Doing health, doing gender: teenagers, diabetes and asthma

Although most research linking health disadvantage with gender has focused on women, recent work indicates that hegemonic masculinities can also place the health of men at risk. The importance of comparing the experiences of women and men has been emphasised and this paper focuses on the ways in which the social constructions of femininities and masculinities affect how teenagers live with asthma or diabetes. The majority of girls incorporated these conditions and the associated treatment regimens into their social and personal identities, showing a greater adaptability to living with asthma or diabetes. However, this could have detrimental effects in terms of control, as girls sometimes lowered expectations for themselves. In addition, two aspects of the treatment regimens, diet and exercise, were found to disadvantage girls and advantage boys, because of contemporary meanings of femininities and masculinities. The social construction of femininities meant that these conditions were not seen as the threat that they were by the majority of boys interviewed, who made every effort to keep both conditions outside their personal and social identities by passing. The majority of boys maintained a 'valued' identity by feeling in control of their body and their condition. However, for the small minority of boys who were no longer able to pass the impact of chronic illness led to a 'disparaged' identity. The interaction of gender and health is seen as a complex two-way process, with aspects of contemporary femininities and masculinities impacting on the management of these conditions, and aspects of these conditions impacting in gendered ways upon the constructions of gender.     

Masculinity,sexuality and vulnerability in ‘working’ with young men in South African contexts: ‘you feel like a fool and an idiot … a loser’

South Africa has seen a rapid increase in scholarship and programmatic interventions focusing on gender and sexuality, and more recently on boys, men and masculinities. In this paper, we argue that a deterministic discourse on men's sexuality and masculinity in general is inherent in many current understandings of adolescent male sexuality, which tend to assume that young women are vulnerable and powerless and young men are sexually powerful and inevitably also the perpetrators of sexual violence. Framed within a feminist, social constructionist the oretical perspective, the current research looked at how the masculinity and sexuality of South African young men is constructed, challenged or maintained. Focus groups were conducted with young men between the ages of 15 and 20 years from five different schools in two regions of South Africa, the Western and Eastern Cape. Data were analysed using Gilligan's listening guide method. Findings suggest that participants in this study have internalised the notion of themselves as dangerous, but were also exploring other possible ways of being male and being sexual, demonstrating more complex experiences of manhood. We argue for the importance of documenting and highlighting the precariousness, vulnerability and uncertainty of young men in scholarly and programmatic work on masculinities.     

Masculinities fathering and health: the experiences of African-Caribbean and white working class fathers

There is a developing body of research that investigates the links between masculinities and men's health experiences, but the links between masculinities and the health of fathers has been a neglected focus for research in the UK. This paper presents some of the findings drawn from a parent study which investigated African-Caribbean and white working class fathers' experiences of fathering, health and social connectedness. Data are drawn from interviews with 13 men (6 African-Caribbean and 7 White working class) living in a city in the West Midlands area of the UK. In this paper, I analyse and discuss African-Caribbean and white working class fathers' stories about the meaning of health, the influences upon their health, and their health practices. It was found that for the African-Caribbean fathers specifically, anticipated or perceived racist prejudice, abuse or discrimination influenced their health experiences. However, the meaning of health for both ethnic groups of fathers was as functional capacity, that is health was an asset that allowed fathers to meet the obligations of paid work and fathering. These obligations were also associated with a restricted sense of personal agency for the men interviewed, and the associated constraints were linked to transgressive consumption of alcohol, food and tobacco. In addition, fathers were also involved in solitary ways of dealing with their vulnerability, vulnerability that was associated with fathers' health concerns, and other difficult life experiences. Fathers' solitary experiences of vulnerability were also mediated by hegemonic forms of masculinity. Nevertheless, the experience of fathering within the lifecourse influenced men's health experiences: reflexivity and challenges to both transgressive consumption and solitary experiences were linked to fathers' perceived obligations to children. The significance of gender, ethnicity and social class for theory and future research with working class fathers and boys is identified, and the need for gender-sensitive public health and health promotion interventions regarding the 'work-family balance' and working class fathers' personal and social skills is also discussed.     

‘Men are leavers alone and women are worriers’: Gender differences in discourses of health

This paper explores gender differences in health talk, how such talk is informed by discourses at a societal level and the extent to which talking about health is a way of ‘doing gender.’ It draws on in-depth interviews with 48 women and men in their twenties and thirties showing that gender influences both the way people talk about health and their willingness to engage in health talk. It explores the way cultural constructions of gender influence the propensity to take risks with particular reference to HIV/AIDs and recreational drug use and the extent to which discourses of risk inform health talk. We discuss how changes in the occupational structure and the associated influx of men into ‘women's’ work are associated with more ‘feminized’ masculinities and a recognition among some men of the male body's vulnerability. They are also associated with men's health talk becoming more like women's. We conclude that cultural constructions of gender not only have an impact on health talk but also on the regulatory power of discourses of risk and risk management.     

Gender and Disadvantage in Health: Men's Health for a Change

Women, typically, have been the focus for discussions of health inequalities in relation to gender. Now research on prostate illhealth turns attention to the neglected area of men's health and to men's disadvantage in health. Drawing on evidence of men's experiences and perspectives of their health, the complexities of the workings of gender in relation to health are explored, using current theorising around masculinities, hegemonic masculinity, negotiated gender and the disaggregation of gender from sex. Touching also on a range of other related issues including methodological ones, the discussion offers ideas towards better understanding of gender in relation to health disadvantage. In the context of the continuing concern about health inequalities, there is scope not only for documenting 'hidden' health disadvantage among men, but also for reviewing how health disadvantage by gender is framed and analysed; both are useful to inform health policy and practice.     

Health help‐seeking by men in Brunei Darussalam: masculinities and ‘doing’ male identities across the life course

Using data collected through semi‐structured interviews and focus group discussions with 37 adult men living in Brunei Darussalam, this paper explores how masculinities and expectations about male roles across the life course influence men's perceptions, of and attitudes towards health and health help‐seeking behaviour. Bruneian men gave accounts that consistently spoke of a series of masculine roles and associated attributes and behaviours, which mapped across the life course. Men described health and the steps that they had taken to protect their health in terms of responsibilities associated with being a breadwinner, provider of support for parents, role model and leader of the family. Whilst adherence to Bruneian norms about masculinity could obstruct men's engagement with health help‐seeking, we also found that men mobilised their understanding of Bruneian masculinity such that it provided culturally legitimate way of engaging in health help‐seeking. We conclude by considering implications for further development of conceptualisations of masculinities, particularly responding to the call to consider Connell's theory of ‘hegemonic masculinity’ in the context of the Global South. We also consider the implications of the findings of this research for policy and practice in provision of health promotion and services in Brunei.     

What matters to girls and boys in a black primary school in South Africa

This article focuses on the construction of gender identities among young boys and girls in a black primary school. Against the backdrop of food insecurity, young boys' and girls' vulnerability to violence and to using violence as a means of getting food is increased. Violence is a clear manifestation of gender inequalities. Drawing on data derived from an ethnographic exploration of children's gender identities in the first years of primary schooling, this article examines how violence underscores much of social relations amongs boys and girls. The article further illustrates how different forms of masculinities and femininities are constructed. Violence is not the domain of boys only. Girls too take on violent femininities. The implications of recognizing children's gendered and violent cultures are discussed briefly in the concluding part of the paper.     

Understanding boys’: Thinking through boys,masculinity and suicide

In the UK, the media are reporting increasing rates of childhood suicide, while highlighting that increasing numbers of pre-adolescent boys (in relation to girls) are diagnosed as mentally ill. In response, academic, professional and political commentators are explaining this as a consequence of gender. One way of doing this has been to apply adult defined understandings of men and masculinities to the attitudes and behaviours of pre-adolescent boys. As a consequence, explanations of these trends point to either ‘too much’ masculinity, such as an inability to express feelings and seek help, or ‘not enough’ masculinity that results in isolation and rejection from significant others, such as peer groups. Using a discourse analysis of semi-structured interviews with 28 children aged 9–13 (12 male, 16 females) and 12 school staff at a school in North East England, this article questions the viability of using normative models of masculinity as an explanatory tool for explaining boys’ behaviours and suggests that researchers in the field of gender and suicide consider how boys’ genders may be constituted differently. We develop this argument in three ways. First, it is argued that studies that use masculinity tend to reduce the formation of gender to the articulation of power across and between men and other men and women. Second, we argue that approaches to understanding boys’ behaviours are simplistically grafting masculinity as a conceptual frame onto boy’s attitudes and behaviours. In response, we suggest that it is important to re-think how we gender younger boys. The final section focuses specifically on the ways that boys engage in friendships. The significance of this section is that we need to question how notions of communication, integration and isolation, key features of suicide behaviours, are framed through the local production of friendships.     

From diminished men to conditionally masculine: sexuality and Australian men and adolescent boys with intellectual disability

Men and boys with intellectual disability represent a unique group who have hitherto been overlooked by researchers and theorists exploring men and masculinities. Qualitative data from an Australian ethnographic study focused on the sexual health needs of men and adolescent boys with moderate to profound intellectual disability. Findings suggest that masculinity for this group of men is more a biopsychosocial phenomenon than a social construct organised around heteronormative ideals. The conditional masculinity of the men participating in the study was based instead on a number of intrinsic and external factors, which are described in detail.     

“AIDS is rape!” gender and sexuality in children's responses to HIV and AIDS

This paper examines young African school children's understanding of HIV and AIDS. Based on focus group interviews with children aged 7–8 in KwaZulu-Natal province, South Africa, it explores the ways in which gender and sexuality feature in their responses to the disease. Data were collected between 2003 and 2004 through 26 focus groups involving 55 boys and 64 girls. The paper argues that younger children are active agents in giving meaning to the disease. Their agency is negotiated within complex social processes involving sexual violence, highly unequal gender/age inequalities, but also sexual expression. Those expressions are subsumed however under a regime of violence and fear catapulting men, albeit with contestation, as chief vectors in the spread of the disease and a source of girls' anxieties. Children's responses to the disease are the effects of material, symbolic and discursive forces effectively constraining the opportunities available to them and creating patterns of vulnerability especially for young girls. Interventions aimed at scaling up efforts to address young children responses to the disease must be situated in parallel efforts to end poverty, sexual violence and pervasive gender inequalities in order to foster more comprehensively the exercise of young children's agency.     

Carework and caring: A path to gender equitable practices among men in South Africa?

Background  

The purpose of this study was to examine the relationship between men who engage in carework and commitment to gender equity. The context of the study was that gender inequitable masculinities create vulnerability for men and women to HIV and other health concerns. Interventions are being developed to work with masculinity and to 'change men'. Researchers now face a challenge of identifying change in men, especially in domains of their lives beyond relations with women. Engagement in carework is one suggested indicator of more gender equitable practice.     

Reframing masculinity: structural vulnerability and HIV among black men who have sex with men and women

This paper calls for a critical reframing of masculinity as an intersectional construct in the HIV epidemic and in public health. In-depth qualitative interviews were conducted with a sample of 56 Black men who have sex with men and women in the San Francisco Bay Area. Men described their sexual identities and practices via complex narratives of masculinity that drew on subordinated and resourceful adaptations to the structural effects of racism, economic marginalisation and homophobia. By focusing on men whose experience of masculinity operates outside fixed identity categories, the paper draws attention to the intersectionality that is, by necessity, constitutive of men’s lived experiences. Findings suggest the value of an integrative framework for understanding Black masculinities as processes and practices simultaneously informed by structural inequalities (racism, economic marginalisation and/or homophobia, in particular) and cultural meanings of gender. By utilising an intersectional approach, public health and sociology can better understand the concurrent resilience and vulnerability of masculinities, while building an interdisciplinary understanding of the symbolic role of Black masculinities in the USA, as well as a means by which to promote health and well-being in and through these gendered contexts.     

Racial and gender differences in adolescent sexual attitudes and longitudinal associations with coital debut.

PURPOSE: Delay of sexual debut is an important strategy in reducing the risk of negative adolescent health outcomes. Race and gender are known to be related to sexual behavior and outcomes, but little is known about how these characteristics affect sexual attitudes. This article examines differences in coital and pregnancy attitudes by gender and race, the influence of attitudes on transition to first coitus for each subgroup, and implications for prevention. METHODS: Data are from Waves I and II of the National Longitudinal Study of Adolescent Health, limited to Non-Hispanic White and African American adolescents (n = 6652). We factor analyzed attitude items, and examined effects of race, gender, and their interaction, controlling for sexual debut at Wave I. We regressed sexual debut longitudinally by attitudes for virgins (n = 3281) separately for each subgroup, controlling for covariates. RESULTS: Compared with boys, girls perceived less positive benefits from sex and more shame and guilt with sex, but had fewer negative perceptions about pregnancy. Compared with White boys, African American boys perceived less shame and guilt about sex; girls did not differ by race. Higher perceived benefits of sex increased the likelihood of sexual debut among African American girls. Perceived shame and guilt lowered the likelihood for White boys and girls. CONCLUSIONS: Reinforcing protective attitudes through gender and race-specific programs may delay sexual intercourse, but more research is needed. More research is also needed to determine whether there is an optimal coital age after which negative health outcomes are attenuated, and whether this differs by gender and race.     

Intervening in masculinity: work,relationships and violence among the intimate partners of female sex workers in South India

Although health researchers have begun to examine the forms of violence and power dynamics that play out in the intimate relationships of female sex workers (FSWs) in India, this knowledge has tended to focus on the perspectives of women, leaving men’s motivations and attitudes relatively unexamined. This paper examines the contours of masculinity and gender norms from the perspective of the intimate partners of FSWs. Based on six months of ethnographic research in Northern Karnataka, the study employed two focus group discussions (FGDs) with Devadasi FSWs (N = 17), as well as four FGDs (N = 34) and 30 in-depth interviews with their intimate partners. Given the precarious labour conditions in this region, tensions developed in the participants’ relationships with FSWs, as these men were unable to meet local ideals of manhood. Violence became a way that men attempted to re-secure a sense of control in their relationships with women, and to fulfil fantasies of male power. We recommend that programs engaging men not only address intimate partner violence but also attend to the social and structural realities surrounding these men’s daily lived experiences.     

Male users' and primary care services health professionals' conceptions of gender and possible impacts on men's health, São Paulo, Brazil

This paper studied the relation between the exercise of masculinities and health care of men in primary health care services. It focuses on representations and meanings of primary health care service users and professional of what it is to be a man. Male service users and professionals were interviewed in two primary health care facilities. Diverse models of masculinity were found, defining various forms of reasoning upon men's health care. This study indicates that issues such as work, sexuality, body structure, relationship with women, and transformations in gender relations are important for men, and should be considered in health care services.     

Uncovering tensions and capitalizing on synergies in HIV/AIDS and antiviolence programs

Research frequently points to the need to empower women to effectively combat the twin epidemics of HIV/AIDS and gender-based violence. Simultaneously, there has been increased attention given to working with men in gender equality efforts. The latter approach intervenes on masculinities as part of the fight against HIV/AIDS and violence. No research has considered these 2 lines of work side by side to address several important questions: What are the points of overlap, and the tensions and contradictions between these 2 approaches? What are the limitations and unintended consequences of each? We analyzed these 2 parallel research trends and made suggestions for how to capitalize on the synergies that come from bolstering each position with the strengths of the other.     

Boys and their teeth: A qualitative investigation of boys' oral health in early childhood

This is a paper based on qualitative focus group interviews with 33 boys in early childhood (ages 5 to 7). The basis of the interviews was originally to understand the way in which boys come to perceive issues around masculinities, physical activity, sport and health. However, given the naturalistic manner of qualitative focus group interviews, additional themes were uncovered around boys' understanding of oral health, in particular the relationship between their teeth and health. At an age where the boys are gaining increasing levels of autonomy in terms of personal hygiene and individual health it appears that dental health is being neglected. The need to address this concern through developing functional health literacy is imperative for boys at this age. Schools are the ideal site in which such an initiative can occur with concomitant knowledge transferred back to the family home.     

A focus on pleasure? Desire and disgust in group work with young men

There are a number of persuasive arguments as to why sexual pleasure should be included in sexual health work with young people, including the suggestion that this would provide young people with accounts of gender and sexuality that are more critical and holistic than those presented in the popular media, pornography and current sex education curricula. This paper considers the possibilities for engaging young men in critical group work about sexual pleasure in research and education contexts, drawing on a mixed-methods study of young people's understandings and experiences of ‘good sex’. The paper provides a reflexive account of one focus group conducted with a group of heterosexual young men and two youth educators. It explores some of the challenges to building relationships with young men and creating ‘safe spaces’ in which to engage in critical sexuality education in socially unequal contexts. In this case study, adult-led discussion elicits rebellious, ‘hyper-masculine’ performances that close down opportunities for critical or reflective discussion. Although there are some opportunities for critical work that move beyond limited public health or school-based sex education agendas, there is also space for collusion and the reinforcement of oppressive social norms. The paper concludes by imagining possibilities for future research and practice.     

Adolescent depression and suicide risk: association with sex and drug behavior

BACKGROUND: Depression is common among adolescents, and suicide is the third leading cause of death among 15- to 19-year-olds. Although both health problems have been associated with drug use and early sexual intercourse, the relationship has not been systematically studied in a nationally representative sample. METHODS: Sixteen patterns of combined sex and drug use behaviors were obtained using cluster analysis of responses to Wave I of the National Longitudinal Study of Adolescent Health conducted from September 1994 through December 1995. Bivariate and multivariate analyses tested correlations between behavior patterns and current depression, serious suicidal ideation, and previous suicide attempt, controlling for gender, race/ethnicity, Hispanic ethnicity, family structure, and parent education. RESULTS: Compared to youth who abstain from risk behaviors, involvement in any drinking, smoking, and/or sexual activity was associated with significantly increased odds of depression, suicidal ideation, and suicide attempts. Odds ratios were highest among youth who engaged in illegal drug use. There were few differences between boys and girls who abstain from sex and drug behaviors. Girls were less likely than boys to engage in high-risk behaviors, but those who did tended to be more vulnerable to depression, suicidal ideation, and suicide attempt. CONCLUSIONS: Teens engaging in risk behaviors are at increased odds for depression, suicidal ideation, and suicide attempts. Although causal direction has not been established, involvement in any sex or drug use is cause for concern, and should be a clinical indication for mental health screening for girls; both boys and girls should be screened if engaging in any marijuana or illegal drug use.     

Changing what it means to ‘become a man’: participants’ reflections on a school-based programme to redefine masculinity in the Balkans

Calls to engage men and boys in efforts to promote health, prevent violence and advance gender equality have grown in recent years. However, there remains little evidence or reflection on how most effectively to change harmful norms related to masculinity. The study addresses this gap by exploring the perspectives of participants in the Young Men Initiative (YMI), an innovative programme that aimed to promote healthier masculinities among boys attending vocational high schools in several Balkan countries through educational workshops, residential retreats and a social marketing campaign. Qualitative data were collected through 37 in-depth interviews and 11 focus-group discussions with boys, youth facilitators and teachers. Findings from four schools (in Belgrade, Sarajevo, Prishtina and Zagreb) suggest that several elements of the programme resonated strongly with participants and supported their meaningful engagement in project activities. Five themes emerged as most salient in identifying how and why specific aspects of YMI positively influenced participants: personal reflection, experience-based learning, connections with youth facilitators, new peer groups and aspirational messaging. Building on these insights, the study highlights potentially useful strategies for other programmes seeking to reach boys and transform their understanding of masculinity.