Current study showed that socioeconomic factors such as education had substantial effects on coping strategies in both sexes and that there was a positive relation between high education level and adaptive coping strategies and a negative relation between low education level and maladaptive coping strategies. In addition, manual jobs caused an increase in maladaptive coping strategies in men. Smoking was the result of maladaptive coping behaviors. Also, leisure time physical activity was weakly associated with adaptive coping styles and high stress levels were associated with maladaptive coping styles in both sexes.
In Iran, different cultural, political, economical, and religious factors contribute to types of stress and coping styles. Positive coping strategies which are used more frequently by Iranian people include emotional and spiritual strategies, appropriate to Iranian culture. However, problem-focused strategies are less practiced in this society (16
). Therefore, in the IHHP training program, effort was made to practice problem-focused coping styles.
Review of the literature reveals that there are large differences in the coping strategies between individuals depending on their developmental and personal characteristics, and environmental factors (17
). Individuals who have higher stress level and subsequent psychological problems have different attitudes toward coping with stress. Thus, individuals with high stress level showed higher levels of maladaptive coping strategies such as self-criticism, rumination, aggression, and avoidance and lower levels adaptive strategies like distraction and seeking for social support (18
). In the present study, individuals with high stress levels used maladaptive coping styles more often but the stress level had no association with adaptive coping strategies. This can be explained by the fact that individuals with high stress level seek any way possible to relieve their stress and its consequences, even through a maladaptive strategy.
Smoking is known as one of the greatest modifiable risk factors for non-communicable diseases, and non-smoking is the key element of a healthy life-style (19
). Smoking is used as a coping strategy in stressful and uncontrollable conditions; however, due to its harmful long-term effects, it is known as a maladaptive coping strategy (20
). It has been shown that higher levels of stress were associated with a greater number of cigarettes smoked. In general, individuals who smoke cigarettes are at greater risk of taking part in maladaptive behaviors (22
). In the present study, smoking was a negative predictor of adaptive coping behaviors and a positive predictor of maladaptive coping behaviors in both sexes. However, this association was stronger in women. This is probably because in Iran smoking in women is considered socially unacceptable and there is a lower rate of female smokers in the population (23
). We can assume that the condition of women who smoke is so stressful that they have resorted to such an uncommon type of behavior. It seems that people who are prone to major psychological problems and maladaptive coping styles are more prevalent among smokers (22
There are some studies on the association between stress and participation in leisure activity. For instance, the National Population Health Survey performed in Canada showed that physical activity in leisure-time caused higher levels of physical health and well-being and lower levels of mental ill-health (24
). Also, it has been found that leisure-time physical activity as an adaptive coping style can buffer or mediate stress (25
) and that the largest mental health benefits are obtained from regular and organized physical recreational activities (26
). The present study showed that leisure weakly enhanced adaptive coping style in both men and women. We believe that the possible cause of this weak association is the small amount of time spent on leisure time physical activities in our community.
One of the most consistent social epidemiologic findings in the area of the public health is the association between socioeconomic status and mental health. Low socioeconomic status has been indirectly associated with poor mental health outcomes through the inability to adopt a suitable coping style (27
). Poetz et al (28
) have shown that multiple variables, including low educational level, low income, and emotional distress, are associated with attaining a maladaptive coping style. The results of the present study are consistent with the previous findings in that higher educational levels were positively related to adaptive coping strategies and inversely to maladaptive ones. In highly educated people, relatively high levels of intellectual function are related to positive health-related behaviors and can result in assuming more adaptive styles, which consequently lead to a healthier life (29
Occupation has been assumed as one of the socioeconomic factors that can influence health. Rsearch on different occupational groups reported higher mortality levels among unskilled workers (30
). However, other factors such as psychological demand, job stress, and lower coping abilities are also more prevalent among unskilled workers (31
). The present study revealed that manual workers used maladaptive strategies more frequently. This can be attributed to higher stress levels in this group, as higher stress level is associated with maladaptive strategies. This difference was not obvious in women probably due to the fact that Iranian women do not pursue careers too frequently and there are fewer job varieties for women.
This study has some limitations. The design of the study addressed only associative and not causative relationships between coping strategies on the one hand, and socioeconomic status and life-style factors on the other. Also, the sample was restricted to Iranian population which limits the generalization ability of our results. In addition, personality and family dimensions which might play important roles in individual coping strategies were not considered in this study.
In summary, this study provided evidence for maladaptive coping strategies in smokers with low educational and high-stress level. Also, greater use of maladaptive coping strategies was shown in male manual workers and greater use of adaptive coping strategies was shown in non-smokers with higher leisure time physical activity and lower stress level. The results point to the importance of the implementation of healthy life-style programs in the community. Healthy life-style program is a primary preventive program which includes using strategies for tobacco control, increasing physical activity, and lowering stress through improvement of coping strategies. These programs were evaluated to improve individual coping strategies and their well-being. Further studies are needed on using coping strategies in dealing with specific stressors and on other factors which influence coping strategies, such as personality and family dimensions.