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Healthy lifestyle choices: could sense of coherence aid health promotion?
  1. Nicholas W J Wainwright1,
  2. Paul G Surtees1,
  3. Ailsa A Welch1,
  4. Robert N Luben1,
  5. Kay-Tee Khaw2,
  6. Sheila A Bingham3
  1. 1
    Strangeways Research Laboratory and University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
  2. 2
    Clinical Gerontology Unit, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
  3. 3
    MRC Dunn Human Nutrition Unit, Cambridge, UK
  1. Nicholas Wainwright, Strangeways Research Laboratory and University of Cambridge Department of Public Health and Primary Care, Worts Causeway, Cambridge CB1 8RN, UK; nick.wainwright{at}


Background: A research framework based on the personal characteristic defined by a sense of coherence (SOC) focuses on the effective use of resources to maintain good health.

Objectives: To test the hypothesis that individual differences in SOC are associated with healthier lifestyle choices independently of social class and education.

Design and setting: Cross sectional. Population based cohort study recruited through 35 general practice registers. Reported dietary intakes of alcohol, fruit and vegetables, fibre, saturated fat, non-discretionary salt (sodium), and total sugars were assessed by food frequency questionnaire. Current cigarette smoking, physical inactivity, and SOC were assessed through questionnaires.

Participants: 7863 men and 10 424 women. Residents of Norfolk (UK).

Results: Compared with participants with the weakest SOC, those with the strongest were 28% less likely to be current smokers (odds ratio 0.72 (95% confidence interval (CI), 0.58 to 0.89)), 36% less likely to be physically inactive (0.64 (0.55 to 0.75)), and reportedly consumed on average 63 g/day more fruit and vegetables (95% CI, 46 to 80), and 1.2 g/day more fibre (0.8 to 1.6). These associations were independent of age, sex, social class, and education. For physical inactivity and consumption of fruit, vegetables, and fibre, these differences exceeded those observed between the extremes of social class and education.

Conclusions: Individual differences in SOC are associated with healthy lifestyle choices independently of social class and education, and may therefore aid the design of future health promotion interventions.

  • sense of coherence
  • smoking
  • physical activity
  • alcohol
  • diet

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  • The study was approved by the Norwich District Health Authority Ethics Committee, and all participants gave signed informed consent.

  • EPIC-Norfolk is supported by programme grants from the Medical Research Council UK (G9502233, G0300128) and Cancer Research UK (C865/A2883) with additional support from the European Union, Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency, and the Wellcome Trust.

  • Competing interests: None.

  • Abbreviations:
    food frequency questionnaire
    health and life experiences questionnaire
    sense of coherence

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