improve the clinical relevance of our allostatic measure. Also, our analyses are based on data from individuals present at baseline and follow-up, which may bias our sample towards a healthier population and, subsequently, underestimate the effects of hopefulness on allostatic load. Lastly, the time period between baseline and follow-up for our study was limited to four years due to changes in how the HRS collected biomarker and physical measures data after the 2010/2012 assessment. This change in data collection also limited our ability to examine the effects of baseline hopefulness on trajectories of allostatic load. Nonetheless, our study provides initial evidence for the prospective link between hopefulness and physiological functioning.

There are several noteworthy methodological and conceptual strengths of this study. First, this study is the first, to our knowledge, to prospectively assess the impacts of hopefulness on allostatic load in a nationally representative and racially diverse sample of adults in mid-life and old age. Examining the effects of baseline hopefulness on future allostatic load limits issues of reverse causality and demonstrates that the physiological benefits of hopefulness persist over short periods of time. Additionally, our outcome measure, allostatic load, is an objective measure of health status that is less prone to reporting bias. Hopefulness was assessed using a validated scale and, in our sample, exhibited high levels of internal reliability. More importantly, our study highlighted the importance of examining between- and within-group heterogeneity in the effects of psychosocial resources on physiological functioning. Doing so has advanced our understanding of how resilience factors operate across racial/ethnic groups and in the context of social stressors.

CONCLUSION

Hopefulness may be an important, yet understudied, indicator of resilience. Its effects on physiological functioning, however, may be intricately tied to the types of stressors a person is exposed to and differences in cognitive appraisal processes. Collectively, our study provides novel findings that advance our understanding of the complex relationship between psychosocial resources, stressors and physiological dysregulation, specifically highlighting the nuances of how hopefulness potentially contributes to resilience across race/ethnicity. For older blacks, the protective effects of being hopeful depend on stress exposure. Lifetime experiences of discrimination may foster resilience by facilitating the development of hopefulness as a coping mechanism in later life. Conversely, being hopeful may be detrimental for older blacks who fail to report or recognize the discriminatory experiences they have overcome. Given that hope is modifiable and can be incorporated into health programs,⁷⁰ future research should further explicate the nuanced role hopefulness plays on health among racially and ethnically diverse older adults.