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Smoking, health behavior, and value priorities
Addictive Behaviors, Vol. 10, pp. 41-44, 1985
0306-4603/85 $3.00 + .00 Copyright © 1985 Pergamon Press Ltd
Printed in the USA. All rights reserved.
SMOKING, HEALTH BEHAVIOR, AND VALUE PRIORITIES CONNIE M. KRISTIANSEN University of Exeter, England A b s t r a c t - I n a postal survey, 113 respondents completed the Rokeach terminal value survey with the additional value, health, and questions regarding their preventive health behavior. Analyses showed that lighter nonsmokers displayed better preventive behavior than heavier smokers. Lighter nonsmokers also reported valuing health more than heavier smokers reported, and were oriented toward safety and inner-directedness compared with heavier smokers who were oriented toward satisfaction and outer-directedness. The preventive behavior of lighter nonsmokers increased with the value of social goals while the preventive behavior of heavier smokers was related to personal goals. These results are considered in the context of previous research which suggested that smokers and nonsmokers may have different value priorities. The implications of these findings for health education are discussed.
Research has occasionally reported generalities in health behavior. For example, Eiser, Sutton, and Wober (1979) found that smokers reported wearing a seat belt less frequently than nonsmokers and Eiser and Harding (1983) found generalities in health attitudes. While some researchers have attributed such differences to individual differences in traits such as impulsivity (Jacobs et al., 1966), Eiser et al. (1979) suggest that smokers may display less preventive behavior because they have different values and believe in their right to put their health at risk, while nonsmokers do not. The most detailed comparisons of values come from research using the Rokeach (1967) Value Survey. Toler (1975), for example, found that substance abusers were concerned with personal values while the general public placed more importance on societal goals. Looking at smoking, Conroy (1979) found that quitters ranked broadmindedness eighth and self-discipline first, while smokers ranked the former third and the latter eighth. Moreover, smokers who were confronted with this information in a value change program significantly increased their ranking of self-discipline and reduced their smoking behavior for a longer period of time than control subjects. Similarly, Kaplan and Cowles (1978) report that in a smoking cessation program, subjects who valued health highly smoked fewer cigarettes before treatment than subjects who valued health less. Controlling for the initial amount smoked, subjects who valued health highly maintained a lower consumption rate over time than subjects who placed less value on health and returned to base-rate levels of smoking. The present study extends such research by examining the values and preventive health behavior of smokers and nonsmokers. METHOD
Questionnaires were sent to a random selection of 20 people from each of the 17 electoral wards in Exeter, England. Respondents completed Form D of the Rokeach Terminal Value Survey with the additional value health (Rokeach, 1973, pp. 357-61). As in Feather (1975), the value ranks were transformed into Z scores corresponding to a This research was funded by a grant from the Health Education Council, England. The author would like to thank C.M. Harding for running the MDS analyses. Requests for reprints should be sent to Connie M. Kristiansen, Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada. 41
42
CONNIE M. KRISTIANSEN
division into 19 equal areas under the normal curve. With this transformation, the larger a value's score the more important the value was considered to be. The remainder of the survey consisted of 15 preventive health behavior (PHB) questions selected f r o m previous works (Becker, Kaback, Rosenstock, & Ruth, 1975; Forouzesh, 1979; Langlie, 1977; Williams & Wechsler, 1972). Smoking status was determined by the question "What type of smoker would you describe yourself as? Heavy (more than 20 cigarettes a day); Moderate (less than 20 cigarettes a day); Light (a few cigarettes a day); Occasional (smoke socially at parties); Non-smoker." The remaining 14 P H B items assessed the frequency of 6 Direct-risk behaviors, such as drinking and driving or avoiding coughers, and 8 Indirect-risk behaviors, such as seat belt use and diet (Langlie, 1977). Responses to the 14 items were reversed, standardized and summed. On the basis of item analyses a 10-item P H B scale was formed (c~ = .55), with which the smoking status item was correlated (r = .33, p < .001). the 6-item Directrisk scale (DR) had an alpha of .49, while the 6 of the 8 Indirect-risk items (IR) which were interrelated yielded an alpha of .41. RESULTS Fifty-eight females (mean age = 45.8), 52 males (mean age = 44.2) and 3 people of unknown sex responded (for details of sample representativeness see Kristiansen, in press). There were no age differences across the five categories of smoking status (F4,108 = 0.53, p > .05), and smoking status was independent of sex (X] = 1.22, p > .05). Preventive health behavior
An analysis of variance on the total 10 item P H B scores across the five categories of smoking status was significant (F4.~08 = 4.12, p < .01). A Scheff6 post-hoc comparison revealed that this difference was primarily due to heavier smokers (n = 28, X = - 2.78) reporting poorer P H B than lighter nonsmokers (n = 85, X = 0.91, F4,~08 = 14.39, p < .01). Hence, subsequent analyses compared lighter nonsmokers and heavier smokers. Lighter nonsmokers reported better DR and IR behavior than heavier smokers reported (DR: lighter nonsmokers X = 0,58, heavier X = - 1 . 7 7 , t111 = 3.55, p < .001; IR: lighter nonsmokers X = 0.41, heavier X = - 1.24, t,H = 2.57, p < .02). Values
Analyses of variance showed that lighter nonsmokers ( X = 1.207) valued health more than heavier smokers ( X = 0.778, El,lit = 8.23, p < .01), as well as a world of beauty ( X lighter nonsmokers = - . 1 9 9 , X heavier smokers = - . 5 4 6 , F~,11~ = 5.04, p < .05). There were no differences in the other 17 values. A stepwise regression analysis showed that the values health (/3 = .338, F~.~ = 13.41, p < .001) and equality (/3 = .241, F~,11~ = 6.79, p < .05) accounted for 12.9°70 of the variance across the five categories of smoking status (FE.H0 = 8.13, p < .001). A discriminant analysis showed that nine values were able to classify respondents as lighter nonsmokers and heavier smokers in 84.1 °70 of the cases (Wilk's lambda = .722, x~ = 34.70, p < .001). Again the value of health entered the function first. Spearman correlations between values were used in a multidimensional scaling (MDS) analysis used to identify the dimensions underlying the values. The values were represented spatially using M I N I S S A (Roskam, 1975) which is a smallest-space nonmetric MDS program. The final solution consisted of four dimensions and had a stress o f .096. The first dimension was labelled noble vs. hedonistic (equality, a world at peace, inner harmony, a world of beauty vs. happiness, pleasure, a comfortable life),
Smoking and value priorities
43
the second was termed personal vs. societal (wisdom, a sense of accomplishment, selfrespect, vs. freedom, national security, a world at peace), the third was called satisfaction vs. safety (mature love, an exciting life vs. family security, national security, health), and the final dimension was outer vs. inner directedness (social recognition, an exciting life vs. salvation, inner harmony, health). Hence, health was located on the safety pole of the satisfaction vs. safety dimension and the inner directedness pole of the inner vs. outer directedness dimension. For each respondent, a score was calculated for each of the four dimensions by multiplying each value rank by its weighting on each dimension. Analyses of variance on these scores showed that lighter nonsmokers were marginally more concerned with safety as opposed to satisfaction (lighter nonsmokers X = - 1 . 6 6 , heavier smokers X = - 0 . 7 0 1 , F~,,I~ = 3.47, p < .07), as well as inner as opposed to outer directedness ( X lighter nonsmokers = - 0 . 5 4 9 , heavier smokers X = 0.231, F~,1H = 3.08, p < .09) than were heavier smokers. Values and health behavior Pearson correlates showed that the total P H B scores of lighter nonsmokers increased as priority was given to a world at peace ( r = .21, p < .05), and decreased with the value o f happiness ( r = - . 2 0 , p < .05). The DR scores of lighter nonsmokers were correlated with the value of a world at peace ( r = .42, p < .001), health ( r = .20, p < .05), salvation ( r = .19, p < .05), mature love (r = - . 2 8 , p < .01) and selfrespect ( r = - . 19, p < .05), whereas there was no relationship between their IR scores and values. The total P H B scores of heavier smokers were correlated with the value of a sense of accomplishment (r = .34, p < .05), freedom ( r = - . 3 8 , p < .05), inner h a r m o n y ( r = .33, p < .05), and pleasure ( r = - .44, p < .01). The DR scores of heavier smokers were related to the value of health ( r = .48, p < .05), salvation ( r = .32, p < .05), a world at peace ( r = .39, p < .05), pleasure (r = - . 5 5 , p < .001), an exciting life ( r = .47, p < .01) and mature love ( r = - . 4 2 , p < .05), whereas their IR scores were related to the value of salvation ( r = .36, p < .05), inner h a r m o n y ( r = .33, p < .05) and national security (r = - . 3 4 , p < .05). Looking at the MDS scores showed that the total P H B scores of lighter nonsmokers ( r = - .22, p < .05) and heavier smokers ( r = - .36, p < .05) decreased with an orientation towards outer as opposed to inner directedness. In addition, heavier smokers' P H B scores were related to a personal rather than societal orientation (r = .32, p < .05). DISCUSSION
The finding that the smoking item was correlated with the total P H B scores suggests that there is some generality across health behaviors. Moreover, the fact that heavier smokers reported engaging in less preventive behavior than lighter nonsmokers suggests that heavier smokers not only need to stop smoking, but could benefit from general health education. The results of the regression and discriminant analyses showed that it was possible to differentiate between the types of smokers f r o m their general value priorities. Hence, as Eiser et al. (1979) and Eiser and Sutton (1977) argue, smoking may in fact be a subjectively rational choice. Further, lighter nonsmokers reported valuing their health more than heavier smokers reported. This suggests that a value confrontation program aimed at increasing the value of health might result in changes in smoking behavior. Since the value health was correlated with DR scores, changes in health value might also affect other health behaviors.
44
CONNIE M. KRISTIANSEN
Like Toler (1975), the preventive b e h a v i o r of heavier smokers was associated with personal values while the preventive b e h a v i o r o f lighter n o n s m o k e r s was associated with societal values. Similarly, heavier smokers were oriented toward outer directedness a n d satisfaction while lighter n o n s m o k e r s were oriented to i n n e r directedness a n d safety. This suggests that i n d i v i d u a l differences in traits such as impulsivity m a y be associated with differences in values, a l t h o u g h this r e m a i n s an empirical question. As a whole, these data suggest that various types of smokers differ in their value priorities a n d that health educators might do well to consider such differences in values. Rather t h a n trying to change the values o f heavier smokers, health educators might also a t t e m p t to depict health behaviors as pleasurable a n d satisfying. REFERENCES Becket, M.H., Kaback, M.M., Rosenstock, I.M., & Ruth, M.V. 0975). Some influences on public participation in a genetic screening programme. Journal o f Community Health, 1, 3-14. Conroy, W.J. (1979). Human values, smoking behavior, and public health programmes. In M. Rokeach (Ed.), Understanding human values: Individual and societal. New York: Free Press. Eiser, J.R., & Harding, C.M. (1983). Smoking, seat-belt use and perception of health risks. Addictive Behaviors, 8, 75-78. Eiser, J.R., & Sutton, S.R. (1977). Smoking as a subjectively rational choice. Addictive Behaviors, 2, 129-134. Eiser, J.R., Sutton, S.R., & Wober, M. (1979). Smoking, seat-belts and beliefs about health. Addictive Behaviors, 4, 331-338. Feather, N.T. (1975). Values in education and society. New York: Free Press. Forouzesh, M.R. (1979). Preventive health behavior in relation to risk taking and locus of control among college students. Dissertation Abstracts International, 39, (8-B), 3746-47. Jacobs, M.A., Anderson, L.S., Champagne, E., Karush, N., Richman, S.J., & Knapp, P.H. (1966). Orality, impulsivity and cigarette smoking in men: Further findings in support of a theory. Journal o f Nervous and Mental Disease, 143, 207-219. Kaplan, G.D., & Cowles, A. (1978). Health locus of control and health value in the prediction of smoking reduction. Health Education Monographs, 6, 129-137. Kristiansen, C.M. (in press). Value correlates of preventive health behavior. Journal o f Personality and Social Psychology.
Langlie, J.K. (1977). Social networks, health beliefs, and preventive health behavior. Journal o f Health and Social Behavior, 18, 244-260. Rokeach, M. (1967). Value Survey. Sunnyvale, CA: Halgren Tests. Rokeach, M. 0973). The nature o f human values. New York: Free Press. Roskam, E.E. (1975). A documentation o f MINISSA (N). University of Nijmegen, Holland, Report 75 MA 15. Toler, C. (1975). The personal values of alcoholics and addicts. Journal o f Clinical Psychology, 31,554-557. Williams, A.F., & Wechsler, H. (1972). Interrelationships of preventive actions in health and other areas. Health Services Reports, 87, 969-976.
0306-4603/85 $3.00 + .00 Copyright © 1985 Pergamon Press Ltd
Printed in the USA. All rights reserved.
SMOKING, HEALTH BEHAVIOR, AND VALUE PRIORITIES CONNIE M. KRISTIANSEN University of Exeter, England A b s t r a c t - I n a postal survey, 113 respondents completed the Rokeach terminal value survey with the additional value, health, and questions regarding their preventive health behavior. Analyses showed that lighter nonsmokers displayed better preventive behavior than heavier smokers. Lighter nonsmokers also reported valuing health more than heavier smokers reported, and were oriented toward safety and inner-directedness compared with heavier smokers who were oriented toward satisfaction and outer-directedness. The preventive behavior of lighter nonsmokers increased with the value of social goals while the preventive behavior of heavier smokers was related to personal goals. These results are considered in the context of previous research which suggested that smokers and nonsmokers may have different value priorities. The implications of these findings for health education are discussed.
Research has occasionally reported generalities in health behavior. For example, Eiser, Sutton, and Wober (1979) found that smokers reported wearing a seat belt less frequently than nonsmokers and Eiser and Harding (1983) found generalities in health attitudes. While some researchers have attributed such differences to individual differences in traits such as impulsivity (Jacobs et al., 1966), Eiser et al. (1979) suggest that smokers may display less preventive behavior because they have different values and believe in their right to put their health at risk, while nonsmokers do not. The most detailed comparisons of values come from research using the Rokeach (1967) Value Survey. Toler (1975), for example, found that substance abusers were concerned with personal values while the general public placed more importance on societal goals. Looking at smoking, Conroy (1979) found that quitters ranked broadmindedness eighth and self-discipline first, while smokers ranked the former third and the latter eighth. Moreover, smokers who were confronted with this information in a value change program significantly increased their ranking of self-discipline and reduced their smoking behavior for a longer period of time than control subjects. Similarly, Kaplan and Cowles (1978) report that in a smoking cessation program, subjects who valued health highly smoked fewer cigarettes before treatment than subjects who valued health less. Controlling for the initial amount smoked, subjects who valued health highly maintained a lower consumption rate over time than subjects who placed less value on health and returned to base-rate levels of smoking. The present study extends such research by examining the values and preventive health behavior of smokers and nonsmokers. METHOD
Questionnaires were sent to a random selection of 20 people from each of the 17 electoral wards in Exeter, England. Respondents completed Form D of the Rokeach Terminal Value Survey with the additional value health (Rokeach, 1973, pp. 357-61). As in Feather (1975), the value ranks were transformed into Z scores corresponding to a This research was funded by a grant from the Health Education Council, England. The author would like to thank C.M. Harding for running the MDS analyses. Requests for reprints should be sent to Connie M. Kristiansen, Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada. 41
42
CONNIE M. KRISTIANSEN
division into 19 equal areas under the normal curve. With this transformation, the larger a value's score the more important the value was considered to be. The remainder of the survey consisted of 15 preventive health behavior (PHB) questions selected f r o m previous works (Becker, Kaback, Rosenstock, & Ruth, 1975; Forouzesh, 1979; Langlie, 1977; Williams & Wechsler, 1972). Smoking status was determined by the question "What type of smoker would you describe yourself as? Heavy (more than 20 cigarettes a day); Moderate (less than 20 cigarettes a day); Light (a few cigarettes a day); Occasional (smoke socially at parties); Non-smoker." The remaining 14 P H B items assessed the frequency of 6 Direct-risk behaviors, such as drinking and driving or avoiding coughers, and 8 Indirect-risk behaviors, such as seat belt use and diet (Langlie, 1977). Responses to the 14 items were reversed, standardized and summed. On the basis of item analyses a 10-item P H B scale was formed (c~ = .55), with which the smoking status item was correlated (r = .33, p < .001). the 6-item Directrisk scale (DR) had an alpha of .49, while the 6 of the 8 Indirect-risk items (IR) which were interrelated yielded an alpha of .41. RESULTS Fifty-eight females (mean age = 45.8), 52 males (mean age = 44.2) and 3 people of unknown sex responded (for details of sample representativeness see Kristiansen, in press). There were no age differences across the five categories of smoking status (F4,108 = 0.53, p > .05), and smoking status was independent of sex (X] = 1.22, p > .05). Preventive health behavior
An analysis of variance on the total 10 item P H B scores across the five categories of smoking status was significant (F4.~08 = 4.12, p < .01). A Scheff6 post-hoc comparison revealed that this difference was primarily due to heavier smokers (n = 28, X = - 2.78) reporting poorer P H B than lighter nonsmokers (n = 85, X = 0.91, F4,~08 = 14.39, p < .01). Hence, subsequent analyses compared lighter nonsmokers and heavier smokers. Lighter nonsmokers reported better DR and IR behavior than heavier smokers reported (DR: lighter nonsmokers X = 0,58, heavier X = - 1 . 7 7 , t111 = 3.55, p < .001; IR: lighter nonsmokers X = 0.41, heavier X = - 1.24, t,H = 2.57, p < .02). Values
Analyses of variance showed that lighter nonsmokers ( X = 1.207) valued health more than heavier smokers ( X = 0.778, El,lit = 8.23, p < .01), as well as a world of beauty ( X lighter nonsmokers = - . 1 9 9 , X heavier smokers = - . 5 4 6 , F~,11~ = 5.04, p < .05). There were no differences in the other 17 values. A stepwise regression analysis showed that the values health (/3 = .338, F~.~ = 13.41, p < .001) and equality (/3 = .241, F~,11~ = 6.79, p < .05) accounted for 12.9°70 of the variance across the five categories of smoking status (FE.H0 = 8.13, p < .001). A discriminant analysis showed that nine values were able to classify respondents as lighter nonsmokers and heavier smokers in 84.1 °70 of the cases (Wilk's lambda = .722, x~ = 34.70, p < .001). Again the value of health entered the function first. Spearman correlations between values were used in a multidimensional scaling (MDS) analysis used to identify the dimensions underlying the values. The values were represented spatially using M I N I S S A (Roskam, 1975) which is a smallest-space nonmetric MDS program. The final solution consisted of four dimensions and had a stress o f .096. The first dimension was labelled noble vs. hedonistic (equality, a world at peace, inner harmony, a world of beauty vs. happiness, pleasure, a comfortable life),
Smoking and value priorities
43
the second was termed personal vs. societal (wisdom, a sense of accomplishment, selfrespect, vs. freedom, national security, a world at peace), the third was called satisfaction vs. safety (mature love, an exciting life vs. family security, national security, health), and the final dimension was outer vs. inner directedness (social recognition, an exciting life vs. salvation, inner harmony, health). Hence, health was located on the safety pole of the satisfaction vs. safety dimension and the inner directedness pole of the inner vs. outer directedness dimension. For each respondent, a score was calculated for each of the four dimensions by multiplying each value rank by its weighting on each dimension. Analyses of variance on these scores showed that lighter nonsmokers were marginally more concerned with safety as opposed to satisfaction (lighter nonsmokers X = - 1 . 6 6 , heavier smokers X = - 0 . 7 0 1 , F~,,I~ = 3.47, p < .07), as well as inner as opposed to outer directedness ( X lighter nonsmokers = - 0 . 5 4 9 , heavier smokers X = 0.231, F~,1H = 3.08, p < .09) than were heavier smokers. Values and health behavior Pearson correlates showed that the total P H B scores of lighter nonsmokers increased as priority was given to a world at peace ( r = .21, p < .05), and decreased with the value o f happiness ( r = - . 2 0 , p < .05). The DR scores of lighter nonsmokers were correlated with the value of a world at peace ( r = .42, p < .001), health ( r = .20, p < .05), salvation ( r = .19, p < .05), mature love (r = - . 2 8 , p < .01) and selfrespect ( r = - . 19, p < .05), whereas there was no relationship between their IR scores and values. The total P H B scores of heavier smokers were correlated with the value of a sense of accomplishment (r = .34, p < .05), freedom ( r = - . 3 8 , p < .05), inner h a r m o n y ( r = .33, p < .05), and pleasure ( r = - .44, p < .01). The DR scores of heavier smokers were related to the value of health ( r = .48, p < .05), salvation ( r = .32, p < .05), a world at peace ( r = .39, p < .05), pleasure (r = - . 5 5 , p < .001), an exciting life ( r = .47, p < .01) and mature love ( r = - . 4 2 , p < .05), whereas their IR scores were related to the value of salvation ( r = .36, p < .05), inner h a r m o n y ( r = .33, p < .05) and national security (r = - . 3 4 , p < .05). Looking at the MDS scores showed that the total P H B scores of lighter nonsmokers ( r = - .22, p < .05) and heavier smokers ( r = - .36, p < .05) decreased with an orientation towards outer as opposed to inner directedness. In addition, heavier smokers' P H B scores were related to a personal rather than societal orientation (r = .32, p < .05). DISCUSSION
The finding that the smoking item was correlated with the total P H B scores suggests that there is some generality across health behaviors. Moreover, the fact that heavier smokers reported engaging in less preventive behavior than lighter nonsmokers suggests that heavier smokers not only need to stop smoking, but could benefit from general health education. The results of the regression and discriminant analyses showed that it was possible to differentiate between the types of smokers f r o m their general value priorities. Hence, as Eiser et al. (1979) and Eiser and Sutton (1977) argue, smoking may in fact be a subjectively rational choice. Further, lighter nonsmokers reported valuing their health more than heavier smokers reported. This suggests that a value confrontation program aimed at increasing the value of health might result in changes in smoking behavior. Since the value health was correlated with DR scores, changes in health value might also affect other health behaviors.
44
CONNIE M. KRISTIANSEN
Like Toler (1975), the preventive b e h a v i o r of heavier smokers was associated with personal values while the preventive b e h a v i o r o f lighter n o n s m o k e r s was associated with societal values. Similarly, heavier smokers were oriented toward outer directedness a n d satisfaction while lighter n o n s m o k e r s were oriented to i n n e r directedness a n d safety. This suggests that i n d i v i d u a l differences in traits such as impulsivity m a y be associated with differences in values, a l t h o u g h this r e m a i n s an empirical question. As a whole, these data suggest that various types of smokers differ in their value priorities a n d that health educators might do well to consider such differences in values. Rather t h a n trying to change the values o f heavier smokers, health educators might also a t t e m p t to depict health behaviors as pleasurable a n d satisfying. REFERENCES Becket, M.H., Kaback, M.M., Rosenstock, I.M., & Ruth, M.V. 0975). Some influences on public participation in a genetic screening programme. Journal o f Community Health, 1, 3-14. Conroy, W.J. (1979). Human values, smoking behavior, and public health programmes. In M. Rokeach (Ed.), Understanding human values: Individual and societal. New York: Free Press. Eiser, J.R., & Harding, C.M. (1983). Smoking, seat-belt use and perception of health risks. Addictive Behaviors, 8, 75-78. Eiser, J.R., & Sutton, S.R. (1977). Smoking as a subjectively rational choice. Addictive Behaviors, 2, 129-134. Eiser, J.R., Sutton, S.R., & Wober, M. (1979). Smoking, seat-belts and beliefs about health. Addictive Behaviors, 4, 331-338. Feather, N.T. (1975). Values in education and society. New York: Free Press. Forouzesh, M.R. (1979). Preventive health behavior in relation to risk taking and locus of control among college students. Dissertation Abstracts International, 39, (8-B), 3746-47. Jacobs, M.A., Anderson, L.S., Champagne, E., Karush, N., Richman, S.J., & Knapp, P.H. (1966). Orality, impulsivity and cigarette smoking in men: Further findings in support of a theory. Journal o f Nervous and Mental Disease, 143, 207-219. Kaplan, G.D., & Cowles, A. (1978). Health locus of control and health value in the prediction of smoking reduction. Health Education Monographs, 6, 129-137. Kristiansen, C.M. (in press). Value correlates of preventive health behavior. Journal o f Personality and Social Psychology.
Langlie, J.K. (1977). Social networks, health beliefs, and preventive health behavior. Journal o f Health and Social Behavior, 18, 244-260. Rokeach, M. (1967). Value Survey. Sunnyvale, CA: Halgren Tests. Rokeach, M. 0973). The nature o f human values. New York: Free Press. Roskam, E.E. (1975). A documentation o f MINISSA (N). University of Nijmegen, Holland, Report 75 MA 15. Toler, C. (1975). The personal values of alcoholics and addicts. Journal o f Clinical Psychology, 31,554-557. Williams, A.F., & Wechsler, H. (1972). Interrelationships of preventive actions in health and other areas. Health Services Reports, 87, 969-976.