Int. J. Behav. Med.
(2009) 16:259–268
DOI 10.1007/s12529-009-9032-x
The Relationship Between Life Satisfaction and Health
Behavior: A Cross-cultural Analysis of Young Adults
Nina Grant & Jane Wardle & Andrew Steptoe
Published online: 25 March 2009
# International Society of Behavioral Medicine 2009
Abstract
Background Positive well-being has been associated with a
range of favorable health outcomes. The contribution of
health-promoting behaviors is unclear.
Purpose The purpose of the study was to assess the
relationship between life satisfaction and seven health
behaviors in young adults and investigate the consistency
of associations across regions.
Method Students (17,246) aged 17–30 years from 21
countries completed questionnaire measures of life satis-
faction, smoking, physical exercise, alcohol consumption,
sun protection, fruit intake, fat consumption, and fiber
intake. Three geopolitical regions were identified: Western
Europe and the USA (12 countries), Central and Eastern
Europe (five countries), and Pacific Asia (four countries).
Results Life satisfaction was positively associated with not
smoking, physical exercise, using sun protection, eating
fruit, and limiting fat intake, but was not related to alcohol
consumption or fiber intake, after adjusting for age, gender,
and data clustering. Results were consistent across regions
for smoking and physical exercise, but differences were
apparent for sun protection, fruit intake, and fat avoidance.
Relationships between life satisfaction and health behaviors
were independent of beliefs in the health benefits of
behavior.
Conclusions The association between life satisfaction and
health-promoting behavior is likely to be bidirectional, but
may partly account for the relationship between positive
states and good health.
N. Grant : J. Wardle : A. Steptoe (*)
Department of Epidemiology and Public Health,
University College London,
1-19 Torrington Place,
London WC1E 6BT, UK
e-mail: a.steptoe@ucl.ac.uk
Keywords Life satisfaction . International . Smoking .
Physical activity . Health behavior . Health beliefs
Introduction
There is accumulating evidence that positive well-being is
associated with health outcomes. Positive well-being is
assessed by a number of constructs that are often regarded
as synonymous, including trait positive affect, subjective
well-being, and life satisfaction [1, 2]. Ryan and Deci [3]
argue that the study of positive well-being broadly falls into
two areas, eudaimonic and hedonic well-being, and that life
satisfaction is one construct under the umbrella of hedonic
well-being. Therefore, throughout this article, we have used
life satisfaction as a marker of positive well-being. Several
studies have demonstrated the relationship between positive
well-being and morbidity and mortality [2]. For example,
longitudinal observational studies of older adults have
shown associations between positive affect and reduced
risk of mortality, onset of disability, and coronary heart
disease, independently of risk factors and negative affect
[4–6]. A 20-year prospective study of Finnish adults
showed that life satisfaction was associated with all cause
mortality [7], and positive orientation was predictive of
longevity in other studies [8, 9].
If positive well-being has a direct effect on future health,
it is likely to be mediated through two pathways. First,
positive states may be associated with favorable biological
responses, including low cortisol levels, faster cardiovas-
cular stress recovery, reduced inflammation, and resilience
to infection [10–12]. Second, positive well-being may be
accompanied by healthy lifestyles and prudent health
behaviors that reduce long-term risk of disease develop-
ment. This study focuses on the association between life
260
satisfaction and a range of health behaviors in a large
sample of young adults.
There is substantial evidence that behaviors such as
smoking, lack of physical exercise, and heavy alcohol
consumption are associated with stress and negative mood
states like depression and anxiety [13–15]. The relationship
of prudent health behaviors with positive well-being is less
well established. Although associations between life satis-
faction and physical activity, not smoking, and moderate
alcohol consumption have been documented in some
studies [16–19], results have been inconsistent [20, 21].
Even less is known about associations between well-being
and other health behaviors such as dietary choice. The first
aim of this study was to confirm associations between life
satisfaction and smoking, physical activity and alcohol
consumption, and test relationships with other behaviors,
specifically sunscreen use and three aspects of food choice
(fruit intake, fiber consumption, and fat avoidance). We
hypothesized that life satisfaction would be positively
associated with not smoking, exercising regularly, drinking
moderately, using sunscreen, eating fruit, avoiding fat, and
consuming fiber in young adults.
Our second aim was to test the consistency of associa-
tions between life satisfaction and health behavior across
cultures. Most research has been carried out in Western
societies though there is now some evidence relating
behaviors such as smoking and heavy drinking with low
well-being in Eastern Europe [22, 23]. It is not clear that
comparable associations between life satisfaction and health
behavior will necessarily be present in different parts of the
world. For example, individualism–collectivism differs
across cultures and may partly explain variation in
subjective well-being [24]. In a previous analysis, we found
that depressed mood was greater in collectivist than
individualist cultures [25]. People in individualist cultures
may base their judgments of life satisfaction more on their
own emotions, whereas those in collectivist cultures place
greater emphasis on society and the views of others [26]. If
the origins of life satisfaction differ, then associations with
health behavior may also vary. The present analysis
involved respondents from 21 countries. We divided the
countries into three regions that differ in cultural mores,
political organization, and history, namely Western Europe
and the USA (western democratic market economies), the
former communist countries of Central and Eastern Europe,
and countries of the Pacific Asian regions, including Japan,
Korea, and Taiwan. This international dataset therefore
allowed us to gauge the robustness of associations between
life satisfaction and health behaviors across a range of
environmental and economic settings. Differences in
associations between life satisfaction and health behaviors
across regions would highlight limits to the generalization
of findings from Western countries.
Int. J. Behav. Med. (2009) 16:259–268
The third issue investigated in this study was whether
associations between life satisfaction and prudent health
behaviors are dependent on health-related motives and
cognition. There is substantial evidence that attitudes and
beliefs are determinants of health behaviors, and they are
central to many theories of health behavior change,
including the theory of reasoned action [27], the health
belief model [28], and social cognitive theory [29]. Beliefs
about the benefits to health are a common element of all
these models [30]. Positive health behaviors may not be
driven by health-related concerns at all. For example, it
could be that regular physical activity is stimulated by
social factors or concerns about physical appearance, rather
than any beliefs about the importance of physical activity
for health, and that these are in turn associated with life
satisfaction. We tested this possibility by investigating the
contribution of beliefs about behaviors to the association
between life satisfaction and behavior. We reasoned that if
people with higher life satisfaction engage in more prudent
health behaviors for health reasons, then the association
with life satisfaction would be reduced or eliminated once
health beliefs had been included in the statistical models.
Methods
Participants
The data analyzed for this study were taken from the
International Health and Behaviour Study, a cross-
sectional questionnaire survey of university students
administered in 24 countries between 1999 and 2001
previously reported in this journal [25]. The questionnaire
was developed in English, then translated and back-
translated into 18 languages (Bulgarian, Czech, Dutch,
Flemish, French, German, Greek, Hungarian, Icelandic,
Italian, Japanese, Korean, Mandarin, Polish, Portuguese,
Romanian, Spanish, and Thai). It was administered to
students from a single university in each of 21 countries
and two universities in the remaining three countries.
Institutions in the different countries were selected as
having comparable academic standing. Respondents were
enrolled on a variety of programs, including economics,
languages, law, and engineering. Students studying health-
related or medical topics were excluded.
The questionnaire consisted of a range of measures of
health behavior and attitudes to health and health beliefs
and was typically administered at the end of classes.
Participants were told that the survey measured activities
relevant to health and formed part of an international
comparison, but were given no other information. Comple-
tion of the survey was voluntary; however, response rates in
most countries were over 90%. The target sample size was
Int. J. Behav. Med. (2009) 16:259–268
800 students aged 17–30 years per country, but ranged from
376 to 2,028 depending on the interests of collaborators in
each country.
The total sample size was 19,647. Three countries
(Colombia, South Africa, and Venezuela) were excluded
since they did not fit into the geopolitical regions compared
in this analysis. Data were therefore analyzed from 17,246
participants from 21 countries, categorized into three
regions as follows: Western Europe and the USA (Belgium,
England, France, Germany, Greece, Iceland, Ireland, Italy,
Netherlands, Portugal, Spain, USA), Central and Eastern
Europe (Bulgaria, Hungary, Poland, Romania, and Slovakia),
and Pacific Asia (Japan, Korea, Taiwan, and Thailand).
Measures
Life satisfaction was measured using a single item, “All
things considered, how satisfied are you with your life as a
whole?” Responses were rated on a scale from 1 to 5,
ranging from “very satisfied” to very dissatisfied with
higher scores indicating greater dissatisfaction. Single-item
life satisfaction measures have been widely used in the
literature in several different cultures [31, 32]. The
proportion of participants rating themselves as very
dissatisfied was low, so these responses were amalgamated
with “fairly dissatisfied” to generate four categories.
The following seven health behaviors were included in
this analysis: cigarette smoking, alcohol consumption,
physical exercise, use of sun protection, fruit intake,
avoidance of dietary fat, and consumption of dietary fiber.
For the purposes of analysis, each behavior was coded into
a binary variable, with 0 as the unhealthy option. Binary
outcomes were chosen for three reasons. First, several
behaviors were measured in binary format, so a uniform
method of data presentation seemed desirable. Second,
there may have been minor variations in the interpretation
of items across languages, so a conservative approach to
data reduction seemed warranted. Third, binary outcomes
allowed us to compute odds ratios, so effect sizes across
regions and behaviors could be computed.
Details of the measures and their derivation can be found
in previous articles describing the analyses of each
behavior, so only brief summaries are presented here.
Short- and long-term reliability of measures has also been
reported [33, 34]. Cigarette smoking was assessed by
selecting one of eight options from “I have never smoked
a cigarette, not even a puff” to “I usually smoke more than
20 cigarettes per day” [35]. Respondents were categorized
as either current smokers (coded as 0) or nonsmokers
(coded as 1). Alcohol consumption was assessed by asking
participants if they drank alcohol and, if so, how many
drinks they consumed on a typical occasion [36]. They
were divided into heavy drinkers (defined as five or more
261
drinks for men and four or more drinks for women on at
least one occasion over the past 2 weeks, coded 0) and
nondrinkers or light/moderate drinkers (coded 1). Data
concerning alcohol consumption were not obtained in
Japan, Korea, or Taiwan, so the Pacific Asian region was
excluded from these analyses. Participants were asked
whether they engaged in any leisure time physical activity
and the number and duration of episodes in the past
2 weeks [37]. In this analysis, those not taking any exercise
were coded as unhealthy and were compared with the
remainder. Sun protection was assessed by asking parti-
cipants if they used sunscreen while sun bathing [38].
Those who responded positively were coded as healthy, and
individuals who stated that they never sunbathed were
excluded from this analysis. Fruit intake was measured
using five options from “never” to “at least once every day”
[39]. The healthy option (coded as 1) was eating fruit at
least once per day, and eating fruit less than once per day
was coded as 0. To measure avoidance of dietary fat,
participants were asked “do you make a conscious effort to
avoid foods that contain fat and cholesterol?” Responses
were either yes or no, with those indicating that they
avoided fat coded as 1. Participants were also asked if they
made deliberate efforts to eat fiber, and those who
responded yes were coded as healthy.
Health beliefs were assessed by asking participants to rate
the importance to health of not smoking, not drinking too
much alcohol, taking regular exercise, using sun protection,
eating fruit, limiting fat intake, and eating fiber. Ratings were
made on one- to ten-point Likert scales ranging from 1=“of
very low importance” to 10=“of very great importance”.
These ratings were included as continuously distributed
variables in the regression models.
Statistical Analysis
The distribution of life satisfaction ratings in men and
women over the complete sample was analyzed using
STATA version 9.0 with country as the primary sampling
unit so as to obtain accurate confidence intervals, taking
account of the clustered nature of the data. The mean age of
participants was 20.53 (2.08), but there were small diffe-
rences in mean age between country samples, ranging from
18.84 in Ireland to 22.55 in Germany. Age was therefore
taken into account in the analyses. The associations
between life satisfaction and behaviors were analyzed using
logistic regression models with the “svylogit” command in
STATA. The dependent variable in each analysis was the
health behavior. Model 1 included life satisfaction, age, and
sex as independent variables. The odds of healthy behavior
for each level of life satisfaction adjusting for age and sex
were computed, with “dissatisfied” as the reference cate-
gory. Confidence intervals (CIs; 95%) taking account of
262 Int. J. Behav. Med. (2009) 16:259–268

data clustering and p values for trends across categories are
presented. Each model was repeated for the complete
sample and for the three geopolitical regions separately.
The extent to which associations between life satisfaction
and health behavior are mediated by health beliefs was
investigated by adding the appropriate health belief to each
regression model. The reduction on odds ratio for life
satisfaction with health beliefs included in the models is an
indicator of mediation [40].
Results
satisfaction ratings were highest in Western Europe and the
USA, intermediate in Central and Eastern Europe, and
lowest in Pacific Asia. For example, the proportion of
respondents who were very satisfied was 26%, 18%, and
12% in these three geopolitical regions. There were
significant gender differences in the distribution of life
satisfaction ratings in all three regions (χ2 =34.67, 16.32,
and 12.15, p<0.01). In both Western Europe and the USA
and Central and Eastern European regions, men were more
satisfied with their lives than women. But in the Pacific
Asian region, men were more likely to be dissatisfied with
their lives than women.

Life Satisfaction Life Satisfaction and Health Behaviors

The sample characteristics and ratings of life satisfaction for
each region are shown in Table 1. The sample from Western
Europe and the USA was larger (10,603) than for Central
and Eastern Europe (4,186) and Pacific Asia (2,458)
because the number of countries was greater. Overall,
8.1% of respondents rated themselves as dissatisfied, 13.4%
as neutral, 56.0% as moderately, and 22.5% as very
satisfied with life. The distribution differed between
Western Europe and the USA and Central and Eastern
Europe (χ2 =56.18, p<0.005), Western Europe and the
USA and the Pacific Asian region (χ2 =653,0, p<0.005),
and between Central and Eastern Europe and Pacific Asia
(χ2 =247.7, p<0.005). As can be seen from Table 1, life
The association between life satisfaction and each of the
seven health behaviors is shown in Table 2.
Smoking More than three quarters (78%) of participants in
this study were nonsmokers, ranging from 76% in Western
Europe and USA and in the Central and Eastern region to
89% in the Pacific Asian region. Across the complete
sample, those with higher life satisfaction were more likely
to be nonsmokers than those with lower life satisfaction.
The trend across categories was significant (p=0.004), with
odds ratios increasing from 1.14 to 1.57 across neutral to
very satisfied (Table 2). In separate analysis of the regions,
the trend across life satisfaction categories was significant

Table 1 Sample size, age, and life satisfaction and in men and women

Sample size (N) (%) Men (%) Women (%) Age M (SD)

All countries 17,246 (100) 7,429 (43) 9,817 (57) 20.53 (2.1)
Dissatisfied 1,392 (8) 649 (9) 743 (8)
Neutral 2,303 (13) 1,067 (14) 1,236 (13)
Moderately satisfied 9,663 (56) 3,920 (53) 5,743 (58)
Very satisfied 3,888 (23) 1,793 (24) 2,095 (21)
Region 1: Western Europe and USA 10,603 4,524 (43) 6,079 (57) 20.38 (2.1)
Dissatisfied 566 (5) 263 (6) 303 (5)
Neutral 1,216 (11) 557 (12) 659 (11)
Moderately satisfied 5,994 (57) 2,409 (53) 3,585 (59)
Very satisfied 2,827 (27) 1,295 (29) 1,532 (25)
Region 2: Central and Eastern Europe 4,186 1,899 (45) 2,287 (55) 21.03 (1.9)
Dissatisfied 391 (9) 186 (10) 205 (9)
Neutral 534 (13) 266 (14) 268 (12)
Moderately satisfied 2,495 (60) 1,069 (56) 1,426 (62)
Very satisfied 766 (18) 378 (20) 388 (17)
Region 3: Pacific Asia 2,458 1,007 (41) 1,451 (59) 20.37 (2.1)
Dissatisfied 435 (18) 200 (20) 235 (16)
Neutral 553 (22) 244 (24) 309 (21)
Moderately satisfied 1,174 (48) 442 (44) 732 (50)
Very satisfied 295 (12) 120 (12) 175 (12)
Int. J. Behav. Med. (2009) 16:259–268
in all three, with stronger effects in Western Europe and
USA and Pacific Asia than in Central and Eastern Europe.
Alcohol The proportion of respondents who did not drink
or drank only moderately was 63% overall, being more
common in Western Europe and the USA compared with
Central and Eastern Europe (65% versus 60%). There was
no consistent association with life satisfaction either in the
complete sample or the separate regions.
Physical Exercise Leisure time physical exercise was
reported by 70% of participants, with the highest
prevalence (71%) in Western Europe and the USA. A
strong association with life satisfaction emerged (p<
0.001), and this was replicated across the three geopoli-
tical regions. As can be seen in Table 2, only 61% of
participants who were dissatisfied with life exercised,
compared with 77% of those with high life satisfaction,
and a dose–response relationship was evident, with the
likelihood of engaging in regular exercise increasing as
life satisfaction increases.
Sun Protection Using sun protection was most common in
respondents from Western Europe and the USA (76%) and
lowest in Pacific Asian countries (66%). Life satisfaction
was positively associated with sunscreen use, with levels
ranging from 63% among dissatisfied or neutral respond-
ents to 74% in the moderately and very satisfied (p<0.001).
These effects were significant in Western Europe and USA
and in Central and Eastern Europe, but not in the Pacific
Asian region.
Fruit Intake Fewer than half respondents ate fruit at least
daily. Rates were higher among respondents from Western
Europe and the USA (47%), compared with the Central and
Eastern Europe (43%) and Pacific Asian regions (29%). We
found a positive association overall between life satisfac-
tion and eating fruit, with a significant trend across
categories (p=0.003, see Table 2). Levels ranged from
36% of the dissatisfied to 49% of the very satisfied. This
effect was significant in separate analyses of Central and
Eastern Europe (p=0.026) and Pacific Asia (p=0.008) but
not in Western Europe and the USA (p=0.556).
Fat Avoidance Attempts to limit fat in the diet were similar
across all three regions, averaging 36.3% overall. A
moderate but significant association between life satisfac-
tion and fat avoidance emerged, with a dose–response
relationship, since the odds ratio for those with high life
satisfaction was 1.39, moderate life satisfaction 1.30, and
neutral 1.19. However, the pattern was not consistent across
regions, being significant only in the separate analysis of
Central and Eastern European countries.
263
Fiber Intake Respondents from Pacific Asia reported the
highest rates of deliberate efforts to consume fiber (51%)
compared with 31% in Western Europe and USA and 28%
in Central and Eastern Europe. There were no significant
relationships between life satisfaction and fiber intake in the
complete sample or in any of the regions separately.
Health Beliefs, Health Behaviors, and Life Satisfaction
The proportion of the sample with strong beliefs in the
importance of each behavior for health ranged from 22%
for limiting fat intake and 63% for not smoking. There were
consistent relationships between health behaviors, and
health beliefs were as documented in previous analyses
except for beliefs concerning alcohol, with stronger health
beliefs being associated with healthier behavioral choices.
For example, the odds of not smoking in relation to beliefs
in not smoking were 1.43, so every unit increase in strength
of beliefs was associated with a 43% increase in the odds of
not smoking. Odds ratios ranged from 1.33 for physical
activity to 1.71 for sunscreen use, after adjustment of age
and gender. These results replicate well-established associ-
ations between health beliefs and health behaviors.
The extent to which health beliefs mediate the relation-
ship between life satisfaction and healthy behavior was
analyzed using logistic regression. In no case were the odds
ratios relating life satisfaction with behavior (significant for
smoking, physical exercise, sun protection, fruit intake, and
fat avoidance) markedly altered when health beliefs were
included in the models (data available on request). The
odds ratios relating life satisfaction with nonsmoking
changed from 1.22 to 1.17, for sun protection from 1.61
to 1.54, for exercise changed from 1.59 to 1.55, for fiber
from 1.04 to 1.13, for fat avoidance from 1.19 to 1.31, for
fruit consumption from 1.39 to 1.38, and for heavy alcohol
drinking from 1.14 to 1.17. The study therefore found no
evidence that health beliefs mediated the association
between life satisfaction and prudent health behavior.
Discussion
The majority of young adults in this study reported positive
well-being, with 70% of men and 79% of women saying
that they were moderately or very satisfied with their lives.
However, the prevalence of high life satisfaction varied
across geopolitical regions, with the highest levels in
Western Europe and the USA and lowest levels in the
Pacific Asian region. Higher depression levels have
previously been observed in the former communist
countries of Central and Eastern Europe compared with
Western Europe [41, 42]. This pattern is thought to reflect
Table 2 Associations between life satisfaction and health behaviors
264

Complete sample Region 1: Western Region 2: Central and Region 3: Pacific Asia
Europe and USA Eastern Europe

Smoking % Nonsmokers Odds ratioa % Nonsmokers Odds ratioa % Nonsmokers Odds ratioa % Nonsmokers Odds ratioa
(95% CI) (95% CI) (95% CI) (95% CI)
Life satisfaction 77 76 76 89
Dissatisfied 73 1 67 1 73 1 82 1
Neutral 76 1.14 (0.92 – 73 1.34 (1.02–1.76) 70 0.89 (0.67–1.19) 88 1.55 (0.81–2.97)
1.41)
Moderately 78 1.24 (0.1.04 – 76 1.51 (1.24–1.83) 76 1.20 (0.84–1.71) 92 2.29 (1.24–4.23)
satisfied 1.47)
Very satisfied 82 1.57 (1.16–2.13) 81 2.01 (1.41–2.87) 82 1.68 (1.27–2.23) 90 2.01 (1.62–2.50)
P trend – 0.004 – 0.001 – 0.014 – 0.007
Alcohol % Moderate/ Odds ratioa % Moderate/ Odds ratioa % Moderate/ Odds ratioa % Moderate/ Odds ratioa
consumption nondrinkers (95% CI) nondrinkers (95% CI) nondrinkers (95% CI) nondrinkers (95% CI)
Life satisfaction 64 65 59
Dissatisfied 60 1 63 1 56 1 – –
Neutral 70 0.63 (0.46–0.85) 71 .69 (0.45–1.06) 70 .52 (0.37–0.75) – –
Moderately 64 0.82 (0.62–1.07) 66 0.87 (0.63–1.20) 60 0.88 (0.49–1.58) – –
satisfied
Very satisfied 60 0.93 (0.64–1.37) 62 1.00 (0.78–0.98) 52 1.13 (0.45–2.87) – –
P trend – 0.389 – 0.272 – 0.375 – –
Physical exercise Physical Odds ratioa Physical Odds ratioa Physical Odds ratioa Physical Odds ratioa
exercise% (95% CI) exercise% (95% CI) exercise% (95% CI) exercise% (95% CI)
Life satisfaction 50 71 69 66
Dissatisfied 61 1 60 1 64 1 59 1
Neutral 63 1.11 (0.92–1.33) 63 1.16 (0.94–1.43) 61 0.86 (0.60–1.25) 65 1.32 (0.49–3.56)
Moderately 70 1.52 (1.28–1.80) 70 1.62 (1.33–1.96) 69 1.28 (0.90–1.82) 67 1.53 (1.02–2.29)
satisfied
Very satisfied 77 2.17 (1.80–2.64) 77 2.21 (1.82–2.67) 80 2.27 (1.70–3.02) 72 1.89 (1.38–2.59)
P trend – 0.001 – 0.001 – 0.000 – 0.048
Sun protection % Sun Odds ratioa % Sun Odds ratioa % Sun Odds ratioa % Sun Odds ratioa
protection (95% CI) protection (95% CI) protection (95% CI) protection (95% CI)
Life satisfaction 69 76 71 53
Dissatisfied 63 1 71 1 65 1 48 1
Neutral 63 1.01 (0.75–1.36) 71 1.00 (0.70–1.42) 57 0.75 (0.46–1.22) 49 0.92 (0.30–2.86)
Moderately 74 1.55 (1.23–1.96) 77 1.32 (0.99–1.76) 72 1.39 (0.88–2.18) 56 1.04 (0.57–1.91)
satisfied
Very satisfied 74 1.79 (1.34–2.39) 75 1.29 (0.98–1.70) 77 2.22 (1.23–4.03) 55 1.10 (0.38–3.20)
P trend – 0.001 – 0.025 – 0.003 – 0.674
Int. J. Behav. Med. (2009) 16:259–268
Table 2 (continued)

Complete sample Region 1: Western Region 2: Central and Region 3: Pacific Asia
Europe and USA Eastern Europe

Fruit intake % Eating Odds ratioa % Eating Odds ratioa % Eating Odds ratioa % Eating Odds ratioa
fruit daily (95% CI) fruit daily (95% CI) fruit daily (95% CI) fruit daily (95% CI)
Life satisfaction 32 47 43 29
Dissatisfied 36 1 47 1 37 1 20 1
Neutral 38 1.12 (0.90–1.40) 47 0.99 (0.77–1.29) 33 0.81 (0.46–1.43) 26 1.39 (0.68–2.85)
Moderately 44 1.41 (1.08–1.84) 48 1.01 (0.94-1.23) 43 1.23 (0.80–1.29) 31 1.71 (0.80–3.63)
satisfied
Very satisfied 49 1.70 (1.20–2.44) 48 1.04 (0.84-1.29) 54 1.98 (0.93–4.23) 41 2.81 (1.88–4.18)
P trend – 0.003 – 0.566 – 0.026 – 0.008
Fat avoidance % Fat Odds ratioa % Fat Odds ratioa % Fat avoidance Odds ratioa % Fat Odds ratioa
avoidance (95% CI) avoidance (95% CI) (95% CI) avoidance (95% CI)
Int. J. Behav. Med. (2009) 16:259–268

Life satisfaction 35 38 36 31
Dissatisfied 30 1 36 1 31 1 23 1
Neutral 34 1.16 (0.93–1.53) 35 0.94 (0.71–1.23) 37 1.37 (1.11–1.70) 30 1.42 (0.56–3.58)
Moderately 37 1.30 (1.03–1.63) 39 1.06 (0.88–1.27) 36 1.26 (1.08–1.47) 32 1.44 (0.64–3.26)
satisfied
Very satisfied 38 1.39 (1.04–1.86) 38 1.08 (0.86–1.35) 37 1.38 (1.03–1.84) 38 1.94 (0.81–3.26)
P trend – 0.023 – 0.146 – 0.049 – 0.089
Fiber intake Increasing fiber Odds ratioa Increasing fiber Odds ratioa Increasing fiber Odds ratioa Increasing fiber Odds ratioa
intake% (95% CI) intake% (95% CI) intake% (95% CI) intake% (95% CI)
Life satisfaction 33 31 28 51
Dissatisfied 33 1 30 1 30 1 41 1
Neutral 31 0.88 (0.68–1.13) 28 0.87 (0.68–1.12) 24 0.75 (0.98–1.46) 44 1.09 (0.40–2.95)
Moderately 34 0.97 (0.78–1.22) 32 1.05 (0.86–1.27) 28 0.91 (0.41–1.99) 55 1.60 (0.53–4.85)
satisfied
Very satisfied 32 0.94 (0.71–1.24) 29 0.96 (0.76–1.22) 31 1.06 (0.60–1.97) 64 2.45 (0.81–7.49)
P trend – 0.999 – 0.844 – 0.453 – 0.086
a
Adjusted for age, sex, and country of origin. P trend indicates significance of trend across life satisfaction categories
265
266
the turmoil of economic transition and loss of social and
cultural stability over recent decades [43]. There is also
evidence of lower subjective well-being and elevated level
of depressive symptom in Pacific Asian compared with
Western countries [32, 44]. Differences in factors such as
individualism–collectivism and culture norms are thought
to contribute [25, 26]. There was an interesting difference
in the gender distribution of life satisfaction across regions,
with men reporting greater life satisfaction on average in
Western Europe and the USA and in Central and Eastern
Europe, but lower levels than women in the Pacific Asian
regions. The explanation for this pattern is not clear.
The main hypothesis of the study was largely con-
firmed, in that life satisfaction was positively associated
with all of the prudent health behaviors except alcohol
consumption and fiber intake. Effects were strong for
physical exercise, with the very satisfied being much more
likely to exercise than the dissatisfied, intermediate for sun
protection and fruit intake, and lower but significant for
cigarette smoking and dietary fat avoidance (Table 2). In
each case, there was a graded association, with the healthy
behavioral choice being most common in the very
satisfied, intermediate in the moderately satisfied and
neutral categories, and rare among respondent reporting
low life satisfaction.
Associations were moderately consistent across geopo-
litical region. For smoking and exercise, the association
with life satisfaction was significant for all three regions,
and effects were present in two of the regions for sun
protection and fruit intake. These results therefore add to
the limited data currently available relating life satisfaction
with prudent health behavior in non-Western countries [22,
23]. In the case of sunscreen use, the association was not
significant in the Pacific Asian region. Respondents from
these countries had the lowest overall use of sunscreen, and
the smaller sample size may have resulted in a lack of
statistical power. Fruit intake was not related to life
satisfaction in Western Europe and the USA. One reason
may be that the highest consumption category was one
portion per day, and this was achieved by nearly half the
respondents in this region. A more sensitive scale discri-
minating between people who ate greater amounts of fruit
might have generated a gradient in this region. Previous
research relating fruit and vegetable intake with positive
well-being in Western countries has been inconsistent. A
4-year randomized dietary intervention trial of a low fat,
high fiber, high fruit, and vegetable regimen showed no
effect on life satisfaction [45]. But, another study of brief
behavioral counseling to increase fruit and vegetable
consumption resulted in improvements in health-related
quality of life that correlated with individual differences in
intake and in plasma vitamin C and E concentrations,
independently of covariates [46].
Int. J. Behav. Med. (2009) 16:259–268
We failed to discern any association between life
satisfaction and alcohol intake in this analysis. Heavy
alcohol consumption has previously been linked with low
life satisfaction in female college students [21], but no
effect was found for either men or women in this study.
One explanation is that reported levels of alcohol intake
were not very high, and associations with low life
satisfaction may only emerge when heavy drinkers are
tested. There are marked cultural variations in the use of
alcohol, particularly among women, which may confound
relationships. Additionally, the association between alcohol
consumption and mood state could be curvilinear [47]. In
another analysis from this data set, we found that high
levels of depressed mood were more prevalent among
nondrinkers and heavy drinkers than in moderate drinkers
[48]. Life satisfaction was also greater in moderate users
compared with abstainers and heavy users in a nationally
representative sample of Australian adults [16].
No association between life satisfaction and fiber intake
was found. There may genuinely have been no relationship,
but measurement issues could also have contributed. The
fiber intake item was not very precise since it did not
enquire about specific foods but about whether participants
made conscious efforts to eat more fiber. People might not
make conscious efforts because their diets are already rich
in fiber and not because they are uninterested in healthy
eating. It is notable that the fat avoidance item shared
nonspecific properties with the fiber measure and also had
rather inconsistent associations with life satisfaction.
The causal pathways linking behavior with positive well-
being are not well understood. Bidirectional processes are
probably involved. For example, the alleviation of clinical
depression is characteristically followed by increased
physical activity, while both longitudinal observational
and interventional trials have shown that increasing
physical activity has beneficial effects on positive psycho-
logical states [49]. Smoking may partly be a consequence
of negative affective states, while stopping smoking leads
to enhanced well-being [14]. It is plausible in the present
study that both cigarette smoking and lack of physical
exercise contribute to low satisfaction and that people who
are dissatisfied with their lives could become lethargic and
inactive and turn to smoking. But, while it appears
reasonable to posit that individuals who are dissatisfied
with their lives exert less self-care, so fail to use sun
protection or engage in healthy dietary choices, the reverse
pattern (that not using sunscreen or eating fruit regularly
promotes low life satisfaction) is less plausible. There may
also be third factors underlying associations between life
satisfaction and health behaviors, indicating that the
relationship is not causal. For example, low socioeconomic
status is linked with a range of risk behaviors and low life
satisfaction, while conscientiousness as a personality trait
Int. J. Behav. Med. (2009) 16:259–268
has been related both to prudent health behaviors [50] and
to life satisfaction [51]. Extraversion is associated with
behaviors such as exercise and is also related to life
satisfaction [1]. Stubbe et al. [52] have recently demon-
strated that the association between exercise participation
and positive well-being may be mediated by genetic factors
influencing both the behavior and well-being. So, several
additional unmeasured factors could contribute to the
observed relationships between life satisfaction and health
behaviors.
Another issue this study addressed is whether the
association between life satisfaction and prudent health
behavior is mediated through health motives. There were
robust associations between health behaviors and beliefs in
the importance to health of carrying out these activities.
However, health beliefs did not mediate associations
between life satisfaction and behavior, as defined by
changes in regression coefficients when appropriate beliefs
were entered into regression models. These results are
consistent across behaviors and strongly suggest that if high
life satisfaction does drive people to engage in more
prudent behavior, it is not for health-related reasons. Each
of the behaviors studied in this investigation has multiple
determinants apart from health maintenance. Motives for
physical activity include the enjoyment of sport, excite-
ment, bodily appearance, and social interaction [53]. Food
choices are influenced by taste, habit, cost, and conve-
nience as well as health and weight control [54]. Social
norms and cosmetic motives are important determinants of
sunscreen use in young adults [55]. It is possible that any
influence of life satisfaction on behavioral choices is
mediated through these or other factors, rather than through
health motives.
This study has a number of strengths, including a large
homogenous sample, uniform measures of health behaviors,
and a standard assessment of life satisfaction. There are also
several limitations. The study was cross-sectional, so causal
conclusions cannot be drawn. The study was carried out
with students from a small number of universities in each
country, and inclusion of other centers could have resulted
in different effects. University students are not representa-
tive of young adults in general, and the prevalence of life
satisfaction and health behaviors may be different in other
sectors of the population. Students were tested here as an
easily identifiable and accessible group of relatively healthy
young adults with similar educational attainment. The
measures in this study were simple self-report items, and
more refined assessments with objective verification would
have been desirable. Nevertheless, the results add to the
literature in documenting associations between positive
well-being and a range of behaviors relevant to health in
different cultural groups. The findings are consistent with
the notion that health behaviors account in part for the
267
relationship between positive psychological states and good
health though do not of course provide proof that this
pathway is relevant.
Acknowledgments This study was supported by the Economic and
Social Research Council and the Medical Research Council, UK. Jane
Wardle is supported by Cancer Research UK and Andrew Steptoe by
the British Heart Foundation. We acknowledge collaborators in
universities worldwide who recruited students to take part in this
survey.
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