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Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda
Personal psychological characteristics are also related to health risks. Personal mastery beliefs, beliefs that one has the ability to control outcomes, have been shown to predict lower mortality in both U.S. and European populations (Bobak et al., 1998; Dalgard and Lund Haheim, 1998; Seeman and Lewis, 1997). Given that most adults spend a large portion of their time in a work setting, it is not surprising that aspects of control with respect to one’s job are particularly consequential with respect to risks for cardiovascular disease (Bosma et al., 1997; Marmot et al., 1997a; Siegrist et al., 1990), as well as mortality (Amick et al., 2002; Theorell et al., 1998). The biological plausibility of a link between perceptions of control and health is suggested by a number of experimental studies showing that exposure to situations characterized by lower control is associated with enhanced physiological stress reactivity (Bohlin et al., 1986a, 1986b; Breier et al., 1987; Frankenhaeuser and Johansson, 1986).
Interventions designed to enhance perceptions of control in both work environments and nursing homes provide suggestive evidence that enhancing control can reduce health risks. Several studies in Sweden have suggested that interventions within the work environment can lower cardiovascular risk profiles (Orth-Gomer et al., 1994; Theorell et al., 2001). In nursing home studies, Langer and Rodin (1976; Rodin and Langer, 1977) demonstrated increased activity and well-being and reduced mortality among residents who are given greater opportunities to control their environment.
Self-efficacy beliefs represent a similar construct to control beliefs, focusing on the perception of one’s ability to successfully perform various activities. Stronger self-efficacy characterizes individuals who believe they have more power to affect events and alter outcomes in their lives. Individuals with weaker self-efficacy beliefs are at significantly greater risk, at older ages, of cognitive (Albert et al., 1995; Seeman et al., 1996) and physical impairments (Mendes de Leon et al., 1996; Seeman et al., 1999). One possible reason for this finding is that older adults with stronger self-efficacy beliefs are more likely to exercise regularly (McAuley, 1993). Such exercise has potentially far-reaching health effects because regular physical activity reduces risks for many health outcomes, including heart disease and physical and cognitive impairment, as well as overall mortality. Interventions to encourage adoption and persistence of regular exercise of some type—especially needed given that 40 percent or fewer older adults report regular physical activity (Darnay, 1994)—may need to consider whether self-efficacy beliefs can be reinforced.