Sot. Sci. Med. Vol. 33, No. 8, pp. 925-936, 1991 Printed in Great Britain. All tights reserved 0277-9536/91 53.00 + 0.00 Copyright 0 1991 Pergamon Press plc THE EUROPEAN HEALTH AND BEHAVIOUR SURVEY: RATIONALE, METHODS AND INITIAL RESULTS FROM THE UNITED KINGDOM JANE WARDLE’ and ANDREW STEPTOE~ ‘Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SES, U.K. and ZDepartment of Psychology, St George’s Hospital Medical School, Cranmer Terrace, London SW17, U.K. Abstract-The aim of this study was to assess a wide range of health-related behaviours, beliefs concerning the importance of behaviours for health, and health knowledge, using a standardized protocol suitable for translation and administration in different countries of Europe. An inventory was developed from previous literature for the assessment of substance use, positive health practices, diet and eating habits, driving behaviour and preventive health care, beliefs concerning the importance of 25 activities for health, and knowledge about the influence of seven factors (including smoking, alcohol and diet) on major diseases. The first phase of the study involved administration of the inventory to approximately 200 male and 200 female university students aged 18-30 in 20 European countries. This report concerns data collected from 419 students in the U.K., together with analyses of short-term response stability. The inventory showed adequate short-term stability. Sex differences were observed in a number of behaviours, including consumption of fats and cholesterol, salt and fibre, dieting, exercise, sun-protection, driving speed, regular dental check-ups, frequency of brushing teeth, access to doctor and blood pressure measurement. Beliefs about the importance of behaviours for health were closely associated with the occurrence or frequency of the behaviours both within and between health behaviour categories. Little relationship was observed between health behaviour and awareness of the role of these same factors in disease. Important gaps in health knowledge were identified. Data concerning the frequency of health-related behaviours is crucial to the planning of health education and primary prevention programmes. The close association between beliefs and behaviour emphasises the importance of cognitive factors, while health knowledge appears to play a less direct role. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSR Key words-health behaviour, health beliefs, medical knowledge, international INTRODUCTION Health behaviour was defined by Kasl and Cobb [l] as “Any activity undertaken by a person believing himself to be healthy for the purpose of preventing disease or detecting it at an asymptomatic stage”. Several limitations to this conceptualization have been recognized over the last two decades, includ- ing the omission of lay or self-defined health behaviours [2], and the exclusion of activities carried out by people with recognised illnesses that are directed at self-management, delaying disease pro- gression or improving general well-being. Neverthe- less, the significance of behaviour and life style for health and well-being is now widely acknowledged. Studies in Alameda County identified seven features of life style-not smoking, moderate alcohol intake, sleeping 7-8 hr a night, exercising regularly, main- taining a desirable body weight, avoiding snacks and eating breakfast regularly-that were together associ- ated with morbidity and subsequent long-term sut- viva1 [3,4]. This pattern has been replicated in independent samples [5,6], although the construction of an additive “health practices index” has been criticised [7l. Research into major causes of morbidity and mortality such as cancer and ischaemic heart disease emphasises the importance, for prevention, of behaviours such as smoking, alcohol consump- tion, dietary choice, sexual behaviours and physical exercise [8,9]. Studies of premature death attribu- table to life style factors also confirm smoking, alcohol consumption and diet as major precursors, together with gaps in primary prevention and screen- ing uptake [lo]. Information concerning health-related behaviour is vital to the planning of health education and primary prevention programmes. Health behaviours have been monitored in several large scale surveys in the United States, including the National Survey of Personal Health Practices and Health Consequences, the Health Promotion and Disease Prevention Sec- tion of the National Health Interview Survey, and the Behavioral Risk Factor Surveill: ,nce System [ 111. International comparisons are also being carried out within parrticular fields of health risk, such as the MONICA project on cardiovascular risk factors [12], and surveys of smoking [13] and personal hygiene [14]. A WHO cross-national survey on health be- haviour in schoolchildren is currently underway, and is concerned with smoking, physical exercise, eating habits, use of alcohol, oral hygiene and sleeping habits in 11-15 year-olds [15]. In general however, comparisons of health behaviours across countries are made difficult by a lack of uniform protocols for data collection, leading to differences in the definition of health-related activities. International compari- sons of health attitudes and knowledge of the links between behaviour and disease are also lacking. 925