 37. Personality and Health 781
ing alcohol and tobacco use (e.g., Caspi et 
al., 1997; Gerrard, Gibbons, Stock, Hou -
lihan, & Dykstra, 2006; Jessor & Jessor, 
1977). Working with data from the longi -
tudinal Oregon Youth Substance Use Proj -
ect, Hampson and colleagues identified a 
mechanism by which more hostile children 
adopt a pathway leading to adolescent sub -
stance use: the development of cognitive 
susceptibility. Children who were rated by 
their teachers as exhibiting more hostile be -
havior at the beginning of the study believed 
increasingly over the next 4 years that more 
of their friends and peers were smoking or 
drinking, and these beliefs predicted stron -
ger intentions to smoke and drink (Hamp -
son, Andrews, & Barckley, 2007; Hampson, 
Andrews, Barckley, & Severson, 2006). The 
children’s intentions were correlated with 
subsequent experimentation with smoking 
and drinking. The effects of hostility were 
mediated by these normative beliefs. Hostil -
ity in childhood is a relatively stable trait, 
which may serve to strengthen its effects 
through accumulation (Hampson, Andrews, 
Barckley, & Peterson, 2007; Woodall & 
Matthews, 1993).
Negative emotionality in childhood can 
both heighten a child’s responsiveness to 
stress and evoke negative emotions in oth -
ers. Over time, these children may face a life 
path of adversity and lower SES, thus creat -
ing a downward spiral. Yet stress, such as 
parental divorce in childhood, need not nec -
essarily lead to negative later-life outcomes. 
In the Terman study, the higher mortality 
risk associated with parental divorce was 
ameliorated among individuals (especially 
men) who achieved a sense of personal sat -
isfaction by midlife (Martin, Friedman, 
Clark, & Tucker, 2005). Clearly, poten -
tially harmful trajectories can be deflected, 
and lifespan models need to accommodate 
twists and turns in the paths from person -
ality to health outcomes. Adolescence and 
early adulthood may be a critical period to 
incur or mitigate adverse effects, because of 
experimentation with behaviors such as sub -
stance abuse, as well as high frequencies of 
potentially health-  damaging risky activities 
(e.g., risky sex, dangerous driving, violence).
One of the earliest longitudinal studies 
of adult temperament and health followed 
medical students at Johns Hopkins Univer -
sity in the late 1940s. They were categorized as slow and solid (wary, self-  reliant), rapid 
and facile (cool, clever), or irregular and un -
even (moody, demanding). During a 30-year 
follow-  up, about half developed some seri -
ous health problem. Most (77%) of the pre -
viously labeled “irregular and uneven” types 
developed a serious disorder during these 30 
years, but only about one-  fourth of the rest 
suffered a major health setback. In further 
follow-  ups, the “irregular and uneven” tem -
perament types, as well as those physicians 
who seemed to have social and emotional 
problems (were repressed loners) and held 
“tension in,” were more likely to have devel -
oped cancer or to have died (Betz & Thom -
as, 1979; Graves, Mead, Wang, Liang, & 
Klag, 1994; Shaffer, Graves, Swank, & Pear -
son, 1987). This study, as well as a study of 
Harvard students also begun in the 1940s, 
illustrated the value of long-term studies of 
personality and heath in adulthood, as well 
as the power of biopsychosocial assessments 
of individual differences to predict key long-
term outcomes (Friedman, 1991; Friedman 
& Martin, 2011; Peterson, Seligman, & 
Vaillant, 1988; Vaillant, 2012).
Over three decades ago, Friedman and 
Booth-  Kewley (1987) proposed a generic 
“disease-  prone personality” characterized 
by negative emotionality, in particular anger/
hostility and depression. This construct was 
contrasted with the then-  popular focus on 
narrow trait-to-  disease links, such as Type 
A behavior and coronary heart disease. The 
idea of a clustering of negative emotionality 
traits associated with poor health has been 
most clearly confirmed with cardiovascular 
disease (see the review by Suls & Bunde, 
2005; see also Brummett et al., 2006; Smith 
& Gallo, 2001; Whiteman, 2006). Suls and 
Bunde (2005) concluded that anger, anxiety, 
and depression are overlapping constructs 
that together predict cardiovascular disease 
among initially healthy populations. How -
ever, investigators typically examine the ef -
fects of only one aspect of negative emotion -
ality (e.g., just hostility or just depression) 
and one disease; needed are studies in which 
the various components are all measured, so 
that their combined influence on cardiovas -
cular health and  general health and mortal -
ity risk can be assessed.
The Healthy Women Study (HWS), a pro -
spective study of changes in behavioral and 
biological characteristics of a population- 