Coping as a moderator of exercise behavior in women at risk for coronary heart disease.

摘要

Coronary Heart Disease (CHD) remains the leading cause of death in the United States (American Heart Association, 1995; AHA). CHD accounts for approximately one half of all deaths in women over 50---more than deaths attributable to cancer, AIDs, osteoporosis, and domestic violence combined (American Heart Association, 1995). Many CHD risk factors are considered to be modifiable via one's lifestyle behaviors. Exercise has been identified as an independent risk factor for CHD (AHA, 1995; Blair, Kohl, Gordon & Paffenbarger, 1992). Physical inactivity is more prevalent among women, African American adults and persons of lower SES, education and social/familial support (Marcus et al., 2000). The Theory of Planned Behavior (Ajzen & Madden, 1986) has been used extensively in the examination of exercise. Active (problem solving coping and planning) Task- focused have been associated with higher levels of physical exercise. Aims of the present study were: (1) to assess to predictive strength of the abbreviated TPB (without the inclusion of Social Norms), (2) conceptualize and measure constructs within the TPB model which would serve to create a more unified model, and (3) assess the role of Task/Problem focused Coping as a moderator of Attitude, Perceived Control and Intention within the TPB model. Participants were women (N = 229) participating in a hospital affiliated Women's Heart Center CHD risk screening in Louisville, Kentucky. Structural equation modeling results supported the fit of the TPB model to the data. Consistent with previous tests of the model in exercise behavior, the TPB model accounted for approximately 30% of total variance in exercise without the inclusion of Subjective Norm. The addition of Task/Problem-focused coping served neither to add to the predictive strength of the TPB model, nor did it moderate Attitude or Perceive Control. Higher levels of Task/Problem focused coping were not associated with increased levels of exercise behavior. Results point to importance of assessment and application across theoretical, methodological and clinical domains. The role of Social Norm in health behavior should be explored further. Questions of contextual and situation-based assessment of coping are particularly salient in this study. Multi-method, ecological and objective coping and exercise behavior measurement is recommended.