Smoking, personality and the gender gap

Person. individ. Difi Vol. 14, No. 6, pp. 757-768, Printed in Great Britain. All rights reserved

SMOKING,

1993 Copyright

PERSONALITY

AND THE GENDER

SHULAMITH KREITLER,* HANS KREITLER Department of Psychology, Tel Aviv University,

and

Ramat

0191-8869/93 $6.00 + 0.00 0 1993 Pergamon PressLtd

GAP

KINERET WEISSLER

Aviv, Tel Aviv 69978, Israel

(Received 26 June 1992) Summary-The study is based on Eysenck’s thesis about the synergistic effects of smoking and personality on health. The purpose was to apply it to explain gender differences in the incidence of smoking-related disease and mortality. Our hypothesis was that women were less susceptible to the noxious effects of smoking because of their specific personality dispositions. There were 96 healthy adult subjects (37 men, 59 women) including 48 smokers and 48 nonsmokers. The following questionnaires were administered in the framework of a routine health check-up: the neuroticism scale, stress reaction scale, the Strelau Temperament Inventory, the Life Events S&ey, the Personal Problems Questionnaire, the Profile of Mood States. the Positive Emotions Check List and the Cognitive Orientation of Health questionnaire. Information about white blood cell count and erythrocyte sedimentation rate was available. Two-way analyses of variance showed effects due to gender or to smoking but mainly interactive effects indicating that women had health-promoting and disease-suppressing characteristics, notably: low scores on inhibition, low number of life events, low number of negative life events and high number of positive life events, low number of problems especially in work, family and interpersonal relations, low scores on depression, anger and anxiety, and high scores on satisfaction. It is suggested that these characteristics contribute to the lower susceptibility of women to smoking-dependent diseases.

A growing body of research in recent years has lent support to Eysenck’s provocative thesis that “smoking and personality form a synergistic relationship” (Eysenck, 1988, p. 460). This thesis implies that smoking affects health negatively only in conjunction with other factors, mainly personality. It runs counter to the commonly accepted view that tobacco smoking is “the great killer”, the single most important cause of diseases such as lung cancer and coronary heart disease (CHD), responsible for the preventable and premature mortality of at least half a million people annually in the U.S. alone (Roberts & Graveling, 1986; Roos, Vernet & Abelin, 1989; Royal College of Physicians, 1971; U.S. Department of Health and Human Services, 1988; U.S. Surgeon-General, 1989). The support for Eysenck’s thesis consists of three sets of findings. One set includes studies, mainly of a univariate design, which indicate very low or no relations between smoking as such and health (Eysenck, 1980, 1985; Wakefield, 1988, 1989). For example, in a 45 year follow-up the correlation of physical health with smoking was r = -0.13, whereas it was r = -0.36 with a psychological variable such as depression (Vaillant & Vaillant, 1990). This set also includes demonstrations that quitting smoking does not lower the incidence of death from cancer or coronary disease (McCormick & Skrabanek, 1988; Multiple Risk Factor Intervention Trial Research Group, 1982; Seltzer, 1989; World Health Organization European Collaborative Group, 1982). A second set includes studies, mostly of a multivariate design, indicating that smoking is correlated with a host of variables that imply increased risk for different specified diseases. Thus, smoking is correlated with the Type A personality variable, mainly the H score which is related most closely to CHD (Kreitler, Weissler, Kreitler & Brunner, 1991). Smokers also tend to be large consumers of coffee, alcohol (Mintz, 1985; Sieber & Angst, 1990) and cholesterol-rich foods (Brackenridge & Bloch, 1972; Rustin, 1978). All or some of these could promote CHD (Dembroski, 1984). Again, smokers are characterized by heterosexual behavior patterns (Rajamohan, Sivanandam & Verghese, 1982), anxiety (Brackenridge & Bloch, 1972), intrapunitiveness (Kureshi & Husain, 1981), the life style of “the loser” (Pulkkinen, 1983) and extraversion (Eysenck, 1980; Knorring & Oreland, 1985). All or some of these factors could promote cancer (Levy, 1985). A third set includes studies showing that the physiological effects of smoking depend on personality variables (Gilbert & Hagen, 1985; Golding, 1988; O’Connor, 1986) and that smoking *To whom

correspondence

should

be addressed. 757

758

SHULAMITH KREITLER et al.

is related to disease and mortality only in interaction with other factors, mainly personality variables or stress or both. This synergistic effect was demonstrated in regard to cancer and CHD (Blohmke, Engelhardt & Stelzer, 1984; Dembroski, 1984; Eysenck, 1988, 1991 chapter 6; Grossarth-Maticek, Eysenck & Vetter, 1988; Quander-Blaznik, 1991). The purpose of this study was to apply Eysenck’s thesis to explore possible reasons for gender differences in the incidence of smoking-related diseases and mortality. A large body of evidence indicates that women are less prone than men to suffer from smoking-related diseases. Thus, the Royal College of Physicians (1971) attributed to smoking 90% of the deaths from lung cancer, 75% from bronchitis and 25% from CHD in men whereas the corresponding percentages in women are 40, 60 and 20%. Roos et al. (1989) claimed that smoking causes 90% of lung cancer and 75% of bronchitis and emphysema in men but only 50 and 60% of the corresponding cases in women. Seltzer (1989) showed that in the Framingham study data the relation of smoking to CHD is low for men but is absent or even inverse for women. Life expectancy of females exceeds that of males in every smoking status (light, heavy) and in each age range (from 25 to over 75 years) (Rogers & Powell-Griner, 1991). Most studies show greater male than female mortality by smoking status (Doll, Gray, Hafner & Peto, 1980; Friedman, Dales & Ury, 1979; Hammond, 1966; a contrasting view was presented by Simborg, 1970). The issue of the gender gap in susceptibility to smoking-induced morbidity is important because the prevalence of smoking in women has risen slowly over the years from about half of that in men in 1955 to a similar rate as in men or even higher than that, for example, in certain groups of professionals or American adolescents (Sorenson & Pechacek, 1986; U.S. Department of Health and Human Services, 1988). Further, in women the rate of smoking cessation is lower than in men (Blake, Pechacek, Klepp, Folsom, Jacobs & Mittelmark, 1984; Stoto, 1986) and the relapse after cessation greater (Gritz, 1980). It seems likely that in the future smoking will be primarily a problem of women (Warburton, Revel1 & Thompson, 1991). The conception that smoking may affect men and women differently is in accord with the findings about gender differences in susceptibility to diseases, including cancer and CHD (Levy, 1985, pp. 1-6; Kreitler, Weissler & Brunner, 1991; Theorell, 1991; Waldron, 1986). Special stimulation for our study was derived from the evidence that in women, smoking is related to other personality factors than in men. Thus, men smokers score high on sensation seeking and rate drugs favorably whereas women do not (Kohn & Coulas, 1985). Women smokers more than men smokers have negative attitudes toward the law (Heaven, 1989). Only women smokers differed from nonsmokers in scoring higher on anger-proneness and lower on Lie/Conventionality (Gilbert, 1988). Some of the findings seemed to suggest that in women smoking may be related to factors that do not promote disease or even inhibit it, for example, higher psychoticism (Dicken & Bryson, 1978; Leon, Kolotkin & Korgeski, 1979) higher neuroticism, lower extraversion (Cherry & Kiernan, 1976) and the use of smoking for stress reduction (Christen & Glover, 1983) and for dealing with negative affect (Biener, 1988). Eysenck (1988) summarized data showing that psychoticism and neuroticism protect against cancer whereas extraversion promotes it. Similarly, stress and negative affect enhance disease-proneness (Cooper, 1983; Zonderman, Costa 8~ McCrae, 1989). Accordingly, the purpose of this study was to explore the possibility that smoking women have characteristics, personality traits and dispositions that could contribute to a lower rate of disease in women than in men. Thus, we examined in men and women the relationship of smoking to five sets of variables likely to modulate physical responses to a potentially noxious factor like smoking. The first set included physiological variables-white blood cells (WBC) and erythrocyte sedimentation rate (ESR)-designed to test whether there are indications of underlying pathology in any of the smoking or gender groups. The second set included personality variables focused mainly on stress susceptibility: (a) neuroticism, selected mainly because it was shown to be a factor protecting against disease (Eysenck, 1988; Koskenvuo, Langinavainio, Kaprio & Sarna, 1984) and related positively to the psychological tendency to recover and maintain physical health (Kreitler & Kreitler, 1991; see later Cognitive Orientation of Health); (b) stress susceptibility (Stress Reaction, Tellegen, 1982) selected because, on the one hand, stress increases risk for disease (Cooper, 1983; Glaser & Kiecolt-Glaser, 1985) and, on the other hand, women differ from men in their reaction to stress (Frankenhaeuser, 1991) and in the use of smoking for stress reduction (Biener, 1988; Russell & Epstein, 1988); and

Smoking

and

gender gap

759

(c) temperament measures (Strelau Temperament Inventory; Strelau, 1983) assessing strength of (SE), strength of inhibition (SI) and mobility (M) or flexibility in responses. These measures were selected because SE, being closely related to extraversion, and SI, being closely related to repressiveness (Kreitler, Kreitler & Weissler, in press), seem to enhance disease-proneness (e.g. Eysenck, 1988, 1991 chapter 6) whereas mobility may be assumed to contribute to protection against disease. The third set included topical stressors, as manifested in life events and personal problems. Life events are related conceptually and empirically to health and stress susceptibility (Miller, 1989; concerning their specific effect on CHD see Faire & Theorell, 1984 chapter 3). Far from being merely situational factors, their impact depends on the individual’s personality (Brown & McGill, 1989) and evaluation of their effects (Rothbaum, Weisz & Snyder, 1982). This is even more evident in regard to personal problems one admits as bothering one (Kreitler, Aronson, Berliner, Kreitler, Arber & Weissler, in press). It is of special interest that heavy smokers were found to prefer to solve their problems alone (Revell, Warburton & Wesnes, 1985). The fourth set included negative and positive emotions. The potentially noxious effects of negative emotions such as depression, anxiety and anger on health are one of the best established conclusions in health psychology (Friedman & Booth-Kewley, 1987; Grossarth-Maticek et al., 1988; Irwin, Daniels, Bloom, Smith & Weiner, 1987; Linn, Linn & Jensen, 1981; Zonderman et al., 1989). A similar case has been made for the beneficial effects of positive emotions, such as joy and hope, on health (Gelkopf, Kreitler & Sigal, in press; Kreitler & Kreitler, 1991). Finally, the fifth set included the Cognitive Orientation (CO) of Health, a measure of general psychological orientation for the maintenance and recovery of physical health (Kreitler & Kreitler, 1991). The scores of the CO of Health have predicted a variety of physical states and reactions, such as the incidence of flu and fever, speed of recovery from a hernia operation, and severity of myocardial infarction (Kreitler, Greif & Kaplinsky, in press) but not overt health behavior such as undergoing tests for the early detection of breast cancer (Kreitler, Chaitchik & Kreitler, 1990). In regard to all five sets of variables our expectation was that women smokers will score higher than men smokers in the health-promoting variables and will score lower in the disease-promoting variables. excitation

METHOD

Subjects The Ss were 96 healthy adults, in the age range of 27 to 65 years (M = 44.53, SD = 13.87). They included 48 smokers (20 men, 28 women) and 48 nonsmokers (17 men and 31 women). ‘Smokers’ were defined as individuals who have smoked for at least 10 years, over 15 cigarettes a day. The mean number of years they have smoked was 17.20 (SD = 2.8) and the mean number of cigarettes they smoked for the preceding 5 years was 19.4 (SD = 4.5). ‘Nonsmokers’ were defined as individuals who have never smoked. Ex-smokers were excluded from the sample in view of evidence that they differ in physiological and psychological factors both from smokers and nonsmokers (Eysenck, 1980; Friedman, Siegelaub, Dales & Seltzer, 1979). The Ss were selected randomly from the population of two collective settlements in Israel. Assessment instruments The following tests and measures were used in the study: (a) Neuroticism, assessed by the Eysenck Personality Questionnaire (EPQ; Eysenck & Eysenck, 1975). (b) Stress Reaction, which is scale No. 5 of the Multidimensional Personality Questionnaire (MPQ; Tellegen, 1982), and includes 28 True/False items. (c) The Strelau Temperament Inventory (STI) which provides scores of three scales: Strength of excitation (SE), strength of inhibition (SI) and mobility (M) (Strelau, 1983). (d) Life Events Survey (LES; Sarason, Sarason & Johnson, 1985) which asks the S to state whether listed events have occurred in his or her life in the preceding year, and if yes, to rate the degree to which they were viewed as negative or positive at the time of their

760

%lJLAMlTH

(e)

(f)

(g) (h)

(i)

KREITLER

et al

occurrence. The scores were the total number of events for the whole year, the number of events evaluated as negative (i.e. ‘somewhat’, ‘ moderately’ or ‘extremely’ negative), the number of events evaluated as positive (i.e. ‘slightly’, ‘moderately’ or ‘extremely’ positive), and an overall index based on the products of the number of events and their evaluations (- 1 for each negatively evaluated event, + 1 for each positively evaluated event). Personal Problems Questionnaire (PPQ; Kreitler et al., in press) which requests the Ss to state whether they are bothered by some problems-one or more, and if yes, to state the problems’ general domain (e.g. work, family, interpersonal) and rate on a 4-point scale the disturbingness of the problem and the dependence of its solution on the individual. In the study we included as variables only those domains of problems checked by at least 10% of the Ss. The Projile of Mood States (POMS; McNair, Lorr & Droppelman, 1971) which provides scores assessing tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia and confusion-bewilderment. The Positive Emotions Check List (PECL; Kreitler & Kreitler, 1991) which assesses love-affection, happiness-joy, curiosity-interest, and contentment-satisfaction. The CO of Health (Kreitler & Kreitler, 1991) that provides a measure of the overall nonconscious motivation supporting health. The assessment is in terms of four types of beliefs (beliefs about self, beliefs about goals, beliefs about rules and norms, and general beliefs about ‘how things actually are’) referring to a set of themes found to be related to health, such as expressing emotions, feeling in control and trusting others. The Ss are asked to check on a 4-point scale the degree of their agreement with each of the presented statements. Each S gets one score for each of the four belief types and one summative index score, which is the sum of the binary transformations of the four belief scores (i.e. each belief score is transformed into 0 or 1 in line with whether it is below or above the group’s mean for that belief type). The higher the scores the stronger the health orientation. Demographic Information Questionnaire, which requested the S to state demographic data (age, gender, profession) and provide detailed information about smoking (duration, quantity, in the present and the past).

Data about the Ss WBC count and ESR was extracted (with consent) from the files of the Ss’ most recent annual check-up. Procedure

The tests were administered in random order in individual sessions, in the framework of the routine annual health check-up. The Ss were selected randomly out of the total population in the settlements. RESULTS Control analyses showed that smokers did not differ from nonsmokers in demographic variables: mean age, mean years of education, mean years of living in Israel, mean occupational status, marital status and number of children. Table 1 presents means and SDS of all the variables used in the study for the four subgroups (smokers men, smokers women, nonsmokers men, nonsmokers women) as well as the four main groups (smokers, nonsmokers, men and women). The data was analyzed by two-way analyses of variance, with smoking and gender as the independent factors. Table 2 presents the analyses for the variables with significant results. Gender eflects

Table 2 shows that in 11 of the 34 variables (32.35%) there was a main effect for gender (the observed percentage deviates significantly from that expected by chance, CR = 2.893, P < 0.01). The data in Table 1 indicate that women had higher levels than men on ESR, neuroticism, stress reaction, positively evaluated life events, overall evaluation index of life events (i.e. they had more positively than negatively evaluated life events), tension-anxiety, fatigue-inertia, and

Smoking

and gender

Table I. Means and SDS of the variables Var WBC ESR Neurot. Stress

W’Q) STI: E STI: SI STI: M Life Ev. Total Life Ev. Bad Life Ev. Good Life Ev. Index Prob/No Prob/ Disturb Prob/ Pressure Prob/ Work Prob/ Family Prob/ Interp. Prob/ Living Prob/ Econom. POMS: Tens-Anx POMS DepDej POMS: Ang-Hos POMS: Vig-Act POMS: Fat-Inr POMS: Conf-Bew PECL: Lov-Aff PECL: HapJoy PECL: Cur-Int PECL: Con-Sat co: Self co: Norms co: General co: Goals co: Index

Sol/M 7787.50 2056.71 13.38 II.95 4.89 3.30 4.75 2.51 41.71 8.46 59.35 5.58 55.34 7.61 8.90 1.75 6.50 1.55 2.40 I .05 -4.10 1.14 2.67 0.80 3.00 0.93 3.33 0.87 0.40 0.25 0.30 0.16 0.10 0.05 0.10 0.27 0.10 0.03 21.56 5.43 36.00 5.71 37.25 6.49 28.58 3.59 19.16 4.21 22.50 3.64 29.40 3.81 30.04 4.52 29.75 4.8 1 29.75 4.45 61.81 5.69 60.00 3.69 60.68 5.08 57.23 5.73

1.67 0.65

Sol/W 9200.00 2164.32 23.67 13.85 8.00 4.62 9.50 4.74 41.71 9.54 46.52 7.62 53.67 8.10 7.00 I .90 2.75 1.24 4.25 0.99 1.55 1.13 1.75 0.79 3.00 0.85 I .50 0.92 0.14 0.23 0.18 0.13 0.11 0.05 0.18 0.24 0.07 0.02 22.24 5.92 32.69 5.56 30.75 6.33 30.62 3.61 20.68 4.29 23.33 3.95 33.25 3.85 32.08 4.66 30.63 4.84 33.72 4.46 65.00 5.64 62.48 3.75 62.50 5.13 61.46 6.42 2.60 0.86

NonsmlM 6480.65 1549.31 11.97 12.51 6.60 4.87 7.26 4.32 42.02 9.83 53.82 6.37 52.37 6.90 9.18 I .63 5.25 I .26 3.93 0.87 -1.35 1.12 2.21 0.74 3.29 0.88 3.59 0.83 0.41 0.29 0.12 0.14 0.06 0.04 0.12 0.27 0.12 0.02 23.88 6.12 40.46 6.42 39.50 7.12 30.52 3.61 20.09 4.62 21.39 4.28 30.59 3.86 28.66 4.63 30.32 4.76 32.93 4.41 60.14 5.52 61.65 3.78 62.60 5.07 57.40 5.78 1.88 0.62

gap

761

in the study in the different

NonsmiW 6395.82 1531.47 22.66 13.74 10.14 4.90 10.76 5.51 45.25 10.03 52.85 7.80 49.78 7.59 9.02 1.74 4.40 1.08 4.62 0.88 0.22 1.13 2.40 0.71 3.33 0.82 3.18 0.89 0.42 0.28 0.22 0.11 0.19 0.05 0.06 0.23 0.06 0.03 36.39 6.24 43.63 6.48 38.50 7.09 30.51 3.65 23.15 4.65 22.41 4.51 31.77 3.92 30.06 4.66 31.52 4.79 29.40 4.43 59.71 5.50 62.83 3.80 62.26 5.10 58.98 6.15 2.07 0.79

Smokers 8611.46 2182.61 19.38 12.12 6.70 3.41 7.52 4.03 41.71 7.19 51.87 7.19 54.32 8.41 7.79 I .94 4.31 1.64 3.48 1.10 -0.80 1.13 2.13 0.75 3.00 0.93 2.26 0.95 0.42 0.26 0.23 0.15 0.11 0.07 0.15 0.26 0.08 0.03 21.96 5.86 34.07 4.11 34.26 5.81 29.77 3.51 20.05 3.98 22.98 3.27 31.65 3.78 31.23 4.49 30.26 4.85 32.06 4.46 63.67 5.71 61.45 3.69 61.74 5.10 59.70 5.97 2.21 0.87

subgroups

Nonsmok 6421.41 1536.6 I 18.87 13.59 8.89 5.87 9.52 6.24 44.11 10.02 53.19 7.72 50.70 7.19 9.08 I .68 4.70 1.17 4.38 0.85 -0.34 1.12 2.33 0.69 3.32 0.84 3.32 0.84 0.25 0.37 0.18 0.10 0.14 0.04 0.08 0.25 0.08 0.03 31.96 6.50 41.58 6.53 38.97 7.27 30.51 3.68 22.07 4.87 22.05 4.55 31.35 3.95 29.56 4.66 31.09 4.80 30.65 4.38 59.86 5.40 62.41 3.81 62.38 5.05 58.42 5.80 2.00 0.75

Men 7187.05 1552.87 12.73 11.90 5.67 5.11 5.90 4.50 41.85 9.36 56.8 I 5.50 53.97 6.85 8.06 I .62 5.93 1.38 3.10 0.92 -2.84 1.14 2.42 0.84 3.13 0.93 3.45 0.82 0.40 0.26 0.20 0.17 0.08 0.04 0.11 0.29 0.06 0.02 22.63 5.32 38.05 6.37 38.56 7.10 29.47 3.60 19.59 4.56 21.99 4.02 29.95 3.85 29.41 4.58 30.01 4.74 31.21 4.43 61.04 5.68 60.76 3.70 61.56 5.08 57.31 5.65 1.77 0.54

Women 7726.25 2048.45 23.11 14.82 9.12 5.70 10.16 5.97 43.57 10.39 49.85 7.92 51.58 7.84 9.03 I .85 3.62 1.06 4.44 0.89 0.85 1.13 2.09 0.73 3.17 0.78 2.38 0.95 0.29 0.21 0.22 0.11 0.15 0.05 0.12 0.20 0.07 0.02 29.67 6.36 38.42 6.36 35.75 7.05 30.56 3.73 21.98 4.55 22.85 4.6 I 32.47 3.99 31.02 4.75 31.10 4.85 31.45 4.45 62.22 5.62 62.66 3.79 62.37 5.16 60.16 6.58 2.32 ._ 0.87

For each variable, the first line presents the means, the second the SDS. Sm = Smokers, Nonsm = Nonsmokers. the description of the variables see text.

For

love-affection. Further, they scored lower than men on number of negatively evaluated life events, number of problems in the domain of work, and experienced pressure to solve their problems. Thus, the findings indicate that women are more susceptible to stress, tend to have more negative as well as positive emotions, evaluate their life events more positively, and have fewer pressing problems, especially in regard to work.

SUULAMITH KREITLER et al.

762

Table 2. Significant results of two-way analyses of variance with gender and smoking as independent variables Variable

Source of variance

WBC

Gender (G) Smoking (S) Interaction (G Residual Gender (G) Smoking (S) Interaction (G Residual Gender (G) Smoking (S) Interaction (G Residual Gender (G) Smoking (S) Interaction (G Residual Gender (G) Smoking (S) Interaction (G Residual

ESR

Neuroticism

Stress reaction U-Q)

STI: SI

Life events/total

Life events/bad

Life events/good

Life events/index

Personal problems/ number

Personal problems/ p*@SUK

Personal problems/ work

Personal problems/ family

Personal problems/ inter-personal

Personal problems/ living conditions POMS: tension-anxiety POMS: depression-dejection POMS: anger-hostility POMS: fatigue-inertia

x S)

df

Mean of squares

F

I I I

124,604.792 28,495,512.912 4,357,579.680 2.494Ji34.956 2,156.418 65.488 11.177 189.554 241.296 30.912 0.359 29.448 266.339 42.200 3.574 33.705 130.134 15.145 399.611 56.934 3.925 11.915 11.682 2.906 12.692 14.359 12.177 3.065 12.155 5.613 14.976 2.874 12.531 3.838 13.919 1.955 0.024 0.015 3.182 0.619 4.201 2.928 2.694 0.646 0.496 0.626 0.492 0.120 0.33 0.037 0.620 0.155 0.005 0.048 0.039 0.010 0.061 0.299 0.251 0.061 121.665 173.287 168.683 24.236 93.666 215.563 141.882 34.404 46.433 91.365 143.104 34.483 81.240 77.252 7.764 19.508

0.050 11.423*** I .747

92 x S)

I I I 92

x S)

1 I I

92 1

I x S)

x S)

Gender (G)

Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual

1 92

I I I 92 1

I 1 92

I 1 1 92

I 1

1 92 1

I I 92 1 1 1 92

I I I

92 1 1

I

92 1 1 1 92 1

I I 92 1 1

I 92 1 1 1 92 1 1 I 92 1 1 1 92 1 1 1 92

11.376*** 0.345 0.059 8.194”’

I.050 0.012 7.902** I .252 0.106 2.286 0.266 7.02” 1.351 4.1OQ* 4.020’ 4.141’ 4.685; 3.973’ 4.229* I.953 5.211* 6.410’ I .963 7.119” 0.039 0.024 5.040* 6.507’ 4.536’ 4.173* 4.133’ 5.217* 4.100’ 0.210 0.237 4.oOls 0.488 4.685’ 3.980’ 1.009 4.902* 4.128’ 5.020’ 7.150’8 6.966** 2.723 8.010” 4.124’ 1.347 2.650 4.150’ 4.164. 3.9601 0.398

Smoking

and gender

gap

163

Table 2-Conhzued

Variable

Source of variance

PECL: love-affection

Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual Gender (G) Smoking (S) Interaction (G x S) Residual

PECL: contentment-satisfaction

CO score: index score

tP
df

I I I 92

I

1 1 92

I I I 92

Mean of sauares 62.829 I.115 17.455 14.995 27.308 0.790 94.547 20.425 2.004 0.072 2.913 0.747

F 4.190* 0.074 I.164 1.337 0.039 4.629’ 2.683 0.097 3.800t

**P
Smoking eflects Table 2 shows that in 9 of the 34 variables (26.41%) there was a main effect for smoking (the observed percentage deviates significantly from that expected by chance, CR = 2.43, P < 0.05). The data in Table 1 indicate that smokers had higher levels than nonsmokers in WBCC, and scored lower than nonsmokers on number of life events, negatively evaluated life events, problems in the domains of work and interpersonal relations, experienced pressure to solve their problems, depressiondejection, tension-anxiety, and fatigue-inertia. Sex-by-smoking

interactions

From the viewpoint of the hypotheses, the results of greatest interest are those that refer to interactions between sex and smoking. There were 15 clear cases of interaction (i.e. 44.12% of the cases, deviating significantly from the percent expected by chance, CR = 3.747, P < 0.01) and in addition one effect with borderline significance (the index score of CO Health). Concerning SI, in smokers women scored lower than men, whereas in nonsmokers the difference between the genders (though in the same direction) was small and nonsignificant. Indeed, women smokers had the lowest scores on inhibition of any of the four subgroups. Thus, smoking women may be assumed to have lower emotional control and more emotional expressiveness than men. Concerning number of life events, in smokers women listed fewer life events in the preceding year than men, whereas in nonsmokers the difference between the genders was indeed in the same direction but small and nonsignificant. Again, women smokers had the lowest number of life events in the four subgroups. Since life events are bound with stress and tension (Faire & Theorell, 1984, chapter 3) we may conclude that smoking women suffer least stress due to life events. Stress is evoked especially by negatively evaluated life events (Connolly, 1976; Glass, 1977), and may even be counteracted by positive events, especially when the person does not expect negative events (Brown & McGill, 1989). In this context it is then of special interest to note that women smokers had much fewer negatively evaluated life events than men smokers (the proportion is 0.42, i.e. less than half; the difference in nonsmokers is in the same direction but smaller), had many more positively evaluated 11%events than men (the proportion is 1.77 whereas in nonsmokers it is only 1.17), and accordingly had on the whole more positively than negatively evaluated life events (in smokers the women’s score was 4.33 times more positive than in men, whereas in nonsmokers both genders had more negative than positive events, though women less so). Concerning number of problems, women smokers had fewer problems than men (the proportion was 0.65) whereas women nonsmokers had more problems than men (the proportion was 1.09). More importantly, smoking women experienced less pressure to solve their problems than smoking men (the proportion was 0.45), whereas in nonsmokers the direction of the gender difference was the same (women to men 0.88) but the difference was very small. The differences between women and men in number of problems were salient in regard to problems at work (women smokers had 0.35 the problems of those that men smokers had, whereas men and women nonsmokers hardly differed), problems in the family (women smokers had 0.60 the problems of those that men smokers had, whereas nonsmoking women had 1.83 more family problems than nonsmoking men), interpersonal problems (women smokers had about as many as men smokers, whereas women

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nonsmokers had 3.17 more interpersonal problems that nonsmoking men) and problems in regard to living conditions (smoking women had 1.80 more problems of this kind than smoking men, whereas nonsmoking women had 0.50 fewer problems than nonsmoking men). Concerning depression-dejection, women smokers scored lower than men smokers, whereas in nonsmokers women scored higher than men. Women smokers had the lowest scores on depression than any of the four subgroups. Again, on anger-hostility, women smokers scored lower than men smokers, whereas in nonsmokers the difference between the genders was very small. Concerning tension-anxeity, women smokers scored about as low as men smokers, whereas women nonsmokers scored much higher than men nonsmokers, in fact higher than all subgroups. Finally, on contentment-satisfaction, women smokers scored higher than men smokers whereas women nonsmokers scored lower than men nonsmokers. Women smokers scored higher than all subgroups. Finally, it may be mentioned that women smokers showed a tendency to score higher than men smokers on the CO of Health index measure (reflecting mainly scores on beliefs about self and about goals), whereas in nonsmokers the difference between the genders was smaller. Women smokers had the highest score on the CO of Health than any of the subgroups. Considering the Bonferroni criteria for multiple analyses of variance results, results at the 0.05 significance level should be interpreted with caution (because for 34 variables the level of significance corresponding to the 0.05 level would be 0.05/34 = 0.002, i.e.
Smoking and gender gap

765

The most important and innovative results refer to the particular characteristics of smoking women, which constituted our hypothesis and were examined by the interactive effects of smoking and gender. These characteristics were found to be the following: (a) Low inhibition, namely, low emotional control and high emotional expressiveness, that have been identified as a cancero-protective factor, mainly for lung cancer and breast cancer (Blohmke et al., 1984; Grossarth-Maticek et al., 1988); (b) A generally low number of life events, namely, low stress due to changes in life conditions in general. In addition, an overall positive evaluation of the life changes that do occur, reflecting an especially low number of negative life events-that are particularly stressfuland a high number of positive life events-that are particularly mood and energy enhancing for basically optimistic individuals (as women smokers may be expected to be in view of their low scores on depression). Low situationally-bound stress and an optimistic approach have been identified as health-promoting factors in general, and for CHD and cancer in particular (Eysenck, 1991). (c) A low number of personal problems, especially in the domains of work (relevant in regard to CHD), and family and interpersonal relations (relevant in regard to cancer) (Eysenck, 1991), and in addition a low experienced pressure to solve the problems-a factor that further reduces the problems’ poignancy. (d) Low scores on depression-dejection, anger-hostility and tension-anxiety. As noted above (Introduction), depression, anger and anxiety have been identified as immuno-suppressive and disease-promoting factors. Low scores on these emotions may be considered as health-promoting. (e) High scores on contentment-satisfaction. Being satisfied with oneself, life and the world is a major component of subjective well-being that has been identified as promoting physical health @track, Argyle & Schwarz, 1991). Thus, all mentioned characteristics of smoking women are of a disease-suppressing or health-promoting nature. Not suprisingly, also the index score of CO Health indicates a tendency in the same direction. Many of the stated characteristics were also found to characterize the health-oriented individual (Kreitler & Kreitler, 1991). In fact, almost all the significant results of smoking-by-gender supported our expectation that smoking women would have personality characteristics promoting physical health. The only exception was problems concerning living conditions: smoking women had more, probably not least because of their smoking. The major conclusion of the findings is that smoking women have a whole set of specific personality characteristics that are health-protective. One may further note that these characteristics are particularly relevant for CHD and cancer, the two major diseases implicated by smoking. The presumed impact of these characteristics may be expected to be enhanced by their broad range and differential contributions to health (viz. some may act as disease suppressing, others as health-promoting). These findings may provide an explanation for the commonly documented fact that women, who smoke the same quantity as men, are less susceptible to the expected smoking-dependent diseases. Thus, we suggest the possibility that smoking women are less susceptible to smoking-dependent diseases because they have personality characteristics that are health-protective in general, and specifically in regard to CHD and cancer. Accordingly, our results provide further support to Eysenck’s thesis about the synergistic effects of smoking and personality on health. Further, they underscore the complexity of the matrix of determinants underlying the occurrence or non-occurrence of disease and highlight the necessity to study the differential effects on health of both health-promoting and disease-suppressing psychological determinants. REFERENCES Biener, L. (1988). Coping and adaptation. In Barnett, R. C., Biener, L. & Baruch, G. K. (Eds), Gender and stress @p. 332-349). New York: The Free Press. Blake, S. M., Pechacek, T., Klepp, K., Folsom, A., Jacobs, D. & Mittelmark, M. (1984). Gender differences in smoking cessation strategies. Paper presented at the Society of Behaoiorul Medicine, Philadelphia, PA.

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