Cognitive flexibility and the health of Black college-attending young adults experiencing interpersonal racial discrimination

Abstract

This study examined the utility of cognitive flexibility for the health of college-attending Black young adults facing chronic interpersonal racial discrimination in a sample of 218 healthy students attending a predominantly White university in the southeastern United States. Path and simple slope analysis indicated that cognitive flexibility moderated the association between racial discrimination and waist circumference but not depressive symptoms. At high cognitive flexibility, more experiences of discrimination were significantly associated with larger waist circumference. Findings suggest that cognitive flexibility may be detrimental for physical health and not of paramount importance for mental health of college-attending Black young adults.

Keywords

body size cognitive processing depression racism students

Black individuals in the United States (i.e. African American, Caribbean Black, Afro-Latinx, African, and bi-/multi-racial individuals) face multiple psychosocial stressors that contribute to poor mental (e.g. Breslau et al., 2005; Williams, 2018) and physical (e.g. Goosby et al., 2018; Kurian and Cardarelli, 2007) health. Interpersonal racial discrimination, defined as differential and unfavorable treatment of members of marginalized racial groups by the dominant racial group (Black et al., 2015), is one such frequent stressor for Black individuals (Kessler et al., 1999; Williams et al., 2019) that has been found to erode health via the chronic activation of stress systems (Geronimus et al., 2006; Lockwood et al., 2018; Paradies et al., 2015; Williams and Mohammed, 2013). Furthermore, chronic interpersonal racial discrimination is an especially important stressor for Black young adults in the predominantly White college context (Griffith et al., 2019; Hope et al., 2015), where they experience significantly more discrimination on campus than other racial/ethnic groups (Ancis et al., 2000; Bourke, 2010; Guiffrida and Douthit, 2010). It has been proposed that cognitive-affective regulation may protect many Black individuals from the health consequences of chronic interpersonal racial discrimination (Mays et al., 2007; Ong and Burrow, 2018). Therefore, this study examines the protective potential of one form of cognitive-affective regulation—cognitive flexibility—in the association between racial discrimination and mental and physical health outcomes in order to inform practice and future research seeking to bolster the health of the Black young adults attending college in the United States.

One way to index cognitive-affective regulation is by examining cognitive flexibility. Ionescu (2012) presented a unifying theoretical framework of cognitive flexibility, asserting that it is the adaptive use of interactional cognitive and contextual mechanisms in the service of generating multiple and/or novel solutions to environmental demands. Indeed, in this framework, cognitive flexibility may be important for selecting and enacting context-specific strategies that are optimally suited to a variety of stressful situations (Brondolo et al., 2009; Hildebrandt et al., 2016). Such flexibility in the context of racial discrimination would be optimal, as it would allow Black young adults to generate and judge the costs and benefits of a multitude of response options, a cognitive appraisal process (Bonanno and Burton, 2013; Gabrys et al., 2018; Outlaw, 1993). In this way, greater flexibility has been posed as protective for the health of Black individuals, as it is believed to facilitate more optimal recovery following racial discrimination (Kessler, 1979; Littleton, 2016). Furthermore, developmental research suggests that young adulthood is a time of increased cognitive flexibility relative to childhood via maturation of the prefrontal cortex (Hauser et al., 2015; Manzi et al., 2011). Although theoretical work has asserted the promise of cognitive flexibility as protective for Black college-attending young adults confronting racial discrimination, to our knowledge this study is the first to test this proposition empirically.

Cognitive flexibility may be protective against increased depressive symptoms and larger waist circumference, two important outcomes for Black college students faced with racial discrimination. Living with depression presents challenges for long-term social, financial, and bodily functioning (Avenevoli et al., 2015), and experiences of racial discrimination have been linked to psychological distress and depressive symptoms for Black college students (Jochman et al., 2019; Schmitt et al., 2014; Sellers et al., 2003). Cognitive flexibility has been evidenced as protective for mental health, specifically as a cognitive-behavioral intervention for individuals suffering from depression (e.g. Dennis and Vander Wal, 2010; LeMoult and Gotlib, 2019; Sudak, 2012). Indeed, cognitive inflexibility has been associated with depression (see Morris and Mansell, 2018, for a review; Whitmer and Banich, 2007), and high levels of cognitive flexibility were found to buffer bisexual individuals from the negative impacts of antibisexual prejudice on psychological distress (Brewster et al., 2013). Scholars have indicated the importance of cognitive flexibility for the prevention of psychopathology in the presence of stressful experiences (see Kashdan, 2010, for a review; Van Steenbergen, 2015). Many therapies for depression aim to foster reappraisal of stressful and negative situations such that they can be coped with effectively. In this way, higher cognitive flexibility may work to mitigate the mental health impact of stress from racial discrimination because it allows individuals to more effectively appraise the situation in order to select an appropriate and beneficial coping strategy (Brondolo et al., 2018; Dennis and Vander Wal, 2010). Higher cognitive flexibility may also decrease the likelihood to use negative health behaviors, such as emotional and/or binge eating, to cope with racial discrimination. Indeed, reduced cognitive flexibility in obese adults has been associated with more difficulty regulating food intake (Perpiñá et al., 2017), reduced ability to regulate negative affect, and more loss of control over eating (Dingemans et al., 2015). It may be that greater cognitive flexibility allows individuals to imagine multiple coping options and ultimately select more adaptive and situation-specific strategies, mitigating the impact of racial discrimination on mental and physical health. However, there is a paucity of literature examining cognitive flexibility to bolster health for Black college-attending young adults experiencing racial discrimination, and even less work has examined cognitive flexibility as protective against physical health risk.

As racial discrimination is a potent psychosocial stressor, studies of the physical health consequences of racism often measure indices of visceral adipose tissue accumulation associated with stress. Higher waist circumference is associated with more exposure to racism for Black Americans (e.g. Bernardo et al., 2017; Hunte, 2011; Tull et al., 1999). Waist circumference during young adulthood is an index of health risk, as increases in waist circumference among Black young adults have been noted (Beydoun and Wang, 2009). A body of evidence from experimental studies supports the notion that cognitive flexibility may be important for the regulation of bodily stress systems that contribute to physical health risk (e.g. Hildebrandt et al., 2016). Despite the promise of cognitive flexibility for mental health, whether its potential benefits can be extended to physical health remains an empirical question.

This study is the first to our knowledge to evaluate if cognitive flexibility moderates the association between chronic interpersonal racial discrimination and both physical (i.e. waist circumference) and mental (i.e. depressive symptoms) health for Black college-attending young adults. It is hypothesized that higher levels of cognitive flexibility will be associated with weaker relationships between discrimination and outcomes compared to lower levels of cognitive flexibility.

Methods

Participants

The overall analytic sample, after accounting for missing data on all study variables (n = 16), included 218 participants aged 18–24 (M = 19.35, standard deviation (SD) = 1.37). The majority of participants were female (67.4%) and had at least one parent who earned at least a Bachelor’s degree (67.9%). In terms of ethnicity, 77.50 percent of the analytic sample identified as African American, 16.1 percent identified as bi-/multi-racial, 3.2 percent identified as African, and 3.2 percent identified as Afro-Caribbean. Approximately 94 percent of the sample indicated no history of cardiovascular risk. Approximately half of the analytic sample were at healthy weight (48.73%), with 3.04 percent underweight, 29.95 percent overweight, and 18.27 percent obese.

Procedure

Data come from a larger two-part study conducted from March 2014 to December 2016 on the health of Black young adults attending a predominantly White university in the southeast. Part one was an online survey, wherein participants completed a self-report questionnaire. Part two entailed a laboratory visit during which waist circumference was measured. Participants were recruited via flyers, class and student organization announcements, and the department of psychology’s participant pool, which is an online system in which undergraduate students sign up to participate in studies as part of their course credit. Participants received $10 or participant pool credit for each part of the study. All participants completed an informed consent document (electronic consent for the survey; written consent for the laboratory visit) before each part of the study and the study was approved by the University of North Carolina at Chapel Hill (Protocol #14-0097).

Measures

The Daily Life Experiences Scale (Harrell, 1997; sample α = .92) was modified to assess the frequency of 18 racial hassles (e.g. “been ignored, overlooked, or not given service because of your race”) across the lifetime (rather than the past year) on a 6-point Likert-type scale ranging from 1 (never) to 5 (once a week or more). The 20-item Cognitive Flexibility Inventory (Dennis and Vander Wal, 2010; sample α = .88) assessed cognitive flexibility on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree) (e.g. “considering multiple options before deciding how to behave in difficult situations”). Depressive symptoms were measured using an established abbreviation of the 12-item Center for Epidemiological Studies Depression Scale (Poulin et al., 2005; sample α = .80), which assessed frequency of symptoms in the past seven days on a scale from 0 (rarely or none of the time) to 3 (most of the time; e.g. “I felt that everything I did was an effort”). Waist circumference was measured using a girth measuring tape placed at the smallest circumference between the iliac crest and rib cage. Waist circumference was utilized as an index of obesity-related cardiovascular disease risk linked to stress, rather than body mass index, based on recommendations by the National Heart, Lung, and Blood Institute and empirical research (Janssen et al., 2004).

Due to the correlational nature of the study, control variables of sex, socioeconomic status, and perceived stress were included in the analysis in order to strengthen confidence in the results. Women tend to have lower measures of waist circumference than men (Kuk et al., 2005). Highest level of parental education was utilized as a proxy for socioeconomic status as larger waist circumference is associated with lower parental education (Goodman et al., 2005). Self-report perceived stress (Perceived Stress Scale; Cohen et al., 1983; α = .84) was utilized in order to differentiate results associated with chronic interpersonal racial discrimination from that of overall stress.

Analytic plan

Descriptive statistics and bivariate correlations were first examined. Research questions were tested by running a saturated path analysis model using full information maximum likelihood estimation in Mplus version 8 (Muthén and Muthén, 2017), which controlled for sex, parental education, and general perceived stress. This analysis strategy allowed both physical and mental health outcomes to be included in the same analytic model, allowing path coefficients to be interpreted respective to the unique variance of each outcome. Missing data were addressed by using full information maximum likelihood estimation (see Supplemental Online Material). Moderation was modeled via the inclusion of the interaction between racial discrimination and cognitive flexibility. Interaction terms were constructed using mean-centered variables. Significant interactions were probed using an online computational tool for the calculation of Johnson–Neyman plots of regions of significance (Preacher et al., 2006). Johnson–Neyman plots were interpreted to determine the levels of cognitive flexibility at which simple slopes were significant.

Results

Descriptive statistics and correlations between study variables are reported in Table 1. The average cognitive flexibility score in the present sample was similar to that of previous research with a Midwestern college-attending sample (Dennis and Vander Wal, 2010).

Table 1.

Descriptive statistics and correlations between study variables.

Variables	1	2	3	4	5	6	7	M (SD) or %	n
1. Sex	–							67.4% female	218
2. Parental education	.11	–						3.84 (1.15)	218
3. Perceived stress	−.17*	−.05	–					26.72 (7.95)	218
4. Chronic discrimination	.02	.04	.40**	–				1.43 (0.75)	218
5. Cognitive flexibility	.01	−.05	−.37**	−.12	–			104.10 (14.75)	218
6. Depressive symptoms	−.10	−.05	.65**	.49**	−.27**	–		10.00 (5.80)	218
7. Waist circumference	.21*	−.06	.07	.16	.10	.19*	–	79.03 (12.17)	128

SD: standard deviation.

Bivariate plots with fitted Loess curves suggest that associations between continuous variables were sufficiently linear in functional form.

p < .05, **p < .01.

Racial discrimination (r (216) = .49, p < .001) and cognitive flexibility (r (216) = −.27, p < .001) evidenced significant bivariate associations with depressive symptoms, whereas these variables were not significantly associated with waist circumference. While racial discrimination and perceived stress were significantly related (r (216) = .40, p < .001), each evidenced different relations with cognitive flexibility. In sum, initial correlations provide support for examining the differential role of cognitive flexibility for mental and physical health.

Moderation analyses were performed via path analysis (see Supplemental Online Material Figure 2 for full model paths). A significant portion of variance (R² = .49, p < .001) in depressive symptoms and waist circumference (R² = .13, p = .030) was explained by the set of predictors. The interaction between racial discrimination and cognitive flexibility was nonsignificant for depressive symptoms (β = −.01, p = .961) and significant for waist circumference (β = .23, p = .021; see Supplemental Online Material Figure 2).

Regions of significance (see Figure 1) indicated that simple slopes were significant above a centered cognitive flexibility score of 6.83. This corresponds to a raw scale score of 110.93 indicating high cognitive flexibility, as the score is in the top quartile of possible scores based on the scale range of 1–140 points.

Figure 1.

Plot of the regions of significance for the simple slopes at various levels of cognitive flexibility. Simple slopes are significant at a centered cognitive flexibility score above 6.83.

Discussion

Our examination of cognitive flexibility as a protective factor for mental and physical health in the face of racial discrimination adds to the literature on the utility of cognitive flexibility as a coping strategy and expands upon that body of literature by considering this utility specifically for Black college-attending young adults facing chronic interpersonal racial discrimination. Based on a small body of pre-existing literature, we hypothesized that cognitive flexibility would be protective in the association between racial discrimination and health outcomes in our sample of Black young adults. Contrary to our hypotheses, cognitive flexibility did not influence the association between racial discrimination and depressive symptoms. Furthermore, cognitive flexibility served to exacerbate the association between racial discrimination and our physical health outcome, such that, at high levels of cognitive flexibility (more than 6.83 points above the average scale score), experiencing more racial discrimination was associated with larger waist circumference.

In interpreting these results, it is important to note that the majority of studies examining cognitive flexibility as protective against mental health risk have utilized predominantly White samples (Kelly, 2018). The effectiveness of cognitive flexibility in reducing depressive symptoms is a key tenant of cognitive-behavioral therapy, yet research indicates that the use of such therapy for Black individuals evidences mixed results due to cultural appropriateness of delivery and elements of study design (Gregory, 2016; Horrell, 2008) and should therefore be adapted for effective use (Jones et al., 2018; Kohn et al., 2002). Furthermore, Harrell (1979) first posited that Black individuals use cognitive flexibility to grapple with chronic societal racism. While Harrell (1979) indicates that the awareness of racism that is characteristic of cognitive flexibility can lead to risk for depression, this mechanism has received scant empirical examination. Therefore, there may be two distinct aspects of cognitive flexibility of importance for Black individuals: the potentially positive aspect of cognitive flexibility (i.e. the adaptive generation of multiple strategies to tackle racism in one’s environment) and the potentially negative aspect of cognitive flexibility (i.e. increased awareness of uncontrollable chronic societal racism that may be distressing). The impact of these different aspects on depressive symptoms may cancel each other out, making cognitive flexibility less important or useful for Black nonclinical populations. In support of this proposition, in a recent study in which college students were exposed to a public speaking social stressor, such exposure was found to enhance cognitive flexibility but this enhancement was significantly reduced when the stressor was perceived as uncontrollable (Gabrys et al., 2019). Furthermore, although Brewster et al. (2013) did find that cognitive flexibility buffered individuals from experiencing psychological distress in the context of antibisexual prejudice, it is likely that the experience of being Black and experiencing racial discrimination involves different societal positions and stressors than the experience of being White and experiencing biphobia, thereby requiring different coping strategies to ameliorate the association between racial discrimination on health (Bowleg, 2008). Further research should explore these possibilities.

Potential explanations for cognitive flexibility as an exacerbating factor for Black young adults in the context of frequent racial discrimination may be informed by research on affective flexibility, which is the degree of cognitive flexibility one employs in a situation that is emotionally stimulating. When affective flexibility is used to process affective material, its use may result in increased rumination (Genet et al., 2013). The experience of interpersonal racial discrimination is an emotionally stimulating event for many Black individuals (Gerrard et al., 2018; Krieger and Sidney, 1996; Ong and Burrow, 2018; Sellers and Shelton, 2003), and therefore it may be that individuals with higher levels of cognitive flexibility are more likely to be hypervigilant and/or ruminate when they experience more frequent racial discrimination. Indeed, such rumination has been associated with higher resting and ambulatory blood pressure (Harbison et al., 2019; Hogan and Linden, 2004; Sansone and Sansone, 2012) and more recently hypervigilance has been associated with waist circumference (e.g. Hicken et al., 2018). Although the stressor and outcome are not exactly the same, our finding is also consistent with Clark and Harrell (1982)’s study, wherein Black college students with higher cognitive flexibility evidenced higher resting systolic and worse recovery of diastolic blood pressure after a stressful mental arithmetic task.

Yet another possibility is that high cognitively flexible individuals may be able to readily imagine multiple solutions to tackle racial discrimination, yet in the face of chronic experiences of racial discrimination the pervasive nature of racism may reduce their locus of control. This discrepancy between cognitive-affective strengths and the presence of chronic discrimination could be especially stressful, leading to physiological dysregulation that may manifest in excess abdominal fat accumulation due to the role of the stress hormone cortisol in increasing lipid-accumulating enzymes (De Kloet and Herman, 2018; Rosmond et al., 1998). Indeed, reduced perceived locus of control has been found to be associated with long-term health in the presence of chronic stress (e.g. Baum et al., 1993; Roddenberry and Renk, 2010). In this way, it remains important to investigate the ways in which factors that are often considered uniformly protective may or may not be adaptive for all populations given the context and nature of specific stressors.

Although this study adds much to the literature, it has several limitations. First, this study assumes that cognitive flexibility is a trait-level variable, yet racial discrimination may not be a context in which cognitive flexibility processes are activated. Second, the study examined the utility of cognitive flexibility utilizing cross-sectional data and a correlational design, which cannot make claims about the causality or directionality of results. Third, our sample was younger and healthier than population-based samples of Black American adults (e.g. Airaksinen et al., 2004), suggesting that participants may not yet have evidenced all the accumulative lifetime impacts of chronic racial discrimination on their health compared to older Black American samples. Although the current sample was chosen because it is a younger population that may especially benefit from early health intervention efforts, these relationships should be explored among more diverse and representative samples. In addition, due to the modest sample size of the present investigation, we were unable to examine the latent structure of study variables. Further examination of the use of the Cognitive Flexibility Inventory with Black young adults is an important next step. Finally, participants who attended the laboratory visit had higher cognitive flexibility than those who did not, suggesting that these results may not generalize to all Black college students in the same way.

Despite these limitations, this investigation contributes to the body of literature on cardiovascular risk for Black college-attending young adults by examining waist circumference. Previous research has indicated that waist circumference is among the more ideal anthropometric measurements to predict cardiovascular disease in most populations, including the Black population, because it is a reliable predictor of low-density lipoprotein (LDL) cholesterol levels, blood glucose levels, and elevated blood pressure which are precursors of cardiovascular disease (Grundy et al., 2018; Zhu et al., 2005). Waist circumference has also been implicated as a better measure of total and “abnormal” fat distribution, also a precursor of cardiovascular disease (Burkhauser and Cawley, 2008; Okosun et al., 1998). Although it is true that body mass index and waist circumference can both be useful anthropometric measurements, waist circumference appears to be a more accurate measurement for stress-related research, as interpersonal stress is associated with an increase in abdominal fat and specifically visceral adipose tissue (Bernardo et al., 2017; Dallman et al., 2005). Finally, although some studies have found that Black individuals tend to have less visceral adipose tissue compared to White individuals (e.g. Conway et al., 1995; Hanley et al., 2018), as this study is a within-group study, we sought to utilize waist circumference as a measurement of visceral adipose tissue that could help us understand within-group variability in physical health risk for this population.

In our nonclinical sample of Black young adults, high cognitive flexibility was not a viable protection in the association between chronic interpersonal racial discrimination and mental health and exacerbated the association between poorer physical health and high levels of discrimination. Perhaps, when thresholds of depressive symptoms are below the clinical level, cognitions indicative of less adaptively flexible coping may not be as severely impaired (Airaksinen et al., 2004). Conversely, perhaps the context of racial discrimination as a stressor for Black young adults specifically may change the way in which cognitive flexibility can influence health. These findings have implications for practice, as they call us to consider if very high levels of cognitive flexibility are advisable for Black college-attending clients who self-report experiencing high levels of racial discrimination. Specifically, this has large implications for the practice of health psychology, in which elements of cognitive behavioral therapy—of which cognitive flexibility is a central tenant—are used in the maintenance of positive health behaviors in both clinical and nonclinical settings (e.g. Tsiros et al., 2008). When Black college-attending young adults are specifically grappling with exposure to chronic interpersonal racial discrimination, which was found to be a unique stressor above general stress in the current sample, use of cognitive flexibility may not be a healthy resource.

Supplemental Material

Supplemental_Online_Material – Supplemental material for Cognitive flexibility and the health of Black college-attending young adults experiencing interpersonal racial discrimination

Supplemental material, Supplemental_Online_Material for Cognitive flexibility and the health of Black college-attending young adults experiencing interpersonal racial discrimination by Vanessa V Volpe, Alexa Beacham and Oluwagbotemi Olafunmiloye in Journal of Health Psychology

Footnotes

Acknowledgements

The authors would like to thank the study participants for contributing their time and knowledge to help us better understand Black young adult health. We also thank the following research assistants involved in data collection: Graziella Perusi Benson, Keadija Wiley, Danny Rahal, Katharine Bailey, Erin Edmonds, Jaslyn Piggott, Mary-Kathryn McKinney, Barry Wallace, Kenya Lee, Simone Biggers, Ronnie Armstrong, Amber Boone, Ariel Everett, Kaitlin Duren, Grayson West, and Kira Gurganus.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Basic Psychological Science Research Grant awarded to the PI (Vanessa V. Volpe) by the American Psychological Association, Emerging Scholars Fellowship awarded to the PI (Vanessa V. Volpe) by the Steve Fund and Active Minds. The authors received no financial support for the authorship or publication of this article.

ORCID iD

Vanessa V Volpe

Supplemental material

Supplemental material for this article is available online.

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