Sm. Sci. Merl. Vol. 28. No. 12. pp. 1269-1274. 1989 Printed in Great Britain. All rights reserved

0277-9536189 $3.00 + 0.00 Copyright C 1989 Pcrgamon Press plc

HEALTH LIFESTYLES AND SELF-DIRECTION IN EMPLOYMENT AMONG AMERICAN MEN:

A TEST OF THE SPILLOVER EFFECT

THOMAS ABEL,’ WILLIAM C. COCKERHAM, ** GUENTHER LUESCHEN’.’ and GERHARD KUNZ~

‘University of Marburg, 3550 Marburg, Bunsenstrasse 2. F.R.G., ‘University of Illinois at Urbana-Champaign, Urbana, IL 61801, U.S.A., ‘Technical University of Aachen, 5100 Aachen, Tempergraben 55, F.R.G. and %niversity of Cologne, 5000 Cologne 4, Gronewaldstrasse 2, F.R.G.

Abstract--This paper examines whether American males with a high degree of control over their work situation pursue healthy lifestyles and rate their physical health more positively than those who score low on occupational self-direction. That is, are persons who control their work more likely to also try to control their health through living in a particularly healthy manner? We found that there was no support for a spillover effect from high occupational self-direction to enhanced participation in health lifestyles or more positive self-rated health. The findings suggest health lifestyles have spread throughout occupational work groups in the U.S. and support research that maintains such lifestyles have spread across social strata in America.

Key words-health lifestyles, self-direction. spillover effect

INTRODUCTION

The purpose of this paper is to examine whether there is a spillover effect from a person’s form of work to participation in certain health lifestyles and level of self-rated health. Utilizing Temme’s [l] scoring system for occupational self-direction, our focus is upon ascertaining whether persons (in this case, employed males), who have a high degree of indepen- dent judgment and initiative in their work, pursue healthy lifestyles and rate their physical health more positively than those who score low on occupational self-direction.

RELEVANT LITERATURE

Spillover models have often been utilized by sociol- ogists seeking to understand the effects of work on social situations outside the workplace [2]. In general, these models claim that work experiences influence nonwork attitudes and behaviors to the extent that a similarity develops in the conduct of work and non- work life [3-61. Persons who exercise relatively inde- pendent and future-oriented decisions at work, are considered more likely to follow the same pattern in their nonwork life. Therefore, high occupational self- direction, defined as the use of initiative, thought, and independent judgment in work [4], may have impor- tant implications for an individual’s personal life. For example, recent research in Japan by Schooler and Naoi [S] suggests that occupational self-direction has even more widespread effects than previously reported. This study found that greater occupational self-direction increases levels of intellectual flexibility

*Address correspondence to: Professor W. Cockerham, Department of Sociology. University of Illinois, 326 Lincoln Hall. 702 S. Wright St.. Urbana, IL 61801. U.S.A.

and a more self-directed orientation toward both self and society, as well as a greater sense of integration into the socio-economic system and more positive attitudes toward the workplace.

But what about health behavior? Does high occu- pational self-direction influence a particularly active approach to the management of one’s health? While it seems reasonable to presume that this is the case, we could not find any previous research in the United States to support this assumption. Three studies from France and one from Canada, however, provide relevant information about the relationship between a person’s perception of health and his or her work role. The Canadian study, conducted by Coburn and Pope [7], was based on data from a sample of employed males in British Columbia and did not find a significant relationship between occupational self- direction and preventive health behavior.

The French studies did not measure occupational self-direction per se, but they did identify differences between manual and nonmanual workers with respect to body management. Boltanski [8] found a “somatic culture” among lower class workers that provided precise and somewhat negative norms for the “social use of the body”. These norms strongly influenced limited dietary habits, use of cosmetics, and utilization of medical services. Essentially these norms promoted a restricted body awareness. That is, these lower class workers did not pay much attention to their physical bodies. Although these persons worked hard physically, they made no special attempt to maintain their body. Boltanski concluded that the type of occupational work (manual) as well as the economic situation (low incomes) among these workers was of central importance for understanding their mode of body perception and style of body management. In another study, Surault [9] found that manual and nonmanual French workers had different attitudes towards their body and illness. Nonmanual

1269

1270 THOMAS ABEL et al.

workers were more sensitive to changes in the physio- logical functioning of their bodies and took better care of their health than manual workers.

Other research by d’Houtaud and Field [lo] examined definitions of health gathered from 4000 French respondents. The results of their analysis show a conceptual difference in perceptions of health by social class. There was a more personalized image of health among middle and upper class respon- dents-all of whom had nonmanual jobs. Health was defined positively by them as a means to achieve personal well-being and vitality. Lower class workers described health in less self-fulfilling terms like simply the absence of illness or the ability to keep on working. They perceived health as the full function- ing of their bodies and the means to work. Thus, for the upper echelon of society, health was viewed as an end in itself (enjoyment of life), while the lower echelon saw health as a means to an end (ability to work). Relating those results to health behavior, d’Houtaud and Field [lo, p. 471 do, in fact, describe a spillover effect from occupational work to general patterns of body management: “It is perfectly under- standable that those who manage social tasks tend also to appropriate their health and to cultivate it for their own purposes, whereas those who perform these tasks tend to alienate themselves from their health, and to place it mainly at the disposal of society, which usually requires their labor.”

Consequently, it can be inferred from the French data that high occupational self-direction tends to promote a healthy lifestyle. Thus, there is some support for the contention that the manner in which people make use of their bodies varies among different socio-cultural and occupational groups [I I]. Drawing upon the theories of Foucault, Turner [12] has described forms of body government and their relevance for health-related behaviors involving dietary management and various body practices. Turner observes that while the body is an object with specific physiological characteristics and is subject to aging and decay, it is not just a physical object. From a sociological perspective, one’s body also has a social function and is socially experienced through inter- action with others. As Satre [13] explains, our body is our contact with the world; that is, our lived experience in the world is from the point of view of the body. Therefore, it would not be surprising if different social strata have different approaches to body management.

The proposition that body management varies by social class is consistent with both Marxist and Weberian theory. Navarro’s [14] Marxist critique of capitalist medical systems claims that workers have no control over their lives including their health. This is because capitalist society is organized to protect the socio-economic advantages of the affluent. This would imply that body management is affected by the extent of self-direction in a person’s occupation. Those persons in control of their work would be able to exercise a much wider range of choices in regard to health activities, while those at the bottom with little or no occupational self-direction would lack such opportunities. Navarro argues, accordingly, that one’s work situation (relationship to the means of production) determines not only one’s lifestyle but

also one’s psychological orientation, including behav- ior, expectations, and interpersonal relations. What is suggested by this perspective is that not only is there a spillover effect from work into nonwork situations, but that the work environment strongly determines (perhaps predetermines) nonwork behavior.

However, a Marxist view of work and health, as expressed by Navarro, provides a relatively rigid perspective. It assumes that health behavior in partic- ular and social behavior in general is controlled by the socio-economic structure of society and the ideol- ogy that underlies it. This view does not award much significance to individual choice and people have some choices, no matter how limited, in whether they want to live as healthy as possible given their circum- stances. Decisions about smoking, alcohol use, and exercise ultimately fall on the individual.

Weber (151, in contrast, does account for choice, as well as motivation, goals, and social values in shaping individual behavior. He additionally pro- vides a more flexible interpretation of the role of lifestyles in modern capitalist societies through his analysis of status groups and the lifestyle dimension. Weber points out that in order to belong to a particular status group, a certain lifestyle is expected and a personal commitment to behavior patterns, values, and material interests of the group was re- quired. Following this line of reasoning, we would expect those lifestyle patterns intended for the pro- motion of health to discriminate between status groups. Certainly the capability to participate most fully in health lifestyles would lie primarily in the middle and upper socio-economic groups who not only have the resources to support it, but the motiva- tion, desire, and tradition for such conduct.

Yet Weber observed that lifestyles frequently spread beyond the groups within which they originate (as seen in the spread of the Protestant Ethic into the general culture of Western society). Featherstone [ 161 suggests that certain features of upper-middle class culture in Great Britain have spread into other social strata as that segment of society has sought to expand and legitimate its lifestyle. The implication, Feather- stone notes, is that Western society is moving toward a form of social stratification without fixed status groups with respect to certain styles of clothing, leisure activities, consumer goods, and bodily disposi- tions. This does not mean a dramatic change in social structure, but rather a tendency toward similarity in consumer culture which is driven by the upper-middle class and reflects a projection of their influence.

An important feature of this trend toward similar- ity in lifestyles is bodily maintenance. Featherstone describes the attraction of bodily maintenance tech- niques, such as the so-called California sports and forms of exercise, health foods, and cosmetics, as part of this process. The extent to which such lifestyles have spread throughout the social strata in Western society is not clear at present. But there is evidence that health lifestyles (exercising, watching one’s diet, and the like) have spread into the culture of American society generally [ 171. Other research reports on the spread of jogging and tennis, as well as improvements in eating habits and a reduction of smoking among males, in West Germany in a manner very similar to the American experience [ 18-201.

Employment among American men 1271

Consequently. health lifestyles may be evolving as part of the general culture of contemporary life and supported by societal and group norms, although participation in such lifestyles remains a matter of choice and may be seriously constrained by limited personal resources. Thus. it may be that the degree of self-direction in one’s work may not be especially significant in influencing participation in health lifestyles as suggested by Coburn and Pope [7]. These practices may extend across socio-economic bound- aries as suggested by Cockerham et al. [l7]. This latter study found a general lack of significant differences in the United States between status groups (as determined by education, income, and occupa- tional status) in relation to participation in health lifestyles involving appearance, food habits, smoking, exercise, and alcohol use. While there may have been differences in the quality of participation. there was a lack of difference when it came to participation per

se. Most people, as Harris and Guten [21] suggest, may do something when it comes to taking care of their health. Hence, there might not be a spillover effect from one’s work situation.

This review of the literature indicates that the question of whether or not high occupational self- direction results in enhanced participation in health lifestyles is unresolved. Studies conducted in France [&IO] suggest that nonmanual workers do indeed have different attitudes toward their body and are more likely to take care of themselves than manual workers. However, it should be noted that the data analyzed in the French studies were collected in the early 1970s and may not be representative of trends in contemporary France. Research from Canada [7] and the U.S. [ 171, 0i-1 the other hand, shows that participation in health lifestyles has spread across socio-economic boundaries, and West German studies [l&20] identify the beginning of a similar trend in that country. The focus of our research, accordingly. is to determine if increased self-direction in one’s work affects participation in health lifestyles and evaluations of personal health status.

DATA AND METHODS

Data were collected by telephone interviews in Illinois in 1985. A randomly selected statewide sample produced 804 interviews. The response rate was 70%. The number of cases was reduced to 349 by selecting only currently employed men for ana- lysis. This selection was necessary because we utilized Temme’s [I] scoring system for occupational self- direction which is based on samples which are exclu- sively male.

*Estimating models with dependent dichotomous variables (here ‘receiving a physical checkup) using ordinary least squares may involve theoretical problems [29]. However, various studies have shown that when the probability of falling to either of two groups represented by the values of the dependent variables lies within a range of 0.25SO.75. a linear function yields reliable information concerning the relative imporiance of predictor variables [30]. Moreover. a still uossible bias in OLS results would yield rather underestimated regressions [31]. The prob- abilities for the ‘check-up’ variable are 0.43X1.57 which suggests a high reliability for our OLS estimates.

With 97% of all households in Illinois having telephones, practically all households in the state had the same probability of being included in the sample. Random-digit dialing was used for Chicago and its suburbs in order to insure that unlisted telephone numbers were included in the sample [22,23]. System- atic sampling from telephone directories was used in the remainder of the state since the proportion of unlisted numbers outside of Chicago is small. Ac- cording to Sudman [23], careful telephone surveys cannot ignore unlisted numbers for large cities where as many as 40% of all telephones may be unlisted. We followed the procedure recommended by Sudman [23, p. 651 as the most efficient method for obtaining a random telephone sample in a state like Illinois: a combination of directory sampling and random-digit dialing. For each household, respondents were selected on the criteria of being 18 years of age or older and having the most recent birthday (the latter method was employed to randomly select the partic- ular member of the household to be interviewed).

A limitation of collecting data by telephone, how- ever, is that only those households with telephones can be included in the sample. In Illinois, the propor- tion of households without telephones is only 3% which is not large enough to affect statistical analysis. While it is correct that lower income households have fewer telephones, single women and highly mobile persons have fewer phones as well. Moreover, a recent study in the United States found that 71% of households below $5000 annual income had tele- phones [24]. For all practical purposes, the propor- tion of households without phones has no influence on our analysis since it is just too small to make any difference in our findings and over 11% of the respondents are from low income households.

Our major dependent variable is health status. This variable consists of the respondent’s self-rating of his or her general level of health on a continum of very good = 5, good = 4, satisfactory = 3, not so good = 2, and bad = 1. This scale provides a measure of the respondent’s perceived health status.

Lifestyle patterns were operationalized as follows: nutrition represents an index composed of 7 ques- tions about the respondent’s nutrition selection (see Appendix). Respondents scored from a high of 4 to a low of 1 on each item according to their emphasis in habits. Smoking status (no smoke) was coded 0 for current smokers, 1 for former smokers, and 2 for those who had never smoked. Drinking status (no alcohol) was coded 0 for those who reported more than 14 drinks per week, 1 for those with 8-14 drinks, 2 for those who had 7 or less drinks or who drink only on special occasions, and 3 for nondrinkers. Receiv- ing a regular physical check-up (check-up) at least once a year was coded 0 for no and I for yes.* Participation in physical activities, exercises, or sports (exercise) was measured in four categories from vigorous participation (4) to no sports or exercise participation (0).

Exogenous variables in our mode1 include income (total family income before taxes in 1984); minority status (coded 0 = white, 1 = black or Hispanic); education (years of forma1 schooling completed); and age (in years). Occupational self-direction is coded according to Temme’s 1975 scoring system;

1272 THOMAS ABEL et al.

Table I. Bivariate correlations, means, and standard dewatmns (,Y = 349)

1. Age 2. Minority 3. Education 4. Income 5. Oct. self-direction 6. Nutrition 7. Exercise 8. Check-up 9. No smoke

10. No alcohol I I. Health status

M.%n SD

1 2 3 4 5 6 7 8 9 10 II

-0.131 -0.202 -0.092

0.019 -0.195 0.373 0.044 -0.036 0.620 0.363 0.187 0.187 -0.052 -0.036 -0.005

-0.280 -0.029 0.246 0.123 0.1 I4 O.l20 -0.111 -0.164 0.142 0.002 -0.144 -0.003 0.110 -0.176 ,-0.103 0.249 0.070 0.079 0.213 0.059 0.121

0. I36 0.086 -0.043 -0.1 I9 0.067 -0.112 -0.160 0.068 -0.026 -0.154 -0.138 0.163 0.261 0.010 0.225 0.129 0.199 -0.061 0.105

40.770 0.198 13.452 34.028 13.049 18.596 2.458 I.566 0.925 I .58 I 4.174 15.169 0.400 2.892 19.286 7.406 4.337 I .549 0.496 0.826 I.059 0.852

in our sample scores for this variable ranged from 26.6 (judges) to -0.9 (warehousemen). Other examples are: secondary school teacher (2 1.3 I), sales- men (12.91), taxidrivers (5.24), and mine operatives (2.13).

Data were analyzed by step-wise multiple regres- sion. The correlation coefficients, means, and standard deviations for all variables are shown in Table 1.

RESULTS

Table 2 shows the regression results for the effects of the socio-demographic (step 1) and lifestyle vari- ables (step 2) on the respondent’s self-rated health status. Occupational self-direction is analyzed in both step 1 and step 2. For step 1, Table 2 shows that age (P <O.Ol), income (P < O.OOl), and minority status (P < 0.05) are statistically significant. Younger persons, respondents with higher incomes, and nonminorities report significantly higher levels of health. Overall, the socio-demographic variables explain over 11% of the variance in the dependent variable.

In the second step we add the five lifestyle vari- ables. Having a regular physical check-up (P < O.OS),

participating in sports and exercises (P < 0.01) and no smoking (P < 0.05) show significant positive effects on health status. The effects of nutrition selection and drinking status also appear in the predicted direction; they are, however, not statisti- cally significant. The lifestyle variables account for an additional 5% of the variance in the dependent variable. These results suggest that participation in certain lifestyles influences a person’s perception of his or her health status.

Moreover, a closer look at the size of the standard- ized regression coefficients (betas) in Table 2 shows a substantial reduction of the influence of age and minority status on self-rated health when the health lifestyles were added to the analysis. In the second step, the beta for age drops about 60% and for minority status about 30%. In fact, Table 2 shows that minority status is no longer significant once the lifestyle variables are added. However, the effect of income on health status was not mediated by these lifestyle variables, indicating a persistent influence of personal finances on perceived level of health. Occu- pational self-direction, on the other hand, was not significant in either step 1 or step 2 and therefore showed no effect on the respondents’ evaluation of their health.

Table 2. Regression of perceived he&h status on socio-demographic factors and behavior variables

Step I

Beta

Step 2

Beta

Age

Income

Minority

Education

Oct. self-direction

No alcohol

Check-up

Nutrition

No smoke

Exercise

-0.0092” (0.0029) O.OIO2***

(0.0025) -0.2369’

(0. I 109) 0.00 I7

(0.0167) 0.0017

(0.0079)

-0.1661 -0.0059’ (0.003 I )

0.2297 0.0104*** (0.0025)

-0.1124 -0.1682 (0.1144)

0.0338 - 0.0097 (0.0171)

0.0 I52 0.0007 (0.0078) 0.0077

(0.0418) O.I795’

(0.0896) 0.0039

(0.0106) 0.1267’

(0.0547) 0.0788**

-0.1063

0.2351

-0.0798

-0.0330

0.0061

0.0097

0.1053

0.0200

0. I247

0.1442 (0.030 I)

Constant/R 4.2073 0.1151 3.6170 0. I630

‘P = 0.05. l *P = 0.01. ***P = 0.001: two-tailed test.

Employment among American men 1273

Table 3. Unstandardized regression coefficients selected for health

lifestyles

Exercises Check-up No smoke

Age -0.0256*” - 0.0043* -0.0057

Minority -0.1539 -0.0219” -0.2605’

Education -0.0893* -0.0119 -0.0716**

Income -0.0047 -0.2875 - 0.0007

Oct. self-dlrectmn -0.0033 - 0.0069 -0.353

RI 0.12 0.07 0.09

*P = 0.05, l *P = 0.01. ***P = 0.001: two-tailed test.

Table 3 shows the regressions of the three life- style variables (exercise, check-ups, and no smoking) found significant in Table 2 for self-rated health on the socio-demographic variables and occupational self-direction. This measure allows us to further explore the relationships observed in Table 2. Table 3 shows younger men more likely to exercise and have check-ups, men with higher levels of educa- tion more likely to exercise and not smoke, and nonminorities having more check-ups and not smoking.

Table 3 does not reveal significant effects for occupational self-direction on the three health behav- iors. Therefore, we did not find that increased self- direction in one’s work affects participation in health lifestyles. Also noteworthy is that despite its strong direct influence on perceived health status, income shows no significant association with participation in health lifestyles. This suggests that financial resources alone do not determine whether or not a person tries to live as healthy a lifestyle as possible.

CONCLUSION

What lifestyle patterns influence perceived health status? Our results show that males who are non- smokers, participate in sports and exercise, and re- ceive a regular physical check-up perceive themselves to be in especially good health. We also found that the positive effect of higher income on perceived health status persists and appears not to be substan- tially mediated by participation in health lifestyles. Other factors may account for the strong relationship between low income and poorer self-rated health: occupational hazards typical for the working poor, inadequate housing. environmental hazards in low income neighborhoods, and low quality medical care. These economically based factors most likely play their parts in a complex manner, producing multiple risks for the poor and affecting how they perceive their chances for good health.

But whereas income affects perception of one’s health, actually adopting a healthier lifestyle appears not to be a predominant matter of income. None of the behavior patterns that we examined as potentially health effective. appeared significantly determined by income. This result lends support to previous research that did not find significant differences in health lifestyles by income [17]. Apart from income, other social factors, namely education and minority status, showed a significant association with some health lifestyles. We found more educated persons to partic- ipate significantly more in exercise and not to smoke. while nonminorities tended to not smoke and have more physical check-ups. Yet with educa-

tion significant for only two health activities and income and occupational self-direction significant for none, we conclude that socio-economic status is not a strong predictor of participation in health lifestyles generally.

The focus of this study, however, was on deter- mining whether there is a spillover effect from occupational self-direction to participation in health lifestyles. We found that persons with a high degree of occupational self-direction in their work were not significantly different than those with lesser self- direction when it came to participating in health lifestyles. This result is complementary to studies in other areas that have found work and nonwork conditions and behavior to be unrelated [25-271. A study by Kelly [27], for example, found reasons for the choice of most leisure activities to be unrelated to a person’s work experiences. Instead, nonwork roles were associated with the selection of forms of leisure. Champoux [3] also found no significant relationships between work and nonwork experiences for males, but for females either a compensatory or spillover model appeared adequate. In our all-male sample, the test for effects of work conditions on health lifestyles supports the conclusion that there is not a significant relationship. Therefore, our data suggest that, for American males, health lifestyles have spread in a normative fashion throughout occupational groups and support those studies [ 17,281 that maintain such lifestyles have also spread across social class boundaries and between Western nations.

As for social theory, we found that Webexian sociology provided a better explanation of the lifestyle dimension than Marxism with its more rigid and deterministic view. These data do not support the Marxist contention discussed by Navarro [14] that the work situation controls nonwork orienta- tions. Weber [15], on the other hand, anticipated the potential for a specific lifestyle to spread across social strata.

The exact reasons for the diffusion of health lifestyles in American society are not well- documented. Cockerham et al. [17] suggest that the enhanced participation of the poor in health lifestyles began with their access to more equitable medical care through Medicare and Medicaid public health insurance programs. Education associated with increased contact with medical care-providers, combined with health promotion in the mass media, appear to have spread the message about healthy lifestyles. This situation, along with a cul- tural tradition emphasizing individualism and self- responsibility for one’s well-being, may be behind the spread of health lifestyles in the U.S. It is our contention that participation in health lifestyles is an important component of the trend toward modernity in Western culture that is spreading across traditional class boundaries. More research is needed, however, to fully substantiate this point.

For example, as previously noted, the French studies cited in this paper showing class distinctions in body management are based on data collected in the early 1970s. As one French reviewer of this paper pointed out, researchers might not find the same results concerning health behavior among the French in 1988 as in the 1970s. Certainly, the mentality about

1274 THOMAS ABEL er al.

modernity may not be the same in France in 1988 as it was more than a decade earlier; consequently, current trends in health behavior in France might well be similar to those now being observed in the U.S. and F.R.G.

Acknowledgements-Support for this study was provided by the Volkswagen Foundation, Hannover, F.R.G.; the Graduate College Research Board, Department of Sociol- ogy, and College of Medicine, University of Illinois at Urbana-Champaign; the Institute for Sports Science, Technical University of Aachen; and the Seminar for Social Science, University of Cologne. Data were collected by the University of Illinois Survey Research Laboratory. An earlier version of this papbr was presented at the I986 Midwest Sociological Sociery meetings in Des Moines, Iowa. A revised version was presented to the International Conference on Changing the Public Health, Edinburgh, Scotland, October 1987.

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the literature on the relationship between work and 30 nonwork. Human Relat. 33, 111-129, 1980. Coburn D. and Pope C. Socioeconomic status and preventive health behavior. J. Hlrh sot. Behau. 15, 31 67-77, 1974. Boltanski L. Die soziale Verwendung des KBrper. In Zur Geschichte des Kiirpers (Edited by Kamper D. and Rittner V.), pp. 138-183. Hanser, Munich, 1976.

Cockerham W.. Kunz G.. Lueschen G. and Spaeth J. Social stratification and self-management of health. J. Hlrh sot. Behar. 27, I-14. 1986. Wetterer A. and von Troschke J. Smoker Moricarion. Springer, Berlin, 1986. Kimmerle R. Jogging-zur Entstehung und Entwick- lung einer kollektiven Bewegung im Sport. Sporrtc*issen- schafr 17, 121-150. 1987. Scheuch E. Recent social changes and their conse- quences for the health care system. Paper presented to the Inrernarional Symposium on Heallh Conducr and Health Care in Ihe Modern Welfare State: United States and F.R.G., Bad Homberg, F.R.G., July 1987. Harris D. and Guten S. Health-protective behavior: an explorative study. J. Hlrh sec. Behac. 20, 17-29, 1979. Waksberg J. Sampling methods for random-digit dial- ing. J. Am. Starisr. Ass. 73, 4&46, 1978. Sudman S. Applied Sampling. Academic Press, New York, 1976. Thornberry 0. and Massey J. Trends in U.S. telephone coverage across time and subgroups. Paper presented to the Inrernational Conference on Telephone Surceys. Charlotte, N.C., November 1987. Odaka K. Work and leisure: the case of Japanese industrial workers. Transacr. Sixrh Cong. Social. 3, 169-188, 1970. London M., Crandall R. and Seals G. The contribution of job and leisure satisfaction to quality of life. J. appl. Psycho/. 62, 328-334, 1977. Kelly J. Situational and social factors in leisure decision. Pacijic Social. Rev. 23, 313-330, 1978. Cockerham W., Kunz G. and Lueschen G. Social stratification and health lifestyles in two systems of health care delivery: a comparison of the United States and West Germany. J. Hlrh sot. Behao. 29, 113-126, 1988. Hanushek E. and Jackson J. Statistical Methods for Social Scienrists. Academic Press, New York, 1977. Cleary P. and Angel R. The analysis of relationships involving dichotomous dependent variables. J. Hlrh sot. Behau. 25, 334348. 1984. Aldrich J. and Cnudde C. Probing the bounds of conventional wisdom: a comparison of regression, probit, and discriminant analysis. Am. J. Polil. Sci. XIX, 514-608, 1975.

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APPENDIX

1979. d’Houtaud A. and Field M. The image of health: variations in perception by social class in a French population. Social. Hlth Illness 6, 30-39, 1984. Dingwall R. Aspecrs of Illness. St Martin’s, New York, 1976. Turner B. The Body & Society. Blackwell, Oxford, 1984. Sartre J. Being and Nothingness. Philosophical Library, New York, 1957. Navarro V. Crisis, Health, and Medicine: A Social Critique. Tavistock. London, 1986. Weber M. Selecrions in Translation (Edited by Runciman W. and translated by Mathews E.). Cambridge University Press, 1978. Featherstone M. Lifestyle and consumer culture. Theory Cull. Sot. 4, 55-70, 1987.

Items for the nulrition index:

How often do you..

I. take vitamins and minerals? 2. eat breakfast? 3. eat special health foods? 4. eat raw fruits and vegetables?

(Often = 4, sometimes = 3. seldom = 2, never = I .)

How important are each of the following to you regarding the food you eat?

5. That is not fattening. 6. That is not artificial. 7. That is low in cholesterol.

(Very important = 4, important = 3, not very important = 2, not at all important = I.)