Education and smoking: confounding or effect modification by phenotypic personality traits?

Untangling the relationship between smoking and systemic sclerosis: an analysis of the EUSTAR cohort

OBJECTIVES

To untangle the association between smoking and systemic sclerosis (SSc).

METHODS

In the European Scleroderma Trials and Research cohort, the autoantibody status was compared between ever-smokers and never-smokers. Time until disease progression was assessed using Kaplan-Meier curves. Cox models were built to investigate the influence of smoking over 15 years of follow-up. All analyses were performed for the total cohort and stratified for sex and for positivity of anti-centromere (ACA) and anti-topoisomerase antibodies (ATA).

RESULTS

Overall, 12 314 patients were included in the study. Of these, 10 393 were women (84%), 4637 were ACA-positive (38%), 3919 were ATA-positive (32%) and 4271 (35%) were ever-smokers. In men, but not in women, smoking was associated with mortality (HR 1.63, 95% CI 1.23 to 2.16, p=0.001). Ever-smoking women were at higher risk for skin progression (HR 1.10, 95% CI 1.00 to 1.22, p=0.046) and for 'any organ progression' (HR 1.07, 95% CI 1.00 to 1.13, p=0.036). In women, 34% of never-smokers were ATA-positive compared with 21% of ever-smokers (p<0.001). In the group of ever-smokers, higher exposure rates, reflected by the number of pack-years (OR 0.98, 95% CI 0.97 to 0.99, p<0.001) and by smoking duration (OR 0.96, 95% CI 0.95 to 0.97, p<0.001), were associated with lower frequency of ATA. In ACA-positive patients, the risk of mortality (HR 1.29, 95% CI 1.02 to 1.63, p=0.033), cardiac involvement (HR 1.25, 95% CI 1.03 to 1.43, p=0.001), skin progression (HR 1.21, 95% CI 1.03 to 1.42, p=0.018) and 'any organ progression' (HR 1.14, 95% CI 1.05 to 1.24, p=0.002) was increased among smokers. In ATA-positive smoking patients, mortality (HR 1.40, 95% CI 1.10 to 1.78, p=0.006), skin progression (HR 1.19, 95% CI 1.03 to 1.37, p=0.020) digital ulcers (HR 1.17, 95% CI 1.02 to 1.34, p=0.029) and 'any organ progression' (HR 1.11, 95% CI 1.00 to 1.22, p=0.048) occurred more frequently.

CONCLUSIONS

Our stratified analysis demonstrates that smoking is associated with an increased risk for mortality in male SSc patients but not in women. Strikingly, smoking is associated with lower prevalence of ATA positivity, in particular in women. In both ATA-positive and ACA-positive patients, smoking is a risk factor for mortality, skin progression and 'any organ progression'.

Trends in Health Behavior of Polish Women in 1986-2021: The Importance of Socioeconomic Status

In the last 35 years Poland has undergone a series of fundamental economic, social, and biological transformations. With the transition from a centrally planned to a free-market economy, a period of economic and social transformation, Poland's accession to the European Union, and the COVID-19 coronavirus pandemic, living conditions in the country have seen dramatic changes. The aim of this study was to assess whether there were changes in the basic health behaviors of Polish women, and if so, in what directions and with what strength, and whether there were differences in these changes depending on the socioeconomic status. Information on basic lifestyle factors (drinking alcohol, smoking, coffee drinking, and physical activity) and socioeconomic status (level of education, Gini coefficient, Gender Inequality Index, women total employment, employed women being in managerial positions, women among scientists) of 5806 women aged 40-50 years were analyzed. During the 1986-2021 period, based on the same methodology, team of technicians and research tools, six birth cohorts of women were examined in 1986, 1991, 1996, 2006, 2019 and 2021. Highly statistically significant changes were found in the frequencies of declared health behaviors from 1986-2021, according to the order of significance in coffee and alcohol consumption, physical activity levels, and smoking and smoking intensity. In subsequent cohorts, there were fewer and fewer women who did not drink coffee and alcohol, while more drank more than two cups of coffee a day and drank alcohol more often than 2× a week. Furthermore, they were more likely to be physically active, and slightly fewer were smokers. The lifestyles of the women were less likely to depend on their socio-economic status than the cohorts. In 1991 and 1996, there was a marked intensification of unhealthy behavior. Changes in the analyzed health behaviors may have been caused by adaptation to the high level of psychosocial stress observed during the transition of the 1986-2021 period and may result in changes in the biological condition and quality and length of life of Polish women. Research on social differences in health behavior provides an opportunity to analyze the biological effects of changes in the living environment.

Impact of COVID-19 lockdown on smoking (waterpipe and cigarette) and participants' BMI across various sociodemographic groups in Arab countries in the Mediterranean Region

INTRODUCTION

Tobacco smokers are at high risk of developing severe COVID-19. Lockdown was a chosen strategy to deal with the spread of infectious diseases; nonetheless, it influenced people's eating and smoking behaviors. The main objective of this study is to determine the impact of the COVID-19 lockdown on smoking (waterpipe and cigarette) behavior and its associations with sociodemographic characteristics and body mass index.

METHODS

The data were derived from a large-scale retrospective cross-sectional study using a validated online international survey from 38 countries (n=37207) conducted between 17 April and 25 June 2020. The Eastern Mediterranean Region (WHO-EMR countries) data related to 10 Arabic countries that participated in this survey have been selected for analysis in this study. A total of 12433 participants were included in the analysis of this study, reporting their smoking behavior and their BMI before and during the COVID-19 lockdown. Descriptive and regression analyses were conducted to examine the association between smoking practices and the participant's country of origin, sociodemographic characteristics, and BMI (kg/m²).

RESULTS

Overall, the prevalence rate of smoking decreased significantly during the lockdown from 29.8% to 23.5% (p<0.05). The percentage of females who smoke was higher than males among the studied population. The highest smoking prevalence was found in Lebanon (33.2%), and the lowest was in Oman (7.9%). In Egypt, Kuwait, Lebanon, and Saudi Arabia, the data showed a significant difference in the education level of smokers before and during the lockdown (p<0.05). Smokers in Lebanon had lower education levels than those in other countries, where the majority of smokers had a Bachelor's degree. The findings show that the BMI rates in Jordan, Lebanon, Oman, and Saudi Arabia significantly increased during the lockdown (p<0.05). The highest percentages of obesity among smokers before the lockdown were in Oman (33.3%), followed by Bahrain (28.4%) and Qatar (26.4%), whereas, during the lockdown, the percentage of obese smokers was highest in Bahrain (32.1%) followed by Qatar (31.3%) and Oman (25%). According to the logistic regression model, the odds ratio of smoking increased during the pandemic, whereas the odds ratio of TV watching decreased. This finding was statistically significant by age, gender, education level, country of residence, and work status.

CONCLUSIONS

Although the overall rates of smoking among the studied countries decreased during the lockdown period, we cannot attribute this change in smoking behavior to the lockdown. Smoking cessation services need to anticipate that unexpected disruptions, such as pandemic lockdowns, may be associated with changes in daily tobacco consumption. Public health authorities should promote the adoption of healthy lifestyles to reduce the long-term negative effects of the lockdown.

Big Five Personality and CTRA gene expression: Lack of association in a midlife sample of US adults (MIDUS-Refresher)

A previous study found that Extraversion and Conscientiousness were associated with increased and decreased expression of a pre-specified set of pro-inflammatory indicator genes. The present study aimed to replicate these findings in a sample of adults from the Refresher Cohort of the Study of Midlife in the United States (MIDUS). Analysis of gene expression composite scores and generalized linear models that took into account the heterogeneity and non-independence of RNA expression across different genes found no significant associations between the pro-inflammatory indicator gene set and the Big Five domains of personality. In addition, there was no significant association between a pre-specified antiviral indicator gene set and the Big Five domains. These findings suggest that relations between Big Five personality and expression of these two immune response indicator gene sets do not consistently appear across samples and may be context-dependent in ways that remain to be elucidated.

Negative affect among daily smokers: A systematic review and meta-analysis

BACKGROUND

Negative Affect (NA), as a personality trait is a tendency towards experiencing a more negative emotion. The body of research suggests that NA encourages smoking relapse and smoking as a reason for NA reduction, though. The likelihood of this connection does not seem to be bright yet. The present study critically reviews researches to synthesize the existing literature to determine the strength of this linkage.

METHODS

Key-word related research was systematically searched in PubMed, PsychINFO, Science Direct and Google Scholar for studies conducted from 1980 to 2019, followed by, the assessment and selection of retrieved studies based on defined inclusion criteria. A random-effects meta-analysis model was used to examine the prospective relationship between NA and smoking. Meta-regression was also used to dig for possible explanations of heterogeneity. Furthermore a multi-moderators model and sub-group analyses examined the moderating factors.

RESULTS

Forty effect-sizes comprising 12 cross-sectional studies, 28 longitudinal studies and 24,913 participants were included in the meta-analysis. The forest plot of the pooled correlation effect size in the random model indicates a significant effect size of the relationship between NA and smoking (r = 0.11; 95%CI 0.071-0.15, P = 0.001) in the meta-analysis with high heterogeneity (Q = 473.916; df=39; P = 0.001; I²=91.77%). Also, the pooled effect size was obtained as 0.143 (95%CI 0.071-0.214) for light-to-moderate and 0.112 (95%CI 0.057-0.166) for moderate-to-heavy smokers, with the effect size ranging from 0.061 to 0.195 which was significant among all subtypes, though this trend seem higher among adolescents, males, and longitudinal studies than in adults, females, and cross-sectional studies.

LIMITATIONS

The review was limited to English articles, and the heterogeneity of the studies were high.

CONCLUSION

These results support the notion that NA was positively and weakly linked to smoking and this linkage is stronger in light-to-moderate smokers, males, and adolescents. Theoretical and clinical implications are discussed with the aim of extending future directions on NA and smoking.

Scientific imperatives vis-à-vis growing inequality in America

A landmark article published in the American Psychologist (Adler et al., 1994) encouraged psychologists to engage in research on socioeconomic inequality and health. Numerous contributions followed to fill in psychosocial and behavioral pathways. Specifically, we review advances on health inequalities research from a large public-use study (Midlife in the United States [MIDUS]). The Great Recession of 2007 to 2009 and its lingering effects are then reviewed to underscore widening inequality in access to education, employment, and income. Two MIDUS national samples of same-aged adults recruited 2 decades apart are then compared to assess historical changes in socioeconomic, physical health, and well-being profiles from the 1990s to postrecession. Despite historical gains in educational attainment over time, we show that indicators of socioeconomic status, health, and well-being are more compromised in the postrecession sample relative to the 1990s sample. Building on these preliminary findings, we elaborate opportunities for further inquiry by the scientific community to examine whether widening socioeconomic inequalities exacerbated by the Great Recession translate to widening health inequalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Occupational Social Class and Personality Traits in Relation to Leisure-Time Physical Activity Level: Cross-Sectional Results From the Copenhagen Aging and Midlife Biobank

OBJECTIVE

To investigate separate and combined associations of occupational social class and personality traits with late midlife leisure-time physical activity duration and intensity.

METHOD

Cross-sectional data from the Copenhagen Aging and Midlife Biobank ( N = 4,649) were analyzed using linear regression models with leisure-time physical activity (metric equivalence) as outcome.

RESULTS

Low versus high occupational social class was associated with 4% (95% confidence interval [CI] = [3%, 5%]) greater leisure-time physical activity duration, but 2% (CI = [1%, 3%]) lower intensity. Each 10-unit increase in extraversion was associated with 5% (CI = [2%, 8%]) greater duration. Intensity increased by each 10-unit increase in conscientiousness (6%, CI = [4%, 7%]), openness (3%, CI = [1%, 4%]), neuroticism (3%, CI = [1%, 4%]), and extraversion (5%, CI = [4%, 7%]). Conscientiousness was positively associated with duration in low, but not in high, occupational social class (interaction p value = .002).

DISCUSSION

Higher occupational social class was associated with lower leisure-time physical activity duration, but higher intensity. Extraversion was positively associated with duration and intensity. Conscientiousness, openness, and neuroticism were positively associated with intensity. Overall, interactions were not consistent.

The associations of personality traits and parental education with smoking behaviour among adolescents

We examined whether personality traits and parental education are associated with smoking initiation in a sample of Spanish secondary school students. Participants, taken from the ITACA study (842 adolescents aged 14–15 years), completed a questionnaire assessing personality traits of the Five Factor Model, smoking behaviours and parental education. Multinomial logistic regression models controlling for age and sex were used to determine the independent associations and interactions of personality traits and parental education with risk of ever trying smoking, as well as with being a regular smoker in adolescence. Higher conscientiousness was related to a lower chance of trying smoking at least once (OR = 0.57, 95% CIs = 0.46, 0.71) as well as being a regular smoker (OR = 0.39, 95% CIs = 0.27, 0.55). Higher emotional instability (neuroticism) was associated with higher risk of being in either smoking category (OR = 1.33, 95% CIs = 1.10, 1.60 and OR = 1.76, 95% CIs = 1.31, 2.35, respectively). Higher extraversion was also associated with a higher risk of both types of smoking behaviour (OR = 1.38, 95% CIs = 1.12, 1.70 and OR = 2.43 (1.67, 3.55, respectively). Higher parental education was significantly related to lower risk of being a regular smoker (OR = 0.70, 95% CIs = 0.54, 0.89), but not with trying smoking in the past. Finally, we found no evidence of the interactions between adolescents’ personality and parental education in predicting adolescent smoking behaviours. We conclude that personality factors and parental education are important and independent factors associated with smoking behaviour in adolescents.

Childhood conscientiousness predicts the social gradient of smoking in adulthood: a life course analysis

BACKGROUND AND AIMS

The social gradient in smoking is well known, with higher rates among those in less advantaged socioeconomic position. Some recent research has reported that personality characteristics partly explain this gradient. However, the majority of existing work is limited by cross-sectional designs unsuitable to determine whether differences in conscientiousness are a predictor or a product of social inequalities. Adopting a life course perspective, we investigated in the current paper the influence of conscientiousness in early and mid-life on the social gradient in smoking and the role of potential confounding factors in a large longitudinal cohort study.

METHODS

Using data from the 1958 National Child Development Study, we examined the extent to which two measures of conscientiousness, one assessed with a personality questionnaire at age 50 and one derived from three related items at 16 years in childhood, explained the social gradient of smoking at age 50 by comparing nested logistic regression models that included social class at birth, cognitive ability, attention and conduct problems at age 7, and educational qualification.

RESULTS

Childhood conscientiousness was a significant predictor of smoking at 50 years (OR=0.86, CI (95%) 0.84 to 0.88), explaining 5.0% of the social gradient independent of all other variables. Childhood conscientiousness was a stronger predictor than adult conscientiousness, statistically accounting for the observed direct association of adult conscientiousness with smoking.

CONCLUSIONS

Conscientiousness may be a predictor rather than a product of social differences in smoking. Inclusion of personality measures and adoption of a life course perspective add significantly to our understanding of health inequalities.

Personality and smoking: individual-participant meta-analysis of nine cohort studies

AIMS

To investigate cross-sectional and longitudinal associations between personality and smoking, and test whether socio-demographic factors modify these associations.

DESIGN

Cross-sectional and longitudinal individual-participant meta-analysis.

SETTING

Nine cohort studies from Australia, Germany, the United Kingdom and the United States.

PARTICIPANTS

A total of 79 757 men and women (mean age = 50.8 years).

MEASUREMENTS

Personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness and openness to experience) were used as exposures. Outcomes were current smoking status (current smoker, ex-smoker and never smoker), smoking initiation, smoking relapse and smoking cessation. Associations between personality and smoking were modelled using logistic and multinomial logistic regression, and study-specific findings were combined using random-effect meta-analysis.

FINDINGS

Current smoking was associated with higher extraversion [odds ratio per 1 standard deviation increase in the score: 1.16; 95% confidence interval (CI) = 1.08-1.24], higher neuroticism (1.19; 95% CI = 1.13-1.26) and lower conscientiousness (95% CI = 0.88; 0.83-0.94). Among non-smokers, smoking initiation during the follow-up period was predicted prospectively by higher extraversion (1.22; 95% CI = 1.04-1.43) and lower conscientiousness (0.80; 95% CI = 0.68-0.93), whereas higher neuroticism (1.16; 95% CI = 1.04-1.30) predicted smoking relapse among ex-smokers. Among smokers, smoking cessation was negatively associated with neuroticism (0.91; 95% CI = 0.87-0.96). Socio-demographic variables did not appear to modify the associations between personality and smoking.

CONCLUSIONS

Adult smokers have higher extraversion, higher neuroticism and lower conscientiousness personality scores than non-smokers. Initiation into smoking is associated positively with higher extraversion and lower conscientiousness, while relapse to smoking among ex-smokers is associated with higher neuroticism.

The association of affective temperaments with smoking initiation and maintenance in adult primary care patients

BACKGROUND

Smoking behaviour and its course is influenced by personality factors. Affective temperaments could allow a more specific framework of the role trait affectivity plays in this seriously harmful health-behaviour. The aim of our study was to investigate if such an association exists in an ageing population with a special emphasis on gender differences.

METHODS

459 primary care patients completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Subjects were characterized according to their smoking behaviour as current, former or never smokers. Univariate analysis ANOVA and logistic regression were performed to analyse differences in the three smoking subgroups to predict smoking initiation and maintenance.

RESULTS

Current smokers were younger and less educated than former or never smokers. Males were more likely to try tobacco during their lifetime and were more successful in cessation. Depressive, cyclothymic and irritable temperament scores showed significant differences between the three smoking subgroups. Irritable temperament was a predictor of smoking initiation in females whereas depressive temperament predicted smoking maintenance in males with a small, opposite effect of HAM-A scores independent of age, education, lifetime depression and BDI scores. Whereas smoking initiation was exclusively predicted by a higher BDI score in males, smoking maintenance was predicted by younger age and lower education in females.

LIMITATIONS

The cross-sectional nature of the study design may lead to selective survival bias and hinder drawing causal relationships.

CONCLUSIONS

Affective temperaments contribute to smoking initiation and maintenance independently of age, education, and depression. The significant contribution of depressive temperament in males and irritable temperament in females may highlight the role of gender-discordant temperaments in vulnerable subgroups.

Culture, inequality, and health: evidence from the MIDUS and MIDJA comparison

This article seeks to forge scientific connections between three overarching themes (culture, inequality, health). Although the influence of cultural context on human experience has gained notable research prominence, it has rarely embraced another large arena of science focused on the influence social hierarchies have on how well and how long people live. That literature is increasingly focused psychosocial factors, working interactively with biological and brain-based mechanisms, to account for why those with low socioeconomic standing have poorer health. Our central question is whether and how these processes might vary by cultural context. We draw on emerging findings from two parallel studies, Midlife in the U.S. and Midlife in Japan, to illustrate the cultural specificity evident in how psychosocial and neurobiological factors are linked with each other as well as how position in social hierarchies matters for psychological experience and biology. We conclude with suggestions for future multidisciplinary research seeking to understand how social hierarchies matter for people's health, albeit in ways that may possibly differ across cultural contexts.

Personality-informed interventions for healthy aging: conclusions from a National Institute on Aging work group

We describe 2 frameworks in which personality dimensions relevant to health, such as Conscientiousness, can be used to inform interventions designed to promote health aging. First, contemporary data and theory do not suggest that personality is "immutable," but instead focus on questions of who changes, in what way, why, when, and how. In fact, the notion that personality could be changed was part and parcel of many schools of psychotherapy, which suggested that long-term and meaningful change in symptoms could not be achieved without change in relevant aspects of personality. We review intervention research documenting change in personality. On the basis of an integrative view of personality as a complex system, we describe a bottom-up model of change in which interventions to change basic personality processes eventuate in changes at the trait level. A 2nd framework leverages the descriptive and predictive power of personality to tailor individual risk prediction and treatment, as well as refine public health programs, to the relevant dispositional characteristics of the target population. These methods dovetail with, and add a systematic and rigorous psychosocial dimension to, the personalized medicine and patient-centeredness movements in medicine. In addition to improving health through earlier intervention and increased fit between treatments and persons, cost-effectiveness improvements can be realized by more accurate resource allocation. Numerous examples from the personality, health, and aging literature on Conscientiousness and other traits are provided throughout, and we conclude with a series of recommendations for research in these emerging areas.

Continued smoking and continued alcohol consumption during early pregnancy distinctively associated with personality

Pregnancy is a unique period to quit smoking and alcohol consumption and although motivated, not all women succeed at this. We investigated the associations of personality with continued smoking and continued alcohol consumption during early pregnancy. In addition, we studied whether antenatal anxiety and depressive symptoms can explain these associations. Two antenatal measurements from the population-based Pregnancy Anxiety and Depression cohort study were used. Pregnant women in their first trimester were recruited via midwifery practices and hospitals. We analyzed a sample of women who continued (n=101) or quit smoking (n=254), and a sample of women who continued (n=110) or quit alcohol consumption (n=1230). Measures included questions about smoking, alcohol consumption, the NEO-Five Factor Inventory (personality), the State Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. We found associations between continued alcohol consumption and higher levels of openness to experience, and lower levels of conscientiousness (p<0.05). The association between conscientiousness and continued alcohol consumption was partly explained by both anxiety and depressive symptoms. No associations between personality and continued smoking emerged. This study contributes to the limited literature on personality differences between women who continue and quit smoking and alcohol consumption during early pregnancy. General population studies have not confirmed the association between openness to experience and alcohol consumption which implies that pregnancy is indeed a unique period. Increased insight in how personality influences continued smoking and alcohol consumption during pregnancy can help health professionals to improve lifestyle interventions targeted at pregnant women.

An Association between Emotional Responsiveness and Smoking Behavior

Introduction. Emotional responsiveness (ER) has been theorized to play a protective role in pathways to tobacco initiation, regular use, and dependence, yet a possible association between ER and smoking behavior has not been studied. Our aim was to test whether measuring ER to a neutral stimulus was associated with decreased odds of current smoking. Methods. We measured ER and smoking status (current, former, and never) in two datasets: a cross-sectional dataset of persons with diabetes (n = 127) and a prospective dataset of depressed patients (n = 107) from an urban primary care system. Because there were few former smokers in the datasets, smoking status was dichotomized (current versus former/never) and measured at baseline (cross-sectional dataset) or at 36 weeks after-baseline (prospective dataset). ER was ascertained with response to a neutral facial expression (any ER versus none). Results. Compared to their nonresponsive counterparts, adjusted odds of current smoking were lower among participants endorsing emotional responsiveness in both the cross-sectional and prospective datasets (ORs = .29 and .32, P's <.02, resp.). Discussion. ER may be protective against current smoking behavior. Further research investigating the association between ER and decreased smoking may hold potential to inform treatment approaches to improve smoking prevalence.

Personality and physical functioning among older adults: the moderating role of education

OBJECTIVES

Drawing upon a vulnerability model, this study tested whether low educational level would amplify the negative contribution of risky personality traits, such as high neuroticism and low conscientiousness, on older adults physical functioning.

METHOD

Five hundred and thirteen French-speaking community-dwelling older adults aged 60-91 years (mean age = 66.37, SD = 5.32) completed measures of physical functioning, education, personality traits, chronic conditions, and demographic variables.

RESULTS

Results revealed that extraversion and conscientiousness were positively associated with physical functioning, whereas neuroticism was a negative predictor, beyond demographics, chronic conditions, and education. The negative relationship between neuroticism and physical functioning was stronger among individuals with low educational level and was nonsignificant among older people with higher level of education.

DISCUSSION

This study is the first to support a vulnerability model, which entails an amplification of neuroticism risk at low education, but a diminishment of neuroticism risk for activity limitations at high education. As a whole, it appears that a focus on either personality or education without taking into account each other provides only a partial account of the predictors of basic daily physical activities in old age.

Psychosocial stressors and cigarette smoking among African American adults in midlife

INTRODUCTION

Psychosocial stress is a significant risk factor for smoking, and Blacks experience higher levels of psychosocial stress relative to other racial/ethnic groups. Limited research has comprehensively examined psychosocial stressors in relation to smoking among Blacks.

METHODS

We examined psychosocial stressors in relation to smoking status (current, previous, and never) in middle-aged Blacks (34-85 years, n = 592) from Milwaukee, Wisconsin, a subset of the Midlife in the United States Study II (2004-2006). Eleven stressor domains were assessed, including psychological and physical work stress, work-family conflict, perceived inequality, relationship stress, neighborhood stress, discrimination, financial stress, recent problems, stressful events, and childhood adversity. We also calculated a cumulative score. Multinomial models were adjusted for age, gender, education, and income.

RESULTS

Seven of the 11 stressors and the cumulative score were associated with higher odds of being a current smoker compared with a never-smoker: neighborhood, financial, relationship, and psychological work stress, perceived inequality, stressful events, childhood adversity (p values <.05; ORs ranged from 1.28 to 1.77). Three stressors and the cumulative score were associated with higher odds of being a previous smoker versus a never-smoker (p < .05). Individuals who scored in the top quartile on 5 or more stressors were 3.74 (95% CI = 2.09-6.71) times as likely to be current smokers, and more than twice as likely to be previous smokers, compared with individuals with no high stressors.

CONCLUSIONS

These results demonstrate a strong relationship between stress and smoking among urban middle-aged Blacks and suggest that cessation programs should address modifiable individual and community-level stressors.

Personality and longevity: knowns, unknowns, and implications for public health and personalized medicine

We review evidence for links between personality traits and longevity. We provide an overview of personality for health scientists, using the primary organizing framework used in the study of personality and longevity. We then review data on various aspects of personality linked to longevity. In general, there is good evidence that higher level of conscientiousness and lower levels of hostility and Type D or "distressed" personality are associated with greater longevity. Limited evidence suggests that extraversion, openness, perceived control, and low levels of emotional suppression may be associated with longer lifespan. Findings regarding neuroticism are mixed, supporting the notion that many component(s) of neuroticism detract from life expectancy, but some components at some levels may be healthy or protective. Overall, evidence suggests various personality traits are significant predictors of longevity and points to several promising directions for further study. We conclude by discussing the implications of these links for epidemiologic research and personalized medicine and lay out a translational research agenda for integrating the psychology of individual differences into public health and medicine.

Health differentials in the older population of England: an empirical comparison of the materialist, lifestyle and psychosocial hypotheses

BACKGROUND

In developed countries with old age structures most deaths occur at older ages and older people account for the majority of those in poor health, which suggests a particular need to investigate health inequalities in the older population.

METHODS

We empirically compared the materialist, psychosocial and lifestyle/behavioural theoretical mechanisms of explanation for socio-economic variation in health using data from two waves of the English Longitudinal Study of Ageing (ELSA), a nationally representative multi-purpose sample of the population aged 50 and over living in England. Three dimensions of health were examined: somatic health, depression and well-being.

RESULTS

The materialist and lifestyle/behavioural paths had the most prominent mediating role in the association between socio-economic position and health in the older population, whereas the psychosocial pathway was less influential and exerted most of its influence on depression and well-being, with part of its effect being due to the availability of material resources.

CONCLUSIONS

From a policy perspective there is therefore an indication that population interventions to reduce health differentials and thus improve the overall health of the older population should focus on material circumstances and population based interventions to promote healthy lifestyles.