Judith G. Chipperfield

Perceived control in relation to socioeconomic and behavioral resources for health

Perceived control is a personality characteristic that contributes to well-being, but few studies have attempted to integrate the functions of perceived control with those of other determinants of health. This research tested two hypotheses about the functions of perceived control: (a) individual differences in perceived control would account for socioeconomic differences in self-rated health status; (b) performance of health-related behaviors would account for the health benefits of perceived control. Using data from adult, nonproxy respondents in the National Population Health Survey of Canada (1995; n = 11, 110), confirmatory factor analysis supported a measurement model of self-rated health status composed of two correlated factors: physical health (i.e., chronic conditions. restricted activities, self-rated general health, physical functional capacity) and mental health (i.e., distress, depression). Structural equation modeling supported the first hypothesis, but not the second, regarding perceived control as a determinant of self-rated physical and mental health. Health-related behaviors partially mediated age differences in self-rated health, but different behaviors functioned in this way for men than for women. The findings suggest that psychological process, that of perceiving control over life events, underlies social inequality in health. Health-related behaviors appear not to serve as the primary mechanism through which perceived control influences health.

Primary and secondary control in academic development: gender-specific implications for stress and health in college students

Abstract During the first year of college, students are faced with numerous educational and personal stressors which can negatively impact their psychological and physical health. The present study examined the benefits of primary and secondary control for self-rated health in students based on Rothbaum, Weisz, and Synders (1982) dual-process model of control, and examined stress and gender as potential mediating variables. College students’ (n=888) primary and secondary academic control and perceived stress were assessed in the first semester, and self-rated global health, illness symptoms, and illness-related behaviors were assessed at the end of the academic year. For males, primary control was indirectly related to better overall health and fewer symptoms through lower stress levels, and both primary and secondary control directly corresponded to lower illness behaviors. For females, only secondary control was related to better overall health and illness symptoms, albeit indirectly through reduced stress. The mediational roles of stress and gender in health research on primary/secondary control and potential control-enhancing interventions are discussed.

Control Striving in Older Adults With Serious Health Problems: A 9-Year Longitudinal Study of Survival, Health, and Well-Being

The present longitudinal study of 143 older adults (73-98 years) with serious health problems (arthritis, heart disease, heart attack, stroke) examined the effects of goal engagement, disengagement, and self-protection control strategies on self-rated physical health (condition severity, functional status) and subjective well-being (life satisfaction) at 5 years and survival at 9 years. Main effects and interactions between strategy use and the occurrence of an acute vascular event (no, yes) as well as age (young-old vs. old-old) were assessed. As hypothesized, goal engagement predicted greater survival for individuals with acute conditions but poorer physical health for those with chronic conditions and among old-old adults. In contrast, goal disengagement predicted poorer physical health for those with acute conditions but better health for individuals with chronic conditions and old-old adults. Self-protective strategies (positive reappraisal) predicted greater survival, health, and subjective well-being for those with acute conditions, as well as better physical health for old-old adults.

Primary and Secondary Control-Enhancing Strategies Implications for Health in Later Life

Objectives:The major goal of this article was to assess the link between controlenhancing strategies and health in an older population. In particular, the use of primarycontrol strategies, which involve modifying the environment (e.g., actively persisting) and compensatory secondary-control strategies, which involve modifying the self (e.g., expecting less of oneself) was studied. Methods:Participants (n= 241) in a large-scale longitudinal study were interviewed to assess their use of strategies and their health. Results:Health (physical and perceived) was found to vary for those using primary and compensatory secondary-control strategies; however, the nature of this variation depended on age. Discussion:The findings may indicate that primary-control strategies have positive health implications for the young-old but that these same strategies become detrimental to health in late life. The findings could further suggest that compensatory secondary-control strategies become increasingly more adaptive in late life.

Stability in perceived control: implications for health among very old community-dwelling adults.

Objective: Our purpose was to examine how stability/variability in perceptions of control (PC) relate to a variety of health-related variables. Design: PC stability/variability across multiple domains was assessed in a longitudinal design including 318 adults, 72 to 99 years of age. Method: PC and health-related measures were obtained during in-person interviews conducted approximately 3 months apart. PC variability was assessed in relation to self-reported health outcomes (perceived health, chronic health conditions, functional status) and objective measures of physician visits and hospitalizations recorded over a 4-year period in a highly reliable and comprehensive database. Results: PC variability was associated with poorer health, poorer functional status, and more physician visits and hospital admissions, even after statistically controlling for mean PC level and direction-of-change in PC. Implications: Our findings suggest that health and well-being among very old individuals may be compromised by fluctuating levels of PC, or conversely, that stability in PC enhances health.

Incongruence between Health Perceptions and Health Problems Implications for Survival among Seniors

Subjective ratings of health are not always congruent with other health indices. The present study explored the congruence/incongruence between subjective overall health ratings and diseases/health problems as reported by elderly individuals. The goals were to consider the prevalence of health congruence/incongruence among seniors and to examine whether congruence/incongruence relates to mortality. Overall, it was found that incongruence was more likely to be in the form of more favorable, rather than less favorable, ratings (i.e., overestimates rather than underestimates). The relationship between congruence/incongruence and mortality was explored using three different follow-up periods and was examined separately among those who were well, ill, or neither well nor ill (i.e., typical elders). Although the findings differed depending on length of follow-up and health status, they generally suppported a link between overestimation of health and survival. Even among ill elders, those who overestimated their health were less likely to die than were those who did not.

Attributing illness to ‘old age:’ Consequences of a self-directed stereotype for health and mortality

Stereotypic beliefs about older adults and the aging process have led to endorsement of the myth that ‘to be old is to be ill.’ This study examined community-dwelling older adults’ (N = 105, age 80+) beliefs about the causes of their chronic illness (ie, heart disease, cancer, diabetes, etc.), and tested the hypothesis that attributing the onset of illness to ‘old age’ is associated with negative health outcomes. A series of multiple regressions (controlling for chronological age, gender, income, severity of chronic conditions, functional status and health locus of control) demonstrated that ‘old age’ attributions were associated with more frequent perceived health symptoms, poorer health maintenance behaviours and a greater likelihood of mortality at 2-year follow-up. The probability of death was more than double among participants who strongly endorsed the ‘old age’ attribution as compared to those who did not (36% vs. 14%). Findings are framed in the context of self-directed stereotypes and implications for potential interventions are considered.

A Prospective Analysis of the Relation Between Self-Rated Health and Health Care Use Among Elderly Canadians

Research indicates that self-rated health is related to a variety of health-related outcomes, such as mortality and functional disability, even when controlling for more “objective” health measures. The present study extends previous research by prospectively examining the relation between self-rated health and health care use among a representative sample of elderly Canadians ( N = 1,181) interviewed in 1991/92. Survey data were linked to administrative records of health care use. Self-rated health was positively related to the number of physician visits during the 12 months following the survey, as well as to the number of tests incurred (e.g., laboratory tests, X-rays), even when controlling for demographic variables, functional disability, morbidity, and prior health care use. Older adults who rated their health as “bad/poor” or “fair” were also more likely to be hospitalized than those who rated their health as “excellent”. These results highlight the importance of considering global measures of health when examining health care use.

Gender differences in use of primary and secondary control strategies in older adults with major health problems

The present study examined primary and secondary control strategies among 143 men and women (73–98 years) who either reported having had or not had an acute event (heart attack or stroke), all of whom had health-related restrictions on everyday tasks and activities. Repeated measures of ANCOVAs tested the between-group effects of gender (men, women) and Acute Event (no, yes) and the within-subject effect, strategy type, on the frequency ratings of multiple control strategies. For men, having suffered an acute health event was unrelated to their use of primary control strategies. In contrast, women who had experienced an acute health event reported significantly less frequent use of primary control strategies than their counterparts who had not, perhaps suggesting that acute health events undermine proactive control striving and precipitate a shift to secondary control. Moreover, women differed significantly from men in their use of secondary control strategies, using them more often and displaying more diversity in their use. By demonstrating that womens use of primary control strategies is related to their past health events and that they adopt secondary control strategies more often than men and in a more differentiated or selective way, our findings underscore the importance of examining gender differences in strategy use during later life.

Detrimental effects of falling on health and well-being in later life: the mediating roles of perceived control and optimism.

Falling is common among older adults, often resulting in decreased functional ability and quality of life. To understand processes underlying the fall/health and well-being relationship, it is important to identify psychosocial mediators. The current study examined the impact of falling on subsequent physical health, negative emotions and physical activity among 231 young-old (<85) and old-old (85+) community-dwelling adults, and the mediating effects of global perceived control (PC) and optimism. Regression results indicated that falling predicted poorer physical health, greater negative emotions and less physical activity among old-old but not young-old adults. Falling negatively predicted PC and optimism, which mediated the effects of falling on health and well-being among the old-old group. Findings have implications for enhancing recovery from falling via bolstering PC and optimism.