How old do I look? Aging appearance and experiences of aging among U.S. adults ages 50-80.

Appearance is an indicator of age and life stage, which are linked to socially salient stereotypes and prejudices. Older adults' appearance-related perceptions and behaviors may affect their experiences of aging within broader society, which may in turn influence health. This study examined associations between two measures related to aging appearance-assessment of one's aging appearance relative to same-age peers and investing time or effort to look younger-positive and negative experiences of aging, and health using multivariable regression. Cross-sectional data were from a nationally representative sample of 2006 U.S. adults ages 50-80 (Mage = 63, 52% women, 71% White) who completed Wave 6 of the National Poll on Healthy Aging in 2019. The majority (59%) reported appearing relatively younger than peers, while fewer reported appearing the same age (35%) or older (6%). About a third (35%) reported investing in looking younger. Appearing relatively younger was associated with more positive (p < .001) and less negative experiences of aging (p = .019). Appearing relatively older showed the opposite relationships (p values < .001). Investing in looking younger was associated with more positive and more negative experiences of aging (p values < .001). Few sociodemographic variations were detected. More positive and less negative experiences of aging were associated with better physical and mental health (p values < .001). While aging appearance is often the basis for jokes, it may affect the quality of older adults' experiences of aging and associated health outcomes. Nuanced findings caution against framing youthful biases in aging appearance and investments in looking younger as solely negative (or positive). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Aging Stigma and the Health of US Adults Over 65: What Do We Know?

This narrative review assessed the current state of research on aging stigma and health relevant to US adults ages 65 and older. We adopted a stigma framework to highlight aging stigma as a meaningful social construct and the complex ways in which it may be harmful for health. We identified 29 studies of various types (experimental, intervention, cross-sectional quantitative, longitudinal quantitative, and qualitative) published between 2010 and 2023 that investigated relationships between concepts related to aging stigma and health. Aging stigma was associated with poor short- and long-term health outcomes spanning cognition, psychological wellbeing, physical health, and hospitalizations. The premise that aging stigma is harmful to health was moderately well supported, while evidence that health influenced aging stigma was weak. Collectively, studies provided insight into several mechanisms through which aging stigma may affect the health of older US adults, while also highlighting areas for future research. Potential strategies for addressing aging stigma as a public health hazard were discussed.

Differences and Disparities in Ageism Affecting Older US Adults: A Review.

Purpose of Review: This review summarizes findings from quantitative research studies published between 2010 and 2022 providing insight on sociodemographic differences and disparities in ageism among US adults ages 50 and older. Findings: Across 21 studies, disparities in ageism were more consistently found such that those who were older (57% of studies), with less education (64%), and of lower socioeconomic status (100%) reported more ageism than their counterparts. Amount of ageism did not differ by sex in the majority (71%) of studies. Findings regarding race/ethnicity were mixed. Other possible differences in ageism, assessed in a small number of studies, were patterned by employment characteristics, geographic residence, religiosity, and political affiliation but not by marital or employment status. Summary: Given that ageism is both common and associated with poor health outcomes, identifying disproportionately affected segments of the older adult population is a necessary prerequisite for developing targeted interventions to reduce negative outcomes linked to ageism and associated health disparities. Evidence within this review suggests that the patterning of ageism may deviate from that typically documented for other social and structural disadvantages. Some groups traditionally considered to be socially marginalized were found to report more ageism while others did not.

Multiple forms of discrimination and inflammation in Black Americans: Are there differences by sex?

RATIONALE: Discrimination is a risk factor and potential pathway through which social determinants such as race and sex contribute to chronic inflammation in Black Americans in middle and later adulthood. Questions remain regarding which forms of discrimination are most salient for inflammatory dysregulation, and whether there are sex-based differences in these pathways. OBJECTIVE: This exploratory study investigates sex differences in the relationships between four forms of discrimination and inflammatory dysregulation among middle aged and older Black Americans. METHODS: Using cross-sectionally linked data from participants in the Midlife in the United States (MIDUS II) Survey (2004-2006) and Biomarker Project (2004-2009) (N = 225, ages 37-84, 67% female), this study conducted a series of multivariable regression analyses. Inflammatory burden was measured using a composite indicator comprised of five biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-selectin, and intercellular adhesion molecule (ICAM). Discrimination measures were lifetime, daily, and chronic job discrimination and perceived inequality at work. RESULTS: Black men generally reported higher levels of discrimination than Black women (3 out of 4 forms), though only sex differences in job discrimination achieved statistical significance (p < .001). In contrast, Black women exhibited more overall inflammatory burden than Black men (2.09 vs. 1.66, p = .024), particularly elevated levels of fibrinogen (p = .003). Lifetime discrimination and inequality at work were associated with higher levels of inflammatory burden, after adjusting for demographic and health factors (p = .057 and p = .029, respectively). The discrimination-inflammation relationships further varied by sex, such that more lifetime and job discrimination predicted greater inflammatory burden in Black women, but not in Black men. CONCLUSION: These findings highlight the potentially detrimental impact of discrimination and emphasize the importance of sex-specific research on biological mechanisms of health and health disparities in Black Americans.

Experiences of Everyday Ageism and the Health of Older US Adults.

Importance: Major incidents of ageism have been shown to be associated with poorer health and well-being among older adults. Less is known about routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their day-to-day lives, known as everyday ageism. Objective: To examine the prevalence of everyday ageism, group differences and disparities, and associations of everyday ageism with indicators of poor physical and mental health. Design, Setting, and Participants: This cross-sectional study was conducted using survey data from the December 2019 National Poll on Healthy Aging among a nationally representative household sample of US adults ages 50 to 80 years. Data were analyzed from November 2021 through April 2022. Exposures: Experiences of everyday ageism were measured using the newly developed multidimensional Everyday Ageism Scale. Main Outcomes and Measures: Fair or poor physical health, number of chronic health conditions, fair or poor mental health, and depressive symptoms. Results: Among 2035 adults ages 50 to 80 years (1047 [54.2%] women; 192 Black [10.9%], 178 Hispanic [11.4%], and 1546 White [71.1%]; mean [SD] age, 62.6 [8.0] years [weighted statistics]), most participants (1915 adults [93.4%]) reported regularly experiencing 1 or more forms of everyday ageism. Internalized ageism was reported by 1664 adults (81.2%), ageist messages by 1394 adults (65.2%), and interpersonal ageism by 941 adults (44.9%). Mean Everyday Ageism Scale scores were higher for several sociodemographic groups, including adults ages 65 to 80 years vs those ages 50 to 64 years (11.23 [95% CI, 10.80-11.66] vs 9.55 [95% CI, 9.26-9.84]) and White (10.43 [95% CI, 10.20-10.67]; P < .001) and Hispanic (10.09 [95% CI, 9.31-10.86]; P = .04) adults vs Black adults (9.23 [95% CI, 8.42-10.03]). Higher levels of everyday ageism were associated with increased risk of all 4 negative physical and mental health outcomes examined in regression analyses (with odds ratios [ORs] per additional scale point as high as 1.20 [95% CI, 1.17-1.23] for depressive symptoms and b = 0.039 [95% CI, 0.029-0.048] for chronic health conditions; P values < .001). Internalized ageism was the category associated with the greatest increase in risk of poor outcomes for all health measures (with ORs per additional scale point as high as 1.62 [95% CI, 1.49-1.76] for depressive symptoms and b = 0.063 [95% CI, 0.034-0.092] for chronic health conditions; P values < .001). Conclusions and Relevance: This study found everyday ageism to be prevalent among US adults ages 50 to 80 years. These findings suggest that commonplace ageist messages, interactions, and beliefs may be harmful to health and that multilevel and multisector efforts may be required to reduce everyday ageism and promote positive beliefs, practices, and policies related to aging and older adults.

Mechanisms of Cardiometabolic Health Outcomes and Disparities: What Characteristics of Chronic Stressors are Linked to HPA-Axis Dysregulation?

Objectives: Chronic stressors are associated with cardiometabolic health conditions and disparities. Mechanisms linking stressors and health remain poorly understood. Methods: Two cohort studies (Cardiac Rehabilitation And The Experience [CREATE] and Tracking Risk Identification for Adult Diabetes [TRIAD]) with harmonized variables were used to examine relationships between six types of chronic stressors in adulthood and Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation, as indicated by blunted diurnal cortisol slopes, which are stress-sensitive biomarkers implicated in cardiometabolic health (merged N = 213, mean age 61, 18% Black). A secondary aim was to explore whether these chronic stressors accounted for Black-White disparities in HPA axis regulation. Results: Some chronic stressors were linked to HPA axis dysregulation, with recent stressors most salient (b = 0.00353, SE = 0.00133, p = .008). Black-White disparities in HPA axis regulation persisted after controlling for racial differences in chronic stressors, which reduced the disparity 11.46%. Discussion: Chronic stressors in adulthood may increase risk for HPA axis dysregulation and associated cardiometabolic health outcomes but may not be a key factor in racial disparities.

Promoting sustained diabetes management: Identifying challenges and opportunities in developing an alumni peer support component of the YMCA Diabetes Control Program.

OBJECTIVE: To explore the perspectives of coaches and participant alumni of the YMCA Diabetes Control Program (DCP) to inform the development of a peer support component of the DCP for sustained diabetes self-management. METHODS: Coaches (n = 2) and alumni (n = 38) participated in semi-structured interviews and focus groups regarding their experiences with the DCP and anticipated challenges and strengths of incorporating alumni peer support into the program. Transcripts were analyzed using content analysis to identify topics related to peer support. RESULTS: Six topics emerged related to strengths and weaknesses of the coach and peer roles, including how those roles influenced motivation and accountability in self-management. Both roles provide encouragement for sustained behavior change, particularly in the face of setbacks. Interest in becoming an alumni peer supporter was strongly related to a sense of reciprocity and potential for mutual benefit, while concerns centered on unclear expectations and a desire for formal training. CONCLUSION: Program alumni saw value in continued formal contact not only with their coaches, but with fellow peers, as part of their sustained diabetes self-management and anticipated reciprocal benefits. PRACTICE IMPLICATIONS: Findings illustrate opportunities for, and the value of, incorporating alumni peer support into hierarchical coach-led diabetes self-management programs.

The Everyday Ageism Scale: Development and Evaluation.

OBJECTIVES: Older adults regularly encounter age-based discrimination and stereotyping in their day-to-day lives. Whether this type of routine ageism negatively affects their health and well-being is unclear, in part due to the absence of validated scales that comprehensively measure this phenomenon and distinguish it from other sources of everyday discrimination. METHODS: This study describes the development of a novel scale, the Everyday Ageism Scale, and its psychometric evaluation using a nationally representative sample of US adults age 50-80 from the December 2019 National Poll on Healthy Aging (N = 2012). RESULTS: Exploratory factor analysis indicated a 3-factor structure comprised of ageist messages, ageism in interpersonal interactions, and internalized ageism. The ten-item scale was psychometrically sound and demonstrated good internal reliability. DISCUSSION: Everyday ageism is a multidimensional construct. Preliminary evaluation of the Everyday Ageism Scale suggests its utility in future studies examining the prevalence of everyday ageism and its relationships with health.

Mechanisms of Racial Health Disparities: Relationships between Coping and Psychological and Physiological Stress Responses.

Objective: Psychological distress and physiological dysregulation represent two stress response pathways linked to poor health and are implicated in racial disparities in aging-related health outcomes among US men. Less is known about how coping relates to these stress responses. The purpose of this exploratory study was to examine whether midlife and older men's coping strategies and behaviors accounted, in part, for Black-White disparities in men's psychological and physiological stress responses. Methods: We examined racial differences in 12 coping strategies (COPE Inventory subscales, religious/spiritual coping, and behaviors such as stress eating and substance use) and their relationships with psychological distress (Negative Affect scale) and physiological dysregulation (blunted diurnal cortisol slopes) using regression models and cross-sectional data from 696 Black and White male participants aged 35-85 years in the National Survey of Midlife Development in the United States (MIDUS) II, 2004-2006. Results: Black men exhibited more psychological distress and physiological dysregulation than White men. Black and White men reported comparable use of most coping strategies, none of which demonstrated similar relationships with both stress responses. Coping strategies explained variations in psychological distress consistent with conventional protective-harmful categorizations. Coping accounted for racial disparities in men's psychological distress, as Black men reported using harmful strategies more often and were more susceptible to their negative effects. Neither differential use of coping strategies nor differing relationships accounted for racial disparities in physiological dysregulation. Conclusions: Findings revealed complex relationships between coping and psychological and physiological stress responses and suggest the importance of differing approaches to reducing associated racial health disparities among men.

An Online Behavioral Health Intervention Promoting Mental Health, Manhood, and Social Support for Young Black Men: The YBMen Project.

Conventional definitions of mental health, manhood, and social support create barriers to accessing behavioral health care for Black men ages 18 to 30. Targeted behavioral health interventions sensitive to culture, social norms, and gender that circumvent these barriers are desperately needed to improve access and integrated care for this group. This article reports mixed methods findings from the 2017 iteration of the Young Black Men, Masculinities, and Mental Health (YBMen) project, a social media-based, psychoeducational program that promotes mental health, progressive definitions of manhood, and sustainable social support for Black men. Young Black men (n = 350) across two universities in the Midwest completed baseline surveys on their mental health, definitions of manhood, and social support. Forty of the men participated in the YBMen intervention and at postintervention reported experiencing fewer depressive symptoms on the Patient Health Questionnaire (PHQ-9, Z = -2.05, p < .01) and the Gotland Male Depression Scale (GMDS; Z = -1.76, p < .05). There were also changes on the Conformity to Masculine Norms Inventory (CMNI) for Self-Reliance (Z = -0.34, p = .26) and Heterosexual Self-Presentation (Z = -0.18, p = .59), though these changes were not statistically significant. A qualitative review of postintervention interviews revealed participants' appreciation of the YBMen project and its influence on their mental health, manhood, and social support. Programmatic efforts that support the behavioral health, positive development, and social relationships of Black men translate into positive families, communities, and experiences as they live, learn, love, and work over the life course.

Engaging Underserved Community Members in Diabetes Self-Management: Evidence From the YMCA of Greater Richmond Diabetes Control Program.

PURPOSE: The purpose of this study was to identify factors influencing participant engagement in a community-based diabetes self-management program (DSMP), with a focus on the needs of underserved groups (eg, racial/ethnic minorities, low income). METHODS: Focus groups were conducted with participants (n = 22) from the YMCA of Greater Richmond's Diabetes Control Program, who were recruited using a purposeful sampling frame to capture a range of experiences. In-depth interviews were conducted with lay health coaches (n = 3). The RADaR qualitative analysis technique was used to identify themes related to factors across the continuum of engagement. RESULTS: Fear affected program enrollment and retention in complex ways. Peers and coaches were important for social support and accountability. The length of the program (12 weeks), accessible information, practical skill building, and emphasis on making small, feasible improvements in pursuit of larger goals were identified as critical for engagement and improving diabetes self-management. Health and outside obligations were the major barriers to program attendance. CONCLUSIONS: Participant and coach perspectives provide important insight into existing strengths of community-based DSMPs that can be expanded on to promote engagement as well as potential opportunities for improvement. Actionable recommendations for increasing engagement of underserved groups in community-based DSMPs are provided.

Mechanisms of Racial Health Disparities: Evidence on Coping and Cortisol from MIDUS II.

OBJECTIVE: Blunted patterns of daily cortisol, an indicator of hypothalamic-pituitary-adrenal (HPA) axis stress response system dysregulation, are implicated in poor health outcomes and racial health disparities. It is unknown how coping-an important, but understudied, component of the stress-health disparities relationship-relates to these biological mechanisms of health. METHODS: This study investigated relationships, including racial differences, between 12 coping strategies and early-day cortisol changes (diurnal cortisol slopes from peak to before lunch) among 700 35-85-year-old Black and White male participants in the National Survey of Midlife Development in the United States (MIDUS) II. Cognitive-oriented (e.g., positive reinterpretation, denial, religious/spiritual) and behavioral (e.g., stress eating, substance use) coping strategies were examined. RESULTS: Overall, Black and White men used similar coping strategies. Most coping strategies were not associated with men's cortisol slopes. Religious/spiritual coping was associated with steeper (more robust) cortisol slopes among White (b = - 0.004, t = - 3.28, p = 0.001) but not Black men. Drug use was associated with steeper cortisol slopes among Black (b = - 0.095, t = - 2.87, p = 0.004) but not White men. CONCLUSIONS: This exploratory study increases our understanding of relationships between coping and stress-related biological mechanisms underlying racial health disparities among men in later life. With some notable exceptions, men's coping strategies were not associated with their diurnal cortisol slopes. This suggests that the coping strategies currently used by older Black and White men may not be important factors, as determinants or intervention targets, in disparities in diurnal cortisol slopes and associated health outcomes among men in this age group.

Cortisol and Racial Health Disparities Affecting Black Men in Later Life: Evidence From MIDUS II.

In the United States, Black men have poorer overall health and shorter life spans than most other racial/ethnic groups of men, largely attributable to chronic health conditions. Dysregulated patterns of daily cortisol, an indicator of hypothalamic-pituitary-adrenal (HPA) axis stress-response functioning, are linked to poor health outcomes. Questions remain regarding whether and how cortisol contributes to Black-White differences in men's health. This exploratory study compared early day changes in cortisol levels (diurnal cortisol slopes from peak to pre-lunch levels) and their associations with medical morbidity (number of chronic medical conditions) and psychological distress (Negative Affect Scale) among 695 Black and White male participants in the National Survey of Midlife in the United States (MIDUS II, 2004-2009). Black men exhibited blunted cortisol slopes relative to White men (-.15 vs. -.21, t = -2.97, p = .004). Cortisol slopes were associated with medical morbidity among Black men (b = .050, t = 3.85, p < .001), but not White men, and were unrelated to psychological distress in both groups. Findings indicate cortisol may contribute to racial health disparities among men through two pathways, including the novel finding that Black men may be more vulnerable to some negative health outcomes linked to cortisol. Further, results suggest that while cortisol may be a mechanism of physical health outcomes and disparities among older men, it may be less important for their emotional health. This study increases understanding of how race and male sex intersect to affect not only men's lived experiences but also their biological processes to contribute to racial health disparities among men in later life.

Identifying subgroups of Black, Hispanic and Asian men at increased risk for comorbid depression and overweight or obesity.

Comorbid depression and overweight or obesity increase risk for developing many chronic diseases. Investigating men of color without using a non-Hispanic White male reference group will capture a more nuanced picture of how socio-demographic factors contribute to increased risk for comorbid depression and overweight or obesity among and between men of color. This study used the U.S.-based 2014 National Health Interview Survey (n = 1363) in May 2018 to examine associations between race/ethnicity and comorbid overweight or obesity and depression in men. Men were more likely to be obese or overweight and depressed if they were older (31-54 years old and 55+) [OR = 2.387, 95% CI: 1.526, 3.873, p = 0.000; OR = 2.220, 95% CI: 1.355, 3.635, p = 0.002], Black [OR = 2.745, 95% CI: 1.622, 4.646, p < 0.001], Hispanic [OR = 2.967, 95% CI: 1.762, 4.995, p < 0.001], or earned $35,000-$74,999 [OR = 1.987, 95% CI: 1.255-3.152, p = 0.004]. We identified socio-demographic sub-groups of men at increased risk for comorbid depression and overweight or obesity. Examining intra-group differences among men of color will help clinicians and researchers to address more nuanced socio-demographic characteristics of groups of men who are more at risk for developing a chronic disease.

An exploratory study of stress and coping among Black college men.

Research on coping mechanisms among Black Americans is robust, yet there is a dearth of studies that use qualitative approaches to examine coping specifically among young Black men. The current and historical landscape of race relations in the United States calls for additional concern and exploration of this topic. To fill gaps in this area, this study uncovered the ways Black college men cope with various stressors that impact their mental health. Eleven qualitative interviews were conducted with 18- to 25-year-old Black men enrolled at a college in the Midwest who participated in the Young Black Men, Masculinities, and Mental Health (YBMen) project. Data were analyzed using a rigorous and accelerated data reduction technique that involved transferring transcript data onto spreadsheets, reducing the data, and conducting a rigorous content analysis to generate themes and subthemes. Participants reported that Black college men cope with stress by discussing their issues with members of their social support networks, engaging in physical activities, and relying on themselves. Some respondents reported that they intentionally avoided dealing with their mental health, whereas others attempted to make sense of their problems. Substance use, violence, and anger were all identified as markers of unaddressed stressors. Stigma emerged as a barrier to seeking help. Study findings highlight within-group differences among Black college men. Mental health researchers must continue to develop creative ways to examine stress and coping so that resources can become more culturally relevant and readily available both within and outside of the spaces Black men occupy. (PsycINFO Database Record

Strengths and weaknesses of the Young Black Men, Masculinities, and Mental Health (YBMen) Facebook project.

The Young Black Men, Masculinities, and Mental Health (YBMen) project is a Facebook-based intervention that provides mental health education and social support to young Black men. The YBMen project was created to better understand and address the pressures and needs of young Black men, particularly with regard to issues related to their conceptualization of masculinity and mental health. Black men from a 2-year liberal arts college in the Midwest (United States) enrolled in the YBMen pilot project. The purpose of this study is to report what participants in the YBMen pilot project liked and disliked about the intervention, along with their suggestions for improvement. Qualitative results from the 8 Black men who actively participated in the YBMen Facebook intervention and completed the postintervention interview are reported. A systematic analysis identified 9 subthemes that described participants' reactions to different components and characteristics of the Facebook intervention. Results indicated that opportunities for relationship building and connectivity, coupled with engaging popular culture references used in the intervention encouraged young Black men to actively participate in the YBMen Facebook intervention. The YBMen project has potential to improve the health and well-being of young Black men by providing nontraditional resources that are easily accessible, culturally sensitive, and gender-specific. Implications of the YBMen project as an effective Internet-based program that promotes mental health and increases social support among young Black men are discussed. (PsycINFO Database Record

Ageism as a Risk Factor for Chronic Disease.

Ageism is one of the most socially condoned and institutionalized forms of prejudice in the United States. Older adults are discriminated against in employment, health care, and other domains. Exposure to unfavorable stereotypes adversely affects the attitudes, cognitions, and behavior of older adults. Recurrent experiences with negative stereotypes combined with discrimination may make ageism a chronic stressor in the lives of older adults. The way stress influences physical health is gaining increasing support. The weathering hypothesis (Geronimus, A. T. (1992) The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethnicity and Disease, 2, 207-221) posits that the cumulative effects of chronic objective and subjective stressors and high-effort coping cause deterioration of the body, premature aging, and associated health problems such as chronic diseases. Researchers have found empirical support for the weathering hypothesis as well as its theorized contribution to racial and ethnic health disparities. Although ageism is not experienced over the entire life course, as racism typically is, repeated exposure to chronic stressors associated with age stereotypes and discrimination may increase the risk of chronic disease, mortality, and other adverse health outcomes. I conclude with implications for practice in the helping professions and recommendations for future research. Ageism warrants greater recognition, social condemnation, and scientific study as a possible social determinant of chronic disease.

"If you do nothing about stress, the next thing you know, you're shattered": Perspectives on African American men's stress, coping and health from African American men and key women in their lives.

Stress has been implicated as a key contributor to poor health outcomes; however, few studies have examined how African American men and women explicitly describe the relationships among stress, coping, and African American men's health. In this paper, we explore strategies men use to cope with stress, and beliefs about the consequences of stress for African American men's health behaviors, morbidity and mortality from the perspectives of African American men and women. A phenomenological analytic approach was used to examine focus group data collected from 154 African American men (18 focus groups) and 77 African American women (8 focus groups). Women's perspectives were captured because women often observe men under stress and can provide support to men during stressful times. Our findings indicate that African American men in this study responded to stress by engaging in often identified coping behaviors (i.e., consumption of calorie dense food, exercise, spiritually-related activities). Men in our study, however, did not always view their responses to stress as explicit coping mechanisms. There was also some discordance between men's and women's perceptions of men's coping behaviors as there were occasions where they seemed to interpret the same behavior differently (e.g., resting vs. avoidance). Men and women believed that stress helped to explain why African American men had worse health than other groups. They identified mental, physical and social consequences of stress. We conclude by detailing implications for conceptualizing and measuring coping and we outline key considerations for interventions and further research about stress, coping and health.

Expanding the NCCN guidelines for distress management: a model of barriers to the use of coping resources.

Cancer-related distress impacts quality of care, resource use, and patient outcomes. Patients are increasingly screened for distress, yet many do not receive coping resources and psychosocial support services that may help to reduce their distress. Distress screening must be paired with attention to the different phases of the distress and coping process, with emphasis on barriers and facilitators of cancer patients' use of coping resources. This paper offers a conceptual model illustrating key pathways and modifying factors of distress and use of coping resources among cancer patients, and potential roles for cancer care providers and institutions in facilitating effective coping and distress reduction. Building on a review of relevant empirical and theoretical literature, we developed a conceptual model that integrates concepts from Stress and Coping Theory into the National Comprehensive Cancer Network's guidelines for Distress Management. We found that barriers and facilitating factors that may inhibit receipt of coping resources and services to reduce cancer-related distress include health and cancer beliefs, accessibility and acceptability, the role of caregivers in cancer treatment, coordination of care, and the quality of patient-provider relationships. Herein, we highlight largely modifable factors that can infuence the successful uptake of coping resources and services to reduce distress among cancer patients. We conclude with recommendations for how cancer care providers and systems can better identify and address barriers to the use of distress reduction resources and support services.