Objective: Emerging research suggests the use of certain strategies to cope with stressors relate to disease and mortality risk, and lifestyle habits may be underlying mechanisms. Studies show psychological symptoms (eg, anxiety) and states (eg, happiness) predict the likelihood of adopting an integrated lifestyle that encompasses key health-related behaviors, like smoking. Yet, whether psychological processes, including stress-related coping, influence the adoption of a healthy lifestyle is unknown. We investigated whether coping strategies typically deemed adaptive (eg, seeking emotional support) and maladaptive (eg, denial) relate to sustaining a healthy lifestyle over a 16-year follow-up. We also explored whether variability in the use of these strategies, reflecting attempts to find the best strategy for a given stressor, subsequently relates to lifestyle.
Methods: Women (N = 46 067) from the Nurses' Health Study II cohort reported their use of 8 coping strategies in 2001, from which we also derived coping variability levels (lower, moderate, greater). Health behaviors (eg, physical activity, smoking, sleep), self-reported every 4 years from baseline until 2017, were combined into a lifestyle score. Generalized estimating equations, controlling for baseline demographics and health-related factors, were performed.
Results: Most adaptive strategies and greater variability levels were associated with a higher likelihood of sustaining a healthy lifestyle (eg, active coping, relative risk [RR] = 1.09, 95% confidence interval [CI], 1.08-1.11), with the reverse evident with maladaptive strategies (eg, behavioral disengagement, RR = 0.94, CI, 0.93-0.95), but some unexpected results also emerged.
Conclusions: Findings highlight the importance of going beyond the usual (mal)adaptive categorization of coping strategies when investigating their predictive value with behavioral outcomes.
Keywords: coping skills; coping variability; emotion regulation; health behavior; lifestyle.
This study explored whether the ways individuals cope with stressors predict their maintenance of healthy lifestyle habits over time. Women from a large long-term study reported how they managed stress in 2001, via 2 types of coping strategies: “adaptive” ones, such as seeking emotional support, and “maladaptive” ones, like avoiding problems. Using their responses, researchers also estimated how flexible women were in their use of coping strategies across stressors—that is, to what extent women likely tried to find the best strategies depending on the situation. Over the next 16 years, women also reported their lifestyle habits, including physical activity, tobacco smoking, diet quality, alcohol consumption, and sleep. The results showed that women who used more adaptive coping strategies or showed greater flexibility in their use were more likely to keep up healthy behaviors. On the other hand, those who used more maladaptive strategies, such as disengaging from problems, were less likely to maintain healthy habits over time. This suggests that coping adaptively and flexibly with stress may play an important role in maintaining healthy lifestyle routines. Understanding how coping influences lifestyle choices could help improve long-term health outcomes, including the development of chronic diseases.
© The Author(s) 2025. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.