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Are Vacations Good for Your Health? The 9-Year Mortality Experience After the Multiple Risk Factor Intervention Trial


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The objective of this study was to determine the risk for various causes of posttrial death associated with vacation frequency during the Multiple Risk Factor Intervention Trial (MRFIT). Middle-aged men at high risk for coronary heart disease (CHD) were recruited for the MRFIT. As part of the questionnaires administered during the first five annual visits, men were asked whether they had had a vacation during the past year. For trial survivors (N = 12,338), the frequency of these annual vacations during the trial were used in a prospective analysis of posttrial all-cause and cause-specific mortality during the 9-year follow-up period. The relative risk (RR) associated with more annual vacations during the trial was 0.83 (95% confidence interval [CI], 0.71-0.97) for all-cause mortality during the 9-year follow-up period. For cause of death, the RRs were 0.71 (95% CI, 0.58-0.89) and 0.98 (95% CI, 0.78-1.23) for cardiovascular and noncardiovascular causes, respectively. The RR was 0.68 (95% CI, 0.53-0.88) for CHD (including acute myocardial infarction). These associations remained when statistical adjustments were made for possible confounding variables, including baseline characteristics (eg, income), MRFIT group assignment, and occurrence of a nonfatal cardiovascular event during the trial. The frequency of annual vacations by middle-aged men at high risk for CHD is associated with a reduced risk of all-cause mortality and, more specifically, mortality attributed to CHD. Vacationing may be good for your health.
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Are Vacations Good for Your Health? The 9-Year Mortality Experience After the
Multiple Risk Factor Intervention Trial
Objective: The objective of this study was to determine the risk for various causes of posttrial death associated with
vacation frequency during the Multiple Risk Factor Intervention Trial (MRFIT). Methods: Middle-aged men at high
risk for coronary heart disease (CHD) were recruited for the MRFIT. As part of the questionnaires administered
during the first five annual visits, men were asked whether they had had a vacation during the past year. For trial
survivors (N12,338), the frequency of these annual vacations during the trial were used in a prospective analysis
of posttrial all-cause and cause-specific mortality during the 9-year follow-up period. Results: The relative risk (RR)
associated with more annual vacations during the trial was 0.83 (95% confidence interval [CI], 0.71–0.97) for
all-cause mortality during the 9-year follow-up period. For cause of death, the RRs were 0.71 (95% CI, 0.580.89)
and 0.98 (95% CI, 0.78–1.23) for cardiovascular and noncardiovascular causes, respectively. The RR was 0.68 (95%
CI, 0.53–0.88) for CHD (including acute myocardial infarction). These associations remained when statistical
adjustments were made for possible confounding variables, including baseline characteristics (eg, income), MRFIT
group assignment, and occurrence of a nonfatal cardiovascular event during the trial. Conclusions: The frequency
of annual vacations by middle-aged men at high risk for CHD is associated with a reduced risk of all-cause mortality
and, more specifically, mortality attributed to CHD. Vacationing may be good for your health. Key words: coronary
heart disease, vacations, respite, restorative behaviors, Multiple Risk Factor Intervention Trial.
CHD coronary heart disease; CI confidence inter-
val; DBP diastolic blood pressure; ICD-9 Interna-
tional Classification of Diseases, ninth revision; MI
myocardial infarction; MRFIT Multiple Risk Factor
Intervention Trial; RR relative risk; SES socioeco-
nomic status; SI special intervention; UC usual
Psychological stress is positively associated with
morbidity and mortality for a variety of diseases, in-
cluding atherosclerosis (1), MI (2, 3), metabolic syn-
drome (4, 5), infectious disease (6, 7), and AIDS (8, 9).
Stress is thought to influence disease risk through a
number of pathways, including alterations in health
behaviors such as smoking (10), alcohol consumption
(11), compliance with medications (12), and emotional
states (13). More recently, it has been recognized that
normal restorative activities, such as sleep (14), exer-
cise (15), and other leisure time activities, might influ-
ence disease risk. The present study examined
whether frequent annual vacations, a common form of
respite, serves a health protective function.
The Framingham Heart Study found an association
between infrequent vacationing and increased inci-
dence of MI or death due to coronary causes during a
20-year follow-up of women participants (16). Because
coronary death was not analyzed separately in this
study (there were only 10 coronary deaths), this in-
creased risk associated with infrequent vacationing
does not necessarily represent an increased risk of
mortality. In another study, men who developed psy-
chosomatic illnesses were less likely to take vacations
than men who never developed such illnesses (17).
Although taking regular annual vacations may serve
a protective function, it is important to consider alter-
native explanations. For example, higher SES may pro-
duce both lower morbidity and mortality (18) and
more frequent annual vacations, thereby producing a
spurious association between frequent annual vaca-
tions and physical health. Along similar lines, poor
health (eg, nonfatal MIs) may produce both higher
rates of subsequent mortality (19) and prevent annual
vacations. It is important to consider these alternative
explanations when analyzing the effects of vacationing
annually on mortality.
The purpose of this study was to evaluate 9-year
posttrial mortality and cause of death among MRFIT
participants as a function of the number of annual
vacations assessed during 5 years of the trial. This
study includes statistical controls for nonfatal health-
related events and SES.
Design of the MRFIT
A total of 361,662 men aged 35 to 57 years were initially screened
at 22 clinical centers in 18 US cities for MRFIT. A total of 12,866 of
these men were enrolled in the trial. At the time of study entry, these
men were in the upper 10% to 15% of the risk score distribution,
which was derived from the Framingham Heart Study data. Exclu-
sion criteria included clinical evidence of CHD, based on history,
From the Department of Psychology (B.B.G.), State University of
New York, Oswego, NY; and the Department of Psychiatry (K.A.M.),
University of Pittsburgh, Pittsburgh, PA.
Address reprint requests to: Karen Matthews, Department of Psy-
chiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA
15213. Address correspondence to: Brooks B. Gump, PhD, MPH,
Department of Psychology, State University of New York, Oswego,
NY 13126. Email:
Received December 27, 1999; revision received March 15, 2000.
608 Psychosomatic Medicine 62:608612 (2000)
Copyright © 2000 by the American Psychosomatic Society
physical examination, or electrocardiography (at rest); a serum cho-
lesterol level 9.05 mmol/liter (350 mg/dl); DBP readings 115
mm Hg; or a body weight at least 50% greater than the standard
weight for height (20–22). After exclusion, the remaining partici-
pants were randomly assigned to an SI (N6428) or UC (N6438)
group. Participants in the SI group received dietary instructions
designed to alter eating patterns to reduce the intake of saturated fats
and to reduce blood cholesterol levels, a smoking cessation program,
and stepped-care drug therapy for hypertension. Details of the mul-
tifactor intervention program are described elsewhere (23, 24). In
our analyses, we included survivors of the trial (N12,338).
Measurement of Annual Vacations
Vacationing was assessed by an item on a checklist of life events
(“Within the last 12 months, have you experienced a vacation?”).
The vacation item was not included on the checklist used at baseline
but was included on the checklist used at the first, second, third,
fourth, and fifth annual examinations. This checklist did not include
an option for indicating that an event had not occurred; as a result,
a missing response on items on this questionnaire did not enable
differentiation of missing data from intentional indications that an
event had not occurred. However, the life events checklist was
administered along with a number of other questionnaires; there-
fore, we treated data as missing for participants with known missing
data for five forced-choice questions that either directly preceded or
followed (depending on year) the life events questionnaire. Missing
data increased steadily from year 1 (N695, 5.4%) to year 5 (N
1550, 12.0%) because of participant death or attrition. Mean vaca-
tioning was computed for all valid responses and reflects the pro-
portion of years the participant reported vacationing for those years
with valid data.
Risk Factor Assessment
The following risk factors were considered: age at study entry;
MRFIT group assignment (SI or UC); education, measured on a scale
from 1 (eighth grade or less) to 9 (graduate or professional degree);
total family income, measured on a scale from 1 ($4200) to 9
($35,000); DBP, defined as the average of two random-zero ma-
nometer readings; serum cholesterol concentration; and cigarette
smoking, determined by self-report. To index cumulative risk factor
burden, we computed trial means for blood pressure, serum choles-
terol, and smoking. For smoking, the average corresponds to the
proportion of assessments when smoking was reported. Additional
details about these assessments are published elsewhere (25, 26).
Morbidity and Mortality Ascertainment
A nonfatal cardiovascular event during the trial was defined as
angina (Rose questionnaire), intermittent claudication (Rose ques-
tionnaire), congestive heart failure, peripheral arterial occlusive dis-
ease, stroke, left ventricular hypertrophy (electrocardiography), im-
paired renal function, accelerated hypertension, coronary artery
bypass surgery, serial electrocardiographic evidence of MI, or defi-
nite clinical MI (determined by coding criteria of electrocardio-
graphic tracings and/or physician inspection of hospital records)
Since February 1982, vital status has been ascertained by match-
ing identifying information reported by participants at the time of
enrollment with the National Death Index. The latest search of the
National Death Index was for all deaths through December 1990 and
is considered to be essentially 100% complete (28). To determine
cause of death, death certificates were collected and coded indepen-
dently by two nosologists using ICD-9 codes (29). Disagreements
between the two nosologists were adjudicated by a third nosologist.
Cause-specific mortality categories (and corresponding ICD-9 codes)
considered in the present study were selected by the MRFIT Mor-
tality and Morbidity Committee and are reported elsewhere (27).
Statistical Analyses
All analyses included trial survivors and considered mortality
during the 9-year follow-up period. Posttrial mortality was analyzed
using Cox proportional hazard regression equations and 95% CIs for
the RRs associated with mean vacationing during the trial. In these
analyses, proportion of years with report of vacation was treated as
a continuous variable (ranging from 0 to 1.00). To control for possi-
ble confounding variables, additional analyses included age, MRFIT
group assignment, DBP, serum cholesterol, education, family in-
come, and cigarette smoking as covariates. Because the occurrence
of nonfatal cardiovascular events (ie, morbidity) might both interfere
with vacationing and predict future cardiovascular mortality, the
occurrence of a nonfatal cardiovascular event during the trial was
included as an additional covariate.
For analysis of differences in participants’ trial characteristics as
a function of annual vacationing, vacationing frequency was dichot-
omized into those reporting vacationing 60% of the years surveyed
(low-frequency group, N6745) and those reporting vacationing for
60% of the years surveyed (high-frequency group, N5822) in
these analyses. This dichotomous variable (low vs. high vacationing
frequency) was used in analyses of variance for tests of continuous
variables (blood pressure, age, educational attainment, smoking, and
cholesterol) and a 2 2
analyses of group proportions for tests of
categorical variables (ie, study group and occurrence of nonfatal
cardiovascular events during the trial).
Characteristics of Participants Taking Frequent
and Infrequent Vacations
For the five assessments of vacationing in the past
year, 12.8% of participants in MRFIT reported never
taking an annual vacation, 10.1% reported 1 annual
vacation, 11.4% reported 2 annual vacations, 14.4%
reported 3 annual vacations, 18.2% reported 4 annual
vacations, and 25.6% reported 5 annual vacations. The
remaining 7.6% had missing data; therefore, frequency
of annual vacations for these participants was the pro-
portion of years in which the participant took a vaca-
tion for those years with valid data. The differences in
characteristics of participants taking frequent and in-
frequent annual vacations are shown in Table 1. The
large sample in MRFIT provides power to detect rather
small effects. Those taking frequent annual vacations
during the trial were significantly younger at study
entry, were less likely to be in the SI group, were less
likely to report cigarette smoking, were more educated,
had a higher family income, were less likely to expe-
rience a nonfatal cardiovascular event during the trial,
and had a higher serum cholesterol level during the
609Psychosomatic Medicine 62:608612 (2000)
Frequency of Annual Vacations During the Trial
and Posttrial Mortality
The median length of follow-up for survivors of the
trial through December 1990 was approximately 9
years (8.8 years; range 7.8 to 10.1 years). During this
time, 770 cardiovascular and 743 noncardiovascular
deaths occurred. The RRs associated with more fre-
quent annual vacations were 0.68 (95% CI, 0.590.79)
for all-cause mortality, 0.61 (95% CI, 0.500.75) for
cardiovascular mortality, and 0.77 (95% CI, 0.62–0.96)
for noncardiovascular mortality. As shown in Table 2,
after the addition of covariates to control for potential
confounding factors, the RRs associated with more
frequent annual vacations were 0.83 (95% CI, 0.71–
0.97) for all-cause mortality, 0.71 (95% CI, 0.580.89)
for cardiovascular mortality, and 0.98 (95% CI, 0.78
1.23) for noncardiovascular mortality.
In addition to analyses of all cardiovascular and all
noncardiovascular deaths, specific causes of death
within each category were considered. For cardiovas-
cular mortality, the frequency of annual vacations was
associated with a significant RR, 0.68 (95% CI, 0.53–
0.88), for CHD. Within the CHD category, cause of
death was further categorized into acute MI (ICD-9
code 410) and other ischemic (coronary) heart disease
(ICD-9 codes 411–414 and 429.2). The RRs associated
with more frequent annual vacations were marginally
significant for acute MI (RR 0.70, 95% CI, 0.49–1.01)
and significant for other ischemic (coronary) heart dis-
ease (RR 0.66, 95% CI, 0.460.94). The frequency of
annual vacations was not associated with significant
RRs for any other specific cause of cardiovascular mor-
tality or noncardiovascular mortality.
The effect of morbidity on both vacationing fre-
quency and subsequent mortality is a particular con-
cern when considering the effects of the frequency of
annual vacations on subsequent mortality. Therefore,
we conducted additional analyses using only the fre-
quency of annual vacations assessed at the first, sec-
ond, and third annual examinations to predict mortal-
ity in survivors of the trial. Using this approach, a
4-year gap is placed between the assessment of the
frequency of annual vacations and the assessment of
mortality, making it unlikely that any observed asso-
ciation between vacationing frequency and mortality
would be a spurious association created by their com-
mon association with morbidity. In these analyses and
with the addition of covariates to control for potential
confounding factors, the RRs associated with more
frequent annual vacations were 0.86 (95% CI, 0.76
1.01, p.079) for all-cause mortality and 0.76 (95%
CI, 0.600.95, p.018) for CHD mortality.
TABLE 1. Characteristics of Participants in MRFIT Taking
Infrequent and Frequent Annual Vacations During the Trial
Participant Characteristics
Annual Vacationing
Age at entry into study, years 46.57 46.21 .001
Study group, % in SI group 51.49 48.29 .001
Smoking, %† 48.66 43.45 .001
DBP, mm Hg
86.36 86.21 .189
Serum cholesterol, mg/dl
239.16 241.48 .001
5.14 5.70 .001
Total family income
6.21 6.85 .001
Nonfatal cardiovascular event
during trial, %
24.02 19.34 .001
Values are trial means.
Education was measured using a nine-point scale (1 eighth grade
or less, 9 graduate or professional degree).
Total family income was measured using a nine-point scale (1
$4200, 9 $35,000).
TABLE 2. Cause of Death, Number of Deaths, and RR (with 95%
CI) for Deaths Through 9 Years of Post-trial Follow-Up
Associated With Frequency of Annual Vacations During the Trial
Cause of Death Deaths
)RR (95% CI)
All causes 1443 0.83 (0.71–0.97) .018
All cardiovascular causes 745 0.71 (0.58–0.89) .002
CHD 540 0.68 (0.53–0.88) .003
Acute MI 262 0.70 (0.49–1.01) .058
Other ischemic CHD 278 0.66 (0.46–0.94) .020
Cardiac dysrhythmias 27 0.72 (0.23–2.23) .571
Hypertensive heart disease 14
Other hypertensive 7
Cerebrovascular 61 0.86 (0.41–1.82) .699
Other cardiovascular disease 97 0.76 (0.42–1.38) .361
All noncardiovascular causes 696 0.98 (0.78–1.23) .868
Neoplastic 464 1.16 (0.88–1.53) .294
Lip, oral cavity, and pharynx 10
Digestive organs and peritoneum 120 1.25 (0.72–2.18) .415
Colorectal 47 1.00 (0.42–2.40) .996
Other gastrointestinal 73 1.45 (0.71–2.95) .305
Respiratory and intrathoracic
187 1.15 (0.74–1.77) .541
Lung 178 1.07 (0.69–1.68) .751
Other neoplasms 147 1.12 (0.68–1.82) .663
Respiratory 41 1.16 (0.45–2.95) .760
Digestive system 48 0.54 (0.23–1.25) .152
Accidents 57 0.65 (0.30–1.42) .282
Other noncardiovascular disease 86 0.71 (0.38–1.34) .292
In all Cox proportional hazard models, the following characteris-
tics were included as covariates: age, study group (SI vs. UC), edu-
cational attainment, income, occurrence of a nonfatal cardiovascular
event during the trial, smoking, DBP, and serum cholesterol (the
later three values were trial averages). Missing covariate values
resulted in a subject being dropped from the analysis.
Insufficient number of events for calculation of RR.
610 Psychosomatic Medicine 62:608612 (2000)
More frequent annual vacations during the MRFIT
was associated with a significant reduction in the risk
of death during the 9-year posttrial period. The spe-
cific cause of death most strongly associated with va-
cationing frequency was CHD. This association per-
sisted with the addition of statistical controls for
baseline characteristics.
Although frequent vacationing may have a direct
protective effect on health, it is important to consider
alternative explanations for the observed associations.
First, it is possible that morbidity produces both less
frequent vacationing and an increased risk of death,
thereby producing a spurious association between the
frequency of annual vacations and mortality. In other
words, those who are ill are both unable to take a
vacation and more likely to die. The continued asso-
ciation of annual vacation frequency and CHD mortal-
ity in the context of statistical controls for nonfatal
cardiovascular events and when using the frequency of
annual vacations assessed during the first 3 years of
the trial to predict mortality 4 years latter (during the
posttrial period) does not support this alternative
The positive association between SES and health is
well documented (18), and in the current sample,
lower SES was associated with less frequent vacation-
ing. Therefore, another possibility is that those of
lower SES are both unable to take a vacation and more
likely to die. A continued significant association be-
tween vacationing frequency and CHD mortality in the
context of a statistical control for participants’ educa-
tional attainment and income does not support this
alternative explanation.
There are a few possible mechanisms through
which vacationing might have direct protective effects
on health. First, vacations may reduce stress by remov-
ing ongoing stressors (eg, avoidance). The health ben-
efits of stress reduction are well documented (30, 31).
Furthermore, the current pattern of findings (ie, stron-
ger effects with CHD relative to other causes of death,
eg, cancer) is consistent with research demonstrating
stronger stress and disease associations for CHD rela-
tive to cancer (32). Second, vacations may reduce
stress by removing potential stressors and anticipated
threats, providing a period of “signaled safety” (33).
Anticipated threats are known to have adverse effects
as great as (34), if not greater than (35), the threat itself.
Finally, annual vacations may provide a unique oppor-
tunity for behaviors having restorative effects on ana-
bolic physiological processes, such as social contact
with family and friends (36–38) and physical activity
(15), in the context of reduction of stress-initiated cat-
abolic effects.
Some limitations of the current study should be
noted. First, vacationing frequency was assessed using
a single question about “a vacation” within the past
year. Therefore, we have no information about the
quantity or length of vacations within each year nor
information about the quality of these vacations. Such
information might enable a description of the type and
pattern of vacationing that have health-protective ef-
fects. Second, the MRFIT included the question about
annual vacations as a measure of attention to the ques-
tionnaires. Therefore, it is possible that the generally
hasty or less than fully compliant participants were
both at greater risk of CHD death and reported few
annual vacations as a consequence of low adherence.
Finally, vacationing frequency may serve as a marker
of other activities or personality characteristics that
are, in turn, associated with the reduced risk of mor-
tality. For example, those taking annual vacations may
also engage in more health-promoting leisure-time ac-
tivities. Leisure-time physical activity was measured
in MRFIT using a questionnaire assessment of various
physical activities. This questionnaire has been vali-
dated against treadmill exercise performance in MR-
FIT (39). Furthermore, leisure-time physical activity
measured with this questionnaire had a modest in-
verse relationship with CHD and overall mortality dur-
ing MRFIT (15). However, the inclusion of leisure-time
physical activity as a covariate in the current analyses
did not alter the significant risk reduction in CHD
mortality associated with vacationing (RR 0.69, p
.006 with all covariates, including leisure-time physi-
cal activity).
In conclusion, more frequent annual vacations dur-
ing the MRFIT seemed to exert a direct positive effect
on mortality during the 9-year posttrial period. Al-
though the specific mechanism of this association re-
mains unknown, these findings suggest the impor-
tance of considering the health benefits of restorative
behaviors, such as vacationing. Vacations may not
only be enjoyable but also health promoting.
This work was supported by Grant HL58867 from
the National Institutes of Health. We thank James Nea-
ton, Ronald Prineas, Lewis Kuller, Greg Grandits, and
Yue-fang Chang for their consultation on analytic
strategy and manuscript preparation.
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... Most of the Sudanese physicians ignore taking their regular annual leaves, which is vital to promote good physical and mental health. Middle-aged males are at high risk for coronary heart disease compared to those who take regular annual vacations; the latter group has a lower risk of death from any cause and, more particularly, death from coronary heart disease [15] . ...
... The complexity of the senior tourism phenomenon and the interconnections with health and well-being require researchers to learn and adopt concepts from various disciplines (Bauer, 2018). Up to now, many empirical studies have focused on examining physical and mental health aspects such as cardiovascular health (Gump & Matthews, 2000), loneliness (Boyes, 2013) and personal development (Tomka et al., 2015). However, while existing studies were helpful in identifying relevant factors of well-being (Hung & Wu, 2021;Hwang & Lee, 2019a;Kim & Woo, 2014;Mahadevan & Fan, 2020), further research is required to theoretically conceptualize the dimensions of seniors' wellbeing in tourism. ...
Research on well-being has experienced exponential growth in tourism studies. However, knowledge about well-being of seniors in tourism is still limited, and thus conceptually underdeveloped, despite the growth of the ageing population and increased research focus on the subject. Consequently, the purpose of this review is to provide a holistic understanding of seniors' well-being in tourism, delineate the current research status, then identify gaps and future avenues for research. A systematic quantitative literature review was conducted, leading to 56 eligible articles extracted for subsequent analysis. By mapping the current state of knowledge, the study indicates a need for a comprehensive theoretical framework based on a holistic view of seniors' well-being in tourism. The findings of the systematic review suggest the need for a eudaimonic approach to the topic and research from residents' perspectives. Suggestions are made to investigate constraints to well-being and cultural differences in conceptions of seniors' well-being in tourism.
... Westman and Eden (1997) found that vacations could supplement social resources, thus decreasing work stress and making time to acquire new social resources. Further, vacations may provide unique opportunities with restorative effects, such as physical activity and social contact with family and friends (Gump and Matthews, 2000). As Dahlgren et al. (2005) demonstrated, a temporary absence from work may be needed for complete recovery from work-related fatigue. ...
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Several studies on tourism have examined the effects of vacation and travel on individuals' wellbeing. However, relatively little is known about the underlying psychological factors and mechanisms. Therefore, this study aimed to investigate the effects of a winter vacation on individuals' wellbeing. A total of 507 participants (255 men and 252 women) completed three questionnaires at three different time points. The questionnaires comprised psychological scales and items to seek demographic information so that the changes in their wellbeing could be assessed. The results revealed that people who traveled had higher subjective wellbeing than those who did not. Moreover, out of the four elements of the recovery experience, mastery was the only one influenced subsequent subjective wellbeing. The findings suggest that it is crucial to take vacations and to savor recovery experiences while off work. In particular, experiencing new and challenging events during a vacation was the most significant predictor of vacationers' subsequent wellbeing. Our results clarify what type of vacation is most effective for wellbeing. The results can help tourism practitioners manage their customers' experiences better during their vacations, and these efforts will arguably contribute not only to the wellbeing of vacationers but also to future company growth.
... This period is reduced to 16.2 days per year observed that 55% of employees do not take vacations as regularly as advised, which has shown visible advances in their physical and mental health. Some preliminary work is done [10] demonstrated that male employees in the age group of 35-57 who were diagnosed with a potential risk of heart disease and did not spend a vacation of 7 days were more likely to die. Similar proved to be true for females too. ...
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Leisure activities have an important part in promoting health and well-being for employees. This research attempts to determine the link between holidays and the health and well-being of employees, while also demonstrating a precedent in improving productivity. There was a study of 75 workers working in India to assess the culture, stress causes and holiday pattern of their employees. The primary indication of our results was a survey of people operating in the Indian subcontinent. The opinions of participants were the information analysed to establish a relationship between the health and well-being of employees and productivity. Impacts of better insurance on employees. The consequences of enhancing the insurance procedure would have a greater level of motivation, retention and productivity for employees. This interpretative sociology would help companies build a workforce that can perform better. The researchers investigated the present condition of employees working in India after using academic ideas and assessing their existing perceived workplaces. At the time of holidays which was the most favoured leisure activity in our survey, we sought to develop a better model to achieve employee health and wellbeing.
... Two systematic literature reviews underline the positive impact of vacations on employees' health and well-being (De Bloom et al., 2009;Chen and Petrick, 2013), evident in indicators, such as fewer health complaints (of sleep impairment, etc.; Fritz and Sonnentag, 2006), enhanced life satisfaction (Gilbert and Abdullah, 2004), and reduced exhaustion (Westman and Etzion, 2001). Furthermore, two long-term epidemiological studies report that not taking vacations for a prolonged time is related to a higher risk of heart attacks, cardiovascular disease, and even premature coronary death (Eaker et al., 1992;Gump and Matthews, 2000). ...
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The aim of this study was to investigate employees' self-reported creativity before and after vacation and to examine the impact of recovery experiences (detachment, relaxation, mastery, meaning, autonomy, affiliation) on changes in creativity. The DRAMMA model of Newman et al. provides the theoretical background of our approach. Longitudinal data was assessed with four repeated measurements. The study encompassed data from 274 white-collar workers. Analyses showed that employees subjectively perceive their creativity to benefit not immediately after their vacation but 2 weeks later. Detachment was significantly related to lower creativity within persons, while mastery experiences explained differences in creativity between persons. This study provides a detailed picture of changes in creativity around vacations.
Purpose The purpose of this study is to provide a comprehensive review of the contribution of tourism to the development of healthy lives and to promote feelings of well-being for older adults. This is related to the 2030 agenda sustainable development goal (SDG) 3 to “ensure healthy lives and promote well-being for all at all ages”. Design/methodology/approach This paper is presented as a conceptual review that will bridge the research gap between tourism and demography and will focus on travel for older tourists that supports a healthy lifestyle and helps to develop positive feelings of well-being. Findings The aging population and changing demographic structure will present both possibilities and difficulties for the economy, services and society. Developing innovative ways to assist people to remain active as they age is important, as well as providing measures to combat loneliness is paramount. Tourism and travel can play a significant role to achieve this SDG. Research limitations/implications A theoretical framework was developed to acknowledge the four contributions (from a physical, psychological [or intellectual], social and spiritual perspective), organizing the findings into a holistic model of health and wellness, which helped to delineate the research. There is a need for a deeper comprehension of a strategy to promote the benefits of leisure travelling that are linked to active ageing and well-being. Practical implications Destination Marketing Organizations and Tourism marketers need to carefully consider the challenges and implications and identify the key drivers that will be vital to propose strategic solutions and innovations to meet the future demands and expectations of older people in an ageing society. Destination management organizations need to promote and plan “memorable experiences” for older tourists that emphasize the physical health benefits, especially if it is feasible in a natural setting. Social implications Social experiences are essential in older people’s lives that can help them avoid feelings of depression and isolation. The transformative promise of the 2030 Agenda for Sustainable Development and its SDGs identify key drivers to propose strategic solutions and innovations to meet the future demands and expectations of older people in an ageing society. Originality/value This study provides a qualitative overview of extant literature, examining the role of tourism from a physical, psychological (or intellectual), social and spiritual perspective that has proved important in promoting a healthy lifestyle as well as creating positive feelings of well-being for older travellers. It also offers future directions and builds theory through a holistic model of the dimensions of wellness. Further, it proposes future research priorities related to older individuals that are linked to healthy lifestyles, which include tourism experiences.
This study contributes to the vacation literature by exploring predictors of change in school teachers’ negative affective states around a 2-week (Christmas) vacation. Drawing from a combination of self-regulatory and effort-recovery theoretical principles, we hypothesized that supplemental work activity during the vacation might have some positive consequences for mood state, while simultaneously impairing the ability to recover from work-related exhaustion. Ninety teachers completed measures across eight consecutive weeks, spanning the period before, during, and after vacation (710 observations in total). Teachers’ weekly levels of emotional exhaustion, anxious mood, and depressed mood decreased significantly from before to during the vacation. Following the vacation, anxious mood showed the most rapid rate of increase, returning to its prevacation level within 2 weeks of work resumption. Exhaustion and depressed mood reemerged more gradually across 4 consecutive weeks following the vacation. Supplemental work activity during the vacation was associated with weaker recovery from exhaustion, but did not exhibit a detrimental relationship with change in anxious or depressed mood. Of note, supplemental working during the vacation was associated with a less pronounced reemergence of anxious mood after the vacation. Workrelated perseverative cognition (worry and rumination) during the vacation impeded energy restoration and mood repair and was related to faster fade out of beneficial vacation effects. These findings demonstrate the utility of examining discrete energy and mood states in respite research, reveal the mixed functions of engaging in supplemental work activity during vacations, and highlight the harmful impact of perseverative cognition on the recovery from work process.
Technical Report
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Ce rapport retrace la mise au point du premier budget de référence pour le Luxembourg.
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It is not known whether psychological stress suppresses host resistance to infection. To investigate this issue, we prospectively studied the relation between psychological stress and the frequency of documented clinical colds among subjects intentionally exposed to respiratory viruses. After completing questionnaires assessing degrees of psychological stress, 394 healthy subjects were given nasal drops containing one of five respiratory viruses (rhinovirus type 2, 9, or 14, respiratory syncytial virus, or coronavirus type 229E), and an additional 26 were given saline nasal drops. The subjects were then quarantined and monitored for the development of evidence of infection and symptoms. Clinical colds were defined as clinical symptoms in the presence of an infection verified by the isolation of virus or by an increase in the virus-specific antibody titer. The rates of both respiratory infection (P less than 0.005) and clinical colds (P less than 0.02) increased in a dose-response manner with increases in the degree of psychological stress. Infection rates ranged from approximately 74 percent to approximately 90 percent, according to levels of psychological stress, and the incidence of clinical colds ranged from approximately 27 percent to 47 percent. These effects were not altered when we controlled for age, sex, education, allergic status, weight, the season, the number of subjects housed together, the infectious status of subjects sharing the same housing, and virus-specific antibody status at base line (before challenge). Moreover, the associations observed were similar for all five challenge viruses. Several potential stress-illness mediators, including smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, and total immunoglobulin levels, did not explain the association between stress and illness. Similarly, controls for personality variables (self-esteem, personal control, and introversion-extraversion) failed to alter our findings. Psychological stress was associated in a dose-response manner with an increased risk of acute infectious respiratory illness, and this risk was attributable to increased rates of infection rather than to an increased frequency of symptoms after infection.
The Multiple Risk Factor Intervention Trial was a randomized primary prevention trial to test the effect of a multifactor intervention program on mortality from coronary heart disease (CHD) in 12,866 high-risk men aged 35 to 57 years. Men were randomly assigned either to a special intervention (SI) program consisting of stepped-care treatment for hypertension, counseling for cigarette smoking, and dietary advice for lowering blood cholesterol levels, or to their usual sources of health care in the community (UC). Over an average follow-up period of seven years, risk factor levels declined in both groups, but to a greater degree for the SI men. Mortality from CHD was 17.9 deaths per 1,000 in the SI group and 19.3 per 1,000 in the UC group, a statistically nonsignificant difference of 7.1% (90% confidence interval, —15% to 25%). Total mortality rates were 41.2 per 1,000 (SI) and 40.4 per 1,000 (UC). Three possible explanations for these findings are considered: (1) the overall intervention program, under these circumstances, does not affect CHD mortality; (2) the intervention used does affect CHD mortality, but the benefit was not observed in this trial of seven years’ average duration, with lower-than-expected mortality and with considerable risk factor change in the UC group; and (3) measures to reduce cigarette smoking and to lower blood cholesterol levels may have reduced CHD mortality within subgroups of the SI cohort, with a possibly unfavorable response to antihypertensive drug therapy in certain but not all hypertensive subjects. This last possibility was considered most likely, needs further investigation, and lends support to some preventive measures while requiring reassessment of others.
Background: A mortality follow-up of 12,866 men was conducted 16 years after randomization to special intervention (SI) or usual care (UC) groups of the Multiple Risk Factor Intervention Trial to assess the long-term effect of cardiovascular risk factor intervention on coronary heart disease (CHD), cardiovascular death (CVD), and total mortality. Methods and results: During the 7-year active-intervention phase of the trial, 6428 of the men were given dietary recommendations to lower blood cholesterol, antihypertensive drugs to lower blood pressure, and counseling for cigarette smoking cessation. The remaining 6438 men were referred to their usual source of medical care. After 16 years, 370 SI and 417 UC men had died from CHD, which represents an 11.4% lower mortality rate for SI versus UC men (95% CI, -23% to 1.9%). Results for total mortality followed a similar pattern; 991 SI and 1050 UC men had died by the end of follow-up (relative difference, -5.7%; 95% CI, -13% to 2.8%). For acute myocardial infarction, a subcategory of CHD, the relative difference was -20.4% (95% CI, -34.4% to -3.4%). Differences between SI and UC men in mortality rates from acute myocardial infarction, CHD, and all causes were greater during the posttrial follow-up period than during the trial. Conclusions: Results of a 7-year multifactor intervention program aimed at lowering blood pressure and serum cholesterol and at cigarette smoking cessation among high-risk men give additional evidence of a long-term, continuing mortality benefit from the program.
The term stress had a common usage in everyday life as well as in biology and medicine long before Hans Selye’s initial report in 1936. However, the development of the stress field as a popular and important area of research can generally be traced to Selye’s concept of the “general adaptation syndrome” (Selye, 1936). Selye was surprised to find that a variety of very different agents such as cold, heat, x-rays, hormones, bacteria, toxins or muscular exercise produced essentially the same triad of symptoms. This was true despite the fact that a highly specific adaptive response existed for any one of these agents by itself. The triad of symptoms included (1) adrenal cortical hypertrophy (indicative of increased adrenocortical activity); (2) involution or shrinkage of the thymus, spleen, lymph nodes and all other lymphatic structures; (3) gastrointestinal ulceration. These symptoms were named the “alarm reaction” and were thought to represent a nonspecific adaptive response of the body. This nonspecific demand upon the body, according to Selye, was the essence of stress (Selye, 1973).
The pituitary-adrenal pathways between stress, and obesity, hyperinsulinaemia, dyslipidaemia, blood pressure and plasminogen activator inhibitor-1 antigen components of the metabolic syndrome were examined in 69 healthy middle-aged men. We found by means of path analyses that chronic perceived stress, i.e. feelings of fatigue, loss of vigour, increased irritability and feelings of demoralization, exerted its effect on waist-to- hip ratio (WHR), a measure of abdominal obesity, and on subsequent metabolic alterations by way of increased ratio of 17-hydroxyprogesterone to 11- deoxycortisol after dexamethasone and ACTH administration, denoting a change of adrenal steroid biosynthesis compatible with a mild decrease in the activity of adrenal 21-hydroxylase, and directly by way of hyperinsulinaemia. The role of stress in the specified chain of events was not explained by age, alcohol consumption, smoking or physical activity. We propose that the pathophysiological effect of stress on WHR, and on subsequent metabolic perturbations may at least in part be due to failure of adrenal hypoactivity to prevent the overshooting of reactions to stress, and that protection of the pathophysiological effects of stress is likely to require the control of multiple neurophysiological mechanisms.
This paper restricts itself to discussion of statistical design considerations; other important design issues such as how patients are being obtained, recruitment sources, eligibility criteria, procedures for classification of causes of death, etc. will be discussed in a separate paper, now in preparation.
This study examined the relationship between social network interaction and total and cardiovascular mortality in 17,433 Swedish men and women between the ages of 29 and 74 during a 6 year follow-up period. The study group was interviewed concerning their social network interactions and a total score was formed which summarized the availability of social contact. A number of sociodemographic and health related background variables known to be associated with mortality risk were also considered. Mortality was examined by linking the interview material with the Swedish National Mortality Registry. In the 6-year follow-up period 841 deaths occurred. The crude relative risk of dying during this period was 3.7 (95% CL 3.2; 4.3) when the lower social network tertile was compared to the upper two tertiles. When controlling for potential confounding effects, only age had a major influence on the association between social network interaction and mortality (RR age-adjusted = 1.46, 95% CL 1.25; 1.72). Controlling for age and sex, age and educational level, age and employment status, age and immigrant status, age and smoking, age and exercise habits and age and chronic disease at interview left the relative risk virtually unchanged. Controlling simultaneously for age, smoking, exercise and chronic illness yielded a risk estimate of 1.36 (95% CL 1.06; 1.69). Similar results were obtained when separately analyzing for cardiovascular disease mortality in an identical manner.
The relation of self-selected leisure-time physical activity (LTPA) to first major coronary heart disease (CHD) events and overall mortality was studied in 12 138 middle-aged men participating in the Multiple Risk Factor Intervention Trial. Total LTPA over the preceding year was quantitated in mean minutes per day at baseline by questionnaire, with subjects classified into tertiles (low, moderate, and high) based on LTPA distribution. During seven years of follow-up, moderate LTPA was associated with 63% as many fatal CHD events and sudden deaths, and 70% as many total deaths as low LTPA (P<.01). Mortality rates with high LTPA were similar to those in moderate LTPA; however, combined fatal and nonfatal major CHD events were 20% lower with high as compared with low LTPA (P<.05). These risk differentials persisted after statistical adjustments for possible confounding variables, including other baseline risk factors and Multiple Risk Factor Intervention Trial group assignments. It is concluded that LTPA has a modest inverse relation to CHD and overall mortality in middle-aged men at high risk for CHD. (JAMA 1987;258:2388-2395)