Andrew Steptoe

DEVELOPMENT OF A MEASURE OF THE MOTIVES UNDERLYING THE SELECTION OF FOOD - THE FOOD CHOICE QUESTIONNAIRE

A number of factors are thought to influence peoples dietary choices, including health, cost, convenience and taste, but there are no measures that address health-related 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.

The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis

Stress influences circulating inflammatory markers, and these effects may mediate the influence of psychosocial factors on cardiovascular risk and other conditions such as psoriasis and rheumatoid arthritis. Inflammatory responses can be investigated under controlled experimental conditions in humans, and evidence is beginning to emerge showing that circulating inflammatory factors respond to acute psychological stress under laboratory conditions. However, research published to date has varied greatly in the composition of study groups, the timing of samples, assay methods, and the type of challenge imposed. The purpose of this review is to synthesize existing data using meta-analytic techniques. Thirty studies met inclusion criteria. Results showed robust effects for increased levels of circulating IL-6 (r=0.19, p=0.001) and IL-1beta (r=0.58, p<0.001) following acute stress, and marginal effects for CRP (r=0.12, p=0.088). The effects of stress on stimulated cytokine production were less consistent. Significant variation in the inflammatory response was also related to the health status of participants and the timing of post-stress samples. A number of psychobiological mechanisms may underlie responses, including stress-induced reductions in plasma volume, upregulation of synthesis, or enlargement of the cell pool contributing to synthesis. The acute stress-induced inflammatory response may have implications for future health, and has become an important topic of psychoneuroimmunological research.

Positive Psychological Well-being and Mortality: A Quantitative Review of Prospective Observational Studies

Objective: To review systematically prospective, observational, cohort studies of the association between positive well-being and mortality using meta-analytic methods. Recent years have witnessed increased interest in the relationship between positive psychological well-being and physical health. Methods: We searched general bibliographic databases: Medline, PsycINFO, Web of Science, and PubMed up to January 2008. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. Results: There were 35 studies (26 articles) investigating mortality in initially healthy populations and 35 studies (28 articles) of disease populations. The meta-analyses showed that positive psychological well-being was associated with reduced mortality in both the healthy population (combined hazard ratio (HR) = 0.82; 95% Confidence Interval (CI) = 0.76–0.89; p < .001) and the disease population (combined HR = 0.98; CI = 0.95–1.00; p = .030) studies. There were indications of publication bias in this literature, although the fail-safe numbers were 2444 and 1397 for healthy and disease population studies, respectively. Intriguingly, meta-analysis of studies that controlled for negative affect showed that the protective effects of positive psychological well-being were independent of negative affect. Both positive affect (e.g., emotional well-being, positive mood, joy, happiness, vigor, energy) and positive trait-like dispositions (e.g., life satisfaction, hopefulness, optimism, sense of humor) were associated with reduced mortality in healthy population studies. Positive psychological well-being was significantly associated with reduced cardiovascular mortality in healthy population studies, and with reduced death rates in patients with renal failure and with human immunodeficiency virus-infection. Conclusions: The current review suggests that positive psychological well-being has a favorable effect on survival in both healthy and diseased populations. CHD = coronary heart disease; CI = Confidence Interval; HIV = human immunodeficiency virus-infection; HR = hazard ratio; ln = natural logarithm; RR = relative risk.

Cortisol awakening response and psychosocial factors: A systematic review and meta-analysis

The magnitude of the cortisol awakening response, a relatively new indicator of hypothalamic-pituitary-adrenocortical (HPA) axis activation, has been related to a number of psychosocial factors. But findings have been inconsistent across studies. We systematically reviewed previous studies investigating the association between the cortisol awakening response and psychosocial factors. 147 eligible studies from 62 articles were identified. Separate analyses were carried out on the increase in cortisol following waking (CARi), and the integrated volume of cortisol released over the waking period (CARauc). We found that the CARi was positively associated with job stress and general life stress. It was negatively associated with fatigue, burnout, or exhaustion. There were less reliable negative associations between the CARi and positive affects. The CARauc was positively related to general life stress and negatively related to posttraumatic stress syndrome. This review concludes that different psychosocial factors are associated with an enhanced or reduced cortisol awakening response.

Mental Stress Induces Transient Endothelial Dysfunction in Humans

BackgroundMental stress has been linked to increased morbidity and mortality in coronary artery disease and to atherosclerosis progression. Experimental studies have suggested that damage to the endothelium may be an important mechanism. Methods and ResultsEndothelial function was studied in 10 healthy men (aged 50.4±9.6 years) and in 8 non–insulin-dependent diabetic men (aged 52.0±7.2 years). Brachial artery flow-mediated dilation (FMD, endothelium dependent) and response to 50 &mgr;g of sublingual glyceryl trinitrate (GTN, endothelium independent) were measured noninvasively by use of high-resolution ultrasound before and after (30, 90, and 240 minutes) a standardized mental stress test. The same protocol without mental stress was repeated on a separate occasion in the healthy men. In healthy subjects, FMD (5.0±2.1%) was significantly (P <0.01) reduced at 30 and 90 minutes after mental stress (2.8±2.3% and 2.3±2.4%, respectively) and returned toward normal after 4 hours (4.1±2.0%). Mental stress had no effect on the response to GTN. In the repeated studies without mental stress, FMD did not change. The diabetic subjects had lower FMD than did the control subjects (3.0±1.5% versus 5.0±2.1%, respectively;P =0.02) but showed no changes in FMD (2.7±1.1% after 30 minutes, 2.8±1.9% after 90 minutes, and 3.1±2.3% after 240 minutes) or GTN responses after mental stress. ConclusionsThese findings suggest that brief episodes of mental stress, similar to those encountered in everyday life, may cause transient (up to 4 hours) endothelial dysfunction in healthy young individuals. This might represent a mechanistic link between mental stress and atherogenesis.

Job strain as a risk factor for coronary heart disease: A collaborative meta-analysis of individual participant data

Summary Background Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. Methods We used individual records from 13 European cohort studies (1985–2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. Findings 30 214 (15%) of 197 473 participants reported job strain. In 1·49 million person-years at risk (mean follow-up 7·5 years [SD 1·7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10–1·37). This effect estimate was higher in published (1·43, 1·15–1·77) than unpublished (1·16, 1·02–1·32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1·31, 1·15–1·48) and 5 years (1·30, 1·13–1·50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%. Interpretation Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. Funding Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.

Social isolation, loneliness, and all-cause mortality in older men and women

Both social isolation and loneliness are associated with increased mortality, but it is uncertain whether their effects are independent or whether loneliness represents the emotional pathway through which social isolation impairs health. We therefore assessed the extent to which the association between social isolation and mortality is mediated by loneliness. We assessed social isolation in terms of contact with family and friends and participation in civic organizations in 6,500 men and women aged 52 and older who took part in the English Longitudinal Study of Ageing in 2004–2005. A standard questionnaire measure of loneliness was administered also. We monitored all-cause mortality up to March 2012 (mean follow-up 7.25 y) and analyzed results using Cox proportional hazards regression. We found that mortality was higher among more socially isolated and more lonely participants. However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.08–1.48 for the top quintile of isolation), but loneliness did not (hazard ratio 0.92, 95% confidence interval, 0.78–1.09). The association of social isolation with mortality was unchanged when loneliness was included in the model. Both social isolation and loneliness were associated with increased mortality. However, the effect of loneliness was not independent of demographic characteristics or health problems and did not contribute to the risk associated with social isolation. Although both isolation and loneliness impair quality of life and well-being, efforts to reduce isolation are likely to be more relevant to mortality.

Do stress-related psychosocial factors contribute to cancer incidence and survival?

A substantial body of research has investigated the associations between stress-related psychosocial factors and cancer outcomes. Previous narrative reviews have been inconclusive. In this Review, we evaluated longitudinal associations between stress and cancer using meta-analytic methods. The results of 165 studies indicate that stress-related psychosocial factors are associated with higher cancer incidence in initially healthy populations (P = 0.005); in addition, poorer survival in patients with diagnosed cancer was noted in 330 studies (P <0.001), and higher cancer mortality was seen in 53 studies (P <0.001). Subgroup meta-analyses demonstrate that stressful life experiences are related to poorer cancer survival and higher mortality but not to an increased incidence. Stress-prone personality or unfavorable coping styles and negative emotional responses or poor quality of life were related to higher cancer incidence, poorer cancer survival and higher cancer mortality. Site-specific analyses indicate that psychosocial factors are associated with a higher incidence of lung cancer and poorer survival in patients with breast, lung, head and neck, hepatobiliary, and lymphoid or hematopoietic cancers. These analyses suggest that stress-related psychosocial factors have an adverse effect on cancer incidence and survival, although there is evidence of publication bias and results should be interpreted with caution.

Neighborhood Problems as Sources of Chronic Stress: Development of a Measure of Neighborhood Problems, and Associations With Socioeconomic Status and Health

The impact of the residential neighborhood on health and well-being is being increasingly recognized in behavioral medicine, with evidence for neighborhood-level effects that are independent of the individual characteristics of residents. This study addressed the possibility that the effects of neighborhood are due in part to exposure to community-wide stressors rather than variations in protective factors such as social capital. A questionnaire survey including a 10-item neighborhood problems scale and measures of self-reported health, health behaviors, and social capital was completed by 419 residents of 18 higher socioeconomic status (SES) neighborhoods and 235 residents of 19 lower SES neighborhoods. Data were analyzed using regression and multilevel methods. Neighborhood problem scores were greater in lower than higher SES neighborhoods, positively associated with individual deprivation, and negatively correlated with social capital. Neighborhood problems were not related to smoking, diet, alcohol consumption, or physical activity. However, neighborhood problems were associated with poor self-rated health, psychological distress on the General Health Questionnaire, and impaired physical function, independent of age, sex, neighborhood SES, individual deprivation, and social capital. Adjusted odds ratios for the highest versus lowest neighborhood problem quartiles ranged from 2.05 (confidence interval = 1.15-3.69) for poor self-rated health to 3.07 (1.63-5.79) for impaired physical function. The results provide preliminary evidence that residential neighborhood problems constitute sources of chronic stress that may increase risk of poor health.

The Association of Anger and Hostility With Future Coronary Heart Disease: A Meta-Analytic Review of Prospective Evidence

OBJECTIVES This review aimed to evaluate the association between anger and hostility and coronary heart disease (CHD) in prospective cohort studies using quantitative methods. BACKGROUND The harmful effect of anger and hostility on CHD has been widely asserted, but previous reviews have been inconclusive. METHODS We searched general bibliographic databases: MEDLINE, PsycINFO, Web of Science, and PubMed up to November 2008. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. RESULTS There were 25 studies (21 articles) investigating CHD outcomes in initially healthy populations and 19 studies (18 articles) of samples with existing CHD. Anger and hostility were associated with increased CHD events in the healthy population studies (combined hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.05 to 1.35, p = 0.008) and with poor prognosis in the CHD population studies (HR: 1.24; 95% CI: 1.08 to 1.42, p = 0.002). There were indications of publication bias in these reports, although the fail-safe numbers were 2,020 and 750 for healthy and disease population studies, respectively. Intriguingly, the harmful effect of anger and hostility on CHD events in the healthy populations was greater in men than women. In studies of participants with CHD at baseline that controlled fully for basal disease status and treatment, the association of anger and hostility with poor prognosis persisted. CONCLUSIONS The current review suggests that anger and hostility are associated with CHD outcomes both in healthy and CHD populations. Besides conventional physical and pharmacological interventions, this supports the use of psychological management focusing on anger and hostility in the prevention and treatment of CHD.