Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health

Gender-based inequalities in health have been frequently documented. This paper examines the extent to which these inequalities reflect the different social experiences and conditions of men's and women's lives. We address four specific questions. Are there gender differences in mental and physical health? What is the relative importance of the structural, behavioural and psychosocial determinants of health? Are the gender differences in health attributable to the differing structural (socio-economic, age, social support, family arrangement) context in which women and men live, and to their differential exposure to lifestyle (smoking, drinking, exercise, diet) and psychosocial (critical life events, stress, psychological resources) factors? Are gender differences in health also attributable to gender differences in vulnerability to these structural, behavioural and psychosocial determinants of health? Multivariate analyses of Canadian National Population Health Survey data show gender differences in health (measured by self-rated health, functional health, chronic illness and distress). Social structural and psychosocial determinants of health are generally more important for women and behavioural determinants are generally more important for men. Gender differences in exposure to these forces contribute to inequalities in health between men and women, however, statistically significant inequalities remain after controlling for exposure. Gender-based health inequalities are further explained by differential vulnerabilities to social forces between men and women. Our findings suggest the value of models that include a wide range of health and health-determinant variables, and affirm the importance of looking more closely at gender differences in health.     

Gender differences in old age mortality: roles of health behavior and baseline health status

This research aims to further current understanding of gender differences in old age mortality. In particular, it assesses the relative importance of health behavior and baseline health conditions in predicting the risk of dying, and how their effects differ between elderly men and women. Data for this research came from a prospective study of a national sample of 2,200 older adults in Japan from 1987 to 1999. Hazard rate models were employed to ascertain the interaction effects involving gender and health behavior (i.e., smoking and drinking) and baseline health status. Gender differences in old age mortality in the Japanese are quite pronounced throughout all of our models. In addition, interaction effects of gender and smoking, functional limitation, and cognitive impairment, indicate that females in Japan suffer more from these risk factors than do their male counterparts. Failure to adjust for population heterogeneity may lead to a significant underestimation of female advantage in survival. The inclusion of health behavior and health status measures only offsets a limited proportion of this gender differential. The increased mortality risk due to smoking, functional limitation, and cognitive impairment among elderly Japanese women suggests that narrowing of gender gap in mortality may be due to not only changes in the levels of these risk factors but also their differential effects on men and women.     

Gender differences in relationships between social capital and individual smoking and drinking behavior in Taiwan

Despite the concept of social capital receiving great attention in the area of health research, few studies have analyzed the differential effects of social capital between genders. This article assesses gender differences in the relationships between social capital and smoking and drinking behavior in Taiwan. Data on individual sociodemographic characteristics, smoking, drinking, and social capital were obtained from the Taiwan Social Change Survey conducted in 1995 and in 2000. The overall response rate was 67%. In total, 3713 women and men aged over 20 years living in 204 neighborhoods were interviewed. Social capital indicators were aggregated at the neighborhood level, and included neighborhood closeness, political influence, social contact, social trust, and social participation. The data were analyzed with multilevel binomial regression models. Gender differences were found in some aspects of social capital. Stronger effects of social trust on smoking were found for women than for men, whereas stronger effects of neighborhood closeness on drinking were found for women than for men. Social participation was positively associated with drinking in both genders. The findings of this study provide new evidence for the differential effects of social capital by gender in Taiwan, suggesting that more studies are needed to understand social capital's effects in Asian societies and the mechanisms by which the effects may vary with gender.     

Gender Differences in Psychosocial Determinants of Adolescent Smoking

Because of the social meaning smoking has acquired and because of different trends in male and female initiation rates, it is reasonable to suspect that different psychosocial factors predict smoking in teen-age boys and girls. A literature review revealed external pressures such as peer and parental smoking are important for both boys and girls though their influence may be moderated differentially by age and type of smoking behavior assessed. Some data support the hypothesis that female smoking is associated with self-confidence, social experience, and rebellion, whereas male smoking is associated with social insecurity. Overall, group differences such as gender and socioeconomic status are well-documented in terms of smoking prevalence but underexplored in the area of psychosocial predictors. In this review, gender differences have been documented with sufficient frequency to warrant further attention to develop gender specific components of smoking prevention programs.     

The contribution of smoking to sex differences in mortality

The contribution of smoking to sex differences in mortality is estimated on the basis of data from 12 studies of the mortality of nonsmoking men and women, together with mortality data for comparable general population samples. Most of the data are for samples drawn from the U.S. population from the late 1950s to 1980. The findings from different studies are generally consistent, once methodological factors are taken into account. The findings indicate that, for total mortality, the proportion of sex differences attributable to smoking decreases from about two-thirds at age 40 to about one-quarter at age 80. Over the adult age span, it appears that about half of the sex difference in total mortality is attributable to smoking. Findings for ischemic heart disease mortality show a similar pattern. For lung cancer, it appears that about 90 percent of the sex difference in mortality is attributable to smoking. The estimated contributions of smoking include both the effects of sex differences in smoking habits and the effects of sex differences in the increase in mortality caused by smoking. The quantitative results should be interpreted with caution, since several lines of argument suggest that multivariate analyses controlling for other relevant factors would produce lower estimates of the contribution of smoking to sex differences in mortality. Despite this limitation, the findings analyzed in this review, together with additional evidence from related research, strongly support the conclusion that cigarette smoking makes a major contribution to men's higher mortality, but other factors also play an important role.     

Relative and absolute gender gap in all-cause mortality in Europe and the contribution of smoking

This paper examined whether international variations in absolute and relative gender differences in mortality are related to the overall mortality rates, and whether the international variation in gender gap in mortality can in part be explained by smoking. I used data on mortality from all causes in 32 European countries published by the World Health Organisation, and indirect estimates of mortality attributable to smoking in the age band 35–69 years by Peto et al. The main analyses were restricted to the age band 35–69 years but results for mortality at all ages were virtually identical. The overall mortality rates (both sexes combined) were strongly related to absolute gender differences (r = 0.91) but only weakly to relative differences (r = 0.35). The gender gap was larger in eastern than in western Europe for rate differences (1005 vs. 530 per 100,000, respectively), but it was similar for rate ratios (2.3 vs. 2.1, respectively). Both absolute and relative gender differences in mortality were strongly related to the difference between men and women in the proportion of all deaths attributed to tobacco (partial correlations, after controlling for the overall death rates, were 0.59 and 0.66, respectively). Excluding tobacco-related deaths attenuated the associations between the overall mortality rates with absolute differences (r = 0.70) and reduced the difference in the absolute gender gap between eastern and western Europe. More importantly, excluding tobacco-related deaths eliminated entirely the association with relative differences (r = –0.15) as well as any suggestion that the relative gender gap is larger in eastern than in western Europe. These results show that tobacco plays an important role in generating international differences in the size of gender gap in mortality. The much discussed association between the overall life expectancy and the gender gap in life expectancy is a numerical product of absolute death rates (differences in life expectancy are driven by differences in rates). The association of overall mortality with male/female mortality ratios is much weaker.     

The life expectancy of nonsmoking men and women

The pronounced difference in life expectancy between men and women in the United States and other industrialized countries has been attributed to a variety of causes, among them, differential rates of cigarette smoking. A study was undertaken to eliminate the confounding factors of imprecision in the taking of smoking histories and exaggeration of early traumatic deaths in life expectancy calculations. Survey data were collected on the lifetime smoking habits of adults in Erie County, Pa., as of 1972-74. In the survey interviews, careful distinctions were made between respondents who had formerly smoked and respondents who had never smoked. The survey data were combined with data collected from surviving relatives about the smoking habits of people who had died in Erie County during the years 1972-74. After deaths attributable to traumatic causes (accidents, suicides, and homicides) were removed, life tables were calculated for male and female nonsmokers over age 30. The resulting life expectancy figures for nonsmoking men and women of parallel age were virtually identical. Thus, differential rates of cigarette smoking are apparently the overwhelming cause for the male-female longevity difference. Actuarial tables should be divided by smoking behavior to reflect this finding. The results of the study suggest that the present longevity difference between men and women will disappear.     

Reliability of self-reported smoking history and age at initial tobacco use

BACKGROUND: Many studies use questionnaires to determine smoking status and age of smoking onset. This study aimed to determine the reliability of self-reported smoking history and age of smoking initiation. METHOD: The proportion of inconsistent answers and correlation coefficients of reported age of initial smoking were measured by an answer-reanswer analysis of questionnaires in an ongoing, two-step, population-based survey of health behavior. Interviews were conducted on the day of recruitment to and the day of discharge from mandatory military service in Israel among a sample of 25,437 young men and women recruited between 1986 and 2000. RESULTS: Of 7276 participants reporting current or past smoking upon recruitment, 559 (7.7%) reported never having smoked upon discharge, thus demonstrating prima facie inconsistency. Variables significantly associated with reliable reporting in a multivariate logistic regression model were female gender (P = 0.04) and more than 4 years of military service (P < 0.01). 6010 subjects who reported a positive smoking history at both recruitment and discharge were available for analysis of reliability of reported age at smoking onset. Intraclass correlation coefficients for recruitment/discharge consistency in reported age at first cigarette were 0.73 (95% CI: 0.71-0.74) and 0.76 (95% CI: 0.74-0.78) for men and women, respectively. Eastern origin, lower subject education level, and lower paternal education level were also associated with lower reliability. CONCLUSIONS: Our results showed a relatively high level of answer-reanswer reliability, with some variance attributable to personal characteristics. These results suggest that self-reported age at onset of tobacco use is practical and reliable in normative, young adult populations. However, time elapsed between questionnaires and demographic and lifestyle characteristics may affect reliability rates, and thus should be carefully regarded in future studies.     

Theory of Planned Behavior explains gender difference in fruit and vegetable consumption

A gender difference in fruit and vegetable intake (FVI) is widely documented, but not well understood. Using data from the National Cancer Institute's Food Attitudes and Behavior Survey, we assessed the extent to which gender differences in FVI are attributable to gender differences in constructs from the Theory of Planned Behavior (TPB). Females reported more favorable attitudes and greater perceived behavior control regarding FVI than males, and these beliefs mediated the observed gender difference. Males reported greater perceived norms for FVI, but norms did not predict FVI. Gender did not moderate the influence of TPB constructs on FVI. Thus, TPB constructs substantially explained the gender difference. Interventions targeted toward adult males may benefit by promoting favorable attitudes and perceived behavioral control over FVI.     

Smoking and pregnancy outcome: trends among black teenage mothers in Missouri.

OBJECTIVES. The purpose of this study is to analyze the smoking changes that have occurred among pregnant Black teenagers in Missouri. The study also examines changes in Black teenage pregnancy outcomes in relation to smoking behavior changes. METHODS. This analysis used computerized data files from the 1978 to 1990 Missouri birth certificates to acquire information on smoking during pregnancy for 41,544 Black teenagers and 105,170 White teenagers. All Missouri births with smoking history were included in the study. RESULTS. During the study period, the rate for Blacks who smoked during pregnancy decreased from 37% in 1978 to less than 22% in 1990. A large part of this reduction is attributable to Black teenagers, whose smoking-during-pregnancy rate declined from 35.8% to 7.2%. Additionally, the Black teenage-specific low-birthweight rate decreased by 13.6% over the study period, possibly influenced by the decrease in smoking. CONCLUSIONS. The results indicate that a major norm has changed in smoking status among pregnant Black teenagers. Understanding the reasons behind this change could assist smoking cessation and other health promotion efforts.     

Gender, risk perceptions, and smoking behavior

The underlying reasons for gender differences in smoking behavior, and thus for the recent trends, are not well understood. Using a sample of 8592 Swedish adolescents aged 15-18, this paper contributes to the literature by exploring gender differences in smoking risk perceptions and in the responses to the latter. The results show significant gender differences in the perception of smoking mortality risk and in the perception of the addictiveness of smoking. Girls perceive the mortality risk of smoking as significantly greater than boys do, but they also perceive the addictiveness of cigarettes as less. These results persist after controlling for a wide range of background characteristics, including smoking risk information sources. Moreover, the findings suggest that while smoking information from sources such as teachers, pals, and own search, affect smoking mortality perceptions in a significant and positive manner among boys, no such effects are obtained among girls. Finally, our results show that both boys and girls take both the addictiveness and mortality risk of smoking into account when making their smoking decision. Moreover, the magnitude of the response is similar among boys and girls. This is in contrast to the general belief that females dislike risks to a greater extent than males.     

Geschlechtsspezifisches Risikoverhalten im Jugendalter

Studies addressing health risk behavior show relatively consistent gender patterns: male adolescents draw attention to themselves by externalizing problem behavior; girls, on the other hand, more often choose an internalizing problem behavior. International, comparative studies show that these patterns of gender differences are not universal but are dependent on the culture in which they occur. For example, in western Europe, there are only minor gender differences in smoking behavior, whereas in eastern Europe the differences are clear cut – to the disadvantage of boys. These empirical findings can be explained by theories on “doing gender”. West and Zimmerman assume that gender is a social category which is negotiated and confirmed by interactions. Adolescents use behaviors that help them to adopt gender roles. For the conception of prevention programs, the role of health risk behavior for the construction of femininity and masculinity has to be taken serious.     

Gender Differences in Teenage Smoking

This study analyzes the patterns and correlates of gender differences in cigarette smoking in a national sample of white high school seniors in 1985. More females than males were smokers, because females had higher rates for the early stages of smoking adoption. Specifically, females were more likely to have tried smoking at least once and, among those who had tried smoking, females were more likely to have smoked more than once or twice. Gender differences in smoking varied, depending on the students' characteristics. For example, the female excess in the early stages of smoking adoption was small or absent among rural students or very religious students, apparently because traditional values inhibit smoking adoption more among females than among males. We estimated the contributions of gender differences in students' characteristics to gender differences in smoking adoption. For example, males were more involved in sports, and this appears to be one reason why males had lower rates of smoking adoption thanfemales. On the other hand, males had more deviant behavior and attitudes, and this would be expected to contribute to greater smoking adoption by males. The findings of this study indicate important gender differences in the determinants of smoking adoption.     

Gender differences in teenage smoking

This study analyzes the patterns and correlates of gender differences in cigarette smoking in a national sample of white high school seniors in 1985. More females than males were smokers, because females had higher rates for the early stages of smoking adoption. Specifically, females were more likely to have tried smoking at least once and, among those who had tried smoking, females were more likely to have smoked more than once or twice. Gender differences in smoking varied, depending on the students' characteristics. For example, the female excess in the early stages of smoking adoption was small or absent among rural students or very religious students, apparently because traditional values inhibit smoking adoption more among females than among males. We estimated the contributions of gender differences in students' characteristics to gender differences in smoking adoption. For example, males were more involved in sports, and this appears to be one reason why males had lower rates of smoking adoption than females. On the other hand, males had more deviant behavior and attitudes, and this would be expected to contribute to greater smoking adoption by males. The findings of this study indicate important gender differences in the determinants of smoking adoption.     

Factors influencing gender differences in smoking and their separate contributions: Evidence from South Korea

This paper explores gender differences in smoking using information on 15,277 adults obtained from the Korea National Health and Nutrition Examination Surveys of 2001 and 2005. Applying a decomposition approach extended from the Oaxaca–Blinder method, we obtained factors influencing gender differences in smoking and estimated their separate contributions. According to the outcomes of decomposition analyses, gender differences in smoking-tendency (or inclination to smoke) accounted for 98% of the total gender difference in smoking. When the gender difference in smoking was decomposed into specified factors, the difference in smoking-tendency between married men and women was found to be the most crucial factor as it explained 11% of the total gender difference in smoking. The gender difference in the proportion of persons attaining a low level of education contributed to a 6% reduction of the total gender difference in smoking. Additionally, factors influencing the gender-specific smoking-tendency were found to be important in explaining the gender difference in smoking. We conclude that, understanding separate contributions of sets of factors affecting gender differences in smoking and devising appropriate policies could effectively reduce the smoking rate of a target gender group to the level of that of a reference gender group.     

Neonatal health care costs related to smoking during pregnancy

RESEARCH OBJECTIVE: Much of the work on estimating health care costs attributable to smoking has failed to capture the effects and related costs of smoking during pregnancy. The goal of this study is to use data on smoking behavior, birth outcomes and resource utilization to estimate neonatal costs attributable to maternal smoking during pregnancy. STUDY DESIGN: We use 1995 data from the Center for Disease Control's (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) database. The PRAMS collects representative samples of births from 13 states (Alabama, Alaska, California, Florida, Georgia, Indiana, Maine, Michigan, New York (excluding New York City), Oklahoma, South Carolina, Washington, and West Virginia), and the District of Columbia. The 1995 PRAMS sample is approximately 25 000. Multivariate analysis is used to estimate the relationship of smoking to probability of admission to an NICU and, separately, the length of stay for those admitted or not admitted to an NICU. Neonatal costs are predicted for infants 'as is' and 'as if' their mother did not smoke. The difference between these constitutes smoking attributable neonatal costs; this divided by total neonatal costs constitutes the smoking attributable fraction (SAF). We use data from the MarketScantrade mark database of the MedStattrade mark Corporation to attach average dollar amounts to NICU and non-NICU nursery nights and data from the 1997 birth certificates to extrapolate the SAFs and attributable expenses to all states. PRINCIPAL FINDINGS: The analysis showed that maternal smoking increased the relative risk of admission to an NICU by almost 20%. For infants admitted to the NICU, maternal smoking increased length of stay while for non- NICU infants it appeared to lower it. Over all births, however, smoking increased infant length of stay by 1.1%. NICU infants cost $2496 per night while in the NICU and $1796 while in a regular nursery compared to only $748 for non-NICU infants. The combination of the increased NICU use, longer stays and higher costs result in a positive smoking attributable fraction (SAF) for neonatal costs. The SAF across all states is 2.2%. Across the states, the SAF varied from a low of 1.3% in Texas to a high of 4.6% in Indiana. CONCLUSIONS: These results further confirm the adverse effects of smoking. Among mothers who smoke, smoking adds over $700 in neonatal costs. The smoking attributable neonatal costs in the US represent almost $367 million in 1996 dollars; these costs vary from less than a million in smaller states to over $35 million in California. These costs are highly preventable since the adverse effects of maternal smoking occur in the short-run and can be avoided by even a temporary cessation of maternal smoking. These cost estimates can be used by managed care plans, state and local public health officials and others to evaluate alternative smoking cessation programs.     

北京市高中生吸烟行为现状及家庭因素与吸烟关联的性别差异研究

目的 了解北京市高中生吸烟行为及家庭因素与吸烟关联的性别差异,为相关干预提供理论依据.方法 于2014年4-5月,采取分层整群随机抽样的方法,对北京市16669名高中生进行问卷调查.分性别采用x2检验和多因素Logistic回归法分析家庭因素与吸烟行为的关联.结果 北京市高中男女生尝试吸烟率分别为40.7％和20.6％...     

Parents' and friends' smoking status as predictors of smoking onset: findings from six European countries

This study assessed the relationship between the smoking behavior of adolescents and the smoking status of their parents and friends among adolescents from six European countries. A longitudinal study collected data from 15 705 adolescents on their own smoking status, and that of their parents, best friend and friends in general. Cross-sectional regression analysis showed that adolescent smoking was most strongly associated with friends' smoking and best friend's smoking, explaining 38% of the variance in the total sample. Longitudinal regression analysis, however, showed that the beta coefficients of the smoking status of the best friend and friends in general were comparable to that of parental smoking. Parental smoking behavior was found to be as predictive of smoking onset after 1 year as friends' smoking status.     

Contribution of deaths related to alcohol or smoking to the gender difference in life expectancy: Finland in the early 1990s

BACKGROUND: In comparison to most other countries in Western Europe, Finland ranks high with regard to male excess mortality. This study examined the contribution of smoking and alcohol to the gender difference in mortality in Finland during 1991-93 among the population aged 15 or over. METHODS: The study is based on data from linked registers. The number of alcohol-related deaths was assessed on the basis of information included in the death certificate, while the conventional method of population attributable fraction was applied to estimate the aggregated contribution of smoking. In combining the effects of alcohol and smoking, three alternative assumptions of their overlap were used. RESULTS: Approximately 51-56% of the gender difference of 7.6 years in the life expectancy at age 15 was estimated to be attributable to alcohol or smoking, depending on the assumption about the overlap of the contribution of alcohol and smoking. CONCLUSIONS: The study confirms the important role of alcohol and smoking as a mechanism contributing to the difference in mortality between men and women in Finland.