One of the main innovations of this

One of the main innovations of this assessment of SRCB was the explicit incorporation of both stress-reduction as a motivation for engaging in the behavior and the perceived effectiveness of that behavior at relieving emotional distress. This stands in sharp glucocorticoid receptors to most epidemiologic work on stress as a determinant of health disparities, which rarely capture the roles of stress perception, appraisal, and response in this relationship (Concha & Mezuk, 2015). We found that people tend to engage in both health-harming and health-promoting SRCBs (i.e., prayer and overeating, exercise and drinking), consistent with work on traditional approaches to coping which finds that the same people use different strategies in different situations (Lazarus & Folkman, 1984). Finally, our measure emphasizes that individuals are (or at least can be) consciously aware of explicitly using these behaviors to cope with stress, as opposed to simply engaging in the behavior without conscious awareness as to why or as merely a distraction. That stress is a motivator for engaging in behaviors that “promote” mental health via coping (even if they harm physical health) means that this connection can be used as a target for intervention to reduce the impact of stress on health (and health disparities). For our second objective, we examined four proxy indicators of context (sex, race/ethnicity, education, and wealth) but only sex consistently moderated both the frequency and content of SRCB, with relatively modest variation by the latter three indicators. Prior work has indicated sex differences in both which experiences tend to be considered stressful and in coping styles, with women scoring higher than men on emotional and avoidance coping (Matud, 2004). This is consistent with our finding that women were more likely to endorse SRCBs, if these are conceptualized as avoidance strategies. However, these findings can be considered inconsistent with psychosocial theory which posits that because of socialization women are more likely to use expressive and emotion-focused coping behaviors relative to men (Ptacek, Smith & Dodge, 1994). If these findings are replicated in other studies, they suggest the role of sex in coping is more nuanced than currently posited. Our findings, since they address behaviors that have known consequences for physical health, may have implications for understanding trajectories of sex disparities over the life course in which women have higher risk of morbidity and disability but lower risk of mortality relative to men (Case & Paxson, 2005). The relatively modest associations with race/ethnicity and SES indicators of context were contrary to our expectations, which were informed by documented health disparities along these dimensions. Our sensitivity analysis using the three-level indicator of race/ethnicity provided evidence that minority status is not consistently associated with greater use, or perceived effectiveness, of positive coping strategies. These results may reflect survival bias if lower educated, less wealthy, or racial/ethnic minorities were less likely to survive to be interviewed in the 2008 wave. The weak relationships between these SRCB and indicators of context may reflect a cohort effect, since these behaviors may represent patterns of coping established earlier in life. Finally, while we examined these contextual factors separately due to sample size limitations, this is not to discount the importance of the intersection of these indicators (i.e., sex and race/ethnicity) for understanding stress and coping (Cole, 2009). For example, future work should examine whether the sex differences observed here are consistent for lower and higher educated groups, as this would inform theoretical models of the sources of variation in heath behavior across socioeconomic strata. Turning to the third objective, the EA Model posits that stress is positively associated with endorsement with SRCBs, particularly negative behaviors (e.g., alcohol, smoking, drugs, eating), and this prediction was supported using two distinct indicators of stress (i.e., a count of stressful life events and psychological distress as measured by the CESD). The finding was stronger in magnitude for the CESD measure of stress; this may reflect measurement limitations, such as more variation in this measure due to the larger sample size for this analysis, or the fact that the CESD asks about contemporaneous (i.e., past two weeks) feelings, as opposed to the stress score which asks about events in the past (including in childhood). However, Chromatids may also suggest something more fundamental about the psychological sequela of self-regulatory coping. Regardless, this finding adds to the growing body of experimental research (e.g., Chaplin et al., 2010; Childs & de Wit, 2014; Koob, 2008; Stephens & Wand, 2012; Tryon et al., 2015; Wardle et al., 2011) supporting this framework as an integrative approach to understand how stress and behaviors intersect to influence mental and physical health. That is, when it comes to understanding the role of stress as a potential cause of health disparities, researchers need to carefully consider how what role health behaviors play in this relationship; these findings demonstrate that simply adjusting for these variables as confounders is unwarranted, as they are intimately linked to the stress-coping process. Finally, it is important to acknowledge that the SRCBs can become conditioned responses that are decoupled from stress-coping efforts over time, which is hypothesized to be one etiologic pathway for substance dependence syndromes (Koob & Volkow, 2016).