• Stress, coping,

and social
support

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 Next week: Ken Resnicow

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 Motivation x self-efficacy quadrants

Can but Can and

doesn’t wants to
Self-efficacy want to

Can’t and Can’t but

doesn’t wants to
want to

Motivation

Motivation Self-efficacy
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 Both motivation and self-efficacy are
influenced by stress and one’s ability
to cope with stress.

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 Association between stress, coping, and motivation:
weight
Motivation

Coping

Stress

UPS T1 Succeed data (n=19533)

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 Association between stress, coping, and motivation:
physical activity
Motivation

Coping

Stress

UPS T1 Succeed data (n=19533)

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 Association between stress, coping, and motivation:
cigarette smoking
Motivation

Coping

Stress

UPS T1 Succeed data (n=19533)

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 Stress / coping questions (S. Cohen)

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 Stress / coping questions
(S. Cohen) (continued)
 How often have you dealt successfully with irritating life hassles?
 How often have you been able to control irritations in your life?
 How often have you felt nervous or stressed?
 How often have you found that you could not cope with all the
things you have to do?
 How often have your felt that things were going your way?
 How often have you felt that you were on top of things?
 How often have you felt difficulties were piling up so high that
you could not overcome them?

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 Coping efforts

 Problem management

 Emotional regulation

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 Dispositional coping style

Generalized ways of behaving that can affect a

person’s emotional or functional reaction to a stressor;
relatively stable across time and situations.

 Optimism
 Information seeking
Monitoring
Blunting

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 Social support
Social Support - aid and assistance exchanged through social
relationships and interpersonal transactions
 Emotional Support: Expressions of empathy, love, trust, caring
 Instrumental Support: Tangible aid and service
 Informational Support: Advice, suggestions, and information
 Appraisal Support: Information that is useful for self-evaluation

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 Research findings
 Low levels of social integration (social isolation) are
most deleterious to health; while social integration
above a certain threshold does not produce additional
benefit.
 Evidence for a link between social networks and social
support and the incidence of a particular disease is not
strong.
 Emotional support has been consistently associated
with coping with, recovering from, and surviving
serious illness.

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 Research findings
 Social relationships have been found to influence the
following health behaviors:
 Compliance with medical regimens
 Help-seeking behavior
 Smoking
 Weight loss

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 Research findings
 Small social networks with strong ties are good for
health enhancements.
 Large social networks with weak ties are good for
facilitating social outreach and the exchange of
informational support.
 Gender differences have been found in type of support
provided.

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 Interventions
Social Support/Network Strategies
 Enhancing existing social network linkages
 Developing new social network ties
 Using indigenous natural helpers
 Enhancing networks through community problem-solving

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 LINKING CELLS TO SOCIETY:

Neighborhoods Health Behaviors

- physical environment - tobacco
- social environment - diet
- exercise

Cumulative
Individual
Physiological Outcome
Characteristics
Dysregulation*

Health Care System

- access
- quality *metabolic, endocrine,
cardiovasular, inflammatory
- prevention dysregulated systems

Source: Centers for Population Health and Health Disparities (CPHHD) 2007
 SOCIAL CAPITAL:

• Reciprocity (“people around here are willing to help their neighbors”)

• Trust (“people in this neighborhood can be trusted”)

• Civic participation (voluntary associations, religious org’s, business gp’s, etc)

Source: Lochner KA, Kawachi I, Brennan RT, and Buka SL. (2003) Social capital and
neighborhood mortality rates in Chicago. Social Science & Medicine. 56(38):1797-805.
 COLLECTIVE EFFICACY:

• Close-knit neighborhood

• Adults that kids look up to

• People willing to help neighbors

• Neighbors don’t get along

• Adults watch out that kids are safe

• People in neighborhood don’t share same values

• Neighbors will do something if a kid hangs out

• Would do something if kid does graffiti

• Would scold kid if showing disrespect

Source: Cohen DA, Finch BK, Bower A, and Sastry N. (2006). Collective efficacy and obesity:
The potential influence of social factors on health. Social Science & Medicine. 62(3):769-78.
 Employer settings:
stressful environments vs stress management

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 Web Guide -
Monitoring Symptoms

Interactive Web Component

• Track severity of symptoms

before and after using stress
reduction technique

• Print to keep results

• Reset and track as often as

wanted

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 Percent of work time missed due to stress over the past 7 days at 6-month follow-up by
HealthMedia Relax versus control conditions, stratified by % worked missed at baseline
assessment (n=82; t=2.12; p<.05).

Reduced stress
% work time missed due to stress

Reduced cortisol
Increased productivity

Treatment condition
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 Caregivers:

Who Are They?

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 Caregiver Defined

Anyone who provides assistance to someone else who is

in some degree incapacitated and needs help.

Informal caregiver and family caregiver are terms that

refer to unpaid individuals such as family members, life-
partners, friends, and neighbors who provide care.

Family Caregiver Alliance

www.caregiver.org

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 Weekly Hours of Informal Caregiving for Dementia

50 46.1
45
40
35
30
Hours

25 22.0
20
15 13.1
10
4.6
5
0
Normal Mild Moderate Severe

Source: Langa et al, JGIM, 2001.

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 Weekly Hours of Informal Caregiving for Stroke

20 18.6

15
Hours

10 8.6
6.1
5

0
Normal Mild Severe

Source: Hickenbottom et al, Neurology, 2002.

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 Weekly Hours of Informal Caregiving for Diabetes

15

10.6
10
8.5
Hours

6.6

0
Normal Oral Meds Insulin

Source: Langa et al, J of Gerontology, 2002.

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 Caregiver Ethnicity

% Providing Care Ethnicity

32% Asian American

29% African American

27% Hispanic American

24% White

% of Individuals Aged 18+ Caring for Someone 50+ by ethnicity

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 Culture & Family Influence

“We were raised in our culture to take care of

each other.”

“It’s like when I was growing up, my mother cared

for others. She would send me to deliver food
to a sick neighbor so I learned it from my
mother. I’ve been like this all my life.”

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 Caregiver Employment Status

Employment Status % of All Caregivers

Full-time 51.8%

Not Employed 19.7%

Retired 15.9%

Part-time 12.3%

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 Feelings Reported by People Caring for Their Parent

Feeling % Reporting

Loving 96%

Appreciated 90%

Proud 84%

Worried 53%

Frustrated 37%

Sad or Depressed 28%

Overwhelmed 22%

Participants could choose all that apply

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 Emotional Impact of Caregiving

• Estimated 46-59% of caregivers are clinically

depressed
• Caregivers use prescription drugs for depression,
anxiety & insomnia 2-3 times more often than
general population
• The less income a caregiver has the more stress
he or she is likely to experience

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 Caregiver coping mechanisms

Multicultural differences:
• 88% of Black caregivers use prayer to cope with stress
• Blacks & Whites are more likely than Hispanics & Asians to talk with friends/relatives
• Asians are less likely to seek help from a professional counselor
• Hispanics are more likely than whites to use the word stressful in describing their caregiving
experiences

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 Self-identification
 Benefits exist to helping a caregiver formally
acknowledge their role
 94% become more proactive in seeking resources &
skills for their care recipient
 83% have increased confidence speaking to
healthcare professionals about their loved one’s
care
 92% like the idea of caregivers being considered a
special group in society

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