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However this explanation of stress as a direct cause of
However, this explanation of stress as a direct cause of social disparities in physical health does not account for the fact that socially-disadvantaged groups, particularly African Americans and Hispanics in the US, despite having higher morbidity and mortality, have better mental health relative to non-Hispanic Whites (Jackson, Knight, & Rafferty, 2010; Mezuk et al. 2010; Mezuk et al. 2013). For example, African Americans are less likely to have major depression, anxiety disorders, or substance abuse/dependence relative to non-Hispanic Whites, a finding that has been replicated across numerous nationally-representative samples and measures of psychopathology (Mezuk et al. 2013). Since stress is an established cause of these mental health outcomes, the apparently paradoxical finding that these socially-disadvantaged groups (which are presumably exposed to more stress than socially-advantaged non-Hispanic whites) do not have worse mental health, despite having worse physical health, warrants a reconsideration of the potential pathways linking stress, health behaviors, and health status. Informed by this evidence, we developed the Environmental Affordances Model of Health Disparities (EA Model; Mezuk et al. 2013) a transdisciplinary framework which guides our empirical research on how stress, behavior, and context intersect to influence mental and physical health.
Methods
Results
Table 1 shows the characteristics of the HRS subsample that completed the experimental module, overall and by number of SRCBs endorsed. Women and individuals with lower wealth were more likely to use SRCBs, but there was no difference by race/ethnicity or education. Stressful events, the composite stress score, and CESD were positively correlated with likelihood of engaging in SRCBs. Finally, greater levels of chronic health conditions and functional limitations were associated with greater use of SRCBs.
The most frequently reported SRCBs were prayer (73%), social support (50%), overeating (38%), and exercise (27%); the least commonly reported were alcohol (22%), talking to a counselor (19%), drug use (16%), and smoking (10%). Fig. 1 and Supplemental Table 1 provide evidence of the construct validity of the SRCB measure. They show the perceived effectiveness of SRCBs at reducing feelings of stress based on frequency of use. Consistent with the notion that individuals should be more likely to engage in a behavior if they felt it order StemRegenin 1 was helpful, individuals who reported that a SRCB was effective at reducing their feelings of stress were more likely to engage in it. For example, only 29% of the people who ever overeat to cope with stress said sensory cortex was effective at reducing their feelings of distress, as compared to 43% of the people who fairly/very often overeat to cope, a difference of 14 percentage points. Similarly, only 50% of people who ever drink alcohol to cope with stress said it was effective, as compared to 88% of people who fairly/often drink alcohol to cope, a difference of 38 percentage points.
Table 2 shows the intersection of positive and negative SRCB. Among those who reported at least one negative (i.e., alcohol, drugs, smoking, or eating) SRCB (N=294), a majority also engaged in at least one positive behavior: 14.9% endorsed exercise, 70.1% endorsed prayer, 30.7% endorsed social support, and 13.5% endorsed talking to a counselor. Among those who reported at least one positive SRCB (N=856), 6.4% also endorsed alcohol, 10.7% endorsed drugs, 14.9% endorsed eating, and 6.6% endorsed smoking.
Discussion
In this paper we presented and evaluated a novel conceptualization and quantitative assessment of health behaviors as self-regulatory strategies with differential implications for mental and physical health. For our first objective, we found that the majority of older adults endorsed at least one SRCB, and that frequency of engaging in these behaviors was related to their perceived effectiveness at relieving distress. For our second objective, sex was the only proxy indicator of context examined that was consistently associated with these coping strategies, with women both more likely to engage in SRCBs and to perceive them to be effective at reducing feelings of distress than men. Finally, for our third objective examining the intersection of stress and SRCB, findings were broadly consistent with the predictions of our theoretical framework for understanding health disparities (Mezuk et al. 2013) in that higher levels of stress (or psychological distress) were associated with greater number of SRCBs, particularly those that harm physical health. This suggests that there is value in broadening both our typologies of coping, and the conceptualization of health behaviors as more than simply confounding variables, in disparities research. We discuss each of these main conclusions in turn.