Health declines and functional limitations are common stressors for older women [1
]. Chronic medical conditions, plus the risk of cancer, as well as heart and lung disease, all increase as women grow older, often exceeding the numbers presented by older men [2
]. Additionally, compared to their male counterpart, older women typically have lower socio-economic status (SES), more inadequate assistance with basic life activities, and higher rates of medical care-seeking behaviors [3
]. Under these hard-to-change circumstances, dealing with one's emotional responses to stressors, i.e., engaging in emotion-focused coping (as defined in the next paragraph), could be a reasonable choice. Indeed, many older women might not have the means to implement more active strategies when facing health challenges that often require health insurance and adequate income. Given the cultural-political context of the U.S., where ethnic minority groups are often in lower social positions, lack of health insurance and related health impairments are a common occurrence among older women from ethnic minority backgrounds [6
]. Interestingly, some investigators have pointed out that coping strategies are even more important than income in their influence on health outcomes [7
]. Thus, accounting for key demographics, geriatric researchers should investigate whether health outcomes in older age are linked to coping strategies potentially amenable to change via clinical interventions. This is a neglected research subject with regard to non-clinical samples of ethnically diverse older women. Testing whether available empirical evidence generalizes to this understudied population is needed, because most of the pertinent research findings are based on younger or medically ill samples. To minimize redundancies, we used the words "worse physical functioning" and "functional/physical limitations" interchangeably.
Concerning the conceptual framework of this study and the characterization of one of its key variables, Lazarus and Folkman's classic definition of coping is a cognitive and behavioral effort made by people for the purpose of reducing, minimizing, mastering, or tolerating the demands that rise from the interaction between them and their environment [8
]. The authors postulated that coping has two major functions: dealing with the problem that is causing distress (problem-focused coping) and regulating emotions stemming from this problem (emotion-focused coping). In their theorization of the link between coping and somatic health status, Lazarus and Folkman envisioned three pathways through which physical health could be adversely affected by coping. Coping may: a) influence neurochemical responses and their characteristics (a topic beyond the scope of the present study), b) involve the excessive use of alcohol, drugs, or tobacco, which could have negative effects on health (thereby making substance use a possible health correlate), and c) regarding certain types of coping (such as avoidant mechanisms), impair health due to lack of adaptive health-related behaviors. In view of the last point, self-distraction (i.e., engagement in work or other activities to avoid thinking about a stressor) and behavioral disengagement (i.e., a reduction in a person's effort to deal with a stressor [9
]) are potentially related to physical health.
We turned to prior literature to identify additional possible correlates of health outcomes in our target population, but found no definite consensus on the coping strategies best suited for this task. Research findings are mixed on the types of coping strategies related to better physical health; this is possibly due, at least partially, to the different ways (positive and negative) in which scholars define emotion-focused coping (a controversial topic beyond the scope of this study). In a meta-analysis on the coping-health link, Penley et al. found emotion-focused coping to be significantly related to negative overall health outcomes, with the opposite being the case for problem-focused coping [10
]. Conversely, McGuinn observed that more recent research efforts show the salutary effects of emotion-focused coping strategies [11
]. In particular, as people grow older, the use of such coping strategies seems to become more prevalent and potentially more beneficial [8
], one more reason not to assume that findings of non-geriatric research in this area are generalizable to older women. Some scholars believe that emotion-focused coping is most frequently used in situations in which stressors are perceived as unchangeable [14
] or as something to be endured [15
]. This could very well apply to the aforementioned predicament in which many ethnically diverse older women find themselves in regard to their health and physical functioning, making the study of emotion-focused coping in this population a critical research target.
A cursory review of some of the relevant literature on the relationship between emotion-focused coping and health indicates that humor, often used to reappraise a stressful situation [16
], had good potential for being related to older women's health outcomes, based on findings on other populations. Indeed, researchers have related humor to better physical health among both cancer patients [17
] and older adults residing in assisted living facilities [16
]. However, to our knowledge, there are no prior studies on this topic regarding community-dwelling, ethnically diverse older women. Positive reframing was also likely to be related to better health in our sample, considering Morse's findings that using this coping strategy in a health-promoting intervention for young women led to fewer reports of negative perimenstrual symptoms [18
]. Some geriatric researchers have targeted positive reframing, but mostly within the context of spirituality/religiosity, a topic beyond the focus of our study. For instance, Gall discovered that various forms of religious coping involve the use of positive reframing, defined by the author as an active-cognitive coping strategy often leading to acceptance of illness [19
]. We were unable to find empirical evidence specifically linking positive reframing to facets of health among community-dwelling older women. Regarding emotion-focused coping strategies that are potentially less adaptive, there is research evidence that self-distraction is a significant correlate of worse health outcomes and lower quality of life in heart failure patients [20
], and that behavioral disengagement is a predictor of greater physical distress among cancer survivors [21
], in line with Lazarus and Folkman's conceptualization [8
] adopted herein. Moreover, findings on younger patients with health conditions such as psoriasis indicate that both behavioral disengagement and alcohol use are significantly and positively related to subjective physical disability [22
]; once again, these findings might not generalize to our target population.
As for demographic factors typically correlated with health outcomes and thus needing to be accounted for when studying the coping-health link, advanced age is a well-known predictor of worse health [2
]. Functional disability also increases with age (more in women than in men [23
]), with more advanced age predicting declined physical performance [24
]. Similarly, income is a known health correlate, as lower SES contributes to the development of a variety of life-threatening illnesses [25
]. Additionally, researchers have found that unmarried status is related to worse health in non-European-American [27
] and medically ill populations [11
], and that having an ethnic minority background is a correlate of women's worse physical health [28
Overall, the literature on emotion-focused coping strategies that are significantly related to health outcomes in non-clinical samples of ethnically diverse older women is limited. In particular, little or no research exists on how emotion-focused coping strategies and well-known demographic correlates of health contribute simultaneously to variance in this populations' physical health dimensions. As a step towards filling this gap in the literature, in the current study we chose to investigate emotion-focused coping strategies that have yet to be tested on such a population. Out of the available theoretical frameworks linking coping with health on which to base our selection of target variables, we chose Lazarus and Folkman's conceptualization of the coping-somatic health status link [8
] (extended to physical functioning). Our choice of variables for this research was also based on prior empirical evidence on this topic, mostly from the study of other populations. Given such theoretical and empirical foundations, we hypothesized that five emotion-focused coping strategies and four known demographic correlates of health would be significantly associated with general health and physical functioning. Specifically, we tested the following hypotheses: 1) Humor and positive reframing would be related to better health and physical functioning; 2) Behavioral disengagement, self-distraction, and substance use would be associated with worse health and physical functioning; 3) More advanced age would be related to worse health and physical functioning; and 4) Higher income, European-American background, and married status would be associated with better health and physical functioning.