Discuss the strengths and limitations of research directed to understanding the effects of differing lifestyles on health

In affluent Western countries, many of us have the luxury of a surplus of resources. In the past, and indeed in less affluent countries, people often die as a result of inadequate medical care, malnourishment or lack of shelter. For those of us in affluent countries, these problems, have to a reasonable extent, been dealt with. As we can now choose what to eat, how to spend our leisure time and, for many of us, where and how we work - our lifestyle is now more directly affecting our health. There is now a range of evidence from different areas of the connection between lifestyle and health, both mental and physical. Connections that have been investigated include stress and tension, negative thinking, exercise and sleep. All of these, which are often a result of lifestyle choices, have been connected with health. Research studies from two major areas of people's lives - their work and their relationships - are reviewed here to examine the connections between lifestyle and health more closely.

Models of health and approaches to health in psychology are quite different to those used in medicine. Psychology tends to concentrate on mental health and how it might affect other areas of a person's life. Instead of seeing health in a negative light as something that can be lost through disease for example, it is seen in a positive light as a sense of mental, physical and social well-being. It is for this reason that psychologists are more keen to examine the connections between lifestyle and health. Perhaps one of the most researched areas is the connection between stress, health and disease. It was Selye (1956) who introduced the idea of the general adaptation syndrome, a theory of how stress might affect health. This idea posits that an organism that is presented with a stressor goes through three stages. Firstly the alarm-phase which includes the increased secretion of hormones. The second stage is an adaptation or resistance phase - this is where the organism tries to adapt to the new stressor. The final stage, which occurs if the stressor continues for long enough, is the organism becomes exhausted and it is at this stage that its physical resources begin to be depleted.

There are theoretical linkages between stress and health, but what about the research evidence? A long line of studies have looked at how levels of stress (which often result from particular lifestyles) are related to health outcomes. Kiecolt-Glaser, Garner, Speicher, Penn, Holliday & Glaser (1984) took blood from 75 medical students, once a month before their final examinations and once on the first day of their examinations. A measure was also taken at both times of what stressful life events the students were experiencing at that time and a measure of their loneliness. The study found that students who showed the highest number of stressful events and the highest levels of loneliness, were also seen to have the lowest levels of natural killer cell activity. It is this lower level of killer cell activity that has been established in medical science as tending to predict a greater susceptibility to disease.

Levels of stress, then, that will often result from lifestyle choices have been shown to have a negative effect on health. Stress may have an interesting contribution towards health by the indirect means of diet. Cartwright, Wardle, Steggles, Simon, Croker & Jarvis (2003) investigated how levels of stress are associated with dietary practices in a sample of 4,320 school children who came from a wide variety of different social and economic backgrounds. The children were asked to complete a perceived stress questionnaire, to supply demographic information, to describe their fatty food intake, fruit and vegetable intake, frequency of snacking and frequency of eating breakfast. In addition, height and weight were also measured. All of these factors were compared using a multivariate analysis to search for connections. The study found strong evidence that stress is intimately associated with dietary decisions. The children who scored the highest on levels of perceived stress, were those children who tended to eat the most snacks and fatty foods, while also being least likely to eat fruit and vegetables or regularly eat breakfast. In addition, the researchers found that there was a relatively linear relationship between the variables, so that the higher the levels of stress, the further dietary patterns diverged from those considered more healthy. Citing Dietz (1994), the authors state that the years 11-12 represent one of the three critical periods that have the most adverse affect on the body if obesity is experienced. It is more likely, if a child is obese at this age, that they will continue to be obese, and of course this has associated health problems for the whole life which include osteoarthritis, cancer and cardiovascular disease. This research represented a different approach to that taken previously - rather than addressing how dietary factors are affected by a particular stressful event, they were looking for an overall average relationship between stress and dietary factors.

The strength of this research is that it involved using a large sample size which normally provides more accurate results as the power of the research is greater. Also, the participants were taken from a variety of socio-economic groups which gives greater weight to the generalisation of the results. Criticisms of the research are based around the use of self-report data, it is often the case that when people complete these kinds of instruments they are not entirely accurate or honest for a wide range of reasons. The methodological problem that the authors identify is that the associations found in the study were moderate, indicating that caution should be utilised in interpretation.

One major part of people's lifestyles that has been investigated in relation to stress is their work and how it affects their lives. Michie & Williams (2003) review the evidence of the factors affecting psychological ill-health as well as sickness leave from work. This study found high levels of psychological ill-health, especially in hospitals in the UK, where rates were between 17-33% (Wall, Bolden & Borrill, 1997). Examining some of the most important causes, this research found that, amongst doctors for example, high levels of psychological ill-health were associated with high workload, long hours and the pressures of work (Agius, Blenkin & Deary, 1996; and Deary, Blenkin & Agius, 1996) Amongst nurses, it was workload pressures that were the most cited cause of psychological ill-health. In areas outside of healthcare, some similar results were found, with work pressure and overload, conflicting demands and lack of control often predicting psychological ill-health in the reviewed literature. The findings were also interesting for their cross-cultural relevance as many of the different pieces of research from diverse countries showed a remarkable similarity in the types of factors that affected psychological ill-health. These centred around the demands of work - workload, long hours and pressure - poor support and lack of control.

The strength of a literature review such as this is based on the variety and selection of studies that it evaluates and compares. All of the studies included here for review had to meet certain criteria, such as being included in a major database, being peer-reviewed and not involving a population that was too narrowly defined. A strength, therefore, is that a literature review can provide an effective comparison of a wide range of research and can compare and contrast. The associated problem with this kind of research is that it often can only provide a very high-level view of the literature and can miss out on the details, which may be essential in understanding psychological processes. In addition, many of the studies involved in this review were cross-sectional in nature which means that causal relationships cannot be proven. The authors also point out that a few of the studies did not rigorously apply scientific methods to their research, as some had small sample sizes and invalid outcome measures.

Having examined some of the purported causes of lifestyle on health, we turn to some of the posited outcomes associated with lifestyle decisions - particularly in the workplace. Marmot, Shipley & Rose (1984) investigated 17,000 British civil servants aged between 40-61 working at Whitehall. They were interviewed and mortality over a ten year period was recorded. A strong relationship was found between mortality and the grade at which the individual worked, so that the higher up the civil service the person was, the longer they lived. There was some statistical controlling done in this study for age and observed health factors, but the main criticisms centre on the fact that correlation does not mean causation. There are other factors that could have been affecting health more directly that were also associated with rank in the civil service. However, Marmot, Davey, Smith, Stansfeld, Patel, North, Head, White, Brunner & Feeney (1991) followed up this study with similar research into 10,000 civil servants at Whitehall that found a higher rate of illness amongst those of a lower grade. The lower grades were also more unlikely to engage in unhealthy behaviours and to report lower perceived health.

The effect of economic status on health outcomes, especially mortality rates, has been replicated in many other samples. Some researchers claim though that, although the effect exists, there are other more important factors. One of the most important choices many people make is in a life partner. The psychological evidence has started to suggest that this might also be an important choice from the point of view of health. Gardner & Oswald (2004) looked at how mortality is affected by, amongst other factors, marriage. Data was used from the British Household Panel Survey which contains over 10,000 adults who have been interviewed annually between 1991 and 2001. Stress was measured in these individuals using the General Health Questionnaire (GHQ). In this study marriage was found to reduce the chances that a man would die in the 10 year period by 7.2%, while for women it was reduced by 4.1%. To compare this to the effects of other health behaviours it has been found that smoking would increase mortality rates by about 7% in a comparable period. This study found that economic variables had little effect on mortality rates, although this study only considered a ten year period and it is possible that financial effects would take longer than this to become obvious.

This research also backed up earlier findings that higher levels of overall stress are associated with earlier death. Criticisms of this type of research centre on the fact that the results are highly dependent on the type of measures and statistical tests used - which may not reveal the true picture. For example marriage and economic status already show some correlation because sharing between two people makes for a less expensive lifestyle and hence married people are, on average, better off.

Sleep is a further important area of people's lives that is intimately connected with health. Rajaratnam & Arendt (2001) review some of the findings on sleep and its relationship to health. They find that recent changes in shift-patterns have contributed to as many as 20% of the population in the UK being forced to work outside the usual 9-5 work patterns that have been prevalent in the latter part of the last century. The authors find clear evidence that lack of sleep has negative effects on health.

The research discussed shows that lifestyle, whether imposed or chosen, has an important effect on health. Connections between stress and health have always been present in the literature. It seems, though, that stress might also act to affect health negatively through an increase in unhealthy dietary factors - especially at a crucial time in development. As people spend so much time at work, occupational factors - a part of lifestyle - have a large effect on health. Indeed from the literature review discussed here, it seems that many people in different countries and cultures show similar causes for psychological ill-health. While economic factors have been found to be important in life expectancy, newer research is starting to suggest that marriage might be more important. A criticism of some of the research in this area is that it tends to be cross-sectional rather than longitudinal in nature, which means it is not possible to infer causation.

Sleep is a further important area of people's lives that is intimately connected with health. Rajaratnam & Arendt (2001) review some of the findings on sleep and its relationship to health. They find that recent changes in shift-patterns have contributed to as many as 20% of the population in the UK being forced to work outside the usual 9-5 work patterns that have been prevalent in the latter part of the last century. The authors find clear evidence that lack of sleep has negative effects on health.

The research discussed shows that lifestyle, whether imposed or chosen, has an important effect on health. Connections between stress and health have always been present in the literature. It seems, though, that stress might also act to affect health negatively through an increase in unhealthy dietary factors - especially at a crucial time in development. As people spend so much time at work, occupational factors - a part of lifestyle - have a large effect on health. Indeed from the literature review discussed here, it seems that many people in different countries and cultures show similar causes for psychological ill-health. While economic factors have been found to be important in life expectancy, newer research is starting to suggest that marriage might be more important. A criticism of some of the research in this area is that it tends to be cross-sectional rather than longitudinal in nature, which means it is not possible to infer causation.

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