Gender 5531 in Iceland to 10 to 6 in Beijing, China (Jackson et al.,
1998). The fact that the differences between countries are
larger than the difference between the sexes suggests that
•male anatomy is not destiny,Ž at least in regard to CHD.
Additionally, the epidemic of cardiovascular disease among
Eastern European men has widened the gender gap in life
expectancy over a very brief time span, suggesting that non-
genetic factors play a role (Weidner, 1998; Weidner &
Mueller, 2000).
Behavioral Factors
Behavioral factors are involved in many of the major causes
of death. Speci“cally, cigarette smoking has been linked to
heart disease, lung cancer (the major form of malignant neo-
plasms), chronic obstructive pulmonary disease, and pneu-
monia. Excessive alcohol consumption increases the risk for
a number of diseases„foremost, heart and liver disease. Al-
cohol, along with lack of seat belt use, also plays a major role
in motor vehicle accidents. Other •accidental deaths,Ž such
as homicide and suicide, often involve “rearms. Overeating,
unhealthy diets, and lack of exercise (resulting in obesity)
contribute to almost all chronic diseases. In regard to obesity,
it appears that adverse health effects are primarily associated
with abdominal fat accumulation (Lapidus et al., 1988; Lars-
son et al., 1988).
Examining gender differences in these behaviors (with the
exception of overeating and exercise) favors women (Reddy
et al., 1992; Waldron, 1995). With regard to overeating
(quantity), the sexes appear to be similar. However, one con-
sequence of overeating, fat distribution, favors women; men
have a tendency to accumulate fat in the abdominal region
(becoming •apple-shapedŽ), whereas most women accumu-
late fat in a •pear-shapedŽ fashion. There seems to be some
evidence that men•s diets have a higher ratio of saturated- to
polyunsaturated fat and men have lower vitamin C intake
than women (Connor et al., in press; Waldron, 1995). This
ratio could contribute to men•s elevated risk for CHD and
cancers. The only gender difference favoring men consis-
tently appears to be exercise. However, this may be due to the
use of questionnaires designed for men, which focus on
sports and neglect physical activities associated with house-
work (Barrett-Connor, 1997).
Furthermore, stress may play a greater role for health-
damaging behaviors among men than among women. For
example, job strain appears to be associated with increases in
health-damaging behaviors (e.g., cigarette smoking, exces-
sive alcohol and coffee consumption, lack of exercise) among
men, but not among women (Weidner, Boughal, Connor,
Pieper, & Mendell, 1997). Thus, considering the major be-
haviors involved in many causes of death, women clearly fare
better than men.
Of the leading causes of death, the most information is
available for heart disease, which still ranks number one as
the cause of death in the United States, accounting for 31.4%
of total deaths in 1997 (National Vital Statistics Reports,
1999). To what extent gender differences in health behaviors
contribute to the observed gender difference in many of
the leading causes of death remains unclear. The study by
Jackson and colleagues (Jackson et al., 1998) sheds some
light on this question, at least in regard to the leading cause of
death, CHD. Based on their analyses of “ve major coronary
risk factors (elevated blood pressure, elevated cholesterol,
low HDL cholesterol, cigarette smoking, and obesity), the
authors conclude that 40% of the variation in the gender
ratios of CHD mortality in 24 countries could be explained
by gender differences in these “ve risk factors. While these
results underscore the importance of these factors for heart
disease and suggest that interventions aimed at reducing
levels of these risk factors in men would narrow the gender
gap in CHD mortality, they also point to other factors that
contribute to the gender gap.Psychosocial FactorsAlthough •otherŽ factors have not been investigated as much
as behavioral factors, evidence of adverse health effects is
accumulating for several psychosocial characteristics:
Hostility/anger, depression or vital exhaustion, lack of social
support, and work stress all have prospectively been linked to
premature mortality from all causes, although most studies
focus on heart disease mortality (Barefoot, Larsen, von der
Lieth, & Schroll, 1995; Cohen & Herbert, 1996; Hemingway
& Marmot, 1999; House et al., 1988; Miller, Smith, Turner,
Guijarro, & Haller, 1996; Rozanski, Blumenthal, & Kaplan,
1999; Schnall, Landsbergis, & Baker, 1994; Shumaker &
Czajkowski, 1994; Uchino, Cacioppo, & Kiecolt-Glaser,
1996; Weidner & Mueller, 2000).
Gender-speci“c associations of personality attributes
(Type A behavior, hostility), negative emotions (particularly
depression), and social support to heart disease have been
summarized previously (Orth-Gomer & Chesney, 1997;
Schwarzer & Rieckman, in press; Weidner, 1995; Weidner &
Mueller, 2000). Not only is the relationship of these risk fac-
tors to heart disease stronger in men than in women (e.g.,
Wulsin et al., 1999), but also women appear to be at an ad-
vantage when considering individual risk factor levels: They
score lower on coronary-prone behaviors such as Type A and
hostility than men. Both of these attributes are characteristics
of the male (•machoŽ) gender role, which has been linked to