Adverse Childhood Experiences, Active Coping, and Cognition in Older African Americans: A Secondary Data Analysis of the Minority Aging Research Study

Adverse Childhood Experiences, Active Coping, and Cognition in Older African Americans: A Secondary Data Analysis of the Minority Aging Research Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adverse Childhood Experiences, Active Coping, and Cognition in Older African Americans: A Secondary Data Analysis of the Minority Aging Research Study Karen Lowe Graham, Louis Fogg, Olimpia Paun, Dawn Bounds, Audrey Stillerman, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6581020/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Adverse Childhood Experiences (ACEs) increase risk for chronic conditions and health-compromising behaviors across the life course. In many studies, African Americans are at the highest risk for childhood adversity among racial and ethnic groups. Few ACE-related studies focus on ACEs’ impact on older African Americans’ health. Fewer still examine how ACEs influence cognition in older African Americans. The John Henryism Active Coping Scale assesses the coping style of overworking to deal with continuous stressors caused by economic and social discrimination. This study investigates the relationship between ACEs and cognition in older African Americans and explores whether active coping moderates the effects of ACEs on cognition in late life. Methods This study is a secondary analysis of data from the Minority Aging Research Study (MARS), a longitudinal community-based study examining cognitive health and aging in older African Americans. The sample of 756 MARS participants completed cognitive global functioning tests as well as ACE ( The First 18 Years Survey) and active coping ( John Henryism Active Coping Scale) questionnaires. We used correlational analysis (t-tests, ANOVA, linear regression) to examine the associations between ACEs and cognition and active coping and cognition. Additionally, we explored whether active coping moderated the impact of ACEs on cognition. Results Study participants were highly educated with low total ACE scores, average cognitive functioning, and high active coping. The financial need subscore was significantly associated with lower cognitive global functioning although the total ACE score was not. Active coping was also associated with poorer cognition. We could not discern whether active coping is a significant moderator of ACEs because total ACEs and cognition were not associated in this sample. Conclusions Financial need and active coping correlated with lower cognitive functioning. Future research with a more representative sample of African Americans, the full complement of conventional and expanded ACEs, and inclusion of positive childhood experiences are key for exploring the complex and nuanced relationships among ACEs, active coping, and cognition to best serve older Black people. older African Americans older Black people Adverse Childhood Experiences cognition cognitive decline dementia active coping John Henryism Background Adverse Childhood Experiences (ACEs) are potentially traumatic events occurring before age 18 that vary in severity and are common. The groundbreaking ACE Study was a collaboration between California’s Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) in which over 17,000 patients were assessed for ACEs. The researchers divided ACEs into three major categories: abuse, neglect, and household stressors. Within these categories, they identified subcategories such as physical, sexual and emotional abuse; physical and emotional neglect; and a broad range of household stressors–mental illness, incarceration, and substance use among household members; parental divorce or separation; and violence against the mother. 1 Further research determined that ACEs are common across every social economic stratum, gender, race, and ethnicity , 1 , 2 , 3 and may be even more common among oppressed and marginalized populations. 4 Over time, other researchers expanded the concept of ACEs to include low socioeconomic status, environmental injustice, discrimination, community violence, other community or structural experiences, and more. 5 , 6 ACEs can be the underlying cause for a multitude of chronic illnesses and self-soothing but health-compromising behaviors across the life span. 1 , 7 , 8 , 9 Through its Behavioral Risk Factor Surveillance Survey (BRFSS), an annual national health phone survey, the CDC estimates that: 1) 61% of adults in the United States (US) have experienced at least one ACE, 2) one in six experienced four or more ACEs, and 3) persons reporting four or more ACEs are at higher risk for physical, mental health, and social problems than those with fewer than four ACEs. 10 , 11 To date, all 50 states and the District of Columbia have included the ACE module in at least one annual BRFSS. 10 Moreover, ACE prevalences have been reported in 22 different countries including the US. 12 African Americans and ACEs Researchers have also begun to examine the prevalence of ACEs by ethnicity and race. 10 , 13 African Americans are at highest risk for experiencing each of the original and expanded ACEs. 13 , 14 , 15 , 16 Indeed, African Americans (Black people born in the United States of African ancestry. “Black” and “African American” will be used interchangeably in this manuscript) are at increased risk for ACEs because of the lingering and long-standing effects of racism and economic discrimination. 17 , 18 These experiences of racial discrimination increase the number of ACEs in the African American community and multiply their effect. 18 Geronimous and colleagues (2010) hypothesized that racial stressors create a “biological ‘weathering’”, or wear and tear, on African Americans. 19 Weathering results in higher rates of chronic illness and disability 20 and is a response to discrimination, micro- and macroaggressions, and centuries of oppression while living as an African American in the United States. 18 , 19 Weathering among African American adults begins much earlier–in childhood. For example, African American children and adolescents living in poverty experienced a domino effect of a multitude of other ACEs. 21 These youth are at higher risk for living in homes with poor health, parental depression, and less social support which, in turn, increase the risk for more serious consequences (i.e., foster care placement; a cycle of generational poverty). 21 , 22 ACEs and Cognitive Impairment While ACEs have been examined among African Americans from childhood into middle age, very few ACE-related studies have focused on the impact of ACEs on older African American participants’ health. 23 , 24 Although older African Americans are two times more likely to develop Alzheimer’s or other related dementias (ADRD), a 2021 study identified only 10 articles examining the relationship between cognition and ACEs in this population. 25 Some of these studies explored the role of the expanded ACEs of school segregation or discrimination on older African Americans’ cognitive health. 26 , 27 Others found an association between low socioeconomic status (an expanded ACE) and cognition in African Americans. 28 The prevalence of cognitive impairment in older adults has been increasing. Approximately six million people in the United States have been diagnosed with a dementia. 29 Currently, 11% of adults over the age of 65 have a dementia. By the time these adults are 85 years old, 40% will have dementia. 29 With the number of ADRD patients increasing annually, identifying and addressing risk factors for this disease is essential, especially in communities hit the hardest by ADRD, like older African Americans. John Henryism Active Coping Active coping is one of the ways African Americans respond to race-related stress 8 , such as the expanded ACEs of racial discrimination and societal disadvantage. 8 , 30 Active coping is a stress-coping mechanism through which people make every attempt to identify stressors and improve their situation, an inner ability to address difficult social or economic challenges. 31 , 32 James and colleagues (1983) hypothesized that active coping is a strategy to deal with on-going, continuous social and environmental stressors such as poverty and racism. 33 Active coping includes: (1) efficacious mental and physical vigor; (2) a strong commitment to hard work; and (3) a single-minded determination to succeed. 34 The John Henryism Active Coping Scale is based on the story of John Henry, a symbol of African Americans’ attempts to control their oppressive circumstances by working twice as hard as their non-Hispanic White counterparts. 33 The John Henryism Active Coping Scale assesses the degree to which respondents engage in the coping style of overworking as a strategy to deal the ongoing stress of economic and social discrimination as well as other social and environmental stressors 33 , 35 The John Henryism Active Coping Scale was designed to assess low-income, rural African Americans. In this population, active coping behavior was associated with poor health and risk for premature death. 33 In some studies of the John Henryism Active Coping Scale , individuals with high active coping scores were found to be at higher risk for chronic illnesses. 19 , 35 , 36 , 37 , 38 , 39 , 40 , 41 Some researchers posited that these results emerged because the majority of participants were Black people who also experienced economic disadvantages. 30 Others found that because the scale was designed for low income, working class, and rural Americans, high income individuals and/or those living in urban areas might have different results. 30 , 34 For these study participants, active coping was associated with activities that are health-promoting and support good overall psychological health. 42 , 43 Studies using this scale have yielded paradoxical results: some link John Henryism with poorer outcomes and some with improved outcomes. Thus, active coping may be detrimental OR support health depending on the specific population. Theoretical Framework for the Current Study The aims for this secondary data analysis are based on the Biopsychosocial Model. 44 This model has three domains and has been broadly used across disciplines and research studies. 45 , 46 , 47 , 48 The biological domain includes structural, physiologic, and genetic phenomena that affect health. The psychological domain includes affect, cognition, and behaviors. The social domain focuses on socioeconomic circumstances, cultural influences and the strength of a person's relationships and network (family, friends, community, workplace). 44 The Biopsychosocial Model provides a conceptual framework to better understand how individuals with high levels of ACEs are at greater risk for chronic illness including ADRD.This framework helps illuminate the links between social conditions (housing segregation, inadequate education, and other forms of discrimination) and higher risk for both psychological and physical health conditions. Forrester and colleagues (2019) identified connections among older African Americans, the expanded ACE of racial discrimination, and cognitive functioning through the lens of the biopsychosocial model. In their work, adverse social conditions were correlated with high levels of stress and dysregulation. These factors appear to increase the risk of cognitive impairment in these older adults. 50 Purpose of the Current Study The purpose of this study was to conduct a secondary data analysis using a sample of community-dwelling older African American participants from the Minority Aging Research Study (MARS). 51 The analysis examined the relationships among ACEs, active coping, and cognitive function in older African Americans. Study aims included: Aim 1. To examine the relationship between the mean scores of ACEs as measured by the First 18 Years Survey 52 and the mean scores of cognitive functioning tests at a single point in time. We hypothesized that MARS participants with higher ACE scores would have poorer cognitive functioning. Aim 2. To examine the moderating effect of active coping as measured by the John Henryism Active Coping Scale on the relationship between childhood adversity and cognitive functioning at a single point in time. We hypothesized that active coping would moderate the effects of ACEs by buffering the impact of adversity on cognitive functioning in urban African American older adults. Methods Study Design This study is a secondary data analysis based on the parent study, MARS. A longitudinal observational study initiated in 2004, MARS investigates the genetic, psychosocial, and biologic risk factors for cognitive aging and ADRD in older African Americans. 51 , 53 MARS is a large cohort study with an enrollment of 756 individuals. Annually, participants undergo a comprehensive risk factor assessment consisting of psychosocial and lifestyle factors (e.g., sleep, physical activity), a neurologic exam, neuropsychological testing, and a blood draw for genetic analyses. 23 , 24 Sample MARS participants: 1) are 65 years or older, 2) self-report as African American, 3) reside in the Chicago metropolitan area, and 4) do not have a dementia diagnosis. Completing one year of annual physical, memory, and neurological testing, including The First 18 Years Survey and the John Henryism Active Coping Scale , was a specific inclusion criterion for this secondary data analysis. Individuals diagnosed with dementia at baseline were excluded from research analysis for the parent study and for this secondary data analysis. The total number of MARS participants was 756. Measures Cognitive Functioning . Cognitive functioning tests can be used to assess common memory problems in individuals over the age of 65. 51 Since its inception, MARS has assessed cognition across a wide range of cognitive domains including Episodic, Semantic , and Working Memory along with Perceptual Speed and Visuospatial Speed . (Table 1 ). The domain scores for this analysis were selected at a single point in time. A combination of cognitive functioning tests was equally weighted and then converted into a z score. A z score > 0 is associated with higher cognitive function in participants. 47 Table 1 MARS Cognitive Function Domains and Tests Domain and Test Names¹ Mini Mental Status Exam Boston Naming Test Episodic Memory Logical Memory Ia Logical Memory IIa East Boston Story Immediate recall East Boston Story Delayed recall Word List Memory Word List Recall Word List Recognition Semantic Memory Verbal Fluency Wide Range Achievement Test Working Memory Digit Span Forward Digit Span Backward Digit Span Ordering Perceptual Speed Symbol Digit Number Comparison Stroop Word Reading Stroop Word Color Naming Visuospatial Ability Line Orientation ¹Cognitive test domains are bolded. ACEs . A decade after the study began, the First 18 Years Survey , began to be included in MARS. The First 18 Years measures ACEs and other childhood adversities. It is based on the Childhood Trauma Questionnaire 54 and other structured questionnaires. Participants completed this survey one time only during their initial assessment. Except for sexual abuse, the First 18 Years Survey assesses all the other experiences included in the original ACE survey along with some others as well. 52 The First 18 Years Survey provides a total adversity score and five subcategory scores: financial need, parental violence, parental intimidation, family separation, and emotional neglect. Five items are rated on a four-point scale; nine items on a five-point scale; and the remaining eight items on a two-point scale. “Refused to answer” is an additional response option for all 22 questions. Scores on the First 18 Years Survey range from 0 to 58. Since the survey’s development, the concept of ACEs has expanded to include racial discrimination, which to date is not part of The First 18 Years Survey . 52 Active Coping . The modified John Henryism Active Coping Scale was added to the study’s test battery around the same time as the First 18 Years Survey . From that time forward, all participants completed this test on an annual basis. The John Henryism Active Coping Scale is scored on a five category Likert scale (“completely false” to “completely true”). The modified scale’s scores range from 0 to 27. Any score above the median is considered “high” active coping. Because there were multiple John Henryism Active Coping Scale measurements for the same individual obtained over several years, we used the mean score for this variable. 33 Additional MARS Data and Procedures Each MARS participant self-reports their race/ethnicity, age, gender, education level, and marital status. These data are used to describe the study sample. In addition, information is updated annually on participants’ personal and family medical history as well as physical measurement (height, weight, and waist circumference). Blood pressure and blood test results are also documented. All MARS participants sign Institutional Review Board (IRB) approved informed consents agreeing to annual memory, neurological, psychological, and social risk factors assessments. Testing is scheduled at a time convenient for the participant and is typically performed in a participant’s home. COVID-related provisions for phone assessments were adopted starting in 2020. Each participant completes a standardized baseline neurological exam, a family history form, and annual memory testing. A health care professional reviews previous test results with the participant at the final annual assessment meeting. The MARS de-identified dataset used for this secondary data analysis is publicly available, so this study was exempt from IRB review. Statistical Analysis All data on MARS study participants are stored on Rush Alzheimer’s Disease Center (RADC) designated database, a secure institutional online platform. SPSS™ software for Windows (Version 26) was used to complete statistical analysis. 55 A p-value of .05 level of significance was used for the analysis. We expected missing data and addressed this discrepancy by completing case analysis. 56 Statistical assumptions were assessed for normality, linearity, and collinearity. In the initial analysis of the cohort’s demographics, we computed the means and calculated frequencies of the demographic characteristics and test scores. For Hypothesis 1 (higher ACE scores will be associated with poorer cognitive functioning), a correlation analysis assessed assumptions for this model. T-tests, ANOVA, and linear regression were used to determine the differences between mean scores of the First 18 Years Survey and the cognitive functioning scores. To investigate Hypothesis 2 (active coping moderates the association between ACEs and cognitive functioning), a linear analysis (t-tests, ANOVA, linear regression) was conducted to assess the presence and strength of the moderating effect of the active coping scale scores as measured by John Henryism Active Coping Scale on ACEs and as measured by the First 18 Years Survey on cognitive functioning scores. Results The mean age of the 756 participants in this secondary analysis of the MARS parent study is 73.6 years (Standard Deviation (SD) = 6.4; range 57–94 years). Those younger than 65 included two spouses of study participants who enrolled in the study to encourage their family member to join as well. Most of the MARS participants were women (77%), and the majority had obtained some college education (70.08%) with an overall average of 14.84 years of schooling. (Table 2 ) Table 2 Minority Aging Research Study (MARS) Patient Demographics Characteristic N = 756 Age Mean 73.8 Education Mean (years) 14.8 Sex Male 179 Female 577 N = number of MARS participants The study’s first aim was to examine the relationship between the mean of total adversity scores (ACEs), as measured by the First 18 Years Survey , and the mean z score of the cognitive global functioning assessment. The participants’ ACE scores on the First 18 Years Survey ranged from 0 to 45 (maximum score = 58), with a mean score of 9.43 (SD = 8.09) Mean Cognitive Global z score was .01 (SD = .61). In the study sample, the total adversity scores on the First 18 Years Survey and cognitive global functioning scores were not significantly correlated (r = .02, p = .07). Only one adversity subcategory, financial need, was significantly correlated with cognitive functioning with higher financial need being correlated with lower cognitive functioning. (Table 3 ). Table 3 Correlational Analysis: Relationships among ACEs, Active Coping, and Cognitive Global Scores Education Total Adverse Experiences Emotional neglect Family separation Financial need Parental intimidation Parental violence John Henry Active Coping Cognitive Global Scores Education -- Total Adverse Experiences − .09* -- Emotional neglect − .12* .82* -- Family separation − .07 .57* .36* -- Financial need − .11* .45* .20* .15* -- Parental intimidation − .04 .82* .48* .38* .28* -- Parental violence − .04 .67* .34* .33 .18* .66* -- John Henry Active Coping − .06 − .04 − .05 .01 − .00 − .04 − .01 -- Cognitive Global Scores .44* .03 − .05 .08 − .10* .07 .03 − .08 -- Mean (SD) 14.83 (3.64) 9.43 (8.09) 2.68 (3.97) 1.46 (1.42) 1.06 (1.58) 2.88 (2.78) 1.90 (1.40) 16.21 (3.75) − .01 (.607) Note. Number of participants = 756. *Correlation is significant at the p < .05 level (2-tailed). Total Adversity refers to the total score on the First 18 Years Survey . Emotional neglect, financial need, parental intimidation, and parental violence are subcategories of the First 18 Years Survey. John Henry Active Coping represents the total score on the John Henry Active Coping Scale. Cognitive Global Scores are standardized z scores encompassing the cognitive test domains and individual tests listed in Table 1 . The second aim was to examine the moderating effect of active coping on the relationship between total adversity scores and cognitive functioning. Overall, the mean score on the John Henryism Active Coping Scale was 16.21(SD 3.75) with a range of 1 to 27. The median score was 16. We were unable to discern whether active coping moderates the impact of ACEs on global cognitive functioning because ACEs and cognitive global functioning were not significantly correlated in this sample. Irrespective of ACEs, however, active coping and cognitive global functioning had an inverse relationship (r = − .09, p = .048) (Table 3 ); individuals with higher active coping scores had lower cognitive functioning scores. Linear regression and an analysis of variance corroborated these results with similar significant results between active coping and cognitive global functioning scores F (1, 755) = 16.17, p < .05. Discussion This secondary data analysis investigated cognitive functioning within the context of childhood history and adult coping style in a large sample of older African Americans, an understudied population. While the financial need-ACE subscore and lower cognitive functioning were significantly associated, aligned with the literature about childhood poverty, cognitive decline, and dementia, 58 our hypothesis that higher total ACE scores would be associated with poorer cognitive functioning was not supported. Although multiple researchers have identified a correlation between total childhood adversity scores and cognitive decline, 10 , 47 , 57 , 59 some studies demonstrate no association between ACE score and cognitive function in older African Americans. 60 , 61 Why was higher total ACE score not associated with lower cognitive functioning in this study? First, participants’ global cognitive functioning was average, and those with dementia had been excluded a priori. Second, survival and selection bias may have played a role in lower total ACE scores. Higher levels of childhood adversity increase the risk for chronic disease, disability, and premature death. 1 Individuals with a higher ACE burden may have died before becoming eligible for the MARS study (65 and older) or have been too sick or disabled to participate in a research study. Low mean ACE scores may have conferred lower risk for ACE-related cognitive decline in study participants. The mean ACE score may also have been spuriously low because of missing information. For example, questions about sexual abuse and racial discrimination are not part of the First 18 Years Survey. Either or both of these items, particularly experiences of racial discrimination, may have contributed to participant ACE scores had they been measured. ACEs may also interfere with autobiographical memory, especially for memories of events occurring earlier in life and/or for those which are severe and can result in dissociation. 62 If ACE scores merely appeared low, but in fact were higher, we would have expected to see lower cognitive global functioning mean scores, which we did not. Finally, a history of positive childhood experiences (PCEs) can mitigate the consequences of ACEs and may be inferred from participants’ longevity and high educational attainment. Higher levels of PCES are associated with lower psychosocial stress and better mental health, psychosocial functioning, physical health and health behaviors. 63 , 64 Because total ACE scores were not significantly correlated with cognitive impairment in this population, we could not assess whether active coping moderated the impact of total ACEs on cognitive global functioning. Although we could not determine whether our second hypothesis was supported, we did find a significant inverse relationship between active coping and cognitive global functioning; higher scores on the John Henryism Active Coping Scale were associated with lower global cognitive function. These results support the work of researchers who found that active coping was related to cognitive dysfunction and decline. 35 , 37 Nonetheless, these results were surprising because the study population is an urban, highly educated group for whom active coping can be salutary. 42 , 43 Perhaps feeling compelled to use active coping to deal with the stress of discrimination, however, is not in anyone’s best interest, regardless of geographic or socioeconomic status. This secondary data analysis has several strengths. Its sample is composed exclusively of African American older adults, a population rarely included in research studies. It includes an exploration of cognitive functioning in context through: 1) a comprehensive battery of cognitive functioning tests; 2) a validated ACE measure; and 3) an active coping measure. Although there are numerous articles on active coping using the John Henryism Active Coping Scale , there is very little research on active coping’s impact on cognition in older African Americans, particularly those from urban areas with higher educational attainment and incomes. Therefore, this manuscript makes an important contribution to the nascent but growing literature on African American elders. This analysis also has limitations. Its data is based on self-reports about childhood experiences occurring at least five decades prior. Research highlights that these answers may not always be reliable. 59 The study sample also may not be representative of the African American population at large because MARS participants are highly educated with 2 + years of college on average. In contrast, nationally only 23% of African Americans have attained this level of education. 65 Education itself can be a protective factor against cognitive decline 23 and higher educational attainment is more likely in the context of lower ACE 16 and higher PCE scores. 66 Lastly, the MARs data does not measure PCEs, which may directly enhance later cognitive function. 67 Future Directions While much of the focus of ACEs research has been on children and young to middle-aged adults, very few studies have included older African Americans. 25 Intentionally prioritizing sufficient representation of this population in research can deepen our understanding of how childhood experiences affect lifelong health and guide us to the most impactful prevention and intervention strategies. Systematically creating and sustaining conditions which eliminate poverty and discrimination, prevent any one group from having to work twice as hard as any other, and support the right opportunities at the right time for everyone are key for cultivating lifelong cognitive functioning, health, and well-being for African Americans. Conclusions This study examined the relationships among ACEs, active coping, and cognition in older African Americans, which are both complex and nuanced. Higher active coping and financial need scores, but not total ACE scores, were associated with poorer cognitive global functioning in the study population. Whether active coping moderates the effect of ACEs on cognition could not be determined. A more representative sample of African American elders and incorporation of administrative records and family reports can strengthen data collection. Exploring the full complement of positive and adverse childhood experiences, including sexual abuse and perceived racial discrimination, will enhance future research, policies, and practice. Abbreviations Adverse Childhood Experiences ACEs Behavioral Risk Factor Surveillance Survey BRFSS Minority Aging Research Study MARS Centers for Disease Control and Prevention CDC United States US Alzheimer’s or other related dementias ADRD Institutional Review Board IRB Rush Alzheimer’s Disease Center RADC Positive Childhood Experiences PCEs Standard Deviation SD Number of participants N Declarations Ethics approval and consent to participate This research was exempt because it was a secondary data analysis of publicly available de-identified data from the Minority Aging Research Study (MARS). Consent for publication Not Applicable Availability of data and materials Details about availability of data and materials are located on the Rush Alzheimer’s Disease Center’s Resource Sharing Hub https://www.radc.rush.edu/requests.htm;jsessionid=1BE1E40897510D7268E794EEA09819CD Competing interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors. Authors' contributions KG engaged in conceptualization, project administration, formal analysis, methodology, validation, visualization, and writing the original draft and revising and editing. LF engaged in data curation, formal analysis, methodology, validation, and visualization. OP engaged in conceptualization, methodology, supervision, and writing-revising and editing. DB engaged in conceptualization, supervision, writing-revising and editing. 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Racial discrimination, John Henryism, and depression among African Americans. J Black Psychol. 2016;42(3):221–43. 10.1177/0095798414567757 . Kobasa SC, Maddi SR, Kahn S. Hardiness and health: a prospective study. J Pers Soc Psychol. 1982;42(1):168–77. 10.1037//0022-3514.42.1.168 . Lieberman M, Tobin S. The Experience of Old Age: Stress, Coping, and Survival. New York, NY: Basic Books; 1983. Mendez YP, Ralston PA, Wickrama KKAS, Bae D, Young-Clark I, Ilich JZ. Lower life satisfaction, active coping, and cardiovascular disease risk factors in older African Americans: outcomes of a longitudinal church-based intervention. J Behav Med. 2018;41(3):344–56. 10.1007/s10865-017-9909-0 . Merritt MM, Bennett GG, Williams RB, Sollers JJ 3rd, Thayer JF. Low educational attainment, John Henryism, and cardiovascular reactivity to and recovery from personally relevant stress. Psychosom Med. 2004;66(1):49–55. 10.1097/01.psy.0000107909.74904.3d . Manne SL, Myers-Virtue S, Kashy D, et al. Resilience, positive coping, and quality of life among women newly diagnosed with gynecological cancers. Cancer Nurs. 2015;38(5):375–82. 10.1097/NCC.0000000000000215 . Bronder EC, Speight SL, Witherspoon KM, Thomas AJ. John Henryism, depression, and perceived social support in Black women. J Black Psychol. 2013;40(2):115–37. 10.1177/0095798412474466 . Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–36. 10.1126/science.847460 . Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord. 2004;82(2):217–25. 10.1016/j.jad.2003.12.013 . Kim J, Ahn H, Lyon DE, Stechmiller J. Building a biopsychosocial conceptual framework to explore pressure ulcer pain for hospitalized patients. Healthc (Basel). 2016;4(1):7. 10.3390/healthcare4010007 . Majer M, Nater UM, Lin JM, Capuron L, Reeves WC. Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurol. 2010;10:61. 10.1186/1471-2377-10-61 . McCrory C, Dooley C, Layte R, Kenny RA. The lasting legacy of childhood adversity for disease risk in later life. Health Psychol. 2015;34(7):687–96. 10.1037/hea0000147 . Renjith V, Pai MS, Castalino F, George A, Pai A. Engel's model as a conceptual framework in nursing research: Well-being and disability of patients with migraine. Holist Nurs Pract. 2016;30(2):96–101. 10.1097/HNP.0000000000000136 . Forrester SN, Gallo JJ, Whitfield KE, Thorpe RJ. A framework of minority stress: From physiological manifestations to cognitive outcomes. Gerontologist. 2019;59(6):1017–23. 10.1093/geront/gny104 . Barnes LL, Shah RC, Aggarwal NT, Bennett DA, Schneider JA. The minority aging research study: Ongoing efforts to obtain brain donation in African Americans without dementia. Curr Alzheimer Res. 2012;9(6):734–45. 10.2174/156720512801322627 . Wilson RS, Krueger KR, Arnold SE, et al. Childhood adversity and psychosocial adjustment in old age. Am J Geriatr Psychiatry. 2006;14(4):307–15. 10.1097/01.JGP.0000196637.95869.d9 . Barnes LL, Wilson RS, Everson-Rose SA, Hayward MD, Evans DA, Mendes de Leon CF. Effects of early-life adversity on cognitive decline in older African Americans and whites. Neurology. 2012;79(24):2321–7. 10.1212/WNL.0b013e318278b607 . Bernstein DP, Fink L, Handelsman L, Foote J. Childhood Trauma Questionnaire . PsycTESTS Dataset. Published online 1994. 10.1037/t02080-000 IBM Corp. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp; 2019. Groenwold RH, Donders AR, Roes KC, Harrell FE Jr, Moons KG. Dealing with missing outcome data in randomized trials and observational studies. Am J Epidemiol. 2012;175(3):210–7. 10.1093/aje/kwr302 . Levine ME, Cole SW, Weir DR, Crimmins EM. Childhood and later life stressors and increased inflammatory gene expression at older ages. Soc Sci Med. 2015;130:16–22. 10.1016/j.socscimed.2015.01.030 . Epub 2015 Jan 21. PMID: 25658624; PMCID: PMC4394113. Le T, Maharani A, Hayter M, Gilleen J, Lee A. Cognitive impairment and dementia-Are they linked to childhood health and socioeconomic status? A systematic review. PLoS ONE. 2025;20(3):e0311074. 10.1371/journal.pone.0311074 . Schüssler-Fiorenza Rose SM, Xie D, Stineman M. Adverse childhood experiences and disability in U.S. adults. PM R. 2014;6(8):670–80. 10.1016/j.pmrj.2014.01.013 . Barnes LL, Wilson RS, Everson-Rose SA, Hayward MD, Evans DA, Mendes de Leon CF. Effects of early-life adversity on cognitive decline in older African Americans and whites. Neurology. 2012;79(24):2321–7. 10.1212/WNL.0b013e318278b607 . PMID: 23233682; PMCID: PMC3578376. Lor Y, George KM, Gilsanz P, Meunier CC, Peterson RL, Hayes-Larson E, Barnes LL, Mungas D, Whitmer RA. What is the association between adverse childhood experiences and late-life cognitive decline? Study of Healthy Aging in African Americans (STAR) cohort study. BMJ Open. 2023;13(11):e072961. 10.1136/bmjopen-2023-072961 . PMID: 37918928; PMCID: PMC10626853. Brown DW, Anda RF, Edwards VJ, Felitti VJ, Dube SR, Giles WH. Adverse childhood experiences and childhood autobiographical memory disturbance. Child Abuse Negl. 2007;31(9):961–9. 10.1016/j.chiabu.2007.02.011 . Han D, Dieujuste N, Doom JR, Narayan AJ. A systematic review of positive childhood experiences and adult outcomes: Promotive and protective processes for resilience in the context of childhood adversity. Child Abuse Negl. 2023;144:106346. 10.1016/j.chiabu.2023.106346 . Huang CX, Halfon N, Sastry N, Chung PJ, Schickedanz A. Positive childhood experiences and adult health outcomes. Pediatrics . 2023;152(1):e2022060951. doi:10.1542/peds.2022-060951 ‌65. BlackDemographics.com. Educational Attainment . https://blackdemographics.com/education-2/education/ . Published date not listed. Accessed April 21, 2025. Sege R, Swedo EA, Burstein D, et al. Prevalence of positive childhood experiences among adults - Behavioral Risk Factor Surveillance System, four states, 2015–2021. MMWR Morb Mortal Wkly Rep. 2024;73(17):399–404. 10.15585/mmwr.mm7317a3 . Lee H, Schafer M. Are positive childhood experiences linked to better cognitive functioning in later life? Examining the role of life course pathways. J Aging Health. 2021;33(3–4):217–26. 10.1177/089826432097254 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Barnes","email":"","orcid":"","institution":"Rush Alzheimer’s Disease Center","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"L.","lastName":"Barnes","suffix":""}],"badges":[],"createdAt":"2025-05-02 22:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6581020/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6581020/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91964918,"identity":"be8f7260-e54f-48c4-8981-e829f3cf7e38","added_by":"auto","created_at":"2025-09-23 08:13:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":925877,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6581020/v1/21b35e76-b073-461e-a335-61c53cc9bf4d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adverse Childhood Experiences, Active Coping, and Cognition in Older African Americans: A Secondary Data Analysis of the Minority Aging Research Study","fulltext":[{"header":"Background","content":"\u003cp\u003eAdverse Childhood Experiences (ACEs) are potentially traumatic events occurring before age 18 that vary in severity and are common. The groundbreaking ACE Study was a collaboration between California\u0026rsquo;s Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) in which over 17,000 patients were assessed for ACEs. The researchers divided ACEs into three major categories: abuse, neglect, and household stressors. Within these categories, they identified subcategories such as physical, sexual and emotional abuse; physical and emotional neglect; and a broad range of household stressors\u0026ndash;mental illness, incarceration, and substance use among household members; parental divorce or separation; and violence against the mother.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Further research determined that ACEs are common across every social economic stratum, gender, race, and ethnicity\u003csup\u003e,\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and may be even more common among oppressed and marginalized populations.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Over time, other researchers expanded the concept of ACEs to include low socioeconomic status, environmental injustice, discrimination, community violence, other community or structural experiences, and more.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eACEs can be the underlying cause for a multitude of chronic illnesses and self-soothing but health-compromising behaviors across the life span.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Through its Behavioral Risk Factor Surveillance Survey (BRFSS), an annual national health phone survey, the CDC estimates that: 1) 61% of adults in the United States (US) have experienced at least one ACE, 2) one in six experienced four or more ACEs, and 3) persons reporting four or more ACEs are at higher risk for physical, mental health, and social problems than those with fewer than four ACEs.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e To date, all 50 states and the District of Columbia have included the ACE module in at least one annual BRFSS.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Moreover, ACE prevalences have been reported in 22 different countries including the US.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eAfrican Americans and ACEs\u003c/h3\u003e\n\u003cp\u003eResearchers have also begun to examine the prevalence of ACEs by ethnicity and race. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e African Americans are at highest risk for experiencing each of the original and expanded ACEs.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Indeed, African Americans (Black people born in the United States of African ancestry. \u0026ldquo;Black\u0026rdquo; and \u0026ldquo;African American\u0026rdquo; will be used interchangeably in this manuscript) are at increased risk for ACEs because of the lingering and long-standing effects of racism and economic discrimination.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e These experiences of racial discrimination increase the number of ACEs in the African American community and multiply their effect.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Geronimous and colleagues (2010) hypothesized that racial stressors create a \u0026ldquo;biological \u0026lsquo;weathering\u0026rsquo;\u0026rdquo;, or wear and tear, on African Americans.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Weathering results in higher rates of chronic illness and disability\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e and is a response to discrimination, micro- and macroaggressions, and centuries of oppression while living as an African American in the United States. \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWeathering among African American adults begins much earlier\u0026ndash;in childhood. For example, African American children and adolescents living in poverty experienced a domino effect of a multitude of other ACEs.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e These youth are at higher risk for living in homes with poor health, parental depression, and less social support which, in turn, increase the risk for more serious consequences (i.e., foster care placement; a cycle of generational poverty).\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eACEs and Cognitive Impairment\u003c/h2\u003e \u003cp\u003eWhile ACEs have been examined among African Americans from childhood into middle age, very few ACE-related studies have focused on the impact of ACEs on older African American participants\u0026rsquo; health.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Although older African Americans are two times more likely to develop Alzheimer\u0026rsquo;s or other related dementias (ADRD), a 2021 study identified only 10 articles examining the relationship between cognition and ACEs in this population.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Some of these studies explored the role of the expanded ACEs of school segregation or discrimination on older African Americans\u0026rsquo; cognitive health.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Others found an association between low socioeconomic status (an expanded ACE) and cognition in African Americans.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe prevalence of cognitive impairment in older adults has been increasing. Approximately six million people in the United States have been diagnosed with a dementia.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Currently, 11% of adults over the age of 65 have a dementia. By the time these adults are 85 years old, 40% will have dementia.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e With the number of ADRD patients increasing annually, identifying and addressing risk factors for this disease is essential, especially in communities hit the hardest by ADRD, like older African Americans.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eJohn Henryism Active Coping\u003c/h3\u003e\n\u003cp\u003eActive coping is one of the ways African Americans respond to race-related stress\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, such as the expanded ACEs of racial discrimination and societal disadvantage.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Active coping is a stress-coping mechanism through which people make every attempt to identify stressors and improve their situation, an inner ability to address difficult social or economic challenges.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e James and colleagues (1983) hypothesized that active coping is a strategy to deal with on-going, continuous social and environmental stressors such as poverty and racism.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Active coping includes: (1) efficacious mental and physical vigor; (2) a strong commitment to hard work; and (3) a single-minded determination to succeed.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e is based on the story of John Henry, a symbol of African Americans\u0026rsquo; attempts to control their oppressive circumstances by working twice as hard as their non-Hispanic White counterparts.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e The \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e assesses the degree to which respondents engage in the coping style of overworking as a strategy to deal the ongoing stress of economic and social discrimination as well as other social and environmental stressors\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e The \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e was designed to assess low-income, rural African Americans. In this population, active coping behavior was associated with poor health and risk for premature death.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn some studies of the \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e, individuals with high active coping scores were found to be at higher risk for chronic illnesses.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e Some researchers posited that these results emerged because the majority of participants were Black people who also experienced economic disadvantages.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Others found that because the scale was designed for low income, working class, and rural Americans, high income individuals and/or those living in urban areas might have different results.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e For these study participants, active coping was associated with activities that are health-promoting and support good overall psychological health.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Studies using this scale have yielded paradoxical results: some link John Henryism with poorer outcomes and some with improved outcomes. Thus, active coping may be detrimental OR support health depending on the specific population.\u003c/p\u003e\n\u003ch3\u003eTheoretical Framework for the Current Study\u003c/h3\u003e\n\u003cp\u003eThe aims for this secondary data analysis are based on the Biopsychosocial Model.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e This model has three domains and has been broadly used across disciplines and research studies.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e The biological domain includes structural, physiologic, and genetic phenomena that affect health. The psychological domain includes affect, cognition, and behaviors. The social domain focuses on socioeconomic circumstances, cultural influences and the strength of a person's relationships and network (family, friends, community, workplace).\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e The Biopsychosocial Model provides a conceptual framework to better understand how individuals with high levels of ACEs are at greater risk for chronic illness including ADRD.This framework helps illuminate the links between social conditions (housing segregation, inadequate education, and other forms of discrimination) and higher risk for both psychological and physical health conditions. Forrester and colleagues (2019) identified connections among older African Americans, the expanded ACE of racial discrimination, and cognitive functioning through the lens of the biopsychosocial model. In their work, adverse social conditions were correlated with high levels of stress and dysregulation. These factors appear to increase the risk of cognitive impairment in these older adults.\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003ePurpose of the Current Study\u003c/h3\u003e\n\u003cp\u003eThe purpose of this study was to conduct a secondary data analysis using a sample of community-dwelling older African American participants from the Minority Aging Research Study (MARS).\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e The analysis examined the relationships among ACEs, active coping, and cognitive function in older African Americans. Study aims included:\u003c/p\u003e \u003cp\u003eAim 1. To examine the relationship between the mean scores of ACEs as measured by the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e and the mean scores of cognitive functioning tests at a single point in time. We hypothesized that MARS participants with higher ACE scores would have poorer cognitive functioning.\u003c/p\u003e \u003cp\u003eAim 2. To examine the moderating effect of active coping as measured by the \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e on the relationship between childhood adversity and cognitive functioning at a single point in time. We hypothesized that active coping would moderate the effects of ACEs by buffering the impact of adversity on cognitive functioning in urban African American older adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study is a secondary data analysis based on the parent study, MARS. A longitudinal observational study initiated in 2004, MARS investigates the genetic, psychosocial, and biologic risk factors for cognitive aging and ADRD in older African Americans.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e,\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e MARS is a large cohort study with an enrollment of 756 individuals. Annually, participants undergo a comprehensive risk factor assessment consisting of psychosocial and lifestyle factors (e.g., sleep, physical activity), a neurologic exam, neuropsychological testing, and a blood draw for genetic analyses.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample\u003c/h3\u003e\n\u003cp\u003eMARS participants: 1) are 65 years or older, 2) self-report as African American, 3) reside in the Chicago metropolitan area, and 4) do not have a dementia diagnosis. Completing one year of annual physical, memory, and neurological testing, including \u003cem\u003eThe First 18 Years Survey\u003c/em\u003e and \u003cem\u003ethe John Henryism Active Coping Scale\u003c/em\u003e, was a specific inclusion criterion for this secondary data analysis. Individuals diagnosed with dementia at baseline were excluded from research analysis for the parent study and for this secondary data analysis. The total number of MARS participants was 756.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eCognitive Functioning\u003c/b\u003e. Cognitive functioning tests can be used to assess common memory problems in individuals over the age of 65.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e Since its inception, MARS has assessed cognition across a wide range of cognitive domains including \u003cem\u003eEpisodic, Semantic\u003c/em\u003e, and \u003cem\u003eWorking Memory\u003c/em\u003e along with \u003cem\u003ePerceptual Speed and Visuospatial Speed\u003c/em\u003e. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The domain scores for this analysis were selected at a single point in time. A combination of cognitive functioning tests was equally weighted and then converted into a z score. A z score\u0026thinsp;\u0026gt;\u0026thinsp;0 is associated with higher cognitive function in participants.\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMARS Cognitive Function Domains and Tests\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain and Test Names\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMini Mental Status Exam\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoston Naming Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEpisodic Memory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLogical Memory Ia\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLogical Memory IIa\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEast Boston Story Immediate recall\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEast Boston Story Delayed recall\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eWord List Memory\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eWord List Recall\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eWord List Recognition\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSemantic Memory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVerbal Fluency\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eWide Range Achievement Test\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking Memory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDigit Span Forward\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDigit Span Backward\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDigit Span Ordering\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceptual Speed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSymbol Digit\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNumber Comparison\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStroop Word Reading\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStroop Word Color Naming\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVisuospatial Ability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLine Orientation\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026sup1;Cognitive test domains are bolded.\u003c/p\u003e \u003cp\u003e \u003cb\u003eACEs\u003c/b\u003e. A decade after the study began, the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e, began to be included in MARS. \u003cem\u003eThe First 18 Years\u003c/em\u003e measures ACEs and other childhood adversities. It is based on the Childhood Trauma Questionnaire\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e and other structured questionnaires. Participants completed this survey one time only during their initial assessment. Except for sexual abuse, the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e assesses all the other experiences included in the original ACE survey along with some others as well.\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e \u003cem\u003eThe First 18 Years Survey\u003c/em\u003e provides a total adversity score and five subcategory scores: financial need, parental violence, parental intimidation, family separation, and emotional neglect. Five items are rated on a four-point scale; nine items on a five-point scale; and the remaining eight items on a two-point scale. \u0026ldquo;Refused to answer\u0026rdquo; is an additional response option for all 22 questions. Scores on the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e range from 0 to 58. Since the survey\u0026rsquo;s development, the concept of ACEs has expanded to include racial discrimination, which to date is not part of \u003cem\u003eThe First 18 Years Survey\u003c/em\u003e.\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eActive Coping\u003c/b\u003e. The modified \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e was added to the study\u0026rsquo;s test battery around the same time as the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e. From that time forward, all participants completed this test on an annual basis. The \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e is scored on a five category Likert scale (\u0026ldquo;completely false\u0026rdquo; to \u0026ldquo;completely true\u0026rdquo;). The modified scale\u0026rsquo;s scores range from 0 to 27. Any score above the median is considered \u0026ldquo;high\u0026rdquo; active coping. Because there were multiple \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e measurements for the same individual obtained over several years, we used the mean score for this variable.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAdditional MARS Data and Procedures\u003c/h2\u003e \u003cp\u003eEach MARS participant self-reports their race/ethnicity, age, gender, education level, and marital status. These data are used to describe the study sample. In addition, information is updated annually on participants\u0026rsquo; personal and family medical history as well as physical measurement (height, weight, and waist circumference). Blood pressure and blood test results are also documented.\u003c/p\u003e \u003cp\u003eAll MARS participants sign Institutional Review Board (IRB) approved informed consents agreeing to annual memory, neurological, psychological, and social risk factors assessments. Testing is scheduled at a time convenient for the participant and is typically performed in a participant\u0026rsquo;s home. COVID-related provisions for phone assessments were adopted starting in 2020. Each participant completes a standardized baseline neurological exam, a family history form, and annual memory testing. A health care professional reviews previous test results with the participant at the final annual assessment meeting.\u003c/p\u003e \u003cp\u003e The MARS de-identified dataset used for this secondary data analysis is publicly available, so this study was exempt from IRB review.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll data on MARS study participants are stored on Rush Alzheimer\u0026rsquo;s Disease Center (RADC) designated database, a secure institutional online platform. SPSS\u0026trade; software for Windows (Version 26) was used to complete statistical analysis.\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e A p-value of .05 level of significance was used for the analysis. We expected missing data and addressed this discrepancy by completing case analysis.\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e Statistical assumptions were assessed for normality, linearity, and collinearity.\u003c/p\u003e \u003cp\u003eIn the initial analysis of the cohort\u0026rsquo;s demographics, we computed the means and calculated frequencies of the demographic characteristics and test scores. For Hypothesis 1 (higher ACE scores will be associated with poorer cognitive functioning), a correlation analysis assessed assumptions for this model. T-tests, ANOVA, and linear regression were used to determine the differences between mean scores of the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e and the cognitive functioning scores. To investigate Hypothesis 2 (active coping moderates the association between ACEs and cognitive functioning), a linear analysis (t-tests, ANOVA, linear regression) was conducted to assess the presence and strength of the moderating effect of the active coping scale scores as measured by \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e on ACEs and as measured by the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e on cognitive functioning scores.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e The mean age of the 756 participants in this secondary analysis of the MARS parent study is 73.6 years (Standard Deviation (SD)\u0026thinsp;=\u0026thinsp;6.4; range 57\u0026ndash;94 years). Those younger than 65 included two spouses of study participants who enrolled in the study to encourage their family member to join as well. Most of the MARS participants were women (77%), and the majority had obtained some college education (70.08%) with an overall average of 14.84 years of schooling. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMinority Aging Research Study (MARS) Patient Demographics\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;756\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMean (years)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eN\u0026thinsp;=\u0026thinsp;number of MARS participants\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study\u0026rsquo;s first aim was to examine the relationship between the mean of total adversity scores (ACEs), as measured by the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e, and the mean z score of the cognitive global functioning assessment. The participants\u0026rsquo; ACE scores on the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e ranged from 0 to 45 (maximum score\u0026thinsp;=\u0026thinsp;58), with a mean score of 9.43 (SD\u0026thinsp;=\u0026thinsp;8.09) Mean Cognitive Global z score was .01 (SD\u0026thinsp;=\u0026thinsp;.61). In the study sample, the total adversity scores on the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e and cognitive global functioning scores were not significantly correlated (r\u0026thinsp;=\u0026thinsp;.02, p\u0026thinsp;=\u0026thinsp;.07). Only one adversity subcategory, financial need, was significantly correlated with cognitive functioning with higher financial need being correlated with lower cognitive functioning. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eCorrelational Analysis: Relationships among ACEs, Active Coping, and Cognitive Global Scores\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal Adverse Experiences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmotional neglect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFamily separation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFinancial need\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eParental intimidation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eParental violence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eJohn Henry Active Coping\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCognitive Global Scores\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Adverse Experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.09*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional neglect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.12*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.82*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily separation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.57*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.36*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinancial need\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.11*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.45*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.20*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.15*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental intimidation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.82*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.48*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.38*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.28*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.67*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.34*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.18*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.66*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJohn Henry Active Coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Global Scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.44*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.10*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.83 (3.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.43 (8.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.68 (3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.46 (1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.06 (1.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.88 (2.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.90 (1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16.21 (3.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01 (.607)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cb\u003eNote.\u003c/b\u003e Number of participants\u0026thinsp;=\u0026thinsp;756. *Correlation is significant at the \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05 level (2-tailed). Total Adversity refers to the total score on the \u003cem\u003eFirst 18 Years Survey\u003c/em\u003e. Emotional neglect, financial need, parental intimidation, and parental violence are subcategories of the First 18 Years Survey. \u003cem\u003eJohn Henry Active Coping\u003c/em\u003e represents the total score on the John Henry Active Coping Scale. Cognitive Global Scores are standardized \u003cem\u003ez\u003c/em\u003e scores encompassing the cognitive test domains and individual tests listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe second aim was to examine the moderating effect of active coping on the relationship between total adversity scores and cognitive functioning. Overall, the mean score on the \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e was 16.21(SD 3.75) with a range of 1 to 27. The median score was 16. We were unable to discern whether active coping moderates the impact of ACEs on global cognitive functioning because ACEs and cognitive global functioning were not significantly correlated in this sample. Irrespective of ACEs, however, active coping and cognitive global functioning had an inverse relationship (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.09, p\u0026thinsp;=\u0026thinsp;.048) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e); individuals with higher active coping scores had lower cognitive functioning scores. Linear regression and an analysis of variance corroborated these results with similar significant results between active coping and cognitive global functioning scores F (1, 755)\u0026thinsp;=\u0026thinsp;16.17, p\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis secondary data analysis investigated cognitive functioning within the context of childhood history and adult coping style in a large sample of older African Americans, an understudied population. While the financial need-ACE subscore and lower cognitive functioning were significantly associated, aligned with the literature about childhood poverty, cognitive decline, and dementia,\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e our hypothesis that higher total ACE scores would be associated with poorer cognitive functioning was not supported. Although multiple researchers have identified a correlation between total childhood adversity scores and cognitive decline,\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e some studies demonstrate no association between ACE score and cognitive function in older African Americans.\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhy was higher total ACE score not associated with lower cognitive functioning in this study? First, participants\u0026rsquo; global cognitive functioning was average, and those with dementia had been excluded a priori. Second, survival and selection bias may have played a role in lower total ACE scores. Higher levels of childhood adversity increase the risk for chronic disease, disability, and premature death.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Individuals with a higher ACE burden may have died before becoming eligible for the MARS study (65 and older) or have been too sick or disabled to participate in a research study. Low mean ACE scores may have conferred lower risk for ACE-related cognitive decline in study participants.\u003c/p\u003e \u003cp\u003eThe mean ACE score may also have been spuriously low because of missing information. For example, questions about sexual abuse and racial discrimination are not part of the \u003cem\u003eFirst 18 Years Survey.\u003c/em\u003e Either or both of these items, particularly experiences of racial discrimination, may have contributed to participant ACE scores had they been measured. ACEs may also interfere with autobiographical memory, especially for memories of events occurring earlier in life and/or for those which are severe and can result in dissociation.\u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e If ACE scores merely appeared low, but in fact were higher, we would have expected to see lower cognitive global functioning mean scores, which we did not.\u003c/p\u003e \u003cp\u003eFinally, a history of positive childhood experiences (PCEs) can mitigate the consequences of ACEs and may be inferred from participants\u0026rsquo; longevity and high educational attainment. Higher levels of PCES are associated with lower psychosocial stress and better mental health, psychosocial functioning, physical health and health behaviors.\u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBecause total ACE scores were not significantly correlated with cognitive impairment in this population, we could not assess whether active coping moderated the impact of total ACEs on cognitive global functioning. Although we could not determine whether our second hypothesis was supported, we did find a significant inverse relationship between active coping and cognitive global functioning; higher scores on the \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e were associated with lower global cognitive function. These results support the work of researchers who found that active coping was related to cognitive dysfunction and decline.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Nonetheless, these results were surprising because the study population is an urban, highly educated group for whom active coping can be salutary.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Perhaps feeling compelled to use active coping to deal with the stress of discrimination, however, is not in anyone\u0026rsquo;s best interest, regardless of geographic or socioeconomic status.\u003c/p\u003e \u003cp\u003eThis secondary data analysis has several strengths. Its sample is composed exclusively of African American older adults, a population rarely included in research studies. It includes an exploration of cognitive functioning in context through: 1) a comprehensive battery of cognitive functioning tests; 2) a validated ACE measure; and 3) an active coping measure. Although there are numerous articles on active coping using the \u003cem\u003eJohn Henryism Active Coping Scale\u003c/em\u003e, there is very little research on active coping\u0026rsquo;s impact on cognition in older African Americans, particularly those from urban areas with higher educational attainment and incomes. Therefore, this manuscript makes an important contribution to the nascent but growing literature on African American elders.\u003c/p\u003e \u003cp\u003eThis analysis also has limitations. Its data is based on self-reports about childhood experiences occurring at least five decades prior. Research highlights that these answers may not always be reliable.\u003csup\u003e\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e The study sample also may not be representative of the African American population at large because MARS participants are highly educated with 2\u0026thinsp;+\u0026thinsp;years of college on average. In contrast, nationally only 23% of African Americans have attained this level of education.\u003csup\u003e65\u003c/sup\u003e Education itself can be a protective factor against cognitive decline\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e and higher educational attainment is more likely in the context of lower ACE\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e and higher PCE scores.\u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e Lastly, the MARs data does not measure PCEs, which may directly enhance later cognitive function.\u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eWhile much of the focus of ACEs research has been on children and young to middle-aged adults, very few studies have included older African Americans.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Intentionally prioritizing sufficient representation of this population in research can deepen our understanding of how childhood experiences affect lifelong health and guide us to the most impactful prevention and intervention strategies. Systematically creating and sustaining conditions which eliminate poverty and discrimination, prevent any one group from having to work twice as hard as any other, and support the right opportunities at the right time for everyone are key for cultivating lifelong cognitive functioning, health, and well-being for African Americans.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study examined the relationships among ACEs, active coping, and cognition in older African Americans, which are both complex and nuanced. Higher active coping and financial need scores, but not total ACE scores, were associated with poorer cognitive global functioning in the study population. Whether active coping moderates the effect of ACEs on cognition could not be determined. A more representative sample of African American elders and incorporation of administrative records and family reports can strengthen data collection. Exploring the full complement of positive and adverse childhood experiences, including sexual abuse and perceived racial discrimination, will enhance future research, policies, and practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAdverse Childhood Experiences\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eACEs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBehavioral Risk Factor Surveillance Survey\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBRFSS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMinority Aging Research Study\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMARS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCenters for Disease Control and Prevention\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCDC\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUnited States\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAlzheimer\u0026rsquo;s or other related dementias\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eADRD\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eInstitutional Review Board\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIRB\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRush Alzheimer\u0026rsquo;s Disease Center\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRADC\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePositive Childhood Experiences\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePCEs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eStandard Deviation\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNumber of participants\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was exempt because it was a secondary data analysis of publicly available de-identified data from the Minority Aging Research Study (MARS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDetails about availability of data and materials are located on the Rush Alzheimer\u0026rsquo;s Disease Center\u0026rsquo;s Resource Sharing Hub https://www.radc.rush.edu/requests.htm;jsessionid=1BE1E40897510D7268E794EEA09819CD \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKG engaged in conceptualization, project administration, formal analysis, methodology, validation, visualization, and writing the original draft and revising and editing. LF engaged in data curation, formal analysis, methodology, validation, and visualization. OP engaged in conceptualization, methodology, supervision, and writing-revising and editing. DB engaged in conceptualization, supervision, writing-revising and editing. AS engaged in conceptualization, supervision, visualization, writing--revising and editing. LB engaged in conceptualization, investigation, methodology, resources, and writing\u0026mdash;revising and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge Elsa Hammerdahl and the Mile Square Research team who supported final preparation of the manuscript for submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFelitti VJ, Anda RF, Nordenberg D, et al. 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J Aging Health. 2021;33(3\u0026ndash;4):217\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/089826432097254\u003c/span\u003e\u003cspan address=\"10.1177/089826432097254\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"older African Americans, older Black people, Adverse Childhood Experiences, cognition, cognitive decline, dementia, active coping, John Henryism","lastPublishedDoi":"10.21203/rs.3.rs-6581020/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6581020/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAdverse Childhood Experiences (ACEs) increase risk for chronic conditions and health-compromising behaviors across the life course. In many studies, African Americans are at the highest risk for childhood adversity among racial and ethnic groups. Few ACE-related studies focus on ACEs\u0026rsquo; impact on older African Americans\u0026rsquo; health. Fewer still examine how ACEs influence cognition in older African Americans. \u003cem\u003eThe John Henryism Active Coping Scale\u003c/em\u003e assesses the coping style of overworking to deal with continuous stressors caused by economic and social discrimination. This study investigates the relationship between ACEs and cognition in older African Americans and explores whether active coping moderates the effects of ACEs on cognition in late life.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study is a secondary analysis of data from the Minority Aging Research Study (MARS), a longitudinal community-based study examining cognitive health and aging in older African Americans. The sample of 756 MARS participants completed cognitive global functioning tests as well as ACE (\u003cem\u003eThe First 18 Years Survey)\u003c/em\u003e and active coping (\u003cem\u003eJohn Henryism Active Coping Scale)\u003c/em\u003e questionnaires. We used correlational analysis (t-tests, ANOVA, linear regression) to examine the associations between ACEs and cognition and active coping and cognition. Additionally, we explored whether active coping moderated the impact of ACEs on cognition.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eStudy participants were highly educated with low total ACE scores, average cognitive functioning, and high active coping. The financial need subscore was significantly associated with lower cognitive global functioning although the total ACE score was not. Active coping was also associated with poorer cognition. We could not discern whether active coping is a significant moderator of ACEs because total ACEs and cognition were not associated in this sample.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFinancial need and active coping correlated with lower cognitive functioning. Future research with a more representative sample of African Americans, the full complement of conventional and expanded ACEs, and inclusion of positive childhood experiences are key for exploring the complex and nuanced relationships among ACEs, active coping, and cognition to best serve older Black people.\u003c/p\u003e","manuscriptTitle":"Adverse Childhood Experiences, Active Coping, and Cognition in Older African Americans: A Secondary Data Analysis of the Minority Aging Research Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-27 16:02:34","doi":"10.21203/rs.3.rs-6581020/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a027de72-2d08-48b9-81ac-fac5c1e1c020","owner":[],"postedDate":"June 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-23T08:12:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-27 16:02:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6581020","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6581020","identity":"rs-6581020","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}