Andrew Steptoe | University College London (original) (raw)

Papers by Andrew Steptoe

Research paper thumbnail of Trends in Smoking, Diet, Physical Exercise, and Attitudes toward Health in European University Students from 13 Countries, 1990–2000

Preventive Medicine, 2002

Smoking, diet, and physical exercise are key determinants of health. This study assessed changes ... more Smoking, diet, and physical exercise are key determinants of health. This study assessed changes over 10 years and their relationship to changes in health beliefs and risk awareness.

Research paper thumbnail of Gender differences in food choice: The contribution of health beliefs and dieting

Annals of Behavioral Medicine, 2004

Background: Gender differences in health behaviors have been reported in many studies but causal ... more Background: Gender differences in health behaviors have been reported in many studies but causal mechanisms have been neglected.Purpose and Methods: This study examines 4 food choice behaviors in a large sample of young adults from 23 countries and tests 2 possible explanatory mechanisms for the gender differences—women’s greater likelihood of dieting and women’s greater beliefs in the importance of healthy diets.Results: Women were more likely than men to report avoiding high-fat foods, eating fruit and fiber, and limiting salt (to a lesser extent) in almost all of the 23 countries. They were also more likely to be dieting and attached greater importance to healthy eating. Dieting status explained around 22% of the gender difference in fat choices, 23% of fiber choices, and 7% of fruit, but none of the gender difference in salt. Health beliefs explained around 40% of the differences in each of the dietary behaviors and together they explained almost 50%. Gender differences in food choices therefore appear to be partly attributable to women’s greater weight control involvement and partly to their stronger belifs in healthy eating.Conclusions: Further research is needed to understand the additional factors that could promote men’s participation in simple healthy eating practices.

Research paper thumbnail of Stress, social support and health-related behavior: A study of smoking, alcohol consumption and physical exercise

Journal of Psychosomatic Research, 1996

The effects of academic examination stress on health behavior was assessed in university students... more The effects of academic examination stress on health behavior was assessed in university students. It was hypothesized that the anticipation of examinations would lead to increases in cigarette smoking and alcohol consumption, and to decreases in physical activity, and that effects would be particularly salient in students with low social supports. One hundred eighty students were divided into exam-stress (51 women, 64 men) and control (49 women, 16 men) groups, and were assessed at baseline and then within 2 weeks of exams, or an equivalent point for the control group. Perceived stress, emotional well-being and health behaviors were assessed by questionnaire and interview. The exam-stress group reported significant increases in perceived stress and emotional distress between baseline and exam sessions, but responses were not affected by social support availability. The controls showed no systematic changes in health behaviors. In the exam-stress group, smoking increased by an average of 54.7% between sessions in women with few social supports, but remained stable in men. There was a decrease in alcohol consumption of 17.5% in students with high social support between sessions, while those with low social supports showed an average increase of 18.5%. Physical activity decreased between baseline and exam sessions in the exam-stress group, but was not affected by social support. The results are discussed in relation to the effects of naturally occurring episodic stress on health behaviors, and the role of social support in moderating responses.

Research paper thumbnail of Development of a Measure of the Motives Underlying the Selection of Food: the Food Choice Questionnaire

Appetite, 1995

A number of factors are thought to influence people's dietary choices, including health, cost, co... more A number of factors are thought to influence people's dietary choices, including health, cost, convenience and taste, but there are no measures that address healthrelated and non-health-related factors in a systematic fashion. This paper describes the development of a multidimensional measure of motives related to food choice. The Food Choice Questionnaire (FCQ) was developed through factor analysis of responses from a sample of 358 adults ranging in age from 18 to 87 years. Nine factors emerged, and were labelled health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity and ethical concern. The questionnaire structure was verified using confirmatory factor analysis in a second sample (n=358), and test-retest reliability over a 2-to 3-week period was satisfactory. Convergent validity was investigated by testing associations between FCQ scales and measures of dietary restraint, eating style, the value of health, health locus of control and personality factors. Differences in motives for food choice associated with sex, age and income were found. The potential uses of this measure in health psychology and other areas are discussed.

Research paper thumbnail of The effects of exercise training on mental well-being in the normal population: A controlled trial

Journal of Psychosomatic Research, 1989

This study was designed to compare

Research paper thumbnail of The effects of exercise training on mood and perceived coping ability in anxious adults from the general population

Journal of Psychosomatic Research, 1989

A comparison was carried out of the psychological effects of a moderate aerobic training programm... more A comparison was carried out of the psychological effects of a moderate aerobic training programme (n = 24) and an attention-placebo strength and flexibility training programme (n = 23) in previously inactive anxious adults from the general population.

Research paper thumbnail of Leisure-Time Physical Exercise: Prevalence, Attitudinal Correlates, and Behavioral Correlates among Young Europeans from 21 Countries

Preventive Medicine, 1997

Background. Increasing leisure time physical exercise is a major target of public health programs... more Background. Increasing leisure time physical exercise is a major target of public health programs throughout the developed world, but few international comparisons of exercise habits among people from diverse cultures have been published. The objectives of this study were to assess the prevalence of exercise among young adults from 21 European countries, to analyze associations with health beliefs and risk awareness, and to investigate relationships among exercise, other health-related behaviors, and emotional well-being.

Research paper thumbnail of Stress, dietary restraint and food intake

Journal of Psychosomatic Research, 2000

Objective: The purpose of this study was to examine the the longitudinal analyses, and the modera... more Objective: The purpose of this study was to examine the the longitudinal analyses, and the moderating effects of gender and restrained eating were examined. High-workload periods associations between work stress and nutritional status in relation to dietary restraint in a community sample of adults.

Research paper thumbnail of Depressive symptoms, social support, and personal health behaviors in young men and women

Health Psychology, 2001

This study investigated the relationship of depressive symptoms, social support, and a range of p... more This study investigated the relationship of depressive symptoms, social support, and a range of personal health behaviors in 2,091 male and 3,438 female university students from 16 countries. Depressive symptoms and social support were measured using the short Beck Depression Inventory and the Social Support Questionnaire; 9 personal health behaviors were also assessed. After the authors took age, social support, and clustering by country into account, depressive symptoms were significantly associated with lack of physical activity, not eating breakfast, irregular sleep hours, and not using a seat belt in both men and women, and additionally with smoking, not eating fruit, and not using sunscreen among women. Low social support was independently associated with low alcohol consumption, lack of physical activity, irregular sleep hours, and not using a seat belt in men and women. Bidirectional causal pathways are likely to link health behaviors with depressed mood.

Research paper thumbnail of Socioeconomic differences in attitudes and beliefs about healthy lifestyles

Journal of Epidemiology and Community Health, 2003

Study objectives: The factors underlying socioeconomic status differences in smoking, leisure tim... more Study objectives: The factors underlying socioeconomic status differences in smoking, leisure time physical activity, and dietary choice are poorly understood. This study investigated attitudes and beliefs that might underlie behavioural choices, including health locus of control, future salience, subjective life expectancy, and health consciousness, in a nationally representative sample. Design: Data were collected as part of the monthly Omnibus survey of the Office of National Statistics in Britain. Participants: A stratified, probability sample of 2728 households was selected by random sampling of addresses. One adult from each household was interviewed. Main results: Higher SES respondents were less likely to smoke and more likely to exercise and eat fruit and vegetables daily. Lower SES was associated with less health consciousness (thinking about things to do to keep healthy), stronger beliefs in the influence of chance on health, less thinking about the future, and lower life expectancies. These attitudinal factors were in turn associated with unhealthy behavioural choices, independently of age, sex, and self rated health. Conclusions: Socioeconomic differences in healthy lifestyles are associated with differences in attitudes to health that may themselves arise through variations in life opportunities and exposure to material hardship and ill health over the life course.

Research paper thumbnail of Mental Stress Induces Transient Endothelial Dysfunction in Humans

Research paper thumbnail of An investigation of coping strategies associated with job stress in teachers

British Journal of Educational Psychology, 1999

Research paper thumbnail of The European health and behaviour survey: Rationale, methods and initial results from the United Kingdom

Social Science & Medicine, 1991

The aim of this study was to assess a wide range of health-related behaviours, beliefs concerning... more The aim of this study was to assess a wide range of health-related behaviours, beliefs concerning the importance of behaviours for health, and health knowledge, using a standardized protocol suitable for translation and administration in different countries of Europe. An inventory was developed from previous literature for the assessment of substance use, positive health practices, diet and eating habits, driving behaviour and preventive health care, beliefs concerning the importance of 25 activities for health, and knowledge about the influence of seven factors (including smoking, alcohol and diet) on major diseases. The first phase of the study involved administration of the inventory to approximately 200 male and 200 female university students aged 18-30 in 20 European countries. This report concerns data collected from 419 students in the U.K., together with analyses of short-term response stability.

Research paper thumbnail of An international comparison of tobacco smoking, beliefs and risk awareness in university students from 23 countries

Addiction, 2002

Aims To assess the prevalence of current tobacco smoking, associations with beliefs about the he... more Aims To assess the prevalence of current tobacco smoking, associations with beliefs about the health benefits of not smoking and awareness of risks for lung cancer and heart disease in university students sampled from 23 countries, and to explore the utility of the World Health Organization (WHO) model of the world-wide tobacco epidemic in understanding differences between countries.Design Anonymous questionnaire survey.Participants A total of 19 298 university students (8482 men, 10 816 women) aged 17–30 years from 23 countries, studying courses unrelated to health.Measurements Standardized measures of smoking, wish to stop smoking, ratings of beliefs in the importance of not smoking for health and awareness of the influence of smoking on lung cancer and heart disease.Findings Prevalence varied widely, being highest in samples from South European countries and lowest in developing countries (Thailand, South Africa). The pattern of tobacco use and differences between men and women conformed largely to the WHO model. Health beliefs were associated strongly with smoking behaviour both within and between countries. Awareness of specific health risks of smoking was very variable, with particularly low levels in Asian, South American and developing country samples. Risk awareness was inconsistently related to behaviour.Conclusions The pattern of tobacco smoking in well-educated young adults appears to conform with wider international patterns of tobacco use. Awareness of specific health risks is poor, and modifying attitudes must be a central element in modifying tobacco use world-wide.

Research paper thumbnail of Stability and changes in health behaviours in young adults over a one year period

Psychology & Health, 1995

Page 1. Psychology and Health, 1995. Vol. 10, pp. 155-169 Reprints available directly from the Pu... more Page 1. Psychology and Health, 1995. Vol. 10, pp. 155-169 Reprints available directly from the Publisher Photocopying permitted by license only 0 1995 Harwood Academic Publishers GmbH Printed in Malaysia STABILITY AND CHANGES IN HEALTH ...

Research paper thumbnail of Job strain and anger expression predict early morning elevations in salivary cortisol

The objectives of this study were to test the hypothesis that high job demands and low job contro... more The objectives of this study were to test the hypothesis that high job demands and low job control (job strain) are associated with elevated free cortisol levels early in the working day and with reduced variability across the day and to evaluate the contribution of anger expression to this pattern. One hundred five school teachers (41 men and 64 women) classified 12 months earlier as high (N = 48) or low (N = 57) in job strain according to the demand/control model sampled saliva at 2-hour intervals from 8:00 to 8:30 hours to 22:00 to 22:30 hours on a working day. Anger expression was assessed with the Speilberger State-Trait Anger Expression Inventory, and negative affect was also measured. Free cortisol was significantly elevated at 8:00 to 8:30 hours in the high job strain group but not at later times of the day or evening. After adjustment for age and negative affect, cortisol was an average of 21.7% higher early in the working day in the high job strain group. This effect was significantly greater in high job strain teachers, who also reported high anger-out. The cortisol decline from morning to evening was greater in the high than low job strain individuals. Independently of job strain, women had a higher cortisol concentration at 8:00 to 8:30 hours than men, whereas cortisol concentration was greater in men than women in the middle of the working day between 12:00 and 16:30 hours. Job strain is associated with elevated free cortisol concentrations early in the working day but not with reduced cortisol variability. The interaction with outward anger expression suggests that individual characteristics modulate the impact of chronic work stress on the hypothalamic-pituitary-adrenocortical system.

Research paper thumbnail of Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes

Proceedings of The National Academy of Sciences, 2005

Negative affective states such as depression are associated with premature mortality and increase... more Negative affective states such as depression are associated with premature mortality and increased risk of coronary heart disease, type 2 diabetes, and disability. It has been suggested that positive affective states are protective, but the pathways through which such effects might be mediated are poorly understood. Here we show that positive affect in middle-aged men and women is associated with reduced neuroendocrine, inflammatory, and cardiovascular activity. Positive affect was assessed by aggregating momentary experience samples of happiness over a working day and was inversely related to cortisol output over the day, independently of age, gender, socioeconomic position, body mass, and smoking. Similar patterns were observed on a leisure day. Happiness was also inversely related to heart rate assessed by using ambulatory monitoring methods over the day. Participants underwent mental stress testing in the laboratory, where plasma fibrinogen stress responses were smaller in happier individuals. These effects were independent of psychological distress, supporting the notion that positive well-being is directly related to health-relevant biological processes.

Research paper thumbnail of Differences in cortisol awakening response on work days and weekends in women and men from the Whitehall II cohort

Psychoneuroendocrinology, 2004

It is thought that the salivary cortisol awakening response can serve as a reliable marker of hyp... more It is thought that the salivary cortisol awakening response can serve as a reliable marker of hypothalamic-pituitary-adrenocortical activity. Response magnitude might be influenced by stress, but results of studies on work-related stress have been inconclusive. Non-compliance with the sampling schedule is a potential confounding factor that has rarely been controlled. The objective of the study was to determine whether the cortisol awakening response is greater on a work day than on a weekend day, and whether responses vary with gender and socioeconomic position. Compliance was controlled by excluding participants who reported a delay of more than 10 min between waking up and taking the first saliva sample. Data were collected from 196 men and women aged 47 to 59 years drawn from the Whitehall II cohort of British civil servants, with free salivary cortisol sampled immediately after waking up and 30 min later on 2 days. Data on stress, perceived control and happiness over the remainder of the day, and on sleep quality, time of waking, and health behaviour were also obtained. The awakening response was lower in non-compliant participants than in compliant ones, so noncompliant participants were excluded from further analyses. Salivary cortisol levels on waking did not differ by gender or socioeconomic position, or between work and weekend days. However, the cortisol awakening response (defined as the difference between waking and 30 min later) was greater on work than weekend days (mean increases 10.5 and 3.7 nmol/l, P Ͻ 0.001). On the work day, women showed larger increases than men (P = 0.011), but there were no gender differences on the weekend day. Across both days, lower socioeconomic position was associated with a larger cortisol awakening response (P = 0.014). Time of waking up was not related to the cortisol awakening response on either day. Participants rated themselves as more stressed, less in control, and less happy over the remainder of the work than weekend day. These results indicate that the cortisol awakening response occurs on both work and non-work days, but that anticipation of the working day is associated with an enhanced response. Cortisol output over the early part of the day may be particularly sensitive to the influence of chronic stress and its anticipation, especially in women. 

Research paper thumbnail of Satisfaction with communication, medical knowledge, and coping style in patients with metastatic cancer

Social Science & Medicine, 1991

Interviews were conducted with 77 patients aged 19-84, admitted to a medical oncology ward for as... more Interviews were conducted with 77 patients aged 19-84, admitted to a medical oncology ward for assessment and modification of treatment. Satisfaction with information provided about tests, symptoms and treatment was assessed, together with satisfaction with care in general, factual knowledge concerning cancer and other medical conditions, and anxiety. Habitual style of coping with stress by information-seeking vs avoidance was measured using the Miller Behavioral Style Scale. Satisfaction levels were generally high. Patients reporting the highest level of satisfaction with information were more avoidant in their coping style than the remainder, and were also less anxious. Factual knowledge about cancer was in contrast greater among patients who were less satisfied with communication. These patterns were not dependent on age or education. It is argued that satisfaction with communication in medical settings is not a simple function of communication skills and the provision of adequately structured information, but that patients' tendencies to cope with stress by seeking out or avoiding information need to be taken into account.

Research paper thumbnail of Trends in Smoking, Diet, Physical Exercise, and Attitudes toward Health in European University Students from 13 Countries, 1990–2000

Preventive Medicine, 2002

Smoking, diet, and physical exercise are key determinants of health. This study assessed changes ... more Smoking, diet, and physical exercise are key determinants of health. This study assessed changes over 10 years and their relationship to changes in health beliefs and risk awareness.

Research paper thumbnail of Gender differences in food choice: The contribution of health beliefs and dieting

Annals of Behavioral Medicine, 2004

Background: Gender differences in health behaviors have been reported in many studies but causal ... more Background: Gender differences in health behaviors have been reported in many studies but causal mechanisms have been neglected.Purpose and Methods: This study examines 4 food choice behaviors in a large sample of young adults from 23 countries and tests 2 possible explanatory mechanisms for the gender differences—women’s greater likelihood of dieting and women’s greater beliefs in the importance of healthy diets.Results: Women were more likely than men to report avoiding high-fat foods, eating fruit and fiber, and limiting salt (to a lesser extent) in almost all of the 23 countries. They were also more likely to be dieting and attached greater importance to healthy eating. Dieting status explained around 22% of the gender difference in fat choices, 23% of fiber choices, and 7% of fruit, but none of the gender difference in salt. Health beliefs explained around 40% of the differences in each of the dietary behaviors and together they explained almost 50%. Gender differences in food choices therefore appear to be partly attributable to women’s greater weight control involvement and partly to their stronger belifs in healthy eating.Conclusions: Further research is needed to understand the additional factors that could promote men’s participation in simple healthy eating practices.

Research paper thumbnail of Stress, social support and health-related behavior: A study of smoking, alcohol consumption and physical exercise

Journal of Psychosomatic Research, 1996

The effects of academic examination stress on health behavior was assessed in university students... more The effects of academic examination stress on health behavior was assessed in university students. It was hypothesized that the anticipation of examinations would lead to increases in cigarette smoking and alcohol consumption, and to decreases in physical activity, and that effects would be particularly salient in students with low social supports. One hundred eighty students were divided into exam-stress (51 women, 64 men) and control (49 women, 16 men) groups, and were assessed at baseline and then within 2 weeks of exams, or an equivalent point for the control group. Perceived stress, emotional well-being and health behaviors were assessed by questionnaire and interview. The exam-stress group reported significant increases in perceived stress and emotional distress between baseline and exam sessions, but responses were not affected by social support availability. The controls showed no systematic changes in health behaviors. In the exam-stress group, smoking increased by an average of 54.7% between sessions in women with few social supports, but remained stable in men. There was a decrease in alcohol consumption of 17.5% in students with high social support between sessions, while those with low social supports showed an average increase of 18.5%. Physical activity decreased between baseline and exam sessions in the exam-stress group, but was not affected by social support. The results are discussed in relation to the effects of naturally occurring episodic stress on health behaviors, and the role of social support in moderating responses.

Research paper thumbnail of Development of a Measure of the Motives Underlying the Selection of Food: the Food Choice Questionnaire

Appetite, 1995

A number of factors are thought to influence people's dietary choices, including health, cost, co... more A number of factors are thought to influence people's dietary choices, including health, cost, convenience and taste, but there are no measures that address healthrelated and non-health-related factors in a systematic fashion. This paper describes the development of a multidimensional measure of motives related to food choice. The Food Choice Questionnaire (FCQ) was developed through factor analysis of responses from a sample of 358 adults ranging in age from 18 to 87 years. Nine factors emerged, and were labelled health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity and ethical concern. The questionnaire structure was verified using confirmatory factor analysis in a second sample (n=358), and test-retest reliability over a 2-to 3-week period was satisfactory. Convergent validity was investigated by testing associations between FCQ scales and measures of dietary restraint, eating style, the value of health, health locus of control and personality factors. Differences in motives for food choice associated with sex, age and income were found. The potential uses of this measure in health psychology and other areas are discussed.

Research paper thumbnail of The effects of exercise training on mental well-being in the normal population: A controlled trial

Journal of Psychosomatic Research, 1989

This study was designed to compare

Research paper thumbnail of The effects of exercise training on mood and perceived coping ability in anxious adults from the general population

Journal of Psychosomatic Research, 1989

A comparison was carried out of the psychological effects of a moderate aerobic training programm... more A comparison was carried out of the psychological effects of a moderate aerobic training programme (n = 24) and an attention-placebo strength and flexibility training programme (n = 23) in previously inactive anxious adults from the general population.

Research paper thumbnail of Leisure-Time Physical Exercise: Prevalence, Attitudinal Correlates, and Behavioral Correlates among Young Europeans from 21 Countries

Preventive Medicine, 1997

Background. Increasing leisure time physical exercise is a major target of public health programs... more Background. Increasing leisure time physical exercise is a major target of public health programs throughout the developed world, but few international comparisons of exercise habits among people from diverse cultures have been published. The objectives of this study were to assess the prevalence of exercise among young adults from 21 European countries, to analyze associations with health beliefs and risk awareness, and to investigate relationships among exercise, other health-related behaviors, and emotional well-being.

Research paper thumbnail of Stress, dietary restraint and food intake

Journal of Psychosomatic Research, 2000

Objective: The purpose of this study was to examine the the longitudinal analyses, and the modera... more Objective: The purpose of this study was to examine the the longitudinal analyses, and the moderating effects of gender and restrained eating were examined. High-workload periods associations between work stress and nutritional status in relation to dietary restraint in a community sample of adults.

Research paper thumbnail of Depressive symptoms, social support, and personal health behaviors in young men and women

Health Psychology, 2001

This study investigated the relationship of depressive symptoms, social support, and a range of p... more This study investigated the relationship of depressive symptoms, social support, and a range of personal health behaviors in 2,091 male and 3,438 female university students from 16 countries. Depressive symptoms and social support were measured using the short Beck Depression Inventory and the Social Support Questionnaire; 9 personal health behaviors were also assessed. After the authors took age, social support, and clustering by country into account, depressive symptoms were significantly associated with lack of physical activity, not eating breakfast, irregular sleep hours, and not using a seat belt in both men and women, and additionally with smoking, not eating fruit, and not using sunscreen among women. Low social support was independently associated with low alcohol consumption, lack of physical activity, irregular sleep hours, and not using a seat belt in men and women. Bidirectional causal pathways are likely to link health behaviors with depressed mood.

Research paper thumbnail of Socioeconomic differences in attitudes and beliefs about healthy lifestyles

Journal of Epidemiology and Community Health, 2003

Study objectives: The factors underlying socioeconomic status differences in smoking, leisure tim... more Study objectives: The factors underlying socioeconomic status differences in smoking, leisure time physical activity, and dietary choice are poorly understood. This study investigated attitudes and beliefs that might underlie behavioural choices, including health locus of control, future salience, subjective life expectancy, and health consciousness, in a nationally representative sample. Design: Data were collected as part of the monthly Omnibus survey of the Office of National Statistics in Britain. Participants: A stratified, probability sample of 2728 households was selected by random sampling of addresses. One adult from each household was interviewed. Main results: Higher SES respondents were less likely to smoke and more likely to exercise and eat fruit and vegetables daily. Lower SES was associated with less health consciousness (thinking about things to do to keep healthy), stronger beliefs in the influence of chance on health, less thinking about the future, and lower life expectancies. These attitudinal factors were in turn associated with unhealthy behavioural choices, independently of age, sex, and self rated health. Conclusions: Socioeconomic differences in healthy lifestyles are associated with differences in attitudes to health that may themselves arise through variations in life opportunities and exposure to material hardship and ill health over the life course.

Research paper thumbnail of Mental Stress Induces Transient Endothelial Dysfunction in Humans

Research paper thumbnail of An investigation of coping strategies associated with job stress in teachers

British Journal of Educational Psychology, 1999

Research paper thumbnail of The European health and behaviour survey: Rationale, methods and initial results from the United Kingdom

Social Science & Medicine, 1991

The aim of this study was to assess a wide range of health-related behaviours, beliefs concerning... more The aim of this study was to assess a wide range of health-related behaviours, beliefs concerning the importance of behaviours for health, and health knowledge, using a standardized protocol suitable for translation and administration in different countries of Europe. An inventory was developed from previous literature for the assessment of substance use, positive health practices, diet and eating habits, driving behaviour and preventive health care, beliefs concerning the importance of 25 activities for health, and knowledge about the influence of seven factors (including smoking, alcohol and diet) on major diseases. The first phase of the study involved administration of the inventory to approximately 200 male and 200 female university students aged 18-30 in 20 European countries. This report concerns data collected from 419 students in the U.K., together with analyses of short-term response stability.

Research paper thumbnail of An international comparison of tobacco smoking, beliefs and risk awareness in university students from 23 countries

Addiction, 2002

Aims To assess the prevalence of current tobacco smoking, associations with beliefs about the he... more Aims To assess the prevalence of current tobacco smoking, associations with beliefs about the health benefits of not smoking and awareness of risks for lung cancer and heart disease in university students sampled from 23 countries, and to explore the utility of the World Health Organization (WHO) model of the world-wide tobacco epidemic in understanding differences between countries.Design Anonymous questionnaire survey.Participants A total of 19 298 university students (8482 men, 10 816 women) aged 17–30 years from 23 countries, studying courses unrelated to health.Measurements Standardized measures of smoking, wish to stop smoking, ratings of beliefs in the importance of not smoking for health and awareness of the influence of smoking on lung cancer and heart disease.Findings Prevalence varied widely, being highest in samples from South European countries and lowest in developing countries (Thailand, South Africa). The pattern of tobacco use and differences between men and women conformed largely to the WHO model. Health beliefs were associated strongly with smoking behaviour both within and between countries. Awareness of specific health risks of smoking was very variable, with particularly low levels in Asian, South American and developing country samples. Risk awareness was inconsistently related to behaviour.Conclusions The pattern of tobacco smoking in well-educated young adults appears to conform with wider international patterns of tobacco use. Awareness of specific health risks is poor, and modifying attitudes must be a central element in modifying tobacco use world-wide.

Research paper thumbnail of Stability and changes in health behaviours in young adults over a one year period

Psychology & Health, 1995

Page 1. Psychology and Health, 1995. Vol. 10, pp. 155-169 Reprints available directly from the Pu... more Page 1. Psychology and Health, 1995. Vol. 10, pp. 155-169 Reprints available directly from the Publisher Photocopying permitted by license only 0 1995 Harwood Academic Publishers GmbH Printed in Malaysia STABILITY AND CHANGES IN HEALTH ...

Research paper thumbnail of Job strain and anger expression predict early morning elevations in salivary cortisol

The objectives of this study were to test the hypothesis that high job demands and low job contro... more The objectives of this study were to test the hypothesis that high job demands and low job control (job strain) are associated with elevated free cortisol levels early in the working day and with reduced variability across the day and to evaluate the contribution of anger expression to this pattern. One hundred five school teachers (41 men and 64 women) classified 12 months earlier as high (N = 48) or low (N = 57) in job strain according to the demand/control model sampled saliva at 2-hour intervals from 8:00 to 8:30 hours to 22:00 to 22:30 hours on a working day. Anger expression was assessed with the Speilberger State-Trait Anger Expression Inventory, and negative affect was also measured. Free cortisol was significantly elevated at 8:00 to 8:30 hours in the high job strain group but not at later times of the day or evening. After adjustment for age and negative affect, cortisol was an average of 21.7% higher early in the working day in the high job strain group. This effect was significantly greater in high job strain teachers, who also reported high anger-out. The cortisol decline from morning to evening was greater in the high than low job strain individuals. Independently of job strain, women had a higher cortisol concentration at 8:00 to 8:30 hours than men, whereas cortisol concentration was greater in men than women in the middle of the working day between 12:00 and 16:30 hours. Job strain is associated with elevated free cortisol concentrations early in the working day but not with reduced cortisol variability. The interaction with outward anger expression suggests that individual characteristics modulate the impact of chronic work stress on the hypothalamic-pituitary-adrenocortical system.

Research paper thumbnail of Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes

Proceedings of The National Academy of Sciences, 2005

Negative affective states such as depression are associated with premature mortality and increase... more Negative affective states such as depression are associated with premature mortality and increased risk of coronary heart disease, type 2 diabetes, and disability. It has been suggested that positive affective states are protective, but the pathways through which such effects might be mediated are poorly understood. Here we show that positive affect in middle-aged men and women is associated with reduced neuroendocrine, inflammatory, and cardiovascular activity. Positive affect was assessed by aggregating momentary experience samples of happiness over a working day and was inversely related to cortisol output over the day, independently of age, gender, socioeconomic position, body mass, and smoking. Similar patterns were observed on a leisure day. Happiness was also inversely related to heart rate assessed by using ambulatory monitoring methods over the day. Participants underwent mental stress testing in the laboratory, where plasma fibrinogen stress responses were smaller in happier individuals. These effects were independent of psychological distress, supporting the notion that positive well-being is directly related to health-relevant biological processes.

Research paper thumbnail of Differences in cortisol awakening response on work days and weekends in women and men from the Whitehall II cohort

Psychoneuroendocrinology, 2004

It is thought that the salivary cortisol awakening response can serve as a reliable marker of hyp... more It is thought that the salivary cortisol awakening response can serve as a reliable marker of hypothalamic-pituitary-adrenocortical activity. Response magnitude might be influenced by stress, but results of studies on work-related stress have been inconclusive. Non-compliance with the sampling schedule is a potential confounding factor that has rarely been controlled. The objective of the study was to determine whether the cortisol awakening response is greater on a work day than on a weekend day, and whether responses vary with gender and socioeconomic position. Compliance was controlled by excluding participants who reported a delay of more than 10 min between waking up and taking the first saliva sample. Data were collected from 196 men and women aged 47 to 59 years drawn from the Whitehall II cohort of British civil servants, with free salivary cortisol sampled immediately after waking up and 30 min later on 2 days. Data on stress, perceived control and happiness over the remainder of the day, and on sleep quality, time of waking, and health behaviour were also obtained. The awakening response was lower in non-compliant participants than in compliant ones, so noncompliant participants were excluded from further analyses. Salivary cortisol levels on waking did not differ by gender or socioeconomic position, or between work and weekend days. However, the cortisol awakening response (defined as the difference between waking and 30 min later) was greater on work than weekend days (mean increases 10.5 and 3.7 nmol/l, P Ͻ 0.001). On the work day, women showed larger increases than men (P = 0.011), but there were no gender differences on the weekend day. Across both days, lower socioeconomic position was associated with a larger cortisol awakening response (P = 0.014). Time of waking up was not related to the cortisol awakening response on either day. Participants rated themselves as more stressed, less in control, and less happy over the remainder of the work than weekend day. These results indicate that the cortisol awakening response occurs on both work and non-work days, but that anticipation of the working day is associated with an enhanced response. Cortisol output over the early part of the day may be particularly sensitive to the influence of chronic stress and its anticipation, especially in women. 

Research paper thumbnail of Satisfaction with communication, medical knowledge, and coping style in patients with metastatic cancer

Social Science & Medicine, 1991

Interviews were conducted with 77 patients aged 19-84, admitted to a medical oncology ward for as... more Interviews were conducted with 77 patients aged 19-84, admitted to a medical oncology ward for assessment and modification of treatment. Satisfaction with information provided about tests, symptoms and treatment was assessed, together with satisfaction with care in general, factual knowledge concerning cancer and other medical conditions, and anxiety. Habitual style of coping with stress by information-seeking vs avoidance was measured using the Miller Behavioral Style Scale. Satisfaction levels were generally high. Patients reporting the highest level of satisfaction with information were more avoidant in their coping style than the remainder, and were also less anxious. Factual knowledge about cancer was in contrast greater among patients who were less satisfied with communication. These patterns were not dependent on age or education. It is argued that satisfaction with communication in medical settings is not a simple function of communication skills and the provision of adequately structured information, but that patients' tendencies to cope with stress by seeking out or avoiding information need to be taken into account.