Background. Smoking, diet, and physical exercise are key determinants of health. This study assessed changes over 10 years and their relationship to changes in health beliefs and risk awareness. Method. A survey was carried out of university students from 13 European countries (Belgium, England, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, The Netherlands, Poland, Portugal, and Spain) in 1990 (4,701 men, 5,729 women) and repeated in 2000 (4,604 men, 5,732 women). We assessed smoking, exercise, fruit and fat intake, beliefs in the importance of behaviors for health, and awareness of the influence of behaviors on heart disease risk. Results. Smoking prevalence increased and fruit consumption decreased between 1990 and 2000, while physical exercise and fat intake were more stable. There were large variations between country samples. Health beliefs weakened, with marked decreases in beliefs about smoking and diet. Across country samples, changes in beliefs correlated with changes in the prevalence of behaviors. Awareness of the effects of smoking and exercise was stable, but knowledge of the role of fat intake increased over the decade. Conclusions. The differences in health behaviors, beliefs, and risk awareness between the two surveys were disappointing in this educated sector of young adult Europeans. The association between changes in beliefs and prevalence of behavior emphasizes the importance of enhancing positive attitudes to healthier lifestyles. (C) 2002 American Health Foundation and Elsevier Science (USA).
