Linking Life Dissatisfaction to Health Behaviors of Older African Americans Through Psychological Competency and Vulnerability

Abstract

The objective of this study was to examine the influence of life dissatisfaction on health behaviors of older African Americans and the linking role of psychological competency (e.g., control and agency) and psychological vulnerability (e.g., negative affect). A structural equation model using baseline data from a larger intervention study of older African Americans was examined. Respondents included 207 (153 females and 54 males with a median age of 60) older African Americans. Life dissatisfaction was directly associated with respondents’ daily fat consumption and sleep and indirectly associated with receiving regular physical exams, physical activity, and fruit and vegetable consumption through their psychological processes. The association between life dissatisfaction and respondents’ health behaviors varied depending on the behavior under consideration. Programs and services designed to improve older African Americans’ health behaviors should address their psychological processes, as this research suggests these psychological processes are associated with different health behaviors.

Keywords

health behaviors African Americans life dissatisfaction vulnerability control

The health of African Americans continues to be a major concern. National data show that African Americans experience higher age-adjusted morbidity and mortality rates related to chronic disease than Caucasians (National Center for Health Statistics, 2006). When compared to Caucasians, African Americans engage in more health risk behaviors (Centers for Disease Control, 2005). Some of the health risk behaviors of older African Americans are less physical activity, more sedentary behavior, insufficient sleep, and poor nutrient consumption (Adams & Schoenborn, 2006; Evenson, Buchner, & Morland, 2012; Fulgoni et al., 2007). These behaviors are related to various preventable health problems such as obesity, hypertension, heart diseases, diabetes, and cancers which are prevalent in African Americans (Fulgoni et al., 2007; Rooks & Whitfield, 2004). An increasing number of studies have shown that African Americans’ health-related behaviors are associated with their stressful life experiences (e.g., Wickrama, Surjadi, & Bryant, 2010). However, less is known about the influence of older African Americans’ perceived life successes and challenges over the life course on their health behaviors.

Research suggests that perceived life successes and frustrations may reflect stressful adverse life conditions they have cumulatively experienced over their life course leading to life satisfaction/dissatisfaction (Jopp & Schmitt, 2010; Luhmann & Eid, 2009). For older African Americans, adverse life experiences often include cumulative exposure to stressful circumstances not faced by other ethnicities such as systematic and day-to-day racial discrimination, adverse work and community conditions, and economic hardship (Clougherty, Eisen, Slade, Kawachi, & Cullen, 2009; Marmot, 1989; Shuey & Wilson, 2008; Taylor & Turner, 2002). Little research has examined these intra-individual psychological processes that may link African Americans’ perceived life failures and challenges (i.e., life dissatisfaction) and their health behaviors. We contend that African Americans’ perceived life successes and challenges over their life course have consequences for their psychological competencies and vulnerabilities in older years which, in turn, influence health-related behaviors.

Life Dissatisfaction and Health Behaviors

Numerous studies have shown life dissatisfaction to be associated with more negative health outcomes (Koivumaa-Honkanen et al., 2000; Pressman & Cohen, 2005), and now there is accumulating evidence that this association is explained by health behaviors (e.g., Grant, Wardle, & Steptoe, 2009). For instance, studies have found some evidence that life dissatisfaction is associated with health behaviors including poor eating habits, difficulty falling asleep, and physical inactivity (Grant et al., 2009; Paunio et al., 2009). The influence of life dissatisfaction on health behaviors may be partially explained by structural mechanisms related to the adverse conditions (e.g., poor work and community conditions, economic hardship) commonly associated with overall life dissatisfaction. These hardships often limit time and finances which are necessary to engage in health-promoting behaviors (i.e., physical activity and regular physical exams) and avoid more emotional health behaviors (i.e., having poor diets [more high-fat food, less fruit and vegetables] and difficulty falling asleep; Burnet et al., 2008; Richmond, Field, & Rich, 2007; Zenk & Powell, 2008). Thus, we hypothesize that older African Americans’ life dissatisfaction will be associated with their health behaviors.

Psychological Processes

Furthermore, we hypothesize that two distinct psychological processes, psychological competency and vulnerability, will serve as linking mechanisms to explain how life dissatisfaction indirectly influences health behaviors. We contend that psychological vulnerability (which we define as negative feelings and thoughts) is not merely the absence of psychological competency (conceptualized here as positive feelings and thoughts that reflect self-control and mastery; Seligman & Csikszentmihalyi, 2000). Instead, psychological competency and psychological vulnerability are independent psychological processes that may have unique health consequences (Kobau et al., 2011) and, therefore, may mediate the association between life dissatisfaction and health behaviors differently. As depicted in Figure 1, we hypothesize distinct influences of psychological competency and vulnerability on health behaviors based on existing research that has shown groups of unrelated health behaviors among older adults (Cohen-Mansfield & Kivity, 2011). In the paragraphs below, we explore how each of these psychological processes may stem from life dissatisfaction and, in turn, contribute to the performance of specific health behaviors.

Figure.1.

Confirmatory factor analysis of 12 items from the Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983) revealing psychological competency and vulnerability as two distinct factors.

Life Dissatisfaction, Psychological Competency, and Health-Promoting Behaviors

The stress process theory (Pearlin, Schieman, Fazio, & Meersman, 2005) contends that chronic stressful experiences erode individuals’ sense of psychological competency. Existing research has shown that cumulative life experiences with stressful events at any age, which is reflected by feelings of life dissatisfaction, are associated with a reduced sense of personal control and mastery (Avison & Cairney, 2003; Cairney & Krause, 2008; Hofer, Busch, & Kiessling, 2008; Wolinsky, Wyrich, Babu, Kroenke, & Tierney, 2003) but that this association is particularly strong for older adults (Cairney & Krause, 2008). Although less research has examined the life dissatisfaction and psychological competency of African Americans, certain negative life events that may lead to life dissatisfaction are race-specific. For instance, African Americans may encounter discriminatory events and disproportionately higher rates of stressful working, economic, and community conditions (Carroll, 1998; Keith, Lincoln, Taylor, & Jackson, 2010). Therefore, we expect that African Americans’ cumulative stressful experiences over the life course (as reflected by their life dissatisfaction) will erode their sense of psychological competency.

In turn, psychological competence, or lack thereof, may influence the performance of health-promoting behaviors because individuals with a sense of control or agency are more likely to plan, initiate, and maintain health-promoting behaviors and believe that they can personally take actions to maintain and/or improve their health (Ajzen, 2002; Mirowsky & Ross, 2003; Thompson, 1981). For instance, those with a high sense of control are more likely to use preventative health care (Seeman & Seeman, 1983). Similarly, self-efficacy is associated with increased exercise behaviors (Woodgate & Brawlay, 2008). Thus, we hypothesize that African Americans’ psychological competency will influence their health behaviors, particularly health-promoting behaviors.

Life Dissatisfaction, Psychological Vulnerability, and Emotion-Driven Health Behaviors

Chronic stressful life experiences, as reflected by life dissatisfaction, may directly generate negative feelings such as a frustration and anger. For instance, chronic stress and specific stressful life events and circumstances have been shown to predict psychological distress of individuals over the age of 50 (Cairney & Krause, 2005), and the life satisfaction of African Americans over the age of 50 is associated with depressive symptoms (Baker, Buchanan, Small, Hines, & Whitfield, 2011). Previous research suggests that chronic stressful experiences more powerfully predict negative feelings and thoughts than acute stressful experiences such as discrete stressful life events (Mossakowski, 2003). Therefore, we expect that African Americans’ cumulative stressful experiences over the life course (as reflected by their life dissatisfaction) will influence their psychological vulnerability after taking their psychological competency into consideration.

In turn, psychological vulnerability, or distress, including depressive symptoms, negative affect, and anxiety, are related to numerous eating behaviors including the consumption of an overall less healthy diet (Konttinen, Mannisto, Sarlio-Lahteenkorva, Silventoinen, & Haukkala, 2010). Research has shown that individuals often rely on eating as a source of distraction or as a way to cope with, and reduce, negative emotions (Macht, 1999; Macht, Haupt, & Ellgring, 2005, Macht & Simons, 2000; Jenkins & Horner, 2005). Referred to as emotional or comfort eating, this type of eating is associated with eating fewer fruits and vegetables (Mikolajczyk, Ansari, & Maxwell, 2009) and consuming above-average amounts of foods that are high in fat (Cools, Schotte, & McNally, 1992; Macht, 2008). Although research has predominantly focused on the quality and quantity of sleep, some research indicates that difficulty falling asleep, a dimension of insomnia sleep complaints associated with emotional hyperarousal (Bonnet & Arand, 2010; Koffel & Watson, 2009), is also associated with psychological vulnerability, including depressive and anxiety symptoms (Carmichael & Reis, 2005; Koffel & Watson, 2009). This aspect of sleep is particularly relevant for older adults, as studies suggest that 12.5–42% of older adults experience difficulty falling asleep (Cricco, Simonsick, & Foley, 2001; Frisoni et al., 1993). The correlation between difficulty falling asleep and depression has also been noted within existing research of older African Americans (Gamaldo, Allaire, & Whitfield, 2008). Based on the existing research, we conceptualize eating a high-fat diet, fruit/vegetable consumption, and difficulty falling asleep as emotion-driven health behaviors because they are thought to be determined by an individual’s emotional state. Thus, we hypothesize that African Americans’ psychological vulnerability will negatively influence their health behaviors, particularly these more emotion-driven health behaviors.

Methods

Sample

Baseline data from participants of six churches participating in a National Institutes of Health (NIH)-funded project to reduce cardiovascular risk in midlife and older African Americans (Ralston et al., 2008) in North Florida were used for the current study. Respondents included 207 older African American women and men (74% female and 26% male). The means and standard deviations of all study variables are shown in Table 1. The youngest respondents reported an age between 43 and 49 years (19.3%) and the oldest respondent (.5%) was over the age of 91. The median and mode age fell in the 57–63 range (25.6%). On average, respondents were married (45%) with two children (28%). The majority of respondents (84.5%) had health insurance. Educational attainment ranged from “some high school” (10.6%) to “PhD” (0.5%). The most common educational levels were having a “high school diploma” (30.1%) and “some college” (29.0%) followed by a “bachelor’s degree” and “master’s degree,” which were each held by 15.0% of respondents. On average, respondents “slightly” disagreed that they were dissatisfied with their life. They reported feeling of psychologically competent “fairly often” and psychologically vulnerable “almost never.” Regarding their health behaviors, on average, respondents “occasionally” had regular physical exams at their doctor’s office, engaged in slightly over an hour of physical activity each week, ate approximately two servings of fruits/vegetables a day, described their diets as “medium” in fat content, and spent around half an hour attempting to fall asleep each night. The percentage of missing responses per variable ranged from 2.8% to 0.5% with a mean missing percentage of 1.2. Full information maximum likelihood (FIML) was used to estimate missing data. Compared to other procedures for dealing with missing data, FIML provides more efficient parameter estimates (Enders, 2001).

Table 1.

Descriptive Statistics and Zero-Order Correlations for all Study Variables.

Study variables	1	2	3	4	5	6	7	8	9	10	11	12	13
1. Life dissatisfaction	—
2. Psychological competency	−.32**	—
3. Psychological vulnerability	.44**	−.07	—
4. Physical exams	−.22**	.27**	.07	—
5. Physical activity	−.17*	.23**	−.10	.09	—
6. Fruits/vegetables (servings/day)	−.16*	.08	−.19**	.04	.08	—
7. High-fat diet	.17*	−.02	.10	.02	−.10	−.08	—
8. Sleep	.12	−.05	.15*	.02	−.05	−.03	−.03	—
9. Health insurance	.06	.05	.24**	−.14*	.02	−.06	−.07	.01	—
10. Age	−.37**	.13	−.15*	.25**	.15*	.09	−.10	−.05	−.04	—
11. Female	−.02	.22**	−.03	.03	.45**	−.05	−.03	−.04	.11	−.02	—
12. Marital status	−.22**	.17*	−.09	.09	−.08	.09	−.02	.15*	−.03	.40**	−.12	—
13. Education	−.08	.30**	.05	.18**	.01	−.02	−.11	.09	.05	−.22**	.14*	−.03	—
M	10.31	15.94	12.69	2.92	67.22	2.29	2.03	27.52	1.11	7.11	1.26	2.45	2.92
SD	6.34	4.34	5.48	.30	112.50	1.22	.58	38.04	.31	1.67	.44	1.04	1.20

Note. Sum scores were used to provide descriptive estimates of the latent constructs: psychological competency and vulnerability. There was a possible range of 0–20 and 0–28 for psychological competency and vulnerability, respectively.

p < .05. **p < .01.

Measures

The measures and procedures were approved by the Institutional Review Board at Florida State University.

Health-Promoting Behaviors

Regular physical exams

Respondents were asked if they never (1), occasionally (2), or regularly (3) “receive a physical exam at your doctor’s office.”

Physical activity

The number of minutes respondents engage in seven physical activities at a single time was assessed using items from the Yale Physical Activity Survey (DiPietro, Caspersen, Ostfeld, & Nadel, 1993). Items included a brisk walk, stretching, vigorous exercise such as aerobics, bicycling, swimming, leisure walking, and hiking. A sum score was computed with higher scores indicating the performance of more physical activities (α = .75).

Emotion-Driven Health Behaviors

Fruit and vegetable consumption

A single item assessed the number of fruits and vegetables respondents typically eat in a day with seven response categories ranging from “zero” to “six or more.”

High-fat diet

Using a single item, respondents indicated whether their diet over the past 12 months was low (1), medium (2), or high (3) in fat. Higher values indicate a high-fat diet.

Sleeping difficulty

Respondents reported the number of minutes it takes for them to fall asleep on an average night.

Life Dissatisfaction

Four items from the Satisfaction with Life scale (Diener, Emmons, Larsen, & Griffin, 1985) were used to assess life dissatisfaction on a 7-point Likert-type scale ranging from strongly disagree to strongly agree. Items included: “In most ways my life is close to my ideal,” “The conditions of my life are excellent,” “I am satisfied with my life,” and “So far I have gotten the important things I want in life.” Sum scores were computed and recoded so that higher scores indicate life dissatisfaction (α = .86).

Psychological Processes

Although the Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983) is generally used as a single measure of perceptions of stress, confirmatory factor analysis of 12 items from the PSS revealed two distinct factors within this scale (comparative fit index [CFI] = .94, root mean square error of approximation [RMSEA] = .06, and χ²/df ratio of 1.86). Upon reviewing the items comprising these two dimensions, we argue that these dimensions reflect respondents’ psychological competency and vulnerability to stress. The correlation between these two factors was not statistically significant (r = −.10, p = .22) showing good discriminant validity.

Psychological competency

A latent construct was created to assess positive feelings and thoughts about life circumstances (i.e., psychological competency) in the last month using 5 items from the PSS (Cohen et al., 1983). Item responses range from never (0) to very often (4), and higher scores indicate greater psychological competency. Questions included “How often have you felt that you were effectively coping with important changes that were occurring in your life?” “How often have you felt confident about your ability to handle your personal problems?” “How often have you felt things were going your way?” “How often have you been able to control the irritations in your life?” and “How often have you been able to control the way you spend your time?” The scale had adequate internal consistency (α = .80), and factor loadings ranged from .59 to .70.

Psychological vulnerability

A latent construct was created to assess negative feelings and thoughts about life circumstances (i.e., psychological vulnerability) in the last month using 7 items from the PSS (Cohen et al., 1983). Responses range from never (0) to very often (4), and higher scores indicate greater psychological vulnerability. Questions included “How often have you been upset because of something that happened unexpectedly?” “How often have you felt that you were unable to control the important things in your life?” “How often have you felt nervous and stressed?” “How often have you found that you could not cope with all the things that you had to do?” “How often have you been angered because of things that happened outside of your control?” “How often have you found yourself thinking about things that you have to accomplish?” and “How often have you felt difficulties were piling up so high that you could not overcome them?” The scale had adequate internal consistency (α = .85), and factor loadings ranged from .53 to .69.

Control Variables

Health insurance status, age, gender, marital status, and education were included as control variables in the current analyses. Respondents were asked if they have health insurance (1 = yes; 2 = no). Age was assessed using 12 categories ranging from “18–21” to “over 91.” Gender was coded as 1 for female and 2 for male. Marital status response options included, “other,” “single,” “married,” “divorced,” and “widowed.” These categories were assigned numerical values ranging from 0 to 5, respectively. Respondents provided their education level using eight categories ranging from some high school (1) to law degree (8).

Analyses

Structural equation modeling (SEM) was used to analyze the influence of older African Americans’ perceived life dissatisfaction on their psychological processes and, in turn, the influence of psychological processes on health-promoting and emotion-driven health behaviors controlling for education, age, marital status, gender, and health insurance status using AMOS 17.0 (Arbuckle, 2006). Goodness of fit was assessed using the chi-square statistic, CFI, and RMSEA. The cutoff value of the CFI should be close to or greater than .95 and the cutoff value of the RMSEA should be close to or less than .06 to indicate that the model fits the data well (Hu & Bentler, 1999).

Results

Bivariate Analyses

Overall, the bivariate correlations were as expected (see Table 1). Individuals who were dissatisfied with their life were less psychologically competent (r = −.32, p < .05) and more psychologically vulnerable (r = .44, p < .05). Life dissatisfaction was also associated with not receiving regular physical exams (r = −.22, p < .05), less physical activity (r = −.17, p < .05), eating fewer fruits and vegetables (r = −.16, p < .05), and eating a high-fat diet (r = .17, p < .05). Psychological competency was associated with receiving regular physical exams (r = .27, p < .05) and physical activity (r = .23, p < .05), whereas psychological vulnerability was associated with eating fewer fruits and vegetables (r = −.19, p < .05).

Testing the Hypothesized SEM

We tested a fully recursive SEM (χ² = 325, df = 179) and the most parsimonious model (χ² = 270, df = 160) examining life dissatisfaction, psychological competency and vulnerability, and health behaviors after controlling for gender, education, age, marital status, and health insurance status. The Δχ² statistic (55, df = 19, p > .10) comparing these two models was not statistically significant indicating that the fully recursive model did not provide a better fit. Therefore, we present and discuss the more parsimonious model (see Figure 2). Life dissatisfaction was directly related to only two health behaviors, both of which were emotion-driven health behaviors, including difficulty falling asleep (β = −.181, p < .05) and consuming a high-fat diet (β = .174, p < .05). Those experiencing life dissatisfaction reported less psychological competency (β = −.319, p < .01) and greater psychological vulnerability (β = .429, p < .01) than individuals who were satisfied with their lives. In turn, psychological competency was associated with the increased frequency of physical activity (β = .230, p < .01) and receiving regular physical exams (β = .265, p < .01) whereas psychological vulnerability was associated with decreased fruit and vegetable consumption (β = −.187, p < .05). Overall, this model fit the data reasonably well with two of the three indicators within acceptable limits (CFI = .85, RMSEA < .06, and χ²/df ratio of 1.82). The CFI may have been slightly lower than anticipated due to testing a rather complex model with a small sample size.

Figure 2.

Structural equation model for the most parsimonious model illustrating the associations between older African Americans’ life dissatisfaction, psychological processes, and health behaviors (standardized coefficients are shown with corresponding t-values in parentheses).

From this model, it appears that there are both direct and indirect associations between life dissatisfaction and health behaviors. More specifically, life dissatisfaction appears to directly influence the consumption of a high-fat diet and difficulty falling asleep. Sobel’s test of indirect effects was used to assess the statistical significance of the indirect effects. Individuals’ life dissatisfaction was indirectly associated with both of the health-promoting behaviors examined (i.e., physical activity and receiving regular physical exams) through their psychological competency. Life dissatisfaction was also indirectly associated with one emotion-driven health behavior, fruit and vegetable consumption, through their psychological vulnerability. Each of these indirect effects was statistically significant at the p < .05 level.

Discussion

All five of the health behaviors examined were significantly associated with life dissatisfaction. However, the nature of this association (i.e., direct or indirect) varied depending on the behavior of interest. Older African Americans with high levels of life dissatisfaction reported consuming a diet that was higher in fat and that it took them longer to fall asleep at night than those who were, overall, satisfied with their life. Life dissatisfaction was indirectly associated with the other health behaviors examined, and psychological processes were the linking mechanism involved in these indirect associations. More specifically, individuals experiencing life dissatisfaction reported less psychological competency and more psychological vulnerability than individuals who were satisfied with their lives. In turn, compared to psychologically competent individuals, those with a poor sense of psychological competency were less likely to receive regular physical exams and spent less time engaging in physical activities, and psychological vulnerable individuals were less likely to consume fruits and vegetables.

Our finding of a direct association between life dissatisfaction and dietary fat intake and difficulty falling asleep is consistent with existing research. Adverse circumstances associated with life dissatisfaction, such as stressful work experiences and/or living in low-SES (socioeconomic status) neighborhoods, may include structural barriers that explain this association. For instance, adverse work experiences may involve shift work or other variable work schedules that make it difficult to maintain an adequate sleep schedule or fall asleep quickly (Akerstedt, 2003). Similarly, low-SES neighborhoods often lack healthy food options and include more fast-food facilities with generally high-fat food menus (Burnet et al., 2008; Zenk & Powell, 2008). More generally, lack of time and finances may necessitate relying on inexpensive foods and food items more readily available within the community including food options that are typically high in fat content (Popkin, Duffey, & Gordon-Larsen, 2005).

This direct influence was only found for two of the health behaviors, and our hypothesis that psychological processes would link life dissatisfaction to health behaviors was supported for the other three behaviors examined. Consistent with the stress process theory (Pearlin et al., 2005), previous studies have found that individuals with a strong sense of personal control and agency (i.e., psychological competency) are more likely to feel that they have power over their health and well-being (Mirowsky & Ross, 2003; Thompson, 1981). Thus, we hypothesized that these individuals may be more likely to take proactive, planned, health-promoting measures to improve or maintain their health, such as regularly receiving regular physical exams and/or participating in physical activity, and our results supported this hypothesis. Older African Americans with a greater sense of psychological competency were more likely to engage in these planned health-promoting behaviors than those without psychological competency, but their psychological competency was not significantly associated with the performance of health behaviors we termed emotion-driven.

We categorized poor eating (i.e., high-fat diet and low fruit and vegetable consumption) and difficulty falling asleep as emotion-driven health behaviors. Our inclusion of sleep as an emotion-driven health behavior was based on findings illustrating the strong comorbidity between difficulty falling asleep and aspects of psychological vulnerability such as depressive and anxiety symptoms (Koffel & Watson, 2009). Similarly, research has often found that these aspects of psychological vulnerability lead to emotional responses including eating increased quantities of foods that are high in fat and decreased quantities of fruits and vegetables (Cools et al., 1992; Macht, 2008; Mikolajczyk et al., 2009). As previously discussed, life dissatisfaction was directly, but not indirectly, linked to two of these emotion-driven health behaviors (i.e., dietary fat intake and difficulty falling asleep), but our linking hypothesis was supported for fruit and vegetable consumption. Consistent with the stress process theory (Pearlin et al., 2005), psychologically vulnerable older African Americans ate fewer fruits and vegetables than those who were not psychologically vulnerable. Interestingly, psychological vulnerability in older African Americans was not associated with their performance of planned, health-promoting behaviors such as physical exercise and receiving a regular medical checkup.

Several limitations of this study should be noted. Our sample was drawn from midlife and older African Americans who attend church and, therefore, may not generalize to individuals outside of this religious or demographic classification. Furthermore, our sample was also comprised mainly of women (74%). Thus, our sample was biased toward women. However, we would expect similar results in samples with a more balanced gender distribution based on existing research that has shown contextual variables, such as those examined in the current study, appear to influence married African American men’s and women’s health behaviors similarly (Wickrama et al., 2011). Regarding the confirmatory factor analysis that revealed two distinct factors of psychological competency and psychological vulnerability, it is possible that these distinct factors are due to the grouping of positively and negatively worded items rather than conceptual differences in the items. However, based on existing research using confirmatory factor analysis to show that positive and negative affect represent separate psychological processes, we contend that the positive and negative items belong to two distinct constructs (Noh, Kaspar, & Wickrama, 2007).

Measurement issues related to our use of secondary data from a primarily nutritional intervention study is also a limitation for two reasons. First, we lacked certain measures that would have ideally been included in the analyses. For instance, we did not have information about the respondents’ income, but we did control for their educational attainment which is highly correlated with income and health status in other studies of African Americans (Cutrona, Russell, Burzette, Wesner, & Bryant, 2011). We were also limited on the health behaviors available so we were not able to determine the influence of life dissatisfaction and psychological processes on other behaviors such as alcohol and tobacco use. Although we recognize that structural constraints (e.g., poor work and community conditions, discrimination) may partly account for the direct association between life dissatisfaction and health behaviors, information on these constructs were not available in the dataset. Second, some of the constructs we did examine were measured by proxy variables, or single items, rather than direct, or more complete, information. For instance, we used life dissatisfaction as a proxy for overall cumulative stressful experiences over the life course, and it would be beneficial for future studies to more directly assess individuals’ exposure to cumulative stressful experiences over the life course (e.g., childhood and adulthood poverty, stressful work experiences, and racial discrimination). We also relied on single-item assessments of several health behaviors (i.e., sleep, dietary fat intake, and fruit and vegetable consumption). The validity of these 1-item measures may vary depending on the behavior under consideration. Regarding fruit and vegetable consumption, research has shown that the use of a single item often leads respondents to underestimate their daily intake (Peterson et al., 2008). This differential reporting may explain why fruit and vegetable consumption within the current sample (m = 2.32 servings/day) was lower than another study of African American churchgoers (m = 3.7 servings/day; McClelland, Demark-Wahnefried, Mustian, Cowan, & Campbell, 2008) where a more comprehensive measure was used.

Regardless of these limitations, the present study makes a unique contribution regarding the association between life dissatisfaction and various health behaviors of older African Americans including elucidating the psychological processes that serve as linking mechanisms between these constructs. This study demonstrates the impact of life dissatisfaction on a variety of health behaviors and the importance of considering numerous pathways, including direct and indirect associations, through which life dissatisfaction leads to unhealthy behaviors. These results also provide partial support for our conceptualization of two overarching types of health behaviors, planned health-promoting and emotion-driven health behaviors, which are influenced by unique psychological processes.

Policies and programs addressing the health behaviors of older African Americans are particularly important due to the high age-adjusted morbidity and mortality rates of African Americans (National Center for Health Statistics, 2006) and the prevalence of health risk behaviors within African American populations (Centers for Disease Control, 2005). Based on our findings, programs and services should be designed to improve older African Americans’ health behaviors by addressing multiple pathways associated with these behaviors. For instance, initiatives that address building psychological competency may be useful for increasing the likelihood of older African Americans’ planned, health-promoting behaviors. Programs should also include components aimed at reducing aspects of psychological vulnerability such as depressive symptoms and negative affect, as this research indicates that reductions in older African Americans’ psychological vulnerability may be useful in reducing emotion-driven health behaviors. These results also suggest that programs and policies focused on a single psychological process, such as increasing competency or decreasing vulnerability, may only be effective at improving specific health behaviors and not a large spectrum of health behaviors simultaneously. For projects with limited resources, such as time and finances, this information can be used to create more concise interventions requiring fewer resources aimed at specific health behaviors. On the other hand, this knowledge also suggests that interventions aimed at both increasing health-promoting behaviors and decreasing emotion-driven health behaviors will be more effective if they focus on more than one psychological process concurrently. It appears that simply working with older African Americans to reduce their level of distress or increase their sense of mastery is not sufficient to encourage improvement in a broad range of health behaviors.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The project described was supported by Award Number R24MD002807 (P.I. Penny A. Ralston) from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities or the National Institutes of Health.

Author Biographies

K. A. S. Wickrama, PhD, is a professor of Human Development and Family Science at the University of Georgia.

Penny A. Ralston, PhD, is professor, dean emeritus, and director of the Center on Better Health and Life for Underserved Populations, Florida State University.

Catherine W. O’Neal, PhD, is a postdoctoral research associate in Human Development and Family Science at the University of Georgia.

Jasminka Z. Ilich, PhD, is a Hazel K. Stiebeling professor of Nutrition at the Florida State University.

Cynthia M. Harris, PhD, is professor and director of the Institute of Public Health at Florida A&M University.

Catherine Coccia, PhD, RD, is an assistant professor of Human Development and Family Studies at Texas A&M University - Kingsville.

Iris Young-Clark is an assistant director of the Center on Better Health and Life for Underserved Populations, Florida State University.

Jennifer Lemacks, PhD, RD, is an assistant professor of Nutrition and Food Systems at the University of Southern Mississippi.

References

Adams

P. F.

Schoenborn

C. A.

(2006). Health behaviors of adults: United States, 2002-04. Vital Health Statistics, 10, 1–140.

Ajzen

(2002). Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology, 32, 665–683.

Akerstedt

(2003). Shift work and disturbed sleep/wakefulness. Occupational Medicine, 53, 89–94.

Arbuckle

J. L.

(2006). Amos (Version 7.0). [Computer Program]. Chicago, IL: SPSS.

Avison

W. R.

Cairney

(2003). Social structure, stress, and personal control. In Zarit

S. H.

Pearlin

L. I.

Schaie

K. W.

(Eds.), Personal control in social and life course contexts (pp. 127–164). New York, NY: Springer.

Baker

T. A.

Buchanan

N. T.

Small

B. J.

Hines

R. D.

Whitfield

K. E.

(2011). Identifying the relationship between chronic pain, depression, and life satisfaction in older African Americans. Research on Aging, 33, 426–443.

Bonnet

M. H.

Arand

D. L.

(2010). Hyperarousal and insomnia: State of the science. Sleep Medicine Reviews, 14, 9–15.

Burnet

D. L.

Plaut

A. J.

Ossowski

Ahmad

Quinn

M. T.

Radovick

. . . Chin

M. H.

(2008). Community and family perspectives on addressing overweight in urban African-American youth. Journal of General Internal Medicine, 23, 175–179.

Cairney

Krause

(2005). The social distribution of psychological distress and depression in older adults. Journal of Aging and Health, 17, 807–835.

10.

Cairney

Krause

(2008). Negative life events and age-related decline in mastery: Are older adults more vulnerable to the control-eroding effect of stress. The Journals of Gerontology, 63B, S162–S171.

11.

Carmichael

C. L.

Reis

H. T.

(2005). Attachment, sleep quality, and depressed affect. Health Psychology, 24, 526–531.

12.

Carroll

(1998). Mundane extreme environmental stress and African American families: A case for recognizing different realities. Journal of Comparative Family Studies, 29, 271–285.

13.

Centers for Disease Control and Prevention. (2005). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

14.

Clougherty

J. E.

Eisen

E. A.

Slade

M. D.

Kawachi

Cullen

M. R.

(2009). Workplace status and risk of hypertension among hourly and salaried aluminum manufacturing employees. Social Science and Medicine, 68, 304–313.

15.

Cohen

Kamarck

Mermelstein

(1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.

16.

Cohen-Mansfield

Kivity

(2011). The relationship among health behaviors in older persons. Journal of Aging and Health, 23, 822–842.

17.

Cools

Schotte

D. E.

McNnally

R. J.

(1992). Emotional arousal and overeating in restrained eaters. Journal of Abnormal Psychology, 101, 348–351.

18.

Cricco

Simonsick

E. M.

Foley

D. J.

(2001). The impact of insomnia on cognitive functioning in older adults. Journal of the American Geriatrics Society. 49, 1185–1189.

19.

Cutrona

C. E.

Russell

D. W.

Burzetta

R. G.

Wesner

K. A.

Bryant

C. M.

(2011). Predicting relationship stability among midlife African American couples. Journal of Consulting and Clinical Psychology, 79, 814–825.

20.

Diener

Emmons

R. A.

Larsen

R. J.

Griffin

(1985). The satisfaction with life scales. Journal of Personality Assessment, 49, 71–75.

21.

DiPietro

Caspersen

C. J.

Ostfeld

A. M.

Nadel

E. R.

(1993). A survey for assessing physical activity among older adults. Medicine and Science in Sports Exercise, 25, 628–642.

22.

Enders

C. K.

(2001). The performance of the full information maximum likelihood estimation in multiple regression models with missing data. Educational and Psychological Measurement, 61, 713–740.

23.

Evenson

K. R.

Buchner

D. M.

Morland

K. B.

(2012). Objective measurement of physical activity and sedentary behavior among US adults aged 60 years or older. Preventing Chronic Disease, 9, 110109.

24.

Frisoni

G. B.

Leo

D. D.

Rozzini

Bernardini

Buono

M. D.

Trabucchi

(1993). Night sleep symptoms in an elderly population and their relation with age, gender, and education. Clinical Gerontologist, 13, 51–68.

25.

Fulgoni

3rd Nicholls

Reed

Buckley

Kafer

Huth

. . . Miller

G. D.

(2007). Dairy consumption and related nutrient intake in African-American adults and children in the United States: Continuing survey of food intakes by individuals 1994-1996, 1998, and the National Health and Nutrition Examination Survey 1999-2000. Journal of the American Dietetic Association, 107, 256–264.

26.

Gamaldo

A. A.

Allaire

J. C.

Whitfield

K. E.

(2008). The relationship between reported problems falling asleep and cognition among African American elderly. Research on Aging, 30, 752–767.

27.

Grant

Wardle

Steptoe

(2009). The relationship between life satisfaction and health behavior: A cross-cultural analysis of young adults. International Journal of Behavioral Medicine, 16, 259–269.

28.

Hofer

Busch

Kiessling

(2008). Individual pathways to life satisfaction: The significance of traits and motives. Journal of Happiness Studies, 9, 503–520.

29.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 61, 1–55.

30.

Jenkins

Horner

S. D.

(2005). Barriers that influence eating behaviors in adolescents. Journal of Pediatric Nursing, 20, 258–267.

31.

Jopp

D. S.

Schmitt

(2010). Dealing with negative life events: Differential effects of personal resources, coping strategies, and control beliefs. European Journal of Ageing, 7, 167–180.

32.

Keith

V. M.

Lincoln

K. D.

Taylor

R. J.

Jackson

J. S.

(2010). Discriminatory experiences and depressive symptoms among African American women: Do skin tone and mastery matter? Sex Roles, 62, 48–59.

33.

Koffel

Watson

(2009). The two-factor structure of sleep complaints and its relation to depression and anxiety. Journal of Abnormal Psychology, 118, 183–194.

34.

Kobau

Seligman

M. E. P.

Peterson

Diener

Zach

M. M.

Chapman

Thompson

(2011). Mental health promotion in public health: Perspectives and strategies from positive psychology. American Journal of Public Health, 101, e1–e9.

35.

Koivumaa-Honkanen

Honkanen

Viinamaki

Heikkila

Kaprio

Koskenvuo

(2000). Self-reported life satisfaction and 20-year mortality in healthy Finnish adults. American Journal of Epidemiology, 152, 983–991.

36.

Konttinen

Mannisto

Sarlio-Lahteenkorva

Silventoinen

Haukkala

(2010). Emotional eating, depressive symptoms and self-reported food consumption. A population-based study. Appetite, 54, 473–479.

37.

Luhmann

Eid

(2009). Does it really feel the same? Changes in life satisfaction following repeated life events. Journal of Personality and Social Psychology, 97, 363–381.

38.

Macht

(1999). Characteristics of eating in anger, fear, sadness, and joy. Appetite, 33, 129–139.

39.

Macht

(2008). How emotions affect eating: A five-way model. Appetite, 50, 1–11.

40.

Macht

Haupt

Ellgring

(2005). The perceived function of eating is changed during examination stress: A field study. Eating Behaviors, 6, 109–112.

41.

Macht

Simons

(2000). Emotions and eating in everyday life. Appetite, 35, 65–71.

42.

Marmot

M. G.

(1989). General approaches to migrant studies: The relation between disease, social class and ethnic origin. In Cruickshank

J. K.

Beevers

D. G.

(Eds.), Ethnic factors in health and disease (pp. 12–17). London, England: Butterworth.

43.

McClelland

Demark-Wahnefried

Mustian

R. D.

Cowan

A. T.

Campbell

M. K.

(1998). Fruit and vegetable consumption of rural African Americans: Baseline survey results of the black churches united for better health 5 a day project. Nutrition and Cancer, 30, 148–157.

44.

Mikolajczyk

R. T.

Ansari

W. E.

Maxwell

A. E.

(2009). Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutrition Journal, 8, 1–8.

45.

Mirowsky

Ross

(2003). Social Causes of Psychological Distress. New York, NY: Aldine de Gruyter.

46.

Mossakowski

K. N.

(2003). Coping with perceived discrimination: Does ethnic identity protect mental health? Journal of Health and Social Behavior, 44, 318–331.

47.

National Center for Health Statistics. (2006). Health, United States, 2006 with chartbook on trends in the health of Americans. Hyattsville, MD.

48.

Noh

Kaspar

Wickrama

K. A.S.

(2007). Overt and subtle racial discrimination and mental health: Preliminary findings for Korean immigrants. American Journal of Public Health, 97, 1269–1274.

49.

Paunio

Korhonen

Hublin

Partinen

Kivimaki

Koskenvuo

Kaprio

(2009). Longitudinal study on poor sleep and life dissatisfaction in a nationwide cohort of twins. American Journal of Epidemiology, 169, 206–213.

50.

Pearlin

L. I.

Schieman

Fazio

E. M.

Meersman

S. C.

(2005). Stress, health, and the life course: Some conceptual perspectives. Journal of Health and Social Behavior, 46, 205–219.

51.

Peterson

K. E.

Hebert

J. R.

Hurley

T. G.

Resnicow

Thompson

F. E.

Greene

G. W.

. . . Nebeling

(2008). Accuracy and precision of two short screeners to assess change in fruit and vegetable consumption among diverse populations participating in health promotion intervention trials. Journal of Nutrition, 138, 2185–2255.

52.

Popkin

B. M.

Duffey

Gordon-Larsen

(2005). Environmental influences on food choice, physical activity and energy balance. Physiology and Behavior, 86, 603–613.

53.

Pressman

S. D.

Cohen

(2005). Does positive affect influence health? Psychological Bulletin, 131, 925–971.

54.

Ralston

P. A.

Ilich-Ernst

Wickrama

K. A. S.

Harris

C. M.

(2008). Reducing cardiovascular disease risk in African Americans. National Institute on Health and Health Disparities funded project. NIH Award, R24MD002807.

55.

Richmond

T. K.

Field

A. E.

Rich

(2007). Can neighborhoods explain racial/ethnic differences in adolescent inactivity? International Journal of Pediatric Obesity, 2, 202–210.

56.

Rooks

R. N.

Whitfield

K. E.

(2004). Health disparities among older African Americans: Past, present, and future perspectives. In Whitfield

K. E.

(Ed.), Closing the gap: Improving the health of minority elders in the new millennium (pp. 45–54). Washington, DC: The Gerontological Society of America.

57.

Seeman

T. E.

(1983). Health behavior and personal autonomy: A longitudinal study of the sense of control in illness. Journal of Health and Social Behavior, 24, 144–160.

58.

Seligman

M. E. P.

Csikszentmihalyi

(2000). Positive psychology: An introduction. American Psychologist, 55, 5–14.

59.

Shuey

K. M.

Wilson

A. E.

(2008). Cumulative disadvantage and Black-White disparities in life-course health trajectories. Research on Aging, 30, 200–225.

60.

Taylor

Turner

R. J.

(2002). Perceived discrimination, social stress, and depression in the transition to adulthood: Racial contrasts. Social Psychology Quarterly, 65, 213–225.

61.

Thompson

S. C.

(1981). Will it hurt less if I can control it? A complex answer to a simple question. Psychological Bulletin, 90, 89–101.

62.

Wickrama

K. A. S.

Surjadi

F. F.

Bryant

C. M.

(2011). Work, marriage, and health behaviors of African American working couples. Personal Relationships, 18, 519–531.

63.

Wolinsky

F. D.

Wyrwich

K. W.

Babu

A. N.

Kroenke

Tierney

W. M.

(2003). Age, aging, and the sense of control among older adults: A longitudinal reconsideration. The Journals of Gerontology, 58B, S212–S221.

64.

Woodgate

Brawlay

L. R.

(2008). Self-efficacy for exercise in cardiac rehabilitation: Review and recommendations. Journal of Health Psychology, 13, 366–387.

65.

Zenk

Powell

(2008). U.S. secondary schools and food outlets. Health Place, 14, 336–346.