Friday, September 01, 2006

Developmental, Cultural and Gender differences in health behaviours

Developmental Differences

From your own experience you will be aware that the types and amount of physical exercise you undertake has changed from when you were a child at primary school, to a young person about to enter adulthood (and beyond, if the case applies). Why does this happen? How can children who seem on the whole to enjoy physical exercise turn into young people some of whom are international sports people and others who have not engaged in any physical activity (other than maybe walking to school/college, sometimes?) for many years? Below is some research evidence that leads us to believe that biological, gender and social factors all come together to alter how we engage in physical exercise, as an example of a health behaviour, during our formative years of development.

For example, Kunesh et al (1992) conducted a detailed investigation of the school play activities of a sample of 11- to 12-year-old girls in central USA. In interviews the girls reported that they found physically active games at home and at school enjoyable. However, in the school playground the girls preferred to stand in a group and talk while the boys participated in various games. When the girls did participate in games they were often criticised by the boys for their supposed inferior skill performance. To avoid this negative treatment the girls excluded themselves. The girls reported that when playing at school they felt nervous and embarrassed. These findings would suggest that while at an early age boys and girls both enjoy physical activities by the time they reach puberty the girls feel that they are being excluded.

As they enter adolescence the gender difference in participation in physical activities becomes more pronounced. From a series of interviews with young people from southeast London, Coakley and White (1992) identified five factors which help explain young people's decisions about participation in sporting activities:

  1. Consideration of the future in regards to the transition into adulthood: Certain sports are accepted and others rejected depending upon their perceived adultness. Teenagers reject those games which they perceive as childish. Young women in particular become less involved in sporting activities which they perceive as having little connection with the female role.
  2. Desire to display and extend personal competence and autonomy: Young people become involved in sporting activities to the extent to which it extends their feelinq of competence and autonomy Aaain there are qender differences with the young women being less likely to define themselves as sportspersons even if they are actively involved in physical activities. For them, sports is often perceived as a more masculine activity.
  3. Constraints related to money, parents and opposite-sex friends: Access to material resources is an important factor in explaining whether young people participate in certain sporting activities.
  4. Support and encouragement from parents, relatives, and/or peers: Young people report that they are often actively encouraged by family or friends to participate in certain physical activities. The young women in particular note the importance of having a friend to accompany them to sporting activities.
  5. Past experiences in school sports and physical education: Many young people report certain negative school experiences which colour their attitudes to physical activities. In particular, young women comment on how school physical education was associated with feelings of discomfort and embarrassment. Young men seem to have more pleasant memories of school sport.

Thus it would seem that developmental factors in regards to the move from childhood, into adolesence and then into young adulthood seem to play a significant role in how younger people engage in and relate to physical exercise. Though we can not exclude gender as an important factor in this equation.

Gender Differences

There appear to be gender differences in relation to exercise. as an example of a health-enhancing behaviour, though it is also hard to separate gender from othe variables, e.g. age and socio-economic background.

Simons-Morton et al. (1997) conducted a large survey of over 2,400 third grade (8- to 9-year-old) children in four US states. They found that not only did boys participate significantly more in moderate to vigorous physical activity but they also participated more in sedentary activities. Specifically, boys spent more time than girls watching television and playing video games.

Gottlieb and Chen (1985) considered the character of physical activity among a sample of 2,695 seventh and eight grade students (12-14 year olds) in Texas. They found that the female students were more likely than the males to participate in running, swimming, dancing, skipping, tennis, roller skating and volleyball. These activities were largely classified by sporting experts as individual, non-competitive and potentially aerobic activities. The male students preferred team, competitive, non-aerobic activities. The male students preferred team, competitive, non-aerobic activities. Gottlieb and Chen concluded that this evidence of sex typing in sporting activities reflected 'the importance of socialization within the family unit and later through the peer group for gender differences'.

Hasbrook (1986) found that gender differences in sporting participation interacted with socio-economic status. Among girls, those from poorer d backgrounds were less likely to participate in physical activity "eas among boys there was no relationship with social position. Oygard and Anderssen (1998) also found that teenage girls with higher levels of education were more physically active whereas again among boys lere was less evidence of a relationship with level of education.

Cultural Differences

By most any gauge of well-being, health correlates with social class (Marmot, Kogevinas, & Elston, 1987). According to Sarafino (1994) individuals from lower classes are more likely than those from from lower classes are more likely than those from higher classes to :

  • Be bom with very low birth weight.
  • Die in infancy or in childhood.
  • Die in adulthood before age 65.
  • Develop a long-standing illness in adulthood.
  • Experience days of restricted activity because of illness.

Not coincidentally, people from the lower classes have poorer health habits and attitudes than those from higher classes; for instance, they smoke more, participate less in active sports, and are less likely to feel that individuals can actively promote their own health (Marmot, Kogevinas, & Elston, 1987). Research has also shown that people from lower classes have less knowledge about risk factors for disease. They are less likely than individuals from upper classes to know, for example, that people can reduce their cardiovascular risk by controlling their blood pressure, stopping smoking, and eating a low-cholesterol diet (Hossack & Leff, 1987).

Unfortunately these factors seem to be compounded by ethnicity differences. For example, the rate of infant mortality in the USA is twice as high for Blacks as it is for Whites. Among babies who survive the first year, the life expectancy for an African American baby is about 6 years shorter than that for a White baby in the USA (USBC, 1991). Moreover, regardless of that African American baby's gender, he or she is far more likely than a same-sex white baby to develop a major chronic disease in its lifetime, and to die of that disease. Thus the Empirical evidence suggests that the health of minority ethnic groups is generally poorer than that of the majority of the population, and that this pattern has been consistently observed in the USA between African-Americans (or Blacks) and Whites for at least 150 years (Krieger, 1987).

Why are the ethnicity differences? Marks et al (2000) offer these factors as possible explanations -

First, the social practice of racism means that minority ethnic groups are the subject of discrimination at a number of different levels. Such discrimination could lead directly or indirectly to health problems additional to any effects related to socioeconomic status, poverty, unemployment and education. Discrimination in the health care system exacerbates the impacts of social discrimination through reduced access to the system and poorer levels of communication resulting from language differences.

Second, ethnocentrism in health services and health promotion favours the needs of majority over minority groups. The health needs of members of minority ethnic groups are less likely to be appropriately addressed in health promotion which in turn leads to lower adherence and response rates in comparison to the majority population. These problems are compounded by cultural, lifestyle and language differences. For example, if interpreters are unavailable, the treatment process is likely to be improperly understood or even impaired and patient anxiety levels will be raised. The lack of permanent addresses for minority ethnic group families created by their high mobility makes communication difficult so that screening invitations and appointment letters are unlikely to be received.

Third, health status differences related to race and culture are to a large extent mediated by differences in SES (social and economic status). Studies of race and health generally control for SES and race-related differences frequently disappear after adjustment for SES. Race is strongly correlated with SES and is even sometimes used as an indicator of SES (Williams and Collins, 1995). Thus ethnicity may not be the issue, rather social and economic factors are.

Fourth, differences in health-protective behaviour may occur because of different cultural or social norms and expectations.

Fifth, differences in readiness to recognize symptoms may occur also as a result of different iral norms and expectations.

Sixth, differences could occur in access to srvices. There is evidence that differential access to optimal treatment cause poorer survival outcomes in African-Americans who have cancer in comparison to other ethnic groups (Meyerowitz et al., 1998).

Seventh, members of minority ethnic groups are more likely to inhabit and work in unhealthy environments because of their lower SES. Eighth, there could be genetic differences between groups which lead to differing lence of disease and some diseases are inherited. There are several recognized examples, including sickle cell disorder affecting people ofAfrican-Caribbean descent, thalassaemia, another blood disorder which affects people of the Mediterranean, Middle Eastern and Asian descent, and Tay-Sachs disease which affects Jewish people.

It would seem then that one of the most important determining factors in regards to health behaviours and overall level of health, is cultural differences, wether these be social, class, economic, ethnic or all of them interacting together. Until these issues are addressed it may be that we will still little significant change in our nations patterns of health inequalities.

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