Pergamon

P~man. indicid. D# Vol. 21. No. 4, pp. 545-555, 1996

Published by Elsevier Science Ltd. Printed in Great Briraln
0191-8869/96 $15.00+0.00
SO191-8869(96)00087-6
ASSOCIATIONS BETWEEN STRESS, PERSONALITY AND
SMOKING
Torbjarn Rundmo, * Geir Smedslund and K. Gunnar Giitestam3
Department of Psychology, University of Trondheim, Dragvoll, 7055 Trondheim, Norway, Department
of Psychiatry and Behavioural Medicine, University of Trondheim, Lade, 7002 Trondheim, Norway;
and Department of Psychiatry and Behavioural Medicine, University of Trondheim. Lade,
7002 Trondheim, Norway
( Rewived 5 Januar_y 1996)
Summary-This artxle reports results from a questionnaire survey of smoking and health which has been
carried out among a representative sample of Norwegians (N = 5014).t About one-third ofthe respondents
smoked (N = 1639). Path analysis showed that the cancer-prone personality (Eysenck, 1988) correlated
with job stress, strain as well as smoking. There was also a tendency that smoking and cancer were
associated. The respondents age and educational level were correlated with their cancer-prone personality
score. Personality predicts strain and smoking among elderly people whose education is restricted to
elementary/junior high school. The article discusses the possibility that the effect on smoking habits and
cancer of the cancer-prone personality may depend partly on the respondents age and education. The
article presents further analyses of the data reported in Smedslund I 1995). Published by Elsevier Science
Ltd.
INTRODUCTION
The association between smoking and cancer was established decades ago (Doll & Hill, 1950;
Fleckseder, 1936; Muller, 1940). According to LaVecchia, Boyle, Franceschi, Levi, Maissoneuve,
Negri, Lucchini and Smans (1991) cigarette smoking is unquestionably the single most important
cause of cancer in man. According to Doll and Peto (198 1) and Ernster (1988) more than 30% of
the cancer deaths in the U.S.A. are due to smoking. Several studies have linked smoking to pancreatic
and bladder cancer, cancer of the larynx as well as cancer of the oesophagus (Cann & Fired, 1984;
Hirayama, 1981; Kantor, Harge, Hoover, Narayana, Sullivan & Fraurmeni, 1984; Olsen, Mandel,
Gibson, Wattenber & Schuman, 1989; see also LaVecchia et al., 1991). According to Doll and Peto
(1981) it seems unquestionable that smoking has a role in lung cancer.
Studies have shown that risk factor ratios of lung cancer are between 8.5 and 50 times greater
among smokers than non-smokers (Kubik, 1984; Schoenberg. Wilcox, Mason, Bill & Sternhagen,
1989). According to Lubin, Richter and Blot (1984) the risk of dying from lung cancer is nine times
greater among cigarette smokers compared to non-smokers, while identical figures for those who
smoked only cigars and pipes were 2.9 and 2.5. Cigar and pipe smoking seem also to be related to
cancer of the mouth, pharynx, oesophagus, larynx and bladder (Carstensen, Pershagen & Eklund,
1987; Kaufman, Palmer, Rosenberg, Stolley, Warshaver & Shapio, 1989).
The increase in lung cancer since the beginning of this century follows an increased prevalence of
cigarette smoking. The decline in male lung cancer rates over the few past years reflects a decline in
mens smoking habits over the recent years. France is the European country that has the highest
frequency of deaths due to oral cavity, pharynx, oesophagus and larynx cancers (LaVecchia et al.,
1991). This may be due to the interaction between tobacco and alcohol, pipe and cigar smoking,
and the use of high-tar/dark cigarettes in France and other countries in the southern part of
Europe, e.g. Italy and Spain (Ferraroni, LaVecchia, Pagano, Negri & Decarli, 1989; Tuyns, Es&e,
Raymond, Berrino, Benhamou, Blanchet, Boffetta, Crosignani, de1 Moral & Lehmann, 1988; see
* To whom all correspondence should be addressed.
t The study was approved by the Norwegian Data Inspectorate and financed by the Norwegian Research Council (project
no. 101950/330).
546 Torbjsrn Rundmo et al.
also LaVecchia et al., 199 1). According to LaVecchia et al. (I 99 1) lung cancer rates reflect cigarette
smoking in the past decades, but not current smoking patterns.
Akiba and Hirayama (1990) followed a cohort of 265,000 residents of 29 Public Health districts
in Japan between 1966 and 198 1. For both sexes a significant dose-response relationship between
cigarette smoking and mortality rate was found for cancer of the liver, pancreas and lung. In
addition, such a relation was also found for cancer of the oral cavity, oesophagus, stomach, larynx,
and bladder in men and cancer of the uterus in women. The relative risks were only slightly affected
by occupation. However, smoking as well as occupation may be important for the development of
lung cancer.
The proportion of lung cancer varies between the geographical areas of Europe, and a clear
pattern related to present smoking habits can not be found. The variations may be due to exposure
at work as well as air pollution (Doll & Peto, 1981; LaVecchia et al., 1991). In addition to physical
stress also organizational stress, the respondents age, gender and education may be related to
cancer.
Eysenck (1986) has outlined a causal theory linking stress and strain to cancer. Acute stress may
lead to strain reactions characterized by depressive feelings of hopelessness and helplessness and
also to an increased cortisol level, which causes immunosuppression. Immunosuppression may also
lower the natural killer cell activity, which may be related to cancer. Furthermore, these reactions
may be linked to a genetic predisposition (see Eysenck, 1988). Therefore, people who are genetically
predisposed to react to stress and strain with a feeling of helplessness and depression may also be
more cancer-prone, i.e. Eysenck links personality to stress and strain as well as cancer. No definite
evidence can be given for the truth of this theory. However, empirical results from several studies
give some support to it. According to Eysenck (1988, p. 74): There is now. . too much empirical
material to doubt that stress-strain, interacting with personality, plays a causal role in the genesis
of cancer, probably in combination with such factors as smoking, drinking etc.
In addition, cancer-prone personality has proven to affect cancer independent of smoking habits.
A cancer-prone personality seems to be the stronger of these two predictors and a stronger predictor
than all other predictors (Eysenck, 1988). Smoking seems to be linked to cancer only for cancer-
prone personality types.
Another study currently in progress, which is going to partly replicate the Grossarth-Maticek
studies, has recently been started in Heidelberg (Amelang & Schmidt-Rathjens, 1992). These inves-
tigators have performed factor analyses of the items constituting the six personality types. Scales 1
and 2 were shown to load positively on one dimension together with scale 4 (negatively). Scales 1
and 2 were intercorrelated to the limits of their reliability. Persons suffering from cancer and persons
suffering from coronary heart disease both scored high on the factor compared to healthy subjects,
but the two disease groups could not be separated from each other. Amelang and Schmidt-Rathjens
(1992) have also found that the scales are dependent on age and gender.
If smoking is associated with cancer, cancer-prone personality predicts cancer, and this relation
is not completely caused by a genetical predisposition, then the cancer-prone personality score
should also to some extent predict strain and smoking. Several studies presented above, conclude
that strain and smoking are related to cancer. According to the U.S. Surgeon General smoking is
probably one of the most significant threats to health (U.S. Department of Health and Human
Services, 1989). If it is true that smoking has such a significant effect as concluded by a lot of
empirical studies, and cancer-prone personality is not at all related to smoking, then it is doubtful
that personality could be such an important factor in cancer. However, personality is an important
predictor. Consequently, the cancer-prone personality should also significantly predict smoking
behaviour.
It seems also reasonable that there is an association between stress, strain and smoking. Smoking
may be a mechanism for mastering stress and strain. This is in accordance with beliefs among
smokers that smoking may reduce negative affect, i.e. when they feel sad, bored, lonely and worried,
and, in addition, causes pleasure and stimulation, i.e. smoking perks them up, gives them a lift,
causes happiness, self-confidence, and so on (see Rohsenow, Abrams, Colby, Gulliver, Niaura &
Monti, 1992; Rundmo, Smedslund & Giitestam, 1995). If the cancer-prone personality is predicting
cancer, cancer is related to stress and strain reactions, and these reactions are also related to
smoking, we could expect to find that the cancer-prone personality score predicts smoking as well
Stress, personality and smoking 547
as cancer. It may be argued that the link between smoking and cancer is too strong to account for
the possibility that the cancer-prone personality is related to cancer without also at the same time
being related to smoking habits. However, if smoking is an insignificant predictor of cancer, then
we would not expect to find a strong correlation between smoking and the cancer-prone personality
type. Perhaps the cancer-prone personality is not at all capable of predicting smoking habits? If so,
cancer should not be significantly related to smoking. Hence, we would expect that smokers and
non-smokers have a fairly equal probability of being ill.
In addition, gender, the respondents education and age may affect the associations between
stress, strain and smoking. According to Berman and Gritz (1991) women with lower educational
attainment are at particularly high risk for smoking initiation and continuation. In addition, we
also know that women are less educated than men and that a greater percentage of smokers are in
lower socio-economic groups (see e.g. Carroll, 1992; Parrot, 1991). These differences may also exert
influence on the associations between the variables.
The core aim of the present paper is to clarify how much of the effect of smoking on cancer is
due to personality. The other predictor variables are gender, education, job stress, and strain. The
paper is based on a representative sample of the Norwegian population. Therefore, some results
concerning job stress, strain, and cancer among the Norwegian public are also reported. The specific
objectives of this paper are to determine:
1. cancer related to the respondents personality, gender, education, and age;
2. job stress and strain among the Norwegian public, the effect on smoking of gender, education,
stress, strain, and cancer-prone personality, as well as the effect of the respondents education
and age on these associations.
METHODS
Sample
A random sample of respondents aged 19 and older in the Norwegian general population replied
to a mailed questionnaire. The sample was chosen by the Norwegian Government Computer
Center. A total of 5014 respondents answered the questionnaire. The response rate was 51.6%. The
respondents were representative of the Norwegian population with regard to gender and smoking
habits. With regard to age, the sample was somewhat skewed, however, not unacceptably. There
was a slight over-representation of respondents in the youngest age group. A total of 1639 (33%)
of the respondents smoked. This is slightly below the Norwegian smoking rate reported by the
Norwegian National Council on Tobacco and Health. Telephone interviews were carried out among
a random sample of 202 non-responders and 188 were actually reached. A greater percentage of
non-responders smoked (40%) when compared to those who responded to the questionnaire (33%).
The questionnaire was sent by mail to the whole sample. The respondents were informed that
they were automatically enrolled in a lottery in which the prizes included one gift certificate of &500
and two gift certificates of &250 at a local travel agency. The respondents were also informed that
responding would give them the opportunity to participate in a smoking cessation program (see
Smedslund, 1995 for further details).
Questionnaire content
The questionnaire contained a total of 257 questions, including demographic variables (gender,
age and education), self-reported job stress, strain variables, diseases that the respondents have or
have had, and smoking habits.
The following educational levels were applied: (1) respondents who only had elementary/junior
high school; (2) vocational/practical education; (3) senior high school; and (4) university/college
education.
A total of 10 items intended to measure job stress, which were the following: The tasks I carry
out have been planned in detail by others; My superiors issue differing and contradicting orders;
I work on several tasks at the same time; I have a sufficient amount of freedom to decide on my
workplace; It is easy to predict the expectations put on me by others . I can finish each individual ,
work-task before starting on a new one; I can take short breaks whenever I wish without having
548 Torbjlarn Rundmo et al.
Table I. Test Items measuring strain
Variable
Headache
Migraine
Thumping heart
Neckpain
Backpain
Pain in arm/shoulders
Chestpain
Other pain
Problem with breathing
Cold or flu
Heartburn
Nausea
Stomach ache
Diarrhea
Constipatmn
Eczema
Allergy
Hot flushes
Sleeping problems
Fatigue
Tension
Dizziness
Anxiety
Depression
Irritation/anger
Low self-respect
Boredom
Other health-problems
to take account of other people; I know what 1 can expect from others; I can decide when and
how each individual work task shall be implemented; and I can do my work independently and
according to my own views. These items were selected from Caplan, Cobb, French, Harrison and
Pinneau (1975) Person-Environment Fit Index, and the selection of test items have previously been
used successfully in empirical research (Rundmo, 1992; 1995). The respondents were asked to assess
their degree of job stress on a five-point evaluation scale for each of these items. The scale ranged
from yes-to a high extent to no-not at all.
The strain items that were included are shown in Table 1. In total there were 28 items. Also on
this scale the respondents were asked to assess their degree of strain on a five-point evaluation scale
ranging from yes-to a high extent to no-not at all.
The respondent was also asked whether or not he or she have or have had cancer. Eysencks
Short Interpersonal Reactions lnterventory (Grossarth-Maticek & Eysenck, 1990) was applied for
testing cancer-prone personality as well as coronary heart disease personality and the normal
group (Eysenck, 1988). This test consisted of a total of 40 test items covering all the main personality
types related to cancer, diseases to the heart, and health. In this study it was the total score on the
cancer-prone personality index which was used for further analyses.
Statistical analyses
Principal component analysis with iteration and varimax rotation was used to analyze the
underlying structure of job stress and strain. Thereafter, the weighted z-score indices were entered
into path models. To avoid the models becoming too complicated, one-factor solutions were applied
for all the principal component analyses. To determine whether or not there were gender differences
in strain and diseases, Students t-test were applied. One-way analysis of variance was used to
determine whether or not there were differences in strain and diseases due to the respondents
education. To find out between which of the groups there were significant differences, Scheffes
multiple range test was used. The LISREL 8-program (Jilreskog & Sbrbom, 1993) was applied for
testing the path models of the associations between education, gender, job stress, strain and smoking.
Stress, personality and smoking
549
Table 2. Experience of cancer and cancer-prone
personality
CaIlcer
Yes
No
Cancer-prone
personality
mean score , P
16.52
6.22 3.38 0.001
Table 3. Cancer, gender. and education
Cancer
Observed
vallle
Expected
value
x2
P
Gender:
Men
Women
E&&m
College/
university
Other
35 ?O
25 30 1.61 NS
lb 21
44 39 1.14 NS
The respondents were divided into sub-groups due to gender and education and identical models
were tested separately for each sub-group.
RESULTS
Cancer related to the respondents personality, gender, education and age
A total of 61 persons either had or have had cancer. A total of 1.5% of the smokers had
experienced cancer while the analogous figure for non-smokers was 1.2%. The total number of
smokers was 1639. In addition, 1230 ex-smokers and 2145 never-smokers were part of the sample.
It was only about 0.5% of the never-smokers who had or had previously experienced cancer. We
also have to take into consideration that this study was retrospective. The registration included the
main groups of cancer. Therefore, the number of persons experiencing cancer is probably greater
than that shown by these figures.
Table 2 shows there was also a significantly greater percentage of those who had or had previously
experienced cancer who had a high score on the cancer-prone personality index (t(4751) = 3.38,
P = 0.001).
Out of a total of 60 cancer cases, men numbered 35 whereas we would expect 30 cases in this
group. A total of 30 cases were expected by statistical inference among women, whereas the observed
figure here was 25 cases. Likewise, respondents who were educated at a college or university
experienced fewer cancer cases than expected (16 observed vs 21 expected) and the opposite was
true for those who did not have a university/college education (see Table 3). The total number of
respondents who had or had previously had cancer was too small to draw any decisive conclusion
about the association between cancer, smoking, gender and education. However, there was a
tendency that cancer could be related to these factors. Age was definitely a significant factor.
When elderly people were compared to younger people there was a significant difference in cancer
(x2(6/N = 4730) = 87.64, P = 0.0000). The older respondents experienced cancer more often.
J ob stress and strain among the Norwegian public
Ten test items intended to measure job stress were chosen. The Cronbachs alpha of the job stress
items was 0.652 (total material), 0.734 (sub-sample of women) and 0.613 (sub-sample of men).
550 Torbjarn Rundmo et al.
Table 4. Mea values ofjob stress
Variable
Work wth several tasks at the same time
Can do my work independently
Easy to predict the expectations put on me
I know what I can expect from others
Freedom to decide on my workplace
Can decide when and how each worktask shall be implemented
Can take short breaks
Can finish each indiwdual work task before starting new
Tasks planned in detail by others
Superior issue differing and contradicting orders
Mean SD N
3.03 1.12 393 I
2.94 1.12 3948
2.88 0.93 3915
2.85 0.91 3915
2.82 1.21 3942
2 75 1.15 3935
2.45 1.43 3943
I .86 I.31 3929
I.71 I.31 394 I
I .03 I.16 3914
4 = to a high extent, 0 = not at all.
Table 5. Mea values of strain
Variable MCd SD N
Table 4 shows that the respondents most often reported that they had to work on several tasks
at the same time and that they were not able to do their work independently and according to their
own views. The mean differences are however small. Smedslund and Rundmo (I 995) have presented
the results of this index in greater detail.
Fatigue
Irritation/anger
Backpain
Tension
Cold or flu
Pain in arm
Neckpain
Headache
Low self-respect
Sleeping problems
Boredom
Depression
Diarrhea
Stomach-ache
Other pain
Other health problems
Thumpmg heart
Dizzmess
Anxiety
Nausea
Heartburn
Allergy
Eczema
Constipation
Chestpain
Hot flushes
Problem with breathing
Migraine
I .89 I .03 4892
I .73 0.83 4869
1.66 I .23 4888
I .6S I.10 4858
1.52 0.74 4894
1.50 1.30 4882
I .46 1.25 4880
I .44 0.99 4890
1.24 1.01 4810
I.18 I.14 4893
1.17 0 96 4855
1.17 I .04 4853
I.16 0.90 4868
I.13 0.91 4856
I .09 I .Oh 4696
I .08 0.99 4588
IO1 I .06 4878
0.90 0.95, 4868
0.89 I .06 4874
0.89 0 79 4856
0.83 0.97 4857
0.80 I.18 4855
0 71 I.12 4851
0.70 0 94 4868
0 65 0.95 4843
0.63 0.96 4847
0.53 0 92 4838
0.35 0.80 4804
4 = to a high extent. 0 = not at all
Men experienced more job stress than women (t(4987) = -6.16; P = 0.000) and the respondents
educational level was also related to job stress, i.e. the less educated the more job stress was
experienced by the respondent (f(2/4937) = 156.72; P = 0.0000). For this analysis the groups
vocational/practical education and senior high school were recoded into one group. Scheffes
multiple range test was used to determine between which of the groups there were significant
differences, and all the three groups differed significantly from each other (P < 0.05). There was
a significant positive correlation between the respondents age and job stress (r(5014) = 0.32;
P = 0.000).
The strain variables intended to measure physical as well as psychological strain. All the test
items were however added without differential weighting and entered into the model. Cronbachs
alpha was 0.904 for the entire material (N = 0.5014). Identical figures for female and male respon-
dents were 0.897 and 0.908. Table 5 shows the mean values of the respondents assessments. The
respondents were asked to assess their degree of strain on a five-point scale ranging from yes-to
a high extent (integer 4) to no-not at all (integer 0). As shown in Table 5, they most frequently
Stress, personality and smoking
Table 6. Gender and strain
Gender Mean f P N
Female 37.09 2147
Male 44.43 -9.62 0.000 2082
Table 7. Education and stram
Schef%s multiple range test
Education Mean F P Group I Group 2 Group 3
College/university
Work related/
Senior high
Junior high
35.87
39.67
49.31 40.07 0.0000
Group I
Group 2
Group 3
<0.05
_._
<005 <0.05
experienced strain due to fatigue, anger, and backpain (see Smedslund & Rundmo, 1995 for further
details).
Table 6 shows that men experienced significantly more strain than women (t(4299) = -9.62;
P = 0.000). There were also differences in strain due to education, i.e. the less educated respondents
also reported the most job stress (&(2/N = 4209) = 40.07; P = 0.0000). There were three groups.
Scheffes multiple range rest showed that all three groups differed significantly (P < 0.05) (see Table
7). Strain and the respondents age was also significantly correlated and older persons had most
strain (~(5014) = 0.22; P = 0.000).
Associations between gender, strain and smoking
A Mann-Whitney U-test showed that there were significant differences in personality
(Z(4753) = -3.01; P = 0.0027), job stress (Z(4753) = -2.10; P = 0.0356) and strain
(Z(4753) = - 3.46; P = 0.0005) depending on whether or not the respondents had or had previously
had cancer.
Figs 1 and 2 show the associations between job stress, education, cancer-prone personality, strain
and smoking among female and male respondents. The results of the path analysis of both sub-
samples are almost identical. As can be seen, 25% (1 -e?) of the variance in the endogenous variable
r=.73
i
yigii&-~ ~~&_&_~~
Goodness of it Index (G&)=1.000
Adjusted GFJ=.997
x2
Job stress
I
y12=. 17
Yl
p21=.06 y2
)
Strain # Smoking
Fig. I. Associations between education, job stress, personality, strain and smoking among female
respondents.
552 Torbjsrn Rundmo et al.
r=.61
Job stress
@21=.1C y2
)
Strain
+ Smoking
Male respondents
x2(2/v=2453)=2.50, p=.286
Goodness of Fit Index (GFI)=l.OOO
Adjusted GFI=.997
Fig. 2. Associations between education, job stress, personality, strain and smoking among male respondents.
was explained among females while the same figure for males was 19%. Taking into consideration
that smoking behaviour is a dichotomous variable, i.e. the respondents were asked whether they
smoked or not, the explanatory power of the model is quite satisfactory. The effect of this is probably
that the error, e,, is overestimated (see Hauser, Tsai & Sewell, 1983). The model fit was found to
be ideal for the female (x2(2/N = 2534) = 2.82; P = 0.245), as well as for the male sub-sample
(x2(2/N = 2453) = 2.50; P = 0.286).
The personality factor was the most successful predictor of smoking among women (yz3 = 0.31)
as well as men (y23 = 0.25). The respondents education seemed to be as important as personality
among female and male respondents (;j2, = - 0.23 in both groups of respondents). The effect of job
stress on smoking was indirect. Job stress affected strain, and strain exerted some influence on
whether or not the respondents smoked (/3*, = 0.06 among women and b2, = 0.10 among men). We
also have to take into consideration that strain is not necessarily limited to job stresses, especially
not for women. Including job stress as a direct predictor variable of smoking did not cause an
increased R* nor did it improve the model significantly. However, as can be seen from Figs 1 and 2,
job stress seemed to be of somewhat greater importance for strain among men (ylz = 0.22), compared
to women (ylz = 0.17). In total these two variables explained 6-7% of the variance in the mediating
variable.
Between two of the predictor variables, the respondents education and the personality variable,
there was, rather surprisingly, also a significant correlation (r = 0.73 among women and r = 0.61
among men). This was also supported by a one-way analysis of variance (F(3/N = 4937) = 52.75;
P = 0.0000). Scheffbs multiple range test showed that it was Group 1 (junior high school) which
deviated significantly from the other three groups (P < 0.05).
Job stress was not as closely related to the personality factor, with r-values respectively of 0.12
and 0.13. The single indicators intended to measure job stress were quite general and would be
relevant for blue as well as white collar employees, which may also explain the rather low correlations
between the respondents education and job stress (0.08 for female and - 0. I3 for male respondents
respectively).
Smoking and education
As shown in Fig. 1 and Fig. 2 there was a highly significant correlation between educational level
and the personality factor. This result may indicate that the personality score in some way may be
related to the respondents education. Therefore, we decide to determine in which way the respon-
dents education had a moderating effect on the association between job stress, personality, strain
Stress, personality and smoking
Table 8. Associations between job stress. personality, strain and smoking due to the respondents education
553
Education
r
job stress-
personality
BII
job stress
+train
72,
job stress
-smoking
;I>
pen-
strain
Y2?
pers.-
smoking C,
J unior high-school 0.15 0.22 0.05 -0.21 -083 92 31
Vocational-practical 0.07 0.21 -0.01 -0.15 -0.73 94 42
Senior high-school 0.05 0.06 -0.03 - 0.09 -0 73 98 45
University/college 0.10 0.24 -0.01 -0.06 -0.57 94 66
and smoking. The results of these analyses are shown in Table 8, which summarizes four path
analyses, one analysis for each of the following groups: Respondents who only had elementary/junior
high school (N = 1084) vocational/practical education (N = 1591) senior high school (N = 538)
and university/college education (N = 1676). The models are identical to the models presented in
Figs 1 and 2 except that the respondents education is removed from the model. This was done due
to the strong correlation between education and the personality predictor variable.
Smoking was most successfully explained by the model among respondents whose education was
limited to elementary/junior high school (R2 = 0.69) while figures in the other groups were 0.57
(vocational/practical education), 0.55 (senior high school), and 0.34 (university/college education).
The association between personality and smoking was most significant among those who only had
elementary/junior high school education (J** = -0.83). The y,,-value was clearly lower in the group
of respondents with a university/college education Pi22 = -0.57) while the two other groups were
in the middle. The yZz-value was -0.73 in both these groups. Thus. it seems to be true that the
association between the personality score and smoking behaviour to some extent depends on the
respondents own education. A y-value of -0.57, in the best educated group of respondents, also
indicates that the score is to some extent associated with the respondents educational level. Other
factors seem to be more important than education for the respondents score.
Age, personality and cancer
The youngest respondents were 19 years old (N = 101) and 95% of the respondents were younger
than 70 years. The respondents were also divided into seven age groups (18-27 years old, 28-38
years, 3949 years, 50~-59 years, 6&69 years, 70-79 years and 80 years old or more). The average
age of the non-smokers was 40 years while the same figure for the smokers was 43 (t(4945) = 7.40;
P = 0.000). There was also a significant correlation between the respondents age and the score of
the cancer-prone personality index (r(4572) = 0.13; P = 0.000). which may indicate a change in
personality due to age.
The probability of cancer seems also to increase by age. The average age of respondents who did
not have or ever had cancer was 41 years, and among the cancer group 59 years (((473 1) = - 8.54;
P = 0.000).
Because age was significantly correlated with cancer-prone personality, and personality with
smoking, the next step was to analyze the effect of age on the associations shown in Table 9. Because
the failure terms of the endogenous variables (shown in Figs 1 and 2) were greatest among well
educated persons we selected the subgroup of respondents who had a university degree or college
education.
As shown in Table 9, there is a tendency that the effects of personality on strain as well as on
smoking increases somewhat with age, i.e. the effect of personality seems to depend on the respon-
Table 9. Associations between job stress. personality, strain and smoking due to age
IS-27 0.08 0.18 - 0.02 0.25 -0.02 0.88 0.99 391
28 -38 0.12 0.17 0.00 0.24 0.03 0.89 0.98 557
3949 0.1 I 0.16 0.06 0.31 -0.03 0.86 0.98 434
5&59 0.1 I 0.12 -0.03 0.30 - 0.02 0.87 0.99 I75
60-69 0.22 0.43 -0.15 0.3 I -0.21 0.67 0.93 82
70 0 I2 0.09 0.60 0.86 -0.58 0.35 0.19 36
554 Torbjsrn Rundmo ec al.
dents age. However, the effect on smoking (e2) of the personality factor as well as job stress was
rather insignificant except among elderly people. As can be seen in the most educated group of
respondents, the predictor variables are no longer aimed at predicting smoking and the prediction
of strain is limited to lO-15% of the variance in the age groups up to 60 years.
DISCUSSION
This paper shows that the cancer-prone personality (Eysenck, 1988) was a significant predictor
of strain and smoking. Furthermore, there was also a tendency that strain and smoking were related
to cancer. However, the personality factor also correlated significantly with the respondents age
and education. When we took this into consideration the effect of personality on strain and smoking
was reduced. This was especially evident among the most highly educated group of respondents,
i.e. those who had a university degree or college education, and among younger respondents. Gender
did not affect the associations between stress, strain personality and smoking. However, there were
gender differences as well as differences due to education and the respondents age on job stress and
strain.
Cancer-prone personality seems to predict cancer (Eysenck, 1988). This is due to the association
between stress and strain on the one hand and personality on the other hand. We also know that
stress and strain are significant predictors of smoking (Rundmo et al., 1995). Therefore, we would
also expect that personality predicts smoking as well as cancer.
The cancer-prone personality seems to predict smoking best among respondents whose education
is limited to junior high school. However, the respondents have to be in the group of elderly people
for this to be true. Therefore, it may be the case that personality in some way or another reflects the
respondents age and educational level.
This result also makes sense when we know that the probability of experiencing cancer increases
with age and especially among persons who experience physical and organizational strain. These
groups are also more frequently smokers compared to persons who have university/college education
and therefore probably know more about the health-damaging effects of smoking. Smoking is the
dependent variable in all the models tested in this paper. The number of respondents who have or
have had cancer was too small to draw any decisive conclusions regarding the effects of these
variables on cancer. Accordingly, this paper does not intend to discuss whether or not age and
education interacts with cancer.
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