Identification of the healthy neurotic: Personality traits predict smoking after disease onset Sara J. Weston, Joshua J. Jackson Washington University in St. Louis, United States article info Article history: Available online xxxx Keywords: Conscientiousness Neuroticism Interaction Healthy neurotic Smoking Disease response abstract Personality traits are known predictors of health behaviors and health status. However, most of this work focuses exclusively on how personality influences health outcomes rather than how personality influ- ences response to disease. Using a large, national study (N = 7051), we investigated whether conscien- tiousness and neuroticism were associated with smoking behavior after the onset of a disease. After the onset of a major chronic disease, high levels of neuroticism predicted less smoking when paired with high levels of conscientiousness, a combination described as healthy neuroticism. Healthy neuroticism only predicted smoking behavior after the onset of disease, not before, suggesting that the relationship between personality and responses to health problems differs from the relationship between personality and the onset of health problems. Ó 2014 Elsevier Inc. All rights reserved. 1. Introduction In the study of health, personality traits have been identified as one of the best psychosocial predictors of both general health sta- tus and specific outcomes (Hampson, 2012). Personality traits pre- dict self-rated health (Hampson, Goldberg, Vogt, & Dubanoski, 2007), physician-rated health (Chapman, Lyness, & Duberstein, 2007), biomarkers of health as far as 30 years in the future (Hampson, Edmonds, Goldberg, Dubanoski, & Hillier, 2013), dis- ease onset (Goodwin & Friedman, 2006; Weston, Hill, & Jackson, submitted for publication), and mortality (Jokela et al., 2013; Roberts, Kuncel, Shiner, Caspi, & Goldberg, 2007). However, few studies investigate the role personality plays in the response to dis- ease. The current study examines the association of personality traits with smoking after a diagnosis of a major disease, such as lung disease or a heart condition. 1.1. The relationship of conscientiousness and neuroticism with physical health The personality traits conscientiousness and neuroticism are among the most frequently and strongly connected to health out- comes and health behaviors (Hampson, 2012). Individuals high in conscientiousness experience better health, as they live longer and are at a lower risk for a variety of illnesses (Chapman, Roberts, & Duberstein, 2011; Kern & Friedman, 2008). This relationship is due to the fact that individuals high in conscientiousness are more likely to engage in positive health behaviors, such as exercise, and less likely to engage in risky health behaviors (Bogg & Roberts, 2004; Hill & Roberts, 2011). Individuals high in neuroticism, on the other hand, are at greater risk for developing illness and have shorter life spans (Hampson, 2012; Roberts et al., 2007). Neuroticism is thought to influence health through both physiological and behavioral path- ways. Individuals high in neuroticism experience more anxiety and stress (Bolger & Schilling, 1991), which in turn disrupts immune functioning (Sutin et al., 2010). As a means to cope with this stress, individuals high in neuroticism are also more likely to turn to unhealthy behaviors, such as smoking or drinking (Contrada, Cather, & O’Leary, 1999; Terracciano & Costa, 2004; Turiano, Whiteman, Hampson, Roberts, & Mroczek, 2012). However, some have argued that high levels of neuroticism can benefit health under certain circumstances (Friedman, 2000). Such arguments of a healthy neuroticism rest on the premise that neu- roticism could lead to vigilance and concern about germs, symp- toms, and treatments. This potentially positive response to stress and uncertainty is less studied than the typical negative pathway where worry and concern is considered harmful. That is, neuroti- cism may potentially be both beneficial and/or harmful for health depending on how individuals deal with their anxiety and worries. For example, increased vigilance towards one’s health could result in less participation in risky behaviors and attentiveness to physi- cal symptoms, ultimately leading to better health. Rather than turning to negative behavioral outlets to relieve stress (e.g., smok- ing), individuals instead may choose to confront their stressors head-on and attempt to manage or decrease the source of stress. http://dx.doi.org/10.1016/j.jrp.2014.04.008 0092-6566/Ó 2014 Elsevier Inc. All rights reserved. E-mail addresses: sweston@wustl.edu (S.J. Weston), j.jackson@wustl.edu (J.J. Jackson) Journal of Research in Personality xxx (2014) xxx–xxx Contents lists available at ScienceDirect Journal of Research in Personality journal homepage: www.elsevier.com/locate/jrp Please cite this article in press as: Weston, S. J., & Jackson, J. J. Identification of the healthy neurotic: Personality traits predict smoking after disease onset. Journal of Research in Personality (2014), http://dx.doi.org/10.1016/j.jrp.2014.04.008