54 Coping and Social Support
elicited by symptom-induced pain or by an interpretation that
the symptom represents a serious health threat such as cancer
(Croyle & Jemmott, 1991). Coping responses to manage
emotions have been evaluated in a similar way to Lazarus
and colleagues; individuals are asked how they coped with
the problem and responses are categorized using similar cat-
egories (e.g., direct coping such as seeking information, and
passive coping such as distraction).
The Role of Coping in Health Behaviors and in
the Management of Health Risk
As compared to the relatively large literature on coping with
illness, there is little published on the role of coping in
health behavior change and in the management of health
risk. Coping with a health risk is de“ned as those efforts to
manage the knowledge that one is at higher risk for disease
because of family history of the disease or because of be-
havioral risk factors. To date, there have been almost
no studies evaluating coping•s role in managing health be-
haviors. Barron, Houfek, and Foxall (1997) examined the
role of repressive coping style in women•s practice of breast
self-examination (BSE). Repressive coping resulted in less
frequent BSE and less pro“cient performance of BSE. Indi-
viduals who exhibited repressive coping also reported more
barriers and fewer bene“ts of BSE. Although it is generally
thought that speci“c coping styles (e.g., monitoring) or cop-
ing strategies (e.g., denial or avoidance) would predict pa-
tients• adherence to medical regimes, the literature linking
coping to medical adherence has not supported this hypoth-
esis. General coping style has not been consistently linked
to adherence (see Dunbar-Jacob et al., 2000). Other investi-
gators have evaluated the role of speci“c coping responses
in treatment adherence. Catz, McClure, Jones, and Brantley
(1999) hypothesized that HIV-positive patients who engaged
in spiritual coping may be more likely to adhere to medical
regimens for HIV. However, their results did not support this
hypothesis.
Coping and Health Outcomes
Whether psychological characteristics in”uence the devel-
opment and course of disease has been a hotly debated topic
in the empirical literature. This discussion of the association
between coping and health outcomes is organized into two
sections: “rst, the association between coping and disease
risk; second, the relation between coping and disease pro-
gression.
Disease RiskThe most investigated topic in this area is the association
between coping and risk for cancer, particularly breast can-
cer. Most scientists view the development of cancer as a
multifactorial phenomenon involving the interaction of ge-
netic, immunological, and environmental factors (see Levy,
Herberman, Maluish, Schlien, & Lipman, 1985). The notion
that psychological factors, particularly certain personality
characteristics, contribute to the development of cancer, has
been proposed by a number of behavioral scientists over the
course of the past 30 years (e.g., Greer, Morris, & Pettingale,
1979). Strategies that individuals use to deal with stress, par-
ticularly the use of denial and repression when dealing with
stressful life events, have been suggested as potential factors
in the development of breast cancer (Anagnostopoulos et al.,
1993; Goldstein & Antoni, 1989). Studies of women who are
at-risk for breast cancer and women undergoing breast biopsy
do not consistently report an association. Edwards et al.
(1990) used the Ways of Coping Checklist and found no as-
sociation between coping and breast cancer risk. Testing for
an interaction effect, additional analyses revealed that coping
did not modify the effect of life event stress on breast cancer
risk, after adjusting for age and history of breast cancer.
Some studies have reported counterintuitive “ndings. For ex-
ample, Chen et al. found that women who confronted stress
by working out a plan to deal with the problem were at higher
risk of breast cancer, independent of life events, and adjusted
for age, family history, menopausal status, personality, to-
bacco and alcohol use. This literature was recently subjected
to a meta-analysis by McKenna and colleagues (McKenna,
Zevon, Corn, & Rounds, 1999), who found a moderate effect
size for denial and repressive coping style in an analysis
of 17 studies. Breast cancer patients were more likely to re-
spond to stressful life events by using repressive coping.
However, such studies cannot prove causation. It is just as
likely that having breast cancer may have resulted in changes
in use of repressive coping. In addition, biological/immuno-
logical mechanisms to account for any association between
repressive coping and the development of breast cancer have
yet to be elucidated.
One study linked coping with outcomes of in vitro fertil-
ization (IVF). Demyttenaere and colleagues (1998) examined
the association between coping (active, palliative, avoidance,
support seeking, depressive coping, expression of negative
emotions, and comforting ideas) and the outcome of IVF.
Women who had higher than median scores on a palliative
coping measure had a signi“cantly greater chance of con-
ceiving than women who had a lower than median score on