554 Cultural Aspects of Health Psychology
behavioral risk factors, such as smoking, excessive alcohol
consumption, and lack of seat belt use (Waldron, 1997), as
well as decreased motivation to learn stress management
skills (Sieverding, in press).
Additionally, women not only report more social support
than men, but also have more sources of social support, thus
decreasing their dependency on a single source. For example,
studies of middle-age people in Massachusetts found that
men were more than twice as likely as women to name their
spouse (or their partner) as their primary provider of social
support (65.5% versus 26.4%). Furthermore, 24.2% of men
(but only 6.1% of women) said this was their only source of
support (New England Research Institutes, 1997). These data
may, in part, explain why men•s health is more seriously
affected by partner loss through separation, divorce, or wid-
owhood (Miller & Wortman, in press).
At “rst glance, gender dif ferences in negative emotions
appear to favor men. In most studies, women report more
negative emotions such as depression than men (although
this is not consistently found in populations where women
and men have similar roles, such as college students; Nolen-
Hoeksema & Girgus, 1994). Although women may report
more depression, they may be coping more effectively than
men. Generally, men are more likely to use avoidant coping
strategies, such as denial and distraction, whereas women
are more likely to employ vigilant coping strategies, paying
attention to the stressor and its psychological and somatic
consequences (Weidner & Collins, 1993). Which style is
more adaptive depends largely on the situation. Most stress-
ful experiences consist of uncontrollable daily hassles,
which are short-lived and typically of no great consequence.
Here avoidant strategies would be more adaptive (•What I
cannot control and what can•t hurt me is best to be ignoredŽ).
Thus, men•s strategies are likely to pay off for these types of
events, contributing to their lesser experience (or report) of
emotional discomfort or distress. But what if disaster hits?
How do people cope with uncontrollable events requiring
long-term adaptation, such as divorce, loss of a loved one,
job loss, sudden “nancial crisis, and economic uncertainty?
Here it may be women•s greater vigilance that is more adap-
tive: preparing for the crisis, seeking help, advice, and so on.
Consistent with this reasoning are data from the Hungarian
population that show that women tend to accept their nega-
tive mood as a disorder to be treated, whereas men are more
likely to engage in self-destructive behavior, such as exces-
sive alcohol consumption (Kopp, Skrabski, & Székely, in
press).
Similarly, research on how people cope with disasters
(e.g., hurricanes and tornadoes) supports the notion of men•s
maladaptive coping: Increases in alcohol consumption and
depression were related to personal disaster exposure among
men, whereas no such direct relationship was evident among
women (Solomon, Smith, Robins, & Fishbach, 1987;
Solomon, in press). Furthermore, socioeconomic deprivation
appears to be more closely related to depression in men than
in women (Kopp et al., 1988). Thus, men•s psychosocial risk
factor pro“le appears to further contribute to their enhanced
health risk.Biobehavioral FactorsSupport for the notions that psychosocial and behavioral fac-
tors affect and are affected by biological processes that di-
rectly in”uence health and illness has been increasing during
the past decade (Baum & Posluszny, 1999). For example, ex-
posure to stress can lead to enhanced cardiovascular arousal
that has been shown to predict cardiovascular disease, at least
in men (for review, see Weidner & Messina, 1998). In labora-
tory studies, men appear to be hyperreactive (e.g., they show
exaggerated cardiovascular reactivity) to a wider range of
environmental stressors than women. On the other hand,
there is some evidence that men bene“t more from social
support (i.e., decreased cortisol response to stress) provided
by their partner than do women (Kirschbaum, Klauer, Filipp,
& Hellhammer, 1995; also see Orth-Gomer & Chesney,
1997). This “nding is consistent with (and may even explain)
the fact that marriage has much greater health bene“ts for
men than for women.
Psychosocial factors, such as stress, affect not only car-
diovascular and endocrine responses, but also reactions of the
immune system. While there is consistent evidence to sug-
gest gender differences in immune function (e.g., women
have higher antibody levels, higher rates of graft rejection,
higher rates of autoimmune diseases, lesser vulnerability to
infectious diseases), few studies have found gender differ-
ences in stress-related immune changes (Glaser & Kiecolt-
Glaser, 1996).
Last, health behaviors such as smoking and alcohol con-
sumption may have different biological consequences for
men than for women. For example, men metabolize nicotine
more rapidly than women and may require higher nicotine in-
take to maintain similar plasma nicotine levels (Waldron,
1997). Similarly, the cardioprotective effects of moderate al-
cohol consumption on high-density lipoprotein cholesterol
levels appear to occur at higher doses of alcohol in men than
in women (Weidner et al., 1991).Gender, Treatment, and Prevention ApproachesGender differences in behavioral, psychosocial, and biobe-
havioral risk factors are likely contributors to the gender gap
in several major causes of death. Although our understanding