Journal of Preventive Medicine

Introduction
In 2019, a new coronavirus called COVID-19 was reported by the World Health Organization (WHO). According to the official statistics of the WHO in 2020, after Italy, Spain, the United States, France, and the United Kingdom, Iran had the highest number of deaths due to COVID-19. In this pandemic, improving health components and preventing disease are the goals of societies. Health-promoting behaviors are a set of health behaviors that are used to maintain and promote health, self-actualization, and individual well-being. One of the factors that play a significant role in creating or aggravating many disorders and the occurrence of malfunctions and maladaptation is stress. Stress is a set of general human reactions to maladaptive and unpredictable internal and external factors, such that the balance and adaptation of a person is disrupted. The psychological factors have effective role in physical health and in compliance with health behaviors. Having health-promoting behaviors are an important and significant strategy for the prevention of infectious diseases during the 20th and 21st centuries. In this study, we aim to evaluate the mediating role of cognitive emotion regulation in the relationship between stress coping styles and health- promoting behaviors during the COVID-19 pandemic.
Methods
This is a descriptive correlational study suing structural equation modeling (SEM). The study population consists of all people over 15 years of age in Bandar Abbas, Iran in 2020. Of these, 306 people (212 females and 94 males) were selected using a convenience sampling method. The inclusion criteria were age >15 years, consent to participate in the study, and being the resident of Bandar Abbas city. The questionnaires (A demographic form, Folkman and Lazarus’ ways of coping questionnaire, Health-promoting lifestyle profile, and Garnefski et al.’s Cognitive Emotion Regulation Questionnaire) were first prepared online. Then, their links were sent to the participants on social media. After collecting data, they were analyzed.
Results
Based on the results, cognitive emotional regulation strategies negatively mediated the relationship between emotion-focused coping style and health-promoting behaviors, and positively mediated the relationship between problem-focused coping style and health- promoting behaviors (Table 1, Figure 1). The coping styles and cognitive emotion regulation strategies in total explained 65% of the variance in health- promoting behaviors.






Discussion
Based on the findings, maladaptive emotional regulation strategies, unlike adaptive emotional regulation strategies, mediated the relationship between stress coping and health-promoting behaviors in a positive and statistically significant way. Adaptive and maladaptive emotion regulation strategies positively and significantly mediated the relationship between problem-focused coping style and health- promoting behaviors. This is consistent with the results of Litzelman et al., and Sepah Mansour and Bagheri. Stress can be directly and indirectly related to health- promoting behaviors. When people try to cope with stress, they may engage in behaviors that provide short-term relief, such as smoking, drinking alcohol, or eating high-calorie or highly processed foods. Health-promoting behaviors improve stress management and health responsibility and reduce depression and anxiety. Emotion regulation is one of the basic factors of health and successful activity and plays an important role in adapting to stressful life events. People who can manage their emotions can more effectively engage in health- promoting behaviors. By regulating and managing their emotions, people can initiate positive and facilitating emotions, use effective social interaction strategies, and have flexibility in paying attention and making decisions under stressful conditions.
Ethical Considerations
Compliance with ethical guidelines
The present study is a research study approved by the code of ethics IR.IAU.BA.REC.1401.005.
Funding
This article has not received any financial support from public, private or non-profit organizations. The article is taken from the thesis of Mrs. Seyedah Serira Hashmipour in the Department of Psychology, PhD, Islamic Azad University, Bandar Abbas Branch.
Authors' contributions
Sampling and writing the article: Seyedah Serira Hashemipour; Editing of the article: Iqbal Zarei; Final review: Sholah Namazi and Azita Amirfakhrai.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors appreciate and thank the Islamic Azad University, Bandar Abbas branch for the preparation of this article.
 

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