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Influences of Gender and Social Class on Adolescents' Perceptions of Health

Influences of Gender and Social Class on Adolescents' Perceptions of Health Abstract Objective: To explore how gender and social class affect perceptions of health status among 16-year-old adolescents. Design: Cross-sectional survey. Setting: University psychology laboratory. Participants: Fifty upper-middle-class and 48 working-class adolescents stratified by gender. Main Outcome Measures: The general health perceptions (GHP) scale of the Medical Outcomes Survey 36-Item Short Form Health Survey (SF-36). The other self-reported health status domains and 3 measures of different aspects of psychological well-being were included as covariates in analysis of variance models. Results: Upper-middle-class females reported the lowest and upper-middle-class males the highest GHP (76.7 vs 88.4, P=.003). A multivariate regression model (adjusted R2=0.08) revealed significant gender (P=.03) differences in GHP, but not a social class effect, and an interaction effect between gender and class (P=.01). With addition of psychological well-being covariates (P<.001), gender remained significant (P=.04) and a significant portion of the interaction effect (P=.13) was explained. When the self-reported physical health status scales (P<.001) were added to the model (adjusted R2=0.51), gender remained significant (P=.03) and the interaction effect was partially explained (P=.07). Conclusions: Gender is a crucial factor in understanding the complex relationships between sociostructural inequalities and health differentials. These data suggest that psychological well-being and self-reported physical health status mediate the effects of gender and the gender and social class interaction in explaining variation in GHP. Contrary to the social class gradient hypothesis, upper-middle-class females reported the lowest GHP. These results suggest that the paradigms applicable to early childhood and adulthood may not be appropriate to understand the complex dynamics of adolescence.Arch Pediatr Adolesc Med. 1997;151:899-904 References 1. Amick BC, Levine S, Tarlov AR, Chapman Walsh DC, eds. Society and Health . New York, NY: Oxford University Press; 1995. 2. Evans RG, Barer ML, Marmor TR. Why Are Some People Healthy and Others Not? The Determinants of Health of Populations . New York, NY: Aldine De Gruyter; 1994. 3. Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the united states, 1960 and 1980 . New Engl J Med . 1993;329:103-109.Crossref 4. Marmot M, Bobak M, Smith GD. Explanations for social inequalities in health . In: Amick BC, Levine S, Tarlov AR. Chapman Walsh DC, eds. Society and Health . New York, NY: Oxford University Press; 1995:172-210. 5. Adler NE, Boyce T, Chesney MA, et al. Socioeconomic status and health: the challenge of the gradient . Am Psychol . 1994;49:15-24.Crossref 6. Singh GK, Yu SM. US childhood mortality, 1950 through 1993: trends and socioeconomic differentials . Am J Public Health . 1996;86:505-512.Crossref 7. Mare RD. Socioeconomic effects on child mortality in the United States . Am J Public Health . 1982;72:539-547.Crossref 8. Wise PH, Kotelchuck M, Wilson ML, Mills M. Racial and socioeconomic disparities in childhood mortality in Boston . New Engl J Med . 1982;313:360-366.Crossref 9. Tarlov AR. Social determinants of health: the sociobiological translation . In: Blaine D, Brunner EJ, Wilkinson RG, eds. Health and Social Organizations . London, England: Routledge Publishing; 1996:71-93. 10. West P. Inequalities? Social class differentials in health in British youth . Soc Sci Med . 1988;27:291.Crossref 11. West P, Macintyre S, Annadale E, Hunt K. Social class and health in youth: findings from the west of Scotland Twenty-07 study . Soc Sci Med . 1990;30:665-673.Crossref 12. Glendining A, Love JG, Hendry LB, Shucksmith J. Adolescence and health inequalities: extensions to Macintyre and West . Soc Sci Med . 1992;35:679-687.Crossref 13. West P. Health inequalities in the early years: is there equalization in youth? Soc Sci Med. In press. 14. Lowry R, Kann L, Collins J, Kolbe L. The effect of socioeconomic status on chronic disease behaviors among US adolescents . JAMA . 1996;276:792-797.Crossref 15. Rosenberg M, Pearlin L. Social class and self-esteem among children and adults . Am J Sociol . 1978;84:53-77.Crossref 16. Sweeting H, West P. Family life and health in adolescence: a role for culture in the health inequalities debate . Soc Sci Med . 1995;40:163-175.Crossref 17. Walsh DC, Sorensen G, Leonard L. Gender, health, and cigarette smoking . In: Amick BC, Levine S, Tarlov AR, Walsh DC, eds. Society and Health . New York, NY: Oxford University Press; 1995:131-171. 18. Krieger N. Social class and the black/white crossover in the age-specific incidence of breast cancer: a study linking census-derived data to population-based registry records . Am J Epidemiol . 1990;131:804-814. 19. Ware J, Sherbourne C. The MOS 36-Item Short Form Health Survey (SF-36), I: conceptual framework and item selection . Med Care . 1992;30:473.Crossref 20. Ware JE, Snow KS, Kosinski M, Gandek B. SF-36 Manual and Interpretation Guide . Boston, Mass: The Health Institute; 1993. 21. Scheier MF, Carver CS. Optimism, coping, and health: assessment and implications of generalized outcome expectancies . Health Psychol . 1985;4:219-247.Crossref 22. Pearlin L, Menaghan E, Lieberman A, Mullan J. The stress process . J Health Soc Behav . 1981;22:337-356.Crossref 23. Sherer M, Maddux J, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers R. The Self-Efficacy Scale: construction and validation . Psychol Rep . 1982;51:663-671.Crossref 24. Norusis MJ. SPSS for Windows Base System User's Guide Release 6.0. Chicago, III: SPSS Inc; 1993. 25. Macintyre S, Hunt K, Sweeting H. Gender differences in health: are things really as simple as they seem? Soc Sci Med . 1996;42:617-624.Crossref 26. Macintyre S, West P. Lack of class variation in health in adolescence: an artefact of an occupational measure of class . Soc Sci Med . 1991;30:665-673. 27. Ren XS, Amick BC. Race and self assessed health status: the role of socioeconomic factors in the United States . J Epidemiol Commun Health . 1996;50:269-273.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

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References (27)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1997.02170460037006
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To explore how gender and social class affect perceptions of health status among 16-year-old adolescents. Design: Cross-sectional survey. Setting: University psychology laboratory. Participants: Fifty upper-middle-class and 48 working-class adolescents stratified by gender. Main Outcome Measures: The general health perceptions (GHP) scale of the Medical Outcomes Survey 36-Item Short Form Health Survey (SF-36). The other self-reported health status domains and 3 measures of different aspects of psychological well-being were included as covariates in analysis of variance models. Results: Upper-middle-class females reported the lowest and upper-middle-class males the highest GHP (76.7 vs 88.4, P=.003). A multivariate regression model (adjusted R2=0.08) revealed significant gender (P=.03) differences in GHP, but not a social class effect, and an interaction effect between gender and class (P=.01). With addition of psychological well-being covariates (P<.001), gender remained significant (P=.04) and a significant portion of the interaction effect (P=.13) was explained. When the self-reported physical health status scales (P<.001) were added to the model (adjusted R2=0.51), gender remained significant (P=.03) and the interaction effect was partially explained (P=.07). Conclusions: Gender is a crucial factor in understanding the complex relationships between sociostructural inequalities and health differentials. These data suggest that psychological well-being and self-reported physical health status mediate the effects of gender and the gender and social class interaction in explaining variation in GHP. Contrary to the social class gradient hypothesis, upper-middle-class females reported the lowest GHP. These results suggest that the paradigms applicable to early childhood and adulthood may not be appropriate to understand the complex dynamics of adolescence.Arch Pediatr Adolesc Med. 1997;151:899-904 References 1. Amick BC, Levine S, Tarlov AR, Chapman Walsh DC, eds. Society and Health . New York, NY: Oxford University Press; 1995. 2. Evans RG, Barer ML, Marmor TR. Why Are Some People Healthy and Others Not? The Determinants of Health of Populations . New York, NY: Aldine De Gruyter; 1994. 3. Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the united states, 1960 and 1980 . New Engl J Med . 1993;329:103-109.Crossref 4. Marmot M, Bobak M, Smith GD. Explanations for social inequalities in health . In: Amick BC, Levine S, Tarlov AR. Chapman Walsh DC, eds. Society and Health . New York, NY: Oxford University Press; 1995:172-210. 5. Adler NE, Boyce T, Chesney MA, et al. Socioeconomic status and health: the challenge of the gradient . Am Psychol . 1994;49:15-24.Crossref 6. Singh GK, Yu SM. US childhood mortality, 1950 through 1993: trends and socioeconomic differentials . Am J Public Health . 1996;86:505-512.Crossref 7. Mare RD. Socioeconomic effects on child mortality in the United States . Am J Public Health . 1982;72:539-547.Crossref 8. Wise PH, Kotelchuck M, Wilson ML, Mills M. Racial and socioeconomic disparities in childhood mortality in Boston . New Engl J Med . 1982;313:360-366.Crossref 9. Tarlov AR. Social determinants of health: the sociobiological translation . In: Blaine D, Brunner EJ, Wilkinson RG, eds. Health and Social Organizations . London, England: Routledge Publishing; 1996:71-93. 10. West P. Inequalities? Social class differentials in health in British youth . Soc Sci Med . 1988;27:291.Crossref 11. West P, Macintyre S, Annadale E, Hunt K. Social class and health in youth: findings from the west of Scotland Twenty-07 study . Soc Sci Med . 1990;30:665-673.Crossref 12. Glendining A, Love JG, Hendry LB, Shucksmith J. Adolescence and health inequalities: extensions to Macintyre and West . Soc Sci Med . 1992;35:679-687.Crossref 13. West P. Health inequalities in the early years: is there equalization in youth? Soc Sci Med. In press. 14. Lowry R, Kann L, Collins J, Kolbe L. The effect of socioeconomic status on chronic disease behaviors among US adolescents . JAMA . 1996;276:792-797.Crossref 15. Rosenberg M, Pearlin L. Social class and self-esteem among children and adults . Am J Sociol . 1978;84:53-77.Crossref 16. Sweeting H, West P. Family life and health in adolescence: a role for culture in the health inequalities debate . Soc Sci Med . 1995;40:163-175.Crossref 17. Walsh DC, Sorensen G, Leonard L. Gender, health, and cigarette smoking . In: Amick BC, Levine S, Tarlov AR, Walsh DC, eds. Society and Health . New York, NY: Oxford University Press; 1995:131-171. 18. Krieger N. Social class and the black/white crossover in the age-specific incidence of breast cancer: a study linking census-derived data to population-based registry records . Am J Epidemiol . 1990;131:804-814. 19. Ware J, Sherbourne C. The MOS 36-Item Short Form Health Survey (SF-36), I: conceptual framework and item selection . Med Care . 1992;30:473.Crossref 20. Ware JE, Snow KS, Kosinski M, Gandek B. SF-36 Manual and Interpretation Guide . Boston, Mass: The Health Institute; 1993. 21. Scheier MF, Carver CS. Optimism, coping, and health: assessment and implications of generalized outcome expectancies . Health Psychol . 1985;4:219-247.Crossref 22. Pearlin L, Menaghan E, Lieberman A, Mullan J. The stress process . J Health Soc Behav . 1981;22:337-356.Crossref 23. Sherer M, Maddux J, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers R. The Self-Efficacy Scale: construction and validation . Psychol Rep . 1982;51:663-671.Crossref 24. Norusis MJ. SPSS for Windows Base System User's Guide Release 6.0. Chicago, III: SPSS Inc; 1993. 25. Macintyre S, Hunt K, Sweeting H. Gender differences in health: are things really as simple as they seem? Soc Sci Med . 1996;42:617-624.Crossref 26. Macintyre S, West P. Lack of class variation in health in adolescence: an artefact of an occupational measure of class . Soc Sci Med . 1991;30:665-673. 27. Ren XS, Amick BC. Race and self assessed health status: the role of socioeconomic factors in the United States . J Epidemiol Commun Health . 1996;50:269-273.Crossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Sep 1, 1997

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