{"id":240,"date":"2021-03-01T20:12:34","date_gmt":"2021-03-01T20:12:34","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&p=240"},"modified":"2021-03-02T13:32:16","modified_gmt":"2021-03-02T13:32:16","slug":"optimism-and-health","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/optimism-and-health\/","title":{"raw":"Optimism and Health","rendered":"Optimism and Health"},"content":{"raw":"

Psychological optimism<\/span><\/h2>\r\n

Dispositional optimism<\/span><\/h3>\r\n
\r\n
\r\n\r\n\"An<\/a>\r\n
\r\n\r\nResearchers\u00a0<\/span>operationalize<\/a>\u00a0the term differently depending on their research. As with any trait characteristic, there are several ways to evaluate optimism, such as the Life Orientation Test (LOT). This 8-item scale was developed in 1985 by Michael Scheier and Charles Carver.<\/span>[8]<\/a><\/sup>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nDispositional optimism and pessimism[9]<\/a><\/sup>\u00a0are typically assessed by asking people whether they expect future outcomes to be beneficial or negative (see below). The LOT returns separate optimism and pessimism scores for each individual. Behaviourally, these two scores correlate around r = 0.5. Optimistic scores on this scale predict better outcomes in relationships,[10]<\/a><\/sup>\u00a0higher\u00a0social status<\/a>,[11]<\/a><\/sup>\u00a0and reduced loss of well-being following adversity.[12]<\/a><\/sup>\u00a0Health preserving behaviors are associated with optimism while health-damaging behaviors are associated with pessimism.[13]<\/a><\/sup>\r\n\r\nSome have argued that optimism is the opposite end of a single dimension with pessimism,[14]<\/a><\/sup>\u00a0with any distinction between them reflecting factors such as\u00a0social desirability<\/a>.\u00a0Confirmatory modelling<\/a>, however, supports a two-dimensional model[15]<\/a><\/sup>\u00a0and the two dimensions predict different outcomes.[16]<\/a><\/sup>\u00a0Genetic<\/a>\u00a0modelling confirms this independence, showing that pessimism and optimism are inherited as independent traits, with the typical correlation between them emerging as a result of a general well-being factor and family environment influences.[4]<\/a><\/sup>\u00a0It is suggested that patients with high dispositional optimism appear to have stronger immune system since it buffers it against psychological stressors.[17]<\/a><\/sup>\u00a0Optimists appear to live longer.[18]<\/a><\/sup>\r\n

Explanatory style<\/span><\/h3>\r\nExplanatory style<\/a>\u00a0is distinct from dispositional theories of optimism. While related to life-orientation measures of optimism, attributional style theory suggests that dispositional optimism and\u00a0pessimism<\/a>\u00a0are reflections of the ways people explain events, i.e., that attributions cause these dispositions.[19]<\/a><\/sup>\u00a0Here, an optimist would view defeat as temporary, does not apply to other cases, and is not considered their fault.[20]<\/a><\/sup>\u00a0Measures of attributional style distinguish three dimensions among explanations for events: Whether these explanations draw on internal versus external causes; whether the causes are viewed as stable versus unstable; and whether explanations apply globally versus being situationally specific. In addition, the measures distinguish attributions for positive and for negative events.\r\n\r\nAn optimistic person attributes internal, stable, and global explanations to good things. Pessimistic explanations attribute these traits of stability, globality, and internality to negative events, such as difficulty in relationships.[21]<\/a><\/sup>\u00a0Models of Optimistic and Pessimistic attributions show that attributions themselves are a cognitive style \u2013 individuals who tend to focus on the global explanations do so for all types of events, and the styles correlate among each other. In addition to this, individuals vary in how optimistic their attributions are for good events, and on how pessimistic their attributions are for bad events, but these two traits of optimism and pessimism are un-correlated.[22]<\/a><\/sup>\r\n\r\nThere is much debate about the relationship between explanatory style and optimism. Some researchers argue that optimism is simply the lay-term for what researchers know as explanatory style.[23]<\/a><\/sup>\u00a0More commonly, it is found that explanatory style is quite distinct from dispositional optimism,[24]<\/a><\/sup>[25]<\/a><\/sup>\u00a0and the two should not be used interchangeably as they are marginally correlated at best. More research is required to \"bridge\" or further differentiate these concepts.[21]<\/a><\/sup>\r\n

Origins<\/span><\/h3>\r\n
\r\n
\r\n\r\n \r\n
\r\n\r\nAs with all psychological traits, differences in both dispositional optimism and pessimism<\/span>[4]<\/a><\/sup>\u00a0and in attributional style<\/span>[26]<\/a><\/sup>\u00a0are\u00a0<\/span>heritable<\/a>. Both optimism and pessimism are strongly influenced by\u00a0<\/span>environmental factors<\/a>, including family environment.<\/span>[4]<\/a><\/sup>\u00a0It has been suggested that optimism may be indirectly inherited as a reflection of underlying heritable traits such as\u00a0<\/span>intelligence<\/a>,\u00a0<\/span>temperament<\/a>, and\u00a0<\/span>alcoholism<\/a>.<\/span>[26]<\/a><\/sup>\u00a0There is evidence from twin studies that show, for instance, that the inherited component of the dispositional optimism is about 25 percent, making this trait a stable personality dimension<\/span>[27]<\/a><\/sup>\u00a0and a predictor of life outcomes.<\/span>[28]<\/a><\/sup>\u00a0Its genetic origin, which interacts with environmental influences and other risks, also determines the vulnerability to depression across the lifespan.<\/span>[29]<\/a><\/sup>\u00a0Many theories assume optimism can be\u00a0<\/span>learned<\/a>,<\/span>[6]<\/a><\/sup>\u00a0and research supports a modest role of family-environment acting to raise (or lower) optimism and lower (or raise)\u00a0<\/span>neuroticism<\/a>\u00a0and pessimism.<\/span>[4]<\/a><\/sup>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nWork utilising\u00a0brain imaging<\/a>\u00a0and\u00a0biochemistry<\/a>\u00a0suggests that at a\u00a0biological trait<\/a>\u00a0level, optimism and pessimism reflect brain systems specialised for the tasks of processing and incorporating beliefs regarding\u00a0good and bad information<\/a>\u00a0respectively.[5]<\/a><\/sup>\r\n

Assessment<\/span><\/h3>\r\n

Life Orientation Test<\/span><\/h4>\r\nThe Life Orientation Test (LOT) was designed by Scheier and Carver (1985) to assess dispositional optimism \u2013 expecting positive or negative outcomes,[21]<\/a><\/sup>\u00a0and is one of the more popular tests of optimism and pessimism. This was also often used in early studies that examine the effects of these dispositions in health-related domains.[30]<\/a><\/sup>\u00a0Scheier and Carver's initial research, which surveyed college students, found that optimistic participants were less likely to show an increase in symptoms like dizziness, muscle soreness, fatigue, blurred vision, and other physical complaints than pessimistic respondents.[31]<\/a><\/sup>\r\n\r\nThere are eight items and four filler items in the test. Four are positive items (e.g. \"In uncertain times, I usually expect the best\") and four are negative items e.g. \"If something can go wrong for me, it will.\"[32]<\/a><\/sup>\u00a0The LOT has been revised twice\u2014once by the original creators (LOT-R) and also by Chang, Maydeu-Olivares, and D'Zurilla as the Extended Life Orientation Test (ELOT). The Revised Life Orientation Test (LOT-R: Scheier, Carver, & Bridges, 1994) consists of six items, each scored on a 5-point scale from \"Strongly disagree\" to \"Strongly agree\" and four filler items.[33]<\/a><\/sup>\u00a0Half of the coded items are phrased in an optimistic way while the other half in a pessimistic way. In comparison with its previous iteration, LOT-R offers good internal consistency overtime although there are item overlaps, making the correlation between the LOT and LOT-R extremely high.[30]<\/a><\/sup>\r\n

Attributional Style Questionnaire<\/span><\/h4>\r\nThis Attributional Style Questionnaire (ASQ: Peterson et al. 1982[34]<\/a><\/sup>) is based on the\u00a0explanatory style<\/a>\u00a0model of optimism. Subjects read a list of six positive and negative events (e.g. \"you have been looking for a job unsuccessfully for some time<\/i>\"), and are asked to record a possible cause for the event. They then rate whether this is internal or external, stable or changeable, and global or local to the event.[34]<\/a><\/sup>\u00a0There are several modified versions of the ASQ including the Expanded Attributional Style Questionnaire (EASQ), the Content Analysis of Verbatim Explanations (CAVE), and the ASQ designed for testing the optimism of children.[21]<\/a><\/sup>\r\n

Associations with health<\/span><\/h3>\r\nOptimism and\u00a0health<\/a>\u00a0are correlated moderately.[35]<\/a><\/sup>\u00a0Optimism has been shown to\u00a0explain<\/a>\u00a0between 5\u201310% of the variation in the likelihood of developing some health conditions (correlation coefficients<\/a>\u00a0between .20 and .30),[36]<\/a><\/sup>\u00a0notably including\u00a0cardiovascular disease<\/a>,[37]<\/a><\/sup>[38]<\/a><\/sup>[39]<\/a><\/sup>\u00a0stroke<\/a>,[40]<\/a><\/sup>\u00a0and\u00a0depression<\/a>.[41]<\/a><\/sup>[42]<\/a><\/sup>\r\n\r\nThe relationship between optimism and health has also been studied with regards to physical symptoms, coping strategies and negative affect for those suffering from\u00a0rheumatoid arthritis<\/a>,\u00a0asthma<\/a>, and\u00a0fibromyalgia<\/a>.\r\n\r\nIt has been found that among individuals with these diseases, optimists are not more likely than pessimists to report pain alleviation due to coping strategies, despite differences in psychological well-being between the two groups.[43]<\/a><\/sup>\u00a0A\u00a0meta-analysis<\/a>\u00a0has confirmed the assumption that optimism is related to psychological well-being: \"Put simply, optimists emerge from difficult circumstances with less distress than do pessimists.\"[44]<\/a><\/sup>\u00a0Furthermore, the correlation appears to be attributable to coping style: \"That is, optimists seem intent on facing problems head-on, taking active and constructive steps to solve their problems; pessimists are more likely to abandon their effort to attain their goals.\"[44]<\/a><\/sup>\r\n\r\nOptimists may respond better to stress: pessimists have shown higher levels of cortisol (the \"stress hormone\") and trouble regulating cortisol in response to stressors.[45]<\/a><\/sup>\u00a0Another study by Scheier examined the recovery process for a number of patients that had undergone surgery.[46]<\/a><\/sup>\u00a0The study showed that optimism was a strong predictor of the rate of recovery. Optimists achieved faster results in \"behavioral milestones\" such as sitting in bed, walking around, etc. They also were rated by staff as having a more favorable physical recovery. In a 6-month later follow-up, it was found that optimists were quicker to resume normal activities.\r\n

Optimism and well-being<\/span><\/h3>\r\nA number of studies have been done on optimism and psychological well-being. One 30 year study undertaken by Lee et al. (2019) assessed the overall optimism and\u00a0longevity<\/a>\u00a0of cohorts of men from the Veterans Affairs Normative Aging Study and women from the\u00a0Nurses\u2019 Health Study<\/a>. The study found a positive correlation between higher levels of optimism and exceptional longevity, which the study defined as a lifespan exceeding 85 years.\r\n\r\nAnother study conducted by Aspinwall and Taylor (1990) assessed incoming freshmen on a range of personality factors such as optimism, self-esteem, locus of self-control, etc.[46]<\/a><\/sup>\u00a0It was found that freshmen who scored high on optimism before entering college were reported to have lower levels of psychological distress than their more pessimistic peers, while controlling for the other personality factors. Over time, the more optimistic students were less stressed, less lonely, and less depressed than their pessimistic counterparts. Thus, this study suggests a strong link between optimism and psychological well-being.\r\n\r\nIn addition low optimism may help explain the association between caregivers' anger and reduced sense of vitality.[47]<\/a><\/sup>\r\n\r\nA recent meta-analysis of optimism supported past findings that optimism is positively correlated with\u00a0life satisfaction<\/a>, happiness,[48]<\/a><\/sup>\u00a0psychological and physical well-being and negatively correlated with depression and anxiety.[49]<\/a><\/sup>\r\n\r\nSeeking to explain the correlation, researchers find that optimists choose healthier lifestyles. For example, optimists smoke less, are more physically active, consume more fruit, vegetables and whole-grain bread, and are more moderate in alcohol consumption.[50]<\/a><\/sup>\r\n\r\n \r\n
\r\n

watch<\/h3>\r\n[embed]https:\/\/youtu.be\/2hHNq45rEnU[\/embed]\r\n\r\n<\/div>\r\n ","rendered":"

Psychological optimism<\/span><\/h2>\n

Dispositional optimism<\/span><\/h3>\n
\n
\n

\"An<\/a><\/p>\n

\n

Researchers\u00a0<\/span>operationalize<\/a>\u00a0the term differently depending on their research. As with any trait characteristic, there are several ways to evaluate optimism, such as the Life Orientation Test (LOT). This 8-item scale was developed in 1985 by Michael Scheier and Charles Carver.<\/span>[8]<\/a><\/sup><\/p>\n<\/div>\n<\/div>\n<\/div>\n

Dispositional optimism and pessimism[9]<\/a><\/sup>\u00a0are typically assessed by asking people whether they expect future outcomes to be beneficial or negative (see below). The LOT returns separate optimism and pessimism scores for each individual. Behaviourally, these two scores correlate around r = 0.5. Optimistic scores on this scale predict better outcomes in relationships,[10]<\/a><\/sup>\u00a0higher\u00a0social status<\/a>,[11]<\/a><\/sup>\u00a0and reduced loss of well-being following adversity.[12]<\/a><\/sup>\u00a0Health preserving behaviors are associated with optimism while health-damaging behaviors are associated with pessimism.[13]<\/a><\/sup><\/p>\n

Some have argued that optimism is the opposite end of a single dimension with pessimism,[14]<\/a><\/sup>\u00a0with any distinction between them reflecting factors such as\u00a0social desirability<\/a>.\u00a0Confirmatory modelling<\/a>, however, supports a two-dimensional model[15]<\/a><\/sup>\u00a0and the two dimensions predict different outcomes.[16]<\/a><\/sup>\u00a0Genetic<\/a>\u00a0modelling confirms this independence, showing that pessimism and optimism are inherited as independent traits, with the typical correlation between them emerging as a result of a general well-being factor and family environment influences.[4]<\/a><\/sup>\u00a0It is suggested that patients with high dispositional optimism appear to have stronger immune system since it buffers it against psychological stressors.[17]<\/a><\/sup>\u00a0Optimists appear to live longer.[18]<\/a><\/sup><\/p>\n

Explanatory style<\/span><\/h3>\n

Explanatory style<\/a>\u00a0is distinct from dispositional theories of optimism. While related to life-orientation measures of optimism, attributional style theory suggests that dispositional optimism and\u00a0pessimism<\/a>\u00a0are reflections of the ways people explain events, i.e., that attributions cause these dispositions.[19]<\/a><\/sup>\u00a0Here, an optimist would view defeat as temporary, does not apply to other cases, and is not considered their fault.[20]<\/a><\/sup>\u00a0Measures of attributional style distinguish three dimensions among explanations for events: Whether these explanations draw on internal versus external causes; whether the causes are viewed as stable versus unstable; and whether explanations apply globally versus being situationally specific. In addition, the measures distinguish attributions for positive and for negative events.<\/p>\n

An optimistic person attributes internal, stable, and global explanations to good things. Pessimistic explanations attribute these traits of stability, globality, and internality to negative events, such as difficulty in relationships.[21]<\/a><\/sup>\u00a0Models of Optimistic and Pessimistic attributions show that attributions themselves are a cognitive style \u2013 individuals who tend to focus on the global explanations do so for all types of events, and the styles correlate among each other. In addition to this, individuals vary in how optimistic their attributions are for good events, and on how pessimistic their attributions are for bad events, but these two traits of optimism and pessimism are un-correlated.[22]<\/a><\/sup><\/p>\n

There is much debate about the relationship between explanatory style and optimism. Some researchers argue that optimism is simply the lay-term for what researchers know as explanatory style.[23]<\/a><\/sup>\u00a0More commonly, it is found that explanatory style is quite distinct from dispositional optimism,[24]<\/a><\/sup>[25]<\/a><\/sup>\u00a0and the two should not be used interchangeably as they are marginally correlated at best. More research is required to “bridge” or further differentiate these concepts.[21]<\/a><\/sup><\/p>\n

Origins<\/span><\/h3>\n
\n
\n

 <\/p>\n

\n

As with all psychological traits, differences in both dispositional optimism and pessimism<\/span>[4]<\/a><\/sup>\u00a0and in attributional style<\/span>[26]<\/a><\/sup>\u00a0are\u00a0<\/span>heritable<\/a>. Both optimism and pessimism are strongly influenced by\u00a0<\/span>environmental factors<\/a>, including family environment.<\/span>[4]<\/a><\/sup>\u00a0It has been suggested that optimism may be indirectly inherited as a reflection of underlying heritable traits such as\u00a0<\/span>intelligence<\/a>,\u00a0<\/span>temperament<\/a>, and\u00a0<\/span>alcoholism<\/a>.<\/span>[26]<\/a><\/sup>\u00a0There is evidence from twin studies that show, for instance, that the inherited component of the dispositional optimism is about 25 percent, making this trait a stable personality dimension<\/span>[27]<\/a><\/sup>\u00a0and a predictor of life outcomes.<\/span>[28]<\/a><\/sup>\u00a0Its genetic origin, which interacts with environmental influences and other risks, also determines the vulnerability to depression across the lifespan.<\/span>[29]<\/a><\/sup>\u00a0Many theories assume optimism can be\u00a0<\/span>learned<\/a>,<\/span>[6]<\/a><\/sup>\u00a0and research supports a modest role of family-environment acting to raise (or lower) optimism and lower (or raise)\u00a0<\/span>neuroticism<\/a>\u00a0and pessimism.<\/span>[4]<\/a><\/sup><\/p>\n<\/div>\n<\/div>\n<\/div>\n

Work utilising\u00a0brain imaging<\/a>\u00a0and\u00a0biochemistry<\/a>\u00a0suggests that at a\u00a0biological trait<\/a>\u00a0level, optimism and pessimism reflect brain systems specialised for the tasks of processing and incorporating beliefs regarding\u00a0good and bad information<\/a>\u00a0respectively.[5]<\/a><\/sup><\/p>\n

Assessment<\/span><\/h3>\n

Life Orientation Test<\/span><\/h4>\n

The Life Orientation Test (LOT) was designed by Scheier and Carver (1985) to assess dispositional optimism \u2013 expecting positive or negative outcomes,[21]<\/a><\/sup>\u00a0and is one of the more popular tests of optimism and pessimism. This was also often used in early studies that examine the effects of these dispositions in health-related domains.[30]<\/a><\/sup>\u00a0Scheier and Carver’s initial research, which surveyed college students, found that optimistic participants were less likely to show an increase in symptoms like dizziness, muscle soreness, fatigue, blurred vision, and other physical complaints than pessimistic respondents.[31]<\/a><\/sup><\/p>\n

There are eight items and four filler items in the test. Four are positive items (e.g. “In uncertain times, I usually expect the best”) and four are negative items e.g. “If something can go wrong for me, it will.”[32]<\/a><\/sup>\u00a0The LOT has been revised twice\u2014once by the original creators (LOT-R) and also by Chang, Maydeu-Olivares, and D’Zurilla as the Extended Life Orientation Test (ELOT). The Revised Life Orientation Test (LOT-R: Scheier, Carver, & Bridges, 1994) consists of six items, each scored on a 5-point scale from “Strongly disagree” to “Strongly agree” and four filler items.[33]<\/a><\/sup>\u00a0Half of the coded items are phrased in an optimistic way while the other half in a pessimistic way. In comparison with its previous iteration, LOT-R offers good internal consistency overtime although there are item overlaps, making the correlation between the LOT and LOT-R extremely high.[30]<\/a><\/sup><\/p>\n

Attributional Style Questionnaire<\/span><\/h4>\n

This Attributional Style Questionnaire (ASQ: Peterson et al. 1982[34]<\/a><\/sup>) is based on the\u00a0explanatory style<\/a>\u00a0model of optimism. Subjects read a list of six positive and negative events (e.g. “you have been looking for a job unsuccessfully for some time<\/i>“), and are asked to record a possible cause for the event. They then rate whether this is internal or external, stable or changeable, and global or local to the event.[34]<\/a><\/sup>\u00a0There are several modified versions of the ASQ including the Expanded Attributional Style Questionnaire (EASQ), the Content Analysis of Verbatim Explanations (CAVE), and the ASQ designed for testing the optimism of children.[21]<\/a><\/sup><\/p>\n

Associations with health<\/span><\/h3>\n

Optimism and\u00a0health<\/a>\u00a0are correlated moderately.[35]<\/a><\/sup>\u00a0Optimism has been shown to\u00a0explain<\/a>\u00a0between 5\u201310% of the variation in the likelihood of developing some health conditions (correlation coefficients<\/a>\u00a0between .20 and .30),[36]<\/a><\/sup>\u00a0notably including\u00a0cardiovascular disease<\/a>,[37]<\/a><\/sup>[38]<\/a><\/sup>[39]<\/a><\/sup>\u00a0stroke<\/a>,[40]<\/a><\/sup>\u00a0and\u00a0depression<\/a>.[41]<\/a><\/sup>[42]<\/a><\/sup><\/p>\n

The relationship between optimism and health has also been studied with regards to physical symptoms, coping strategies and negative affect for those suffering from\u00a0rheumatoid arthritis<\/a>,\u00a0asthma<\/a>, and\u00a0fibromyalgia<\/a>.<\/p>\n

It has been found that among individuals with these diseases, optimists are not more likely than pessimists to report pain alleviation due to coping strategies, despite differences in psychological well-being between the two groups.[43]<\/a><\/sup>\u00a0A\u00a0meta-analysis<\/a>\u00a0has confirmed the assumption that optimism is related to psychological well-being: “Put simply, optimists emerge from difficult circumstances with less distress than do pessimists.”[44]<\/a><\/sup>\u00a0Furthermore, the correlation appears to be attributable to coping style: “That is, optimists seem intent on facing problems head-on, taking active and constructive steps to solve their problems; pessimists are more likely to abandon their effort to attain their goals.”[44]<\/a><\/sup><\/p>\n

Optimists may respond better to stress: pessimists have shown higher levels of cortisol (the “stress hormone”) and trouble regulating cortisol in response to stressors.[45]<\/a><\/sup>\u00a0Another study by Scheier examined the recovery process for a number of patients that had undergone surgery.[46]<\/a><\/sup>\u00a0The study showed that optimism was a strong predictor of the rate of recovery. Optimists achieved faster results in “behavioral milestones” such as sitting in bed, walking around, etc. They also were rated by staff as having a more favorable physical recovery. In a 6-month later follow-up, it was found that optimists were quicker to resume normal activities.<\/p>\n

Optimism and well-being<\/span><\/h3>\n

A number of studies have been done on optimism and psychological well-being. One 30 year study undertaken by Lee et al. (2019) assessed the overall optimism and\u00a0longevity<\/a>\u00a0of cohorts of men from the Veterans Affairs Normative Aging Study and women from the\u00a0Nurses\u2019 Health Study<\/a>. The study found a positive correlation between higher levels of optimism and exceptional longevity, which the study defined as a lifespan exceeding 85 years.<\/p>\n

Another study conducted by Aspinwall and Taylor (1990) assessed incoming freshmen on a range of personality factors such as optimism, self-esteem, locus of self-control, etc.[46]<\/a><\/sup>\u00a0It was found that freshmen who scored high on optimism before entering college were reported to have lower levels of psychological distress than their more pessimistic peers, while controlling for the other personality factors. Over time, the more optimistic students were less stressed, less lonely, and less depressed than their pessimistic counterparts. Thus, this study suggests a strong link between optimism and psychological well-being.<\/p>\n

In addition low optimism may help explain the association between caregivers’ anger and reduced sense of vitality.[47]<\/a><\/sup><\/p>\n

A recent meta-analysis of optimism supported past findings that optimism is positively correlated with\u00a0life satisfaction<\/a>, happiness,[48]<\/a><\/sup>\u00a0psychological and physical well-being and negatively correlated with depression and anxiety.[49]<\/a><\/sup><\/p>\n

Seeking to explain the correlation, researchers find that optimists choose healthier lifestyles. For example, optimists smoke less, are more physically active, consume more fruit, vegetables and whole-grain bread, and are more moderate in alcohol consumption.[50]<\/a><\/sup><\/p>\n

 <\/p>\n

\n

watch<\/h3>\n