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Public Health Policy Analysis
OP77 Type a Behaviour Pattern and Coronary Heart Disease: Philip Morris’ “Crown Jewel”
  1. M Petticrew,
  2. K Lee,
  3. M McKee
  1. Faculty of Public Health and Policy, LSHTM, London, UK


Background The Type A Behaviour Pattern (TABP) – characterised as individuals who are highly competitive, time-conscious and aggressive - has been the subject of research for over fifty years. The concept was developed in the 1950s by U.S. cardiologists Meyer Friedman and Ray Rosenman who argued that TABP was a risk factor for coronary heart disease (CHD), notably among white middle-class males. The theory was initially supported by findings from the Western Collaborative Group study (WCGS) and the Framingham study. However, subsequent studies found no consistent evidence that TABP predicts CHD onset or outcome. This pattern of early positive findings followed by negative findings (a “decline effect”) has long been a puzzle for TABP researchers. Despite this, the concept of Type A behaviour has continued to enjoy public appeal, fostered through popular books by Friedman and Rosenman which describe “how to recognise the deadly Type A pattern in your own personality”. TABP has also remained the subject of contemporary public health research, and it features in discussions on the psychosocial causes of health inequalities. We analysed tobacco industry documents to show that Philip Morris and RJ Reynolds were major funders of TABP research, with selected positive findings used to counter concerns regarding tobacco and health.

Methods The Legacy Tobacco Documents Library ( was systematically searched from 1959 to 2011 to identify relevant documents. The names of key individuals were identified through retrieved documents using a snowballing technique.

Results Our document analysis suggests that, in the case of TABP, the decline effects described above may be explained by the influence of tobacco industry funding. Phillip Morris channeled significant funds for TABP research through Duke and Yale Universities, including part-funding the Framingham study. It also funded a 10-year clinical trial of the effectiveness of counselling to reduce TABP, which it referred to as its “Crown Jewel”, and funded Meyer Friedman’s Institute to a total of almost US$11million. A history of the relationship between TABP research and the Tobacco Industry will be presented.

Conclusion It has not previously been shown that research into TABP was strongly influenced by the Tobacco Industry. This analysis extends further our understanding of the extent to which the tobacco industry has shaped major themes in contemporary public health research. Our findings also help explain the inconsistencies in the findings of epidemiological studies into TABP and mortality.

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