552 Cultural Aspects of Health Psychology
(e) addressing the effect of acculturation in shaping attitudes
and expectancies (particularly among Hispanics; Ahluwalia,
Resnicow, & Clark, 1998; DHHS, 1998; Klonoff & Landrine,
1999).
Physical Activity Interventions
A review of the literature suggests that there are relatively few
studies of physical activity interventions for minorities
(Stone, McKenzie, Welk, & Booth, 1998). Of these results,
several document programs that signi“cantly increase the aer-
obic “tness with a moderate exercise training regimen and are
culturally appropriate (for review, see Duey et al., 1998). In
studies of barriers to physical activity among minorities, the
most common environmental barriers included safety, avail-
ability, cost, transportation, child care, lack of time, health
concerns, lack of motivation, and an exercise environment
that includes Blacks (Carter-Nolan, Adams-Campbell, &
Williams, 1996; Eyler et al., 1998; Jones & Nies, 1996). The
social dimension of the planned activity may be as important
as the selection of activities. Research in this area suggests
that community-based exercise programs that are speci“c
to African Americans are needed (Jones & Nies, 1996).
So, the challenge is to create culturally appropriate physical
activity programs (D. Clark, 1997). Data from adolescents
suggest that there is need for speci“city in the selection of
physical activities (Sallis et al., 1996). For example, swim-
ming is not seen as a viable activity among African Americans
because of the effect of water and chlorine on their hair.
A review of the literature on physical activity in African
Americans suggests that greater attention is needed in the
development of culturally appropriate instruments. These in-
struments should include well-de“ned, inof fensive terminol-
ogy, and increase the recall of unstructured and intermittent
physical activities (Tortolero, Masse, Fulton, Torres, & Kohl,
1999).
Dietary Interventions
Given the high rates of obesity among minority populations,
particularly minority women, and the consequences for
chronic illness, dietary interventions are critical to improving
the health of ethnic minorities. A realistic diet plan should be
based on individual needs, economic status, availability of
food, likes and dislikes, lifestyle, and family dynamics (Kaul
& Nidiry, 1999). Two critical components to successful
dietary intervention among minority populations are individ-
ualized diets and sensitivity to food preferences (Kaul &
Nidiry, 1999). In addition to nutrition education, the develop-
ment of exercise and behavior modi“cation related to food
intake must also be taught in dietary interventions.
GENDEROne universal inequity that cuts across both ethnic and socioe-
conomic class lines is the gender gap in life expectancy. On
average, men die seven years earlier than women (National
Vital Statistics Reports, 1999). Almost all of the 10 leading
causes of death for the entire population in 1997 show men to
be at greater risk than women. That is, the male-to-female ra-
tios of age-adjusted death rates exceeded 1.3 for the number
one killer, diseases of the heart (ratio1.8), followed by ma-
lignant neoplasms (ratio1.4), chronic obstructive pul-
monary diseases and allied conditions (ratio1.5), accidents
(ratio2.4), pneumonia and in”uenza (ratio1.5), suicides
(ratio4.2), kidney diseases (ratio1.5), and chronic liver
disease and cirrhosis (ratio2.3; National Vital Statistics
Reports, 1999). These causes of mortality accounted for
70.7% of deaths among men and women in the United States
in 1997. It should be noted that very large male-to-female ra-
tios were recorded for homicide and HIV infection (3.8 and
3.5, respectively). However, deaths due to these causes ranked
13 and 14 among the leading 15 causes of death for the popu-
lation in 1997, each accounting for only 0.7% of total deaths
(National Vital Statistics Reports, 1999). Several factors
might account for the gender gap in life expectancy. These can
be grouped into four categories: biological, behavioral, psy-
chosocial, and biobehavioral.Biological FactorsIn her now-classic papers dealing with the question, •Why
do women live longer than men?Ž Waldron concludes that
•physiological dif ferences have not been shown to make any
substantial contribution to higher male death ratesŽ (Wal-
dron & Johnston, 1976, p. 23; also see Waldron, 1976). This
conclusion has not changed much over the past decades.
Although men•s greater vulnerability to infectious diseases
(attributed in part to lower levels of serum level of im-
munoglobulin M [IgM]) is a probable contributor to the
greater male mortality in several of the leading causes of
death, gender differences in IgM are present only between
the ages of 5 and 65 (Reddy, Fleming, & Adesso, 1992).
However, males still have higher rates of infectious diseases
than females before and after these age markers (Reddy
et al., 1992). Even the role of estrogens in the protection from
heart disease among women has been questioned (Barrett-
Connor, 1997; Barrett-Connor & Stuenkel, 1999). Further-
more, international data on coronary heart disease (CHD)
mortality from 46 communities in 24 countries show that al-
though CHD mortality rates in women are less than male
rates, male-to-female ratios vary widely, ranging from 10 to