Conscientiousness, Perceived Risk, and Risk ...

Health Psychology 2000, Vol. 19, No. 5, 496-500

Copyright 2000 by the American Psychological Association, Inc. 0278-6133/00/$5.00 IX)I: 10.1037//0278-6133.19.5.496

BRIEF REPORT

Conscientiousness, Perceived Risk, and Risk-Reduction Behaviors: A Preliminary Study Judy A. Andrews, Maureen Barckley, Edward Lichtenstein, and Michael E. Lee

Sarah E. Hampson University of Surrey

Oregon Research Institute

Participants (N = 343) from an Oregon community completed surveys at baseline, 3 months, and 12 months to assess personality, the perceived health risk of radon in combination with smoking, and changes in smoking behavior. Conscientiousness predicted instituting a more restrictive household smoking rule (p < .01), and perceived risk predicted reduction in cigarettes smoked per day for men (p < .001). Perceived risk predicted a reduction in the proportion of cigarettes smoked in the home for those who had high (p < .05) but not low or moderate levels of Conscientiousness, a dimension in one personality model. The results demonstrate the importance of Conscientiousness in the prediction of health behavior, particularly behavior that affects others as well as oneself. Key words: smoking, radon, Conscientiousness, perceived risk, health behavior

Information about the tenfold increase in health risk from the combination of indoor smoking and household radon level was used in an intervention to motivate smoking cessation, a reduction in smoking, and restrictions on smoking indoors (Hampson, Andrews, Lee, Lichtenstein, & Barckley, 2000; Lee, Lichtenstein, Andrews, Glasgow, & Hampson, 1999; Lichtenstein, Andrews, Lee, Glasgow, & Hampson, in press). Here, we report the effects of Conscientiousness and risk perceptions on sustained quit, reduction in cigarettes smoked, reduction in proportion of cigarettes smoked indoors, and changes in household rules regarding smoking in the home. Conscientiousness, one of the dimensions comprising the fivefactor model of personality (Digrnan, 1990; McCrae & Costa, 1997), includes such traits as reliability, perseverance, and selfdiscipline. There is increasing evidence that it contributes to healthful behaviors (Wiebe & Christensen, 1997). Higher scores on Conscientiousness have been associated with health-protective behaviors both prospectively (Brickman, Yount, Blaney, Rothberg, & Kaplan De-Nour, 1996; Friedman et al., 1995; Siegler, Feaganes, & Rimer, 1995) and concurrently (Arthur & Graziano, 1996; Booth-Kewley & Vickers, 1994; Castle, Skinner, & Hamp-

son, 1999; Christensen & Smith, 1995; Ingledew & Brunning, 1999; Lemos-Gir~dez & Fidalgo-Aliste, 1997; Marks & Lutgendoff, 1999; Vollrath, Knoch, & Cassano, 1999). Accordingly, we hypothesized that higher levels of Conscientiousness would independently predict beneficial changes in smoking behaviors. Theories of health-protective behavior (e.g., Ajzen, 1988, 1991; Becker, 1974; Maddux & Rogers, 1983) posit that risk-reduction behaviors are determined, in part, by the perceived level and likelihood of the health risks and the expected benefits versus costs of behaving in ways to reduce them (Weinstein, 1993). There is mounting empirical support for these models (e.g., Armitage & Conner, in press; Conner & Norman, 1996; Sutton, 1998). Therefore, we hypothesized that higher levels of perceived health risk would predict beneficial changes in smoking behaviors. Of particular interest was the possible moderating effect of Conscientiousness on risk perceptions. We hypothesized that risk perceptions would affect changes in smoking behaviors, but only for those who were more conscientious. For example, a person may believe that radon and smoking constitute a threat to his or her health, but lack of self-discipline and ability to plan ahead may serve as barriers to changing smoking. Past research investigating the moderating effect of Conscientiousness in the prediction of healthful behavior has produced inconsistent results (Schwartz et al., 1999; Wiebe & Christensen, 1997), so further investigation of Conscientiousness as a moderator is needed. Age and gender are both related to reduction in tobacco use and cessation (Grim et al., 1998; Ockene et al., 2000). Risk-taking declines with age as people's behavior becomes more normative over time (Helson & Kwan, 2000). Women typically report higher levels of perceived risk for a variety of hazards (Slovic, 1992), including radon and smoking (Hampson et al., 2000). For these

Sarah E. Hampson, Department of Psychology, University of Surrey, Guildford, United Kingdom; Judy A. Andrews, Maureen Barckley, Edward Lichtenstein, and Michael E. Lee, Oregon Research Institute, Eugene, Oregon. This research was supported by National Cancer Institute Grant R01CA68186. Correspondence concerning this article should be addressed to Sarah E. Hampson, Department of Psychology, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom. Electronic mail may be sent to s.hampson@ surrey.ac.uk. 496

BRIEF REPORT masons, w e examined in all analyses the main and interactive effects o f age and gender on changes in smoking behaviors. Method

Participants a n d Procedure A coupon offering a free radon test kit to households with at least one smoker was included in energy bills mailed by one utility in Western Oregon. The 714 members of households who requested a free radon test kit and returned the baseline survey were randomized to receive one of three interventions. In all three interventions, household members received feedback on their radon level as well as two kinds of written materials that educated them about the increased health risk from the combination of radon and smoking. Although a large majority of these households tested below the Environmental Protection Agency's (EPA) action level for radon (4pCi/L), such low readings in combination with smoking greatly increase the risk of lung cancer for smoking household members and probably for nonsmokers as well (Committee on Health Risks of Exposure to Radon, 1998). Quitting or reducing the number of cigarettes smoked indoors is advised. The intent of the intervention materials was to motivate changes in smoking behavior of household members. The three intervention conditions were (a) the EPA's (1994) A Citizen's Guide to Radon, Co) the Oregon Research Institute (ORI) pamphlet (a brief account of the risks of the combination of radon and smoking developed by us), and (c) the ORI pamphlet plus telephone counseling (for details of the intervention, see Lichtenstein et al., in press). There was no difference in the effectiveness of the two types of written materials, but those receiving the ORI pamphlet plus telephone counseling showed the largest effects on quitting and on instigating new household smoking bans (Lee et al., 1999; Lichtenstein et al., in press). As part of the evaluation component of the intervention, a household member completed a survey at baseline, 3 months, and 12 months after enrollment. The surveys could be completed by the same or different household members at each assessment. Surveys at both 3 and 12 months were returned by 568 (80%) households. Participants for the present study were limited to the 343 respondents who completed both the 3-month survey, which included the measure of risk perceptions, and the 12-month survey, which included the Conscientiousness scale. We found no differences in household size, proportion of smokers, average number of cigarettes smoked by household members, or household smoking rules between households where the same member completed both the 3- and 12-munth surveys and households where a different member completed the 3- and 12-month surveys (n = 225). The baseline survey could have been completed by another family member, who reported on the age, gender, smoking status, average number of cigarettes smoked per day, and number of cigarettes smoked per day in the home for all household members. Of the 343 respondents, 44 did not complete the baseline survey themselves (24 of whom were smokers at baseline). At baseline, the mean age of these 343 respondents was 50 years, 51% were women, and 203 were smokers who smoked an average of 20.4 cigarettes per day (48% of these cigarettes inside the home). We found no differences in reported age, gender, initial smoking status, cigarettes smoked per day, or proportion of cigarettes smoked indoors between those who completed the baseline survey themselves and those for whom others completed the baseline survey.

497

restrictive household rule, was based on an assessment of household smoking roles at baseline and 12 months and used the following responses: (a) "No smoidng in the house" (total ban); CO) "No smoking when certain people are present, such as non-smokers or children" or "Smoking restricted to certain areas in the house" (partial ban); and (c) "No rules for smoking in the house" (no ban). Risk perceptions. The perceived risk of the combination of radon and smoking was assessed by four questions rated on a 9-step scale where higher numbers indicated greater health risk ("How likely is that radon and smoking in your home will seriously damage your health?" "How likely is that radon and smoking in your home will seriously damage the health of other household members?" "How likely is that radon and smoking seriously damages the health of people in general?" and "Compared to all the other things that can damage your health, is the risk of cigarette smoking something you can think about calmly or is it one that you find frightening?"). These four items were combined to form an internally reliable scale (coefficient a = .88). Risk perceptions w e ~ assessed at 3 months after enrollment, when all intervention activities were completed, t Conscientiousness. The Conscientiousness personality trait was assessed by the 9-item scale from the Big Five Inventory (Benet-Martfnez & John, 1998). The items are brief behavioral statements (e.g., "Does a thorough job") that are rated for their accuracy as self-descriptions on a 5-point scale (1 = disagree strongly. 5 -- agree strongly). Individuals' responses to each item were s,,mrned to give their Conscientiousness scale score (coefficient ,~ -- .74). Conscientiousness was assessed at the 12month follow-up and was assumed to have remained stable from baseline to that point. The 12-month test-retest stability of this scale was .79 in a sample of college students (O. P. John, personal communication, February 1999). Costa and McCrae (1988) reported stability coefficients for younger and older men and women, assessed by the HEO personality inventory, ranging from .71 to .84 over a 3-year interval.

Overview o f Analyses For all analyses predicting smoking outcomes, we restricted the sample to those who were smokers at baseline (n = 203). To maintain independence between analyses predicting quitting smoking and those predicting a decrease in cigarettes per day and a decrease in proportion of cigarettes smoked per day at home, the participants for the latter two analyses were restricted to those who continued to smoke at follow-up (n ffi 171). When predicting a more restrictive ban, the sample was limited to those who had no ban or only a partial ban on smoking in the home at baseline (n ffi 270). We used hierarchical multiple linear regression to predict cigarettes smoked per day and the proportion of cigarettes smoked per day indoors at home at 12 months, controlling for the baseline level of the outcome and logistic regression to predict sustained quit and a more restrictive indoor smoking ban (no change vs. more restrictive). In all models, gender, age, perceived risk, Conscientiousness, and intervention condition were entered first and were retained in the model. (The intervention condition compared the ORI pamphlet plus phone counseling vs. the two conditions receiving written materials only.) Interactions were entered next: the two-way interaction of gender and Conscientiousness and the two- and three-way interactions of age and gender with Conscientiousness, perceived risk, and their interaction. For reasons of parsimony, we chose not to examine the effects of the three-way interactions of gender and age with perceived risk or Conscientiousness or the four-way interaction of gender and age with

Measures Smoking outcomes. We used three outcome measures: (a) sustained quit, defined by responding negatively to the question "Do you currently smoke, even occasiunallyT' at both 3 and 12 months; (b) a decrease in the number of cigarettes smoked per day from baseline to 12 months; and (e) a reduction in the number of cigarettes smoked inside the home, from baseline to 12 months. The fourth outcome measure, change to a more

' The shortcomings of the 3-month risk perception measure as an approach to assessing awareness of the synergistic increase in risk of the combination of radon and smoking relative to the risk of either hazard alone were discussed by Hampson et al. (2000). In the present study, we used the absolute, not relative, levels of perceived health risk from radon and smoking.

498

BRmF REPORT

perceived risk and Conscientiousness. To simplify the models, we removed interactions using backward elimination, starting with the higher order interaction first (Cohen & Cohen, 1983). We examined significant interactions using procedures recommended by Aiken and West (1991).

B = -0.02. Conscientiousness and perceived risk did not independently predict other outcomes. We found a significant interaction of Conscientiousness with perceived risk, as hypothesized, only in the prediction of a decrease in proportion of cigarettes smoked inside the home. This interaction was interpreted by testing the significance of the simple slope of the regression lines for high (one standard deviation above the mean), low (one standard deviation below the mean), and moderate (at the mean) levels of Conscientiousness. Perceived risk significantly predicted a reduction in the proportion of cigarettes smoked in the home for those individuals high in Conscientiousness, B = - 0 . 0 3 ; t ( 1 6 8 ) = - 2 . 4 6 , p < .05, but not for those with low (B = 0.02) or moderate (B = 0.02) levels of Conscientiousness.

Results

Respondent Characteristics Respondents perceived the combination of radon and smoking as somewhat risky to health ( M = 5.8, SD = 2.3, on a 9-point scale), and w o m e n perceived greater risk ( M = 6.2, SD = 2.2) than did m e n ( M = 5.3, SD = 2.3). The participants described themselves as conscientious ( M = 36.8, SD = 5.8, m a x i m u m score = 45), and there were no gender differences (men, M = 36.7, SD = 6.1; women, M = 36.9, SD = 5.5). The equivalent mean for an adult sample drawn from an adjacent community in Oregon was 35.5 (SD = 4.4), indicating that our participants were not unusually conscientiousness.

Discussion This study provided partial support for our hypotheses concerning Conscientiousness and beliefs about risks to health in the prediction of changes in smoking behaviors. Conscientiousness predicted change to more restrictive household rules but was not associated with reduction in cigarettes smoked per day or of cigarettes smoked indoors. Risk perceptions predicted reduction in cigarettes smoked per day for men, but not for women. Risk perceptions did not predict reduction in cigarettes smoked indoors or change in household smoking rules, The expected moderating effect of Conscientiousness on risk perceptions was only observed for reduction in the proportion of cigarettes smoked indoors, Lower levels of Conscientiousness were a barrier to carrying out this risk-reduction behavior, even when perceived risk was high. Consistent with past research, reduction in the number of cigarettes smoked per day was associated with being older. The pattern of findings suggests that Conscientiousness is more likely to be implicated in beneficial changes in smoking behaviors that affect other people in addition to the smoker. More conscientious respondents with higher levels of perceived health risk were more likely to reduce the number of cigarettes smoked indoors, which suggests a concern about the effects of their smoking on others. Households of more conscientious respondents were more

Prediction of Outcomes Table 1 shows the results of analyses predicting cigarettes smoked per day and proportion of cigarettes smoked indoors at 12 months (controlling for the baseline measures of these variables) and more restrictive rules. None of the hypothesized predictor variables predicted sustained quit, so results for this outcome are not presented. As shown in the table, gender did not independently predict any outcome. However, age independently predicted reduction in number of cigarettes per day, with older participants more likely to cut down. The results provided partial support for our hypotheses. Conscientiousness significantly predicted a more restrictive household rule. Households with responders who were more conscientious were more likely to instigate a more restrictive ban. Perceived risk regarding the combination of radon and smoking significantly interacted with gender in the prediction of reduction in number of cigarettes per day. For men, perceived risk predicted a reduction in cigarette use, B = - 1 . 4 5 ; t(162) = -3.62, p < .001; for women, the effect of perceived risk on cigarette use was not significant,

Table 1

Predicting Smoking Outcomes From Demographic Variables, Conscientiousness, and Perceived Risk Cigarettes smoked per day

Cigarettes smoked indoors

B

B

t

B

Wald

ratio

CI

0.69 0.04 0.00 -0.06 -0.00 0.02

11.81"** - 1.33 1.08 1.20 1.07 - 1.62

-0.27 0.01 0.25 0.07 -1.19

0.96 0.88 0.79 0.90** 2.61

0,76 1,01 1,28 1.08 1,11

(0.76, 2.26) (O.99, 1.03) (0.74, 2.19) (1.03, 1.13) (0.98, 1.25)

-0.00

-2.26*

More restrictive rules Odds

Predictor variable Cigarettes smoked per day at baseline Cigarettes smoked indoors at baseline Gender Age Condition Conscientiousness Perceived risk Perceived Risk × Gender Conscientiousness x Perceived Risk

Note. CI = confidence interval. *p < .05. **p < .01. ***p < .001.

0.67 -0.54 -0.12 -0.38 -0.02 - 1.45 1.44

t 11.99"** -0.43 -2.57* 0.76 -0.25 -3.62*** 2.51"

BRIEF REPORT likely to change to a more restrictive household smoking rule, which also suggests a concern for others. More conscientious respondents may have been more motivated to persuade others in their household of the importance of limiting smoking in the home. The mechanism by which the levels of Conscientiousness of one household member can have health consequences for the others is of considerable interest and should be explored further. The finding that perceived risk predicted a decrease in the number of cigarettes smoked per day for men but not for women suggests that these women may have had greater difficulty than the men with the quitting process. The evidence for gender differences in smoking cessation is inconsistent, but where gender differences have been found, men are more successful (Ward, Klesges, Zbikowski, Bliss, & Garvey, 1997). One possible explanation is that women who perceive a health risk are less likely than men to make an effortful behavior change that is primarily for their own benefit. Consistent with this explanation, changes on the two smoking outcomes that affected others' health as well as the respondents' (i.e., reducing the number of cigarettes smoked indoors and changing to a more restrictive household rule) did not show gender effects. A limitation of this study was that, because of space constraints on the survey, risk perceptions were measured at 3 months and Conscientiousness was assessed at 12 months. To be a truly prospective design, both risk perceptions and Conscientiousness should have been assessed at 3 months. However, we have no reason to believe that Conscientiousness, a stable trait in adults (Costa & McCrae, 1988), would have undergone significant change between surveys. Another concern is that risk perceptions were measured at 3 months but not at baseline; therefore, we could not assess the effects of the interventions on perceived risk. Change in perceived risk over the first 3 months may have been a more powerful predictor of change in smoking behaviors than the absolute level of perceived risk at 3 months. Strengths of this study included the examination of both personality and health beliefs in the same model with a reasoned basis for testing a moderator hypothesis and the measurement of perceived risk in a natural setting in which respondents were facing a real threat from smoking and radon in their household. The moderator approach examined here is one of a number of possible models (e.g., health beliefs as mediators of the effects of personality), and these alternatives may be more appropriate in other health contexts (Contrada, Cather, & O'Leary, 1999). The present results add to the growing literature demonstrating the importance of Conscientiousness for health behavior and the value of examining the combined effects of personality and health beliefs in more complex models than have typically been tested in the past. References Alken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage. Ajzen, I. (1988). Attitudes, personality and behavior. Milton Keynes, England: Open University Press. Ajzen, I. (1991). The theory of planned behavior. Organization Behavior and Human Decision Processes, 50, 179-211. Armitage, C. J., & Conner, M. (in press). Efficacy of the theory of planned behavior: A meta-analytic review. British Journal of Social Psychology. Arthur, W., Jr., & Graziano, W. G. 0996). The five-factor model, consci-

499

entiousness, and driving accident involvement. Journal of Personality, 64, 593-618. Becket, M. H. (Ed.). (1974). The health belief model and personal health behavior. Health Education Monographs, 2(4), 324-508. Benet-Martinez, V., & John, O. P. (1998). Los Chaco Grandes across cultures and ethnic groups: Multitrait multimethod analyses of the Big Five in Spanish and English. Journal of Personality and Social Psychology, 75, 729-750. Booth-Kewley, S., & Vickers, R. R. (1994). Associations between major domains of personality and health behavior. Journal of Personality, 62, 281-298. Brickman, A. L., Yonnt, S. E., Blaney, N. T., Rothberg, S. T., & Kaplan De-Nour, A. (1996). Personality traits and long-term health status: The influence of neuroticism and conscientiousness on renal deterioration in Type I diabetes. Psychosomatics, 37, 459-468. Castle, C. M., Skinner, T. C., & Hampson, S. E. (1999). Young women and stmtanning: An evaluation of a health education leaflet. Psychology and Health, 14, 517-527. Christen,sen, A. J., & Smith, T. W. (1995). Personality and patient adherence: Correlates of the five-factor model on renal dialysis. Journal of Behavioral Medicine, 18, 305-313. Cohen, J., & Cohen, P. (1983). Applied multiple regression~correlation analysis for the behavioral sciences (2rid ed.). Hillsdale, NJ: Erlbaum. Committee on Health Risks of Exposure to Radon. (1998). Health effects of exposure to radon. Washington, DC: National Academy of Sciences. Conner, M., & Norman, P. (Eds.). (1996). Predicting health behavior: Research and practice with social cognition models. Buckingham, England: Open University Press. Contrada, R. J., Cather, C., & O'Leary, A. (1999). Personality and health: Dispositions and processes in disease susceptibility and adaptation to illness. In L. A. Pervin & O. P. John (Eds.), Handbook of personality: Theory and research (pp. 577-604). New York: Guilford Press. Costa, P. T., & McCrae, R. R. (1988). Personality in adulthood: A six-year longitudinal study of self-reports and spouse ratings on the NEO personality inventory. Journal of Personality and Social Psychology, 54, 853-863. Digman, J. M. (1990). Personality structure: Emergence of the five-factor model. In M. R. Rosenzweig & L. W. Porter (Eds.), Annual review of psychology (Vol. 41, pp. 417-446). Palo Alto, CA: Annual Reviews. Environmental Protection Agency. (1994). A citizen's guide to radon (2nd ed.). Washington, DC: U.S. Government Printing Office. Friedman, H. S., Tucker, J. S., Schwartz, J. E., Martin, L. R., TomlinsonKeasey, C., Wingard, D. L., & Criqui, M. H. (1995). Childhood conscientiousness and longevity: Health behaviors and cause of death. Journal of Personality and Social Psychology, 68, 696-703. Grit,z, E. R., Thompson, B., Emmons, K., Ockene, J. K., McLerran, D. F., & Nielsen, I. R. (1998). Gender differences among smokers and quitters in the Working Well Trial. Journal of Preventive Medicine, 27, 553561. Hampson, S. E., Andrews, J. A., Lee, M. E., Lichtenstein, L, & Barckley, M. (2000). Radon and cigarette smoking: Perceptions of this synergistic risk. Health Psychology, 19, 247-252. Helson, R., & Kwan, V. S. Y. (2000). Personality change in adulthood: The broad picture and the processes in one longitudinal study. In S. E. Hampson (Ed.), Advances in personality psychology (Vol. 1, pp. 77106). Hove, England: Psychology Press. Ingledew, D. K., & Brunning, S. (1999). Personality, preventive behavior and comparative optimism about health problems. Journal of Health Psychology, 4, 193-208. Lee, M. E., Lichtenstein, E., Andrews, J. A., Glasgow, R. E., & Hampson, S. E. (1999). Radon-smoking synergy: A population-based behavioral risk reduction approach. Preventive Medicine, 29, 222-227. Lemos-Gir~dez, S., & Fidalgo-Aliste, A. M. (1997). Personality disposi-

500

BRIEF REPORT

tions and health-related habits and attitudes: A cross-sectional study. European Journal of Personality, 11, 197-209. Lichtenstein, E., Andrews, J. A., Lee, M., Glasgow, R. E., & Hampson, S. E. (in press). Using radon risk to motivate smoking reduction: Evaluation of written materials and brief telephone counseling. Tobacco

Control. Maddux, J. E., & Rogers, R. W. (1983). Protection motivation and selfefficacy: A revised theory of fear appraisals and attitude change. Journal of Experimental Social Psychology, 19, 469-479. Marks, G. R., & Lutgendorf, S. K. (1999). Perceived health competence and personality factors differentially predict health behaviors in older adults. Journal of Aging and Health, 11, 221-239. McCrae, R. R., & Costa, P. T., Jr. (1997). Personality trait structure as a human universal. American Psychologist, 52, 509-516. Ockene, J. K., Emmons, K. M., Mermelstein, R. J., Perkins, K. A., Bonoolo, D. S., & Voorhees, C. C. (2000). Relapse and maintenance issues for smoking cessation. Health Psychology, 19(1, Suppl.), 17-31. Schwartz, M. D., Taylor, K. L., Willard, K. S., Siegel, J., Larndan, R. M., & Moran, K. (1999). Distress, personality, and mammography utilization among women with a family history of breast cancer. Health Psychology, 18, 327-332.

Siegler, I. C., Feaganes, J. R., & Rimer, B. K. (1995). Predictors of adopting mammography in women under age 50. Health Psychology, 14, 274-278. Slovic, P. (1992). Perceptions of risk: Reflections on the psychometric paradigm. In S. Krimsky & D. Golding (Eds.), Social theories of risk (pp. 117-152). Westport, CT: Praeger. Sutton, S. (1998). Predicting and explaining intentions and behavior:. How well are we doing? Journal of Applied Social Psychology, 28, 13171338. Vollrath, M., Knoch, D., & Cassano, L. (1999). Personality, risky health behavior, and perceived susceptibility to health risks. European Journal of Personality, 13, 39-50. Ward, K. D., Klesges, R. C., Zbikowski, S. M., Bliss, R. E., & Garvey, A. J. (1997). Gender differences in the outcome of an unaided smoking cessation attempt. Addictive Behaviors, 22, 521-533. Weinstein, N. D. (1993). Testing four competing theories of healthprotective behavior. Health Psychology, 12, 324-333. Wiebe, J. S., & Christensen, A. J. (1997). Health beliefs, personality, and adherence in hemodialysis patients: An interactional perspective. Annals of Behavioral Medicine, 19, 31-35.