Social and Cultural Influences on Women’s Health 533second factor that may increase women•s distress when deal-
ing with multiple roles because those individuals who are
highly committed to a single role (i.e., job, parenthood)
are more likely to experience role strain than individuals who
are equally committed to multiple roles.
The disparity in research “ndings regarding the health ef-
fects of multiple roles highlights the need for clinicians and
researchers to further investigate the possible negative effects
that can be garnered by women who occupy multiple roles,
speci“cally with regard to physical and psychological health.
More research addressing additional personal and social re-
sources that can offset negative sequelae, as well as other
possible risk and protective factors, is warranted in individu-
als from diverse social groups (e.g., marital status, sexual
preference, SES), occupations, and ethnic-racial back-
grounds. Future research on multiple roles needs to focus not
only on the individual, but also on the effect socially con-
structed gender roles have in shaping society•s perception of
different roles, as well as the degree to which these gender
roles shape the attitudes and behaviors of women.
Sex Roles, Socialization, and Women’s Health
This section examines the ways the female sex role and so-
cialization process may contribute directly or indirectly to
women•s health. The etiology of the disorders and stressors
discussed suggests the role of society largely explains the
higher prevalence of these disorders among women.
Gender is a salient social category that helps individuals and
society understand and perceive the world (Beall, 1993). Unlike
biological sex, gender is in”uenced by the society in which the
individual lives, as different cultures have different gender
stereotypes that in”uence the way men and women are per-
ceived. Gender schema theory (Bem, 1981) proposes that soci-
ety classify the behaviors and attitudes of women and men into
•feminineŽand •masculineŽtraits, and that one•s self-concept is
assimilated to his or her gender schema. In most cultures, the dis-
tinction between male and female is clear, and individuals
are expected to behave in a way that is appropriate to their re-
spective sex role. In Western cultures, the traditional female sex
role has been characterized by traits of warmth and expressive-
ness while the traditional male sex role suggests traits of domi-
nance and instrumentality. The in”uence of this female sex role
has numerous direct and indirect consequences on the psycho-
logical and physical health of women. For example, the female
sex role and socialization process largely impact women•s de-
sire to be thin and may be a contributing factor to high rates of
eating disorders. American society tends to equate thinness with
attractiveness, especially for individuals in higher socioeco-
nomic brackets (Sokol & Gray, 1998). Women are judged by
their physical appearances more often than men (Sobal, 1995),
and it has been suggested that body weight and shape are the
primary factors in determining a woman•s attractiveness and de-
sirability (Polivy & McFarlane, 1998). In reality, the average
woman is not able to achieve these standards, which results in
feelings of low self-esteem, body dissatisfaction, and excessive
dieting (Heffernan, 1998). As discussed earlier, the impact of
societal expectations on mental and physical health is also
evident for women experiencing infertility as well as postpar-
tum depression.Coping and Women’s Expression of IllnessSeveral suggestions involving socialization have been of-
fered to explain gender discrepancy in morbidity and mortal-
ity. An older idea is that the •sick roleŽ is more in line with
women•s sex role stereotype of being a homemaker than to
men•s role of provider, and that this allows greater accep-
tance and opportunity for women to seek medical attention
for their illnesses (Nathanson, 1975). It also has been sug-
gested that sickness is a socially acceptable way for women
to be relieved of their household, caregiving, and employ-
ment responsibilities (Toner, 1994). An alternative explana-
tion is that women•s higher morbidity rates result from the
stress women experience occupying multiple roles (i.e., wife,
mother, paid employee), which in turn leads to higher rates of
illness (Reifman, Biernat, & Lang, 1991).
Equally important is how women cope with illness. In a
study of couples where one partner had been diagnosed with
cancer, Baider and colleagues (1996) attempted to further un-
derstand gender differences in coping with psychological dis-
tress. Their evaluation of 101 couples revealed that the wives
of male spouses with cancer reported signi“cantly higher
levels of anxiety than did female patients or their sick partners.
Interestingly, the distress experienced by female patients
was accounted for by degree of dif“culty in the domestic envi-
ronment, extended family relations, and their husband•s
psychological distress, with education having a protective ef-
fect. However, distress among male patients primarily was
accounted for by the degree of dif“culty in the domestic
environment. It is noteworthy that the psychological distress
experienced by the male patient contributed to the distress ex-
perienced by the female spouse; however, the psychological
distress of the female patient did not contribute to the male
spouse•s distress. These results suggest that the health behav-
iors and coping styles used by women may be explained by the
female social role that encourages women to focus on emo-
tional support, nurturance, and caring for others, as well as
care for oneself, while the male social role encourages con-
cern with instrumentality and problem solving. Nezu and