Self-Directedness: Cause and Effects throughout the Life Course

By Judith Rodin; Carmi Schooler et al. | Go to book overview

Control and the Epidemiology
of Physical Health: Where Do
We Go From Here?

Sheldon Cohen
Carnegie Mellon University

Syme (this volume) has eloquently argued for the potential importance of the control concept in the epidemiology of disease. He presents data from psychology, epidemiology, and sociology that support the role of control in the maintenance of health. Moreover, he convincingly argues that the control concept may provide explanations for the influence of other psychosocial risk factors such as Type A Behavior pattern, social class, and social support. I agree with Dr. Syme's basic premise. The existing evidence is provocative and indicates a need for further research to clarify the role of control in disease onset and progression. Where we disagree is on how to proceed from here. Syme proposes a generalist perspective. Specifically, he argues that it is useful at this point to accept broad definitions of both control and disease and continue to search for relations between these concepts. Alternatively, I argue that the appropriate strategy at this point is to move toward greater specificity in defining control, in defining disease outcomes, and in explaining how control would influence disease.

The thrust of my argument is that future research in this area should be driven by highly specified models of the relation between control and health that are both biologically and psychologically plausible. Epidemiologic studies are expensive and time consuming and must be designed to be cost effective. Shotgun approaches to this kind of work are neither politically nor scientifically practical. Well-specified models can maximize the economy of such work by providing guidelines for choosing appropriate samples, measures of control, measures of underlying biologic and psychologic mediation, and disease outcomes. Models that provide

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