The Impactof Gender Roleson Health

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The Impact of Gender Roles on Health
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a a
María del Pilar Sánchez–López , Isabel Cuellar–Flores & Virginia
b
Dresch
a
Universidad Complutense de Madrid, Research Group Psychological
Styles, Gender, and Health , Madrid , Spain
b
Universidade Federal Fluminense, Departamento de Psicologia ,
Niteroi , Brazil
Accepted author version posted online: 17 Jan 2012.Published
online: 29 Mar 2012.
To cite this article: María del Pilar Sánchez–López , Isabel Cuellar–Flores & Virginia Dresch
(2012) The Impact of Gender Roles on Health, Women & Health, 52:2, 182-196, DOI:
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Women & Health, 52:182–196, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 0363-0242 print/1541-0331 online
DOI: 10.1080/03630242.2011.652352
MARÍA DEL PILAR SÁNCHEZ–LÓPEZ, PhD

and ISABEL CUELLAR–FLORES, PhD candidate
Universidad Complutense de Madrid, Research Group Psychological Styles, Gender,
Downloaded by [Biblioteca Universidad Complutense de Madrid] at 00:57 22 January 2014
and Health, Madrid, Spain
VIRGINIA DRESCH, PhD

Universidade Federal Fluminense, Departamento de Psicologia, Niteroi, Brazil
The present research focused on a sample of Spanish undergrad-

uate women and men to evaluate whether gender was related to
substance use and chronic illness. This research examined the as-
sociations of conformity to masculine norms for men and confor-
mity to feminine norms for women with substance use in chronic
illnesses. Spanish male (n D 226) and female (n D 234) college
undergraduates completed measures of chronic diseases, alcohol
and tobacco consumption, and conformity to gender norms. Mul-
tivariable regression analyses demonstrated that being female was
related to lower alcohol and cigarette consumption but a greater
rate of chronic illnesses. Although masculinity did not explain the
rate of chronic illnesses, specific feminine and masculine gender
norms were related to alcohol and tobacco use and prevalence
of chronic diseases. The present study provides insights for further
cross-cultural psychological studies on the mediating effect of self-
reported conformity to gender norms (rather than only sex) on
health. Limitations and implications are discussed.
KEYWORDS gender norms, gender and health, femininity, mas-

culinity, sex differences
INTRODUCTION
Health studies of men and women have revealed differences in morbidity

and mortality. Specifically, although women have poorer physical health and
Received September 22, 2011; revised December 13, 2011; accepted December 17, 2011.
Address correspondence to Virginia Dresch, PhD, Universidade Federal Fluminense,
Departamento de Psicologia, Bloco O. CEP: 24.250–310, Niteroi (Rio de Janeiro), Brazil. E-mail:
virginiadresch@vm.uff.br
182
The Impact of Gender Roles on Health 183
higher rates of chronic disease and disability than men (Case & Paxson, 2005;
Kirchengast & Haslinger, 2008), life expectancy of men is shorter than that
of women (Arias et al., 2003). In Spain, as in other countries, women have
poorer self-perceived physical health and a higher prevalence, for example,
of diabetes and diseases of the musculoskeletal system (INE, 2006), but the
life expectancy of men is shorter than that of women (INE, 2005). Such
findings are the crux of the traditional morbidity–mortality paradox: the fact
that women live longer than men do, but their health is worse. While most
studies of health and health-related behaviors have focused on the similarities
and differences between men and women, this study explored the relation
of gender norms of masculinity and femininity to health and health-related
behaviors.
Biological differences between men and women have not been demon-
strated to account fully for gender differences in health. Therefore, psy-
chosocial factors may play an important role by creating, maintaining, or
reinforcing biological sex differences in health (Bird & Rieker, 2008; Terua
et al., 2010). A sizeable portion of the higher mortality in men than in
women may be linked to a greater number of health-risk behaviors, such
as the consumption of unhealthy substances or lower health care utilization
(Courtenay, 1998). In particular, men of all ages are more likely to engage in
alcohol and tobacco consumption (Hudd et al., 2000; WHO, 2002b, 2004).
In contrast, the excessive morbidity of women has been attributed to dif-
ferent health-reporting behaviors or different health knowledge compared
with men. Women record health behaviors less adequately (Case & Deaton,
2003), and they report more symptoms and chronic illnesses that result in
poorer health but contribute relatively little to mortality risk (Molarius &
Janson, 2002; Spiers et al., 2003). In Spain, women of all ages report poorer
self-perceived health and more chronic diseases than men do (INE, 2006;
Rodríguez–Sanz, Carrillo, & Borrel, 2006). Although previous explanations
potentially account for the sex differences in morbidity and mortality ob-
served in the data (Sánchez–López et al., 2008), they do not address why men
and women have different distributions of health behaviors and conditions.
For example, these explanations do not explain why men are more likely
to engage in riskier health behavior or why women tend to report more
chronic illnesses and symptoms than men do. Moreover, they do not facilitate
the detection and explanation of intragroup differences among women and
among men (Mahalik, Levi–Minzi, & Walker, 2007).
Few research studies have examined the relationships between feminin-
ity or masculinity and health in Spain. Only Matud and Aguilera (2009) and
Pérez–Blasco and Serra (1995) have analyzed femininity and psychological
health. The authors believe it is likely that conformity to gender norms has a
significant relation to Spanish men’s and women’s physical health and health-
related behaviors. On the one hand, the Spanish population shares many
traditional gender norms with the United States, as demonstrated by studies
184 M. P. Sánchez–López et al.
that use U.S. femininity and masculinity inventories in Spain (e.g., García–
Vega, Fernández–García, & Rico–Fernández, 2005). Studies have adapted
the Conformity to Feminine Norms Inventory—CFNI (Mahalik et al., 2003)
and the Conformity to Masculine Norms Inventory—CMNI (Mahalik et al.,
2005) to Spanish adults (Sánchez–López et al., 2009; Cuéllar–Flores, Sánchez–
López, & Dresch, 2011), indicating similarities in the gender ideologies of
these cultures. Moreover, both U.S. and Spanish cultures demonstrate differ-
ences between women and men in health conditions and health behaviors,
and constructions of gender roles appear to be connected to differential
health risks in Spanish males and females (Rohlfs, Borrell, & Fonseca, 2000;
Velasco, 2009).
Consequently, the purpose of this research was twofold: (1) To eval-
uate gender differences in chronic illness and substance use. Based on
previously discussed research on differences in chronic illnesses and health-
related behaviors in men and women (INE, 2006; Rodríguez-Sánchez, Car-
rillo, & Borrell, 2006; WHO, 2002a, 2002b), the authors first hypothesized
that men would report higher rates of smoking and alcohol consumption and
lower rates of chronic illnesses than women (Hypothesis 1). (2) To evaluate
the associations of conformity to masculine norms for men and conformity
to feminine norms for women with rates of reported chronic illness and
substance use. Given previous findings relating traditional masculinity and
femininity to substance use (Mahalik, Burns, & Sydez, 2007; Mahalik, Levi–
Minzi, & Walter, 2007; Liu & Iwamoto, 2007), the authors hypothesized that
masculinity in men would explain the greater rates of smoking and alcohol
consumption (Hypothesis 2), and femininity in women would explain the
lower frequency of tobacco and alcohol consumption observed (Hypothesis
3). The relationship between femininity and masculinity and health status
was explored. Based on the normative data for males and females, mas-
culinity was anticipated to be related to lower rates of chronic diseases
(Hypothesis 4) and femininity was expected to be related to greater rates
of chronic illnesses (Hypothesis 5).
METHOD
Participants
The study sample comprised 460 university students, of whom 226 were men
and 234 were women, living in Madrid, Spain. The participants were recruited
using two approaches. Male and female students, mostly in their third year of
school, were recruited from three different psychology degree classes. These
participants were then asked to contact another student in any university
course, and the interested students who met the inclusion criteria (female
and male university students aged 18 years or over) received questionnaire
packets to complete and return to the researcher. Ninety percent of the

university students who were approached agreed to participate, and all of
these students were eligible. Ninety percent of the eligible students agreed
to continue participating in the study after completing the recruitment and
informed consent process.
Instruments
HEALTH DATA
To assess health status and health-related behaviors, questions were included

about the ‘‘number of cigarettes smoked/day’’ and ‘‘frequency of alcohol
consumption’’ (which asked participants how often six types of alcoholic
drinks were consumed, from zero D ‘‘not consumed,’’ to 3 D ‘‘consumed
during the week and weekend ’’) and the absence or presence of 28 diseases
(e.g., varicose veins, mental disorder, asthma, etc.). The questions were taken
from the National Health Survey (INE, 2006).
CONFORMITY TO GENDER NORMS
Responses to the CFNI (Mahalik et al., 2005) for women and the CMNI
for men were used and had a 4-point scale (0 D strongly disagree to 3 D
strongly agree) for each question. The statements of the CMNI are designed to
measure attitudes, beliefs, and behaviors that reflect conformity or noncon-
formity to 11 subscales associated with masculine gender roles. The CFNI
has 8 subscales of feminine norms that measure various attitudes, beliefs,
and behaviors associated with feminine gender roles, both traditional and
non-traditional. The Spanish versions of the CMNI (Cuéllar–Flores, Sánchez–
López, & Dresch, 2011) and the CFNI (Sánchez–López et al., 2009) have been
demonstrated to have satisfactory psychometric properties.
Procedure
This study obtained approval from the institutional review board of the Uni-
versidad Complutense de Madrid, Spain. All participants were invited to take
part in the study following a short description of the nature of the study (i.e.,
‘‘to better understand people’s health’’), and all participants gave (written and
signed) informed consent after the researchers explained the purpose of the
investigation, provided a description of the procedures of the study and
alternatives to participation, guaranteed participants’ freedom to withdraw
from any part of the study without consequences, and described the risks
and benefits of participating in the study. The anonymity of their data was
guaranteed, and the students were asked to be as honest as possible.
The participants took approximately 30 minutes to complete the mate-
rials at a pre-established place and time and returned the materials to the
researchers. All participants completed the health data. To measure confor-

mity to gender norms, the women completed only the CFNI, and the men
completed only the CMNI. No participants were rewarded for completing
the survey materials.
Data Analyses
Preliminary analyses comparing the ages of women and men, marital status,
and employment situation indicated statistically significant (p < 0.05) differ-
ences in age between the sexes. Therefore, age was included as a covariable.
The F-test served to assess model adequacy and 2 was used to assess the
effect size of the differences. Second, simple linear regression analyses were
performed by transforming male or female to a dummy variable (women D 0;
men D 1). Being male or female was introduced as an explanatory variable
while alcohol and cigarette consumption and rate of chronic illnesses as
dependent variables. R2 statistic and the F-test were used to assess the
fit of the models. Significance was set at p < .05. To test whether men
reported greater alcohol and cigarette consumption and less chronic illness
than women (Hypothesis 1), two sets of analyses were conducted. First, a
one-way multivariate analysis of covariance (MANCOVA) was performed,
with male or female as the independent variable and health variables as
dependent variables.
Second, linear regression analyses were performed by transforming male
or female to a dummy variable (women D 0; men D 1). Multiple linear
regression analyses by steps were used to test the hypothesis that greater
conformity to masculine norms was related to higher rates of smoking and
alcohol consumption (Hypothesis 2) and lower rates of chronic illnesses
in men (Hypothesis 4), whereas greater conformity to feminine norms was
related to lower rates of smoking and alcohol consumption (Hypothesis 3)
and a greater rate of chronic illnesses in women (Hypothesis 5). All subscales
of the CMNI or the CFNI as well as the total scores were introduced as
independent variables in separate analyses for men and women, respectively.
Both inventories are independent, and their subscales measure particular
masculine and feminine norms that do not overlap and are gender-specific.
In the subsamples of men and of women, the crude association between the
series of CMNI or CFNI variables (variables with p < 0.05 in the univariate lin-
ear regression analyses) and health indexes were determined. Subsequently,
the adjusted association by means of multiple linear regression analyses was
determined. Stepwise linear regression was conducted to determine the best
set of gender variables related to health status. The R2 statistic was used to
study the goodness of fit and the F-test for the overall fit of the regression
models. Variables with p < 0.10 in the multiple analyses were included in
the stepwise regression analyses. A value of p < 0.05 was used to retain the
variables in the final model.
TABLE 1 Sociodemographic Characteristics of the Participants
Statistic
Women (n D 234) Men (n D 226) (p values)
Age Age t D 5.11(***)

Mean (SD) D 21.35 (1.97) years Mean (SD) D 22.5 (2.62) years
Range D 18–29 years Range D 18–30 years
Marital status Marital status 2 D 0.00 (n.s)
92.7% single 92.9% single
6.8% de facto marriage 6.7% de facto marriage
0.4% married 0.4% married
Employment Employment 2 D 4.40 (n.s)

46.6% not working 38.6% not working
31.2% sporadic work 31.4% sporadic work
22.2% regular work 30% regular work
University major University Major 2 D 175.59(***)
72.6% psychology 23.5% psychology
9% physiotherapy 11.1% economics
7 % economics 6.2% computer science
11.4% Other: architecture, 5.8% physiotherapy
business administration and 53.4% Other: architecture, politics,
management. other engineering
Note. ***p .001, ns D not significant.
RESULTS
The mean age of the women was 21.35 years (SD D 1.97) and the mean
age of the men was 22.50 years (SD D 2.62). Men and women only differed
significantly with regard to age and degree course (Table 1). The distributions
of marital status (single, de facto marriage, and marriage) and employment
(not working, sporadic work, and regular work) were the same for women
and men.
More men consumed cigarettes and drank more alcohol per day and
but fewer reported chronic illnesses than women (see Table 2). According
to Cohen’s (1988) guidelines, the magnitude of these differences was small
to moderate. In support of Hypothesis 1, compared with being female, being
TABLE 2 Means and Standard Deviations of Health Variables, MANCOVA Results and Effect
Size of the Differences
Women Men
(n D 234) (n D 226) 2
Mean (SD) Mean (SD) F (effect size)
Number of cigarettes/day 2.54 (5.48) 3.63 (7.10) 4.49* .02 (low)

Frequency of alcohol consumption/week 2.49 (2.16) 3.65 (3.19) 11.5*** .05 (low)
Total number of diseases 2.25 (1.87) 1.09 (1.33) 31.08*** .13 (medium)
Note.* p .05. ***p .01. Effect sizes are generally defined as small (r D .01–06) and medium (r D .6–
.14).
male was related to greater consumption of alcohol (F D 19.50; p < .001)

and cigarettes (F D 6.62; p < .05) and lower rates of chronic diseases (F D
49.07; p < .001) and explained between 1% and 9% of variance (Table 3).
Some masculinity norms (dominant and playboy) were directly corre-
lated with alcohol consumption, and disdain for homosexuality was inversely
related to tobacco use (Table 4). The effect sizes were small. Several feminine
norms (romantic relationship, sexual fidelity, and total score) were inversely
correlated with alcohol and cigarette consumption: investment in appearance
was inversely related to tobacco consumption, and domesticity was directly
correlated with chronic diseases. The effect sizes were small to medium.
The multivariable regression models indicated significant gender differ-
ences for all health variables except for the number of reported diseases
being lower in men. All variables included in each of the models met the
assumption of non-multicollinearity (that is, tolerance values higher than
.80). Consistent with Hypothesis 2, conformity to two of the three significant
masculine norms was related to greater frequency of alcohol consumption in
men, whereas one of the two masculine norms that was related to cigarette
consumption was positively related to the dependent variable (Table 5).
The playboy subscale was related to greater alcohol consumption, whereas
the winning and dominant subscales were associated with lower alcohol
use and explained 7% of the variance (F D 7.28; p < .001). Disdain for
homosexuals explained lower tobacco consumption, whereas primacy of
work was associated with greater consumption of cigarettes; the two scales
explained 4% of the variance (F D 4.68; p < .05). The results were not
consistent with Hypothesis 3, and none of the masculine norms were related
to reporting chronic diseases.
Consistent with Hypothesis 4, conformity to the feminine norms ro-
mantic relationship and sexual fidelity were associated with lower alcohol
consumption and explained 13% of the variance in women (F D 19.61;
p < .001) (Table 6). Investment in appearance, sexual fidelity, and romantic
relationship were related to lower consumption of cigarettes per day and
TABLE 3 Unadjusted Regression Analyses: Relation of Sex to

Health Variables
Frequency of alcohol consumption/week

ˇ R2 B SE df F
.20 .04 1.13 .25 459 19.50***
Number of cigarettes/day
ˇ R2 B SE df F
.11 .01 1.51 .59 459 6.62*
Total number of diseases
ˇ R2 B SE df F
.31 .09 1.07 .15 459 49.07***
Note. N D 460. *p .05. **p .01. ***p .001. Gender was coded
as female D 0, male D 1.
TABLE 4 Means and Standard Deviations of Health Variables and Pearson’s Correlations with
Conformity to Feminine and Masculine Norms in Women and Men, Respectively
Pearson’s Correlations
Frequency
Number of of alcohol
cigarettes/ consumption/ Total number
Mean (SD) day week of diseases
Men (n D 226)
1. Winning 14.84 (4.47)
2. Emotional control 14.53 (5.20)

3. Risk-taking 15.90 (3.82)
4. Violence 9.47 (4.30)
5. Power over women 7.36 (4.15)
6. Dominant 5.84 (1.86) .138*
7. Playboy 13.29 (6.07) .199**
8. Self-reliance 6.76 (3.00)
9. Primacy of work 8.15 (3.08)
10. Disdain for homosexuality 12.96 (5.79) .152*
11. Pursuit of status 10.64 (2.40)
TOTAL (Range D 51–208) 119.77 (24.18)
Women (n D 234)
1. Nice in relationships 37.45 (5.51)
2. Thinness 21.52 (6.38)
3. Modesty 15.20 (6.58)
4. Domestic 14.94 (5.12) .135*
5. Care for children 12.92 (3.14)
6. Romantic relationship 13.77 (3.58) .195** .331**
7. Sexual fidelity 15.36 (3.42) .210** .277**
8. Invest in appearance 12.46 (3.30) .236**
TOTAL (Range D 80–188) 143.66 (16.39) .165* .244**
Note. *p D .05. **p D .01. Effect sizes are generally defined as small (r D .1), medium (r D .3), and large
(r D .5).
explained 10% of the variance (F D 9.12; p < .001). Furthermore, supporting

Hypothesis 5, conformity to the gender norm domesticity was associated with
greater reporting of chronic diseases and explained 1% of variance (F D 4.33;
p < .05).
DISCUSSION
The results of the comparisons between women and men in this study were
in accordance with the prior literature on differences in health conditions and
health behaviors (Case & Deaton, 2003; Case & Paxson, 2005; Hudd et al.,
2000; WHO, 2002b, 2004), including in Spain (INE, 2002, 2006; Rodríguez-
Sánz, Carrillo, & Borrell, 2006), and supported the first hypothesis: more
men reported more smoking and alcohol consumption and fewer reported
chronic illnesses compared to women. However, the magnitude of the dif-
TABLE 5 Multivariable Regression Analyses: Relation of Men’s Health to Conformity to

Masculine Norms
Step ˇ R2 R2 B SE df F
1 Playboy .19 .04 .04 .10 .03 224 9.22**

2 Playboy C .24 .06 .03 .12 .03 223 8.28***
Winning .17 .12 .04
3 Playboy C .20 .10 .03 222
Winning C .23 .07 .02 .16 .05 7.28***

Dominant .16 .27 .12
1 Disdain for homosexuals .15 .02 .02 .18 .08 224 5.29*
2 Disdain for homosexuals C .16 .04 .01 .20 .08 223 4.68*
Primacy of work .13 .30 .15
Note. n D 226. *p .05. **p .01. ***p .001. Explanatory variables included in the model: CMNI
subscales and total score.
TABLE 6 Multivariable Regression Analyses: Relation of Women’s Health to Conformity to

Feminine Norms
1 Romantic relationship .33 .10 .10 19 .03 232 28.46***

2 Romantic relationship .27 .13 .03 .16 .03 231 19.61***
Sexual fidelity .19 .08 .02
1 Invest in appearance .23 .05 .05 .38 .10 232 13.67***

Romantic relationship .13 .20 .09
Total number of diseases
1 Domestic .13 .01 .01 .07 .03 232 4.33*
Note. n D 234. *p .05. **p .01. ***p .001. Explanatory variables included in the model: CFNI
subscales and total score.
ferences found in this study was not high. These results confirm previous
studies in Spain, indicating that the differences between women and men
in health and substance use vary when the educational level and age of
the participants are considered and were less among young and university-
educated people (Bacigalupe & Martín, 2007; Hernández–Pedreño, 2002).
A central purpose of the present research was to test the relationship
between conformity to gender norms and health variables that might con-
tribute to explaining the ‘‘paradox’’ observed in the data of higher morbid-
ity but lower mortality among women. One of these health variables was
substance use, which may increase the risk of pathologies, such as cancer
or accidents, thus increasing the risk of mortality (Hudd et al., 2000). As
expected (Hypothesis 2), the findings that the dominant, playboy, and pri-
macy of work masculine norms explained substance consumption (alcohol
in the former and tobacco in the latter) supported previous research associ-
ating specific masculine norms with health behaviors. For example, Liu and
Iwamoto (2007) reported that the playboy norm was related to alcohol use,
and Locke and Mahalik (2005) reported a significant relationship between
problem drinking and the dominant and playboy norms. These findings
suggest that some constructions of masculinity may be more important than
others in understanding the relationship between masculinity and men’s
health behaviors. Other results, such as the inverse relationship between
disdain for homosexuality, or winning and substance use, do not have a
clear explanation. These results must be confirmed in future studies before
possible explanations can be suggested.
The results also suggest that femininity was associated with lower fre-
quencies of tobacco and alcohol consumption (Hypothesis 3). The lower
substance consumption in women relative to men might be explained by
the non-congruence with traditional feminine norms. For example, feminine
norms, such as sexual fidelity and romantic relationships, which were related
to lower cigarette and alcohol use, may be non-congruent with the feelings
of autonomy attributed to smoking in women. In fact, in Spain, substance
use has been related to a lower regard for values linked to conventional
socialization (Zimmermann, Sieverding, & Müller, 2011).
Also unique to the gender approach, the potential association between
conformity to feminine and masculine norms and chronic diseases (Hypothe-
ses 4 and 5) was tested. Consistent with other studies (Williams & Wiebe,
2000), conformity to masculine norms did not explain the difference in the
number of reported illnesses. In contrast, conformity to one feminine norm
was associated with a greater number of diseases, supporting the hypothesis
(Hypothesis 5). One possibility, therefore, is that the relationship between
masculinity and reporting illness might not be as strong and direct as the link
between femininity and reporting illness. The female stereotype in Spain has
been associated with greater vulnerability to somatization and with difficul-
ties recognizing and attending to one’s own needs and desires (Martinez–
Benlloch & Bonilla, 2000). The authors speculate that women might be
expected to be in poorer health than men, which can cause women to report
more bodily changes in terms of ill health and exposure to specific physical
and psychological risks. For instance, the relationship identified between
domesticity and the number of chronic diseases may indicate specific risks
in connection with housework and may explain previous results suggesting
that housewives reported poorer physical health, lower self-esteem, life satis-
faction, and social support than those in other working conditions (Sánchez–
López, Aparicio-Garcia, & Dresch, 2006; Artazcoz et al., 2004).
In light of the debate on gender and health, the finding that some gender
norms are ‘‘directly’’ related to certain health indexes, while other norms
are ‘‘inversely’’ related to the same or different indexes is particularly in-
teresting and deserves consideration. Investigating the relationship between
health and gender requires a multidimensional approach that furthers the
understanding of the costs and benefits of gender roles for health (Mahalik
et al., 2005). For example, conformity to some feminine norms could be
related to greater reporting of chronic illnesses, which is a health cost, and
to less smoking, which is a protective health behavior or health benefit. For
some of the substance behaviors, conformity to one masculine norm was
related to higher reporting of substance consumption, and conformity to
another masculine norm was related to lower consumption. These results
also confirm previous research (Liu & Iwamoto, 2007). In addition, possible
benefits of nonconformity, including prevention of some of the risk behav-
iors (e.g. consumption of alcohol and cigarettes) connected to traditional
masculine gender roles in the research literature (e.g., Mahalik et al., 2003)
were found.
Interestingly, the magnitude of the variance of substance use explained
by conformity to gender norms was greater than the magnitude explained
by being male or female. The finding that conformity to gender norms
was related not only to health behaviors but also to particular disorders
contributes new information to previous research. This finding may suggest
that gender (as measured here) is ‘‘at least’’ as important as sex (male/female)
in explaining health and might be equally useful in explaining the morbidity-
mortality paradox. Future research should seek a better understanding of
within-gender differences for men and women in relation to symptoms and
substance use and conformity to gender norms. The relation of specific risks
and benefits to certain gender norms and certain pathologies or health indi-
cators, such as the relationship between gender and mental health, should be
extended because the data in this study do not specifically address this area.
Furthermore, the use of objective health indicators is necessary to complete
the investigation of the self-reported measures used in this study.
In general, the results provide additional evidence that results from
previous studies with the CMNI (Liu & Iwamoto, 2007; Mahalik, Burns, &
Syzdek, 2007; Mahalik, Levi–Minzi, & Walter, 2007) or with other measures
of gender (Emslie, Hunt, & Macintyre, 2002; Hunt, 2002) may apply to
university students in Spain. The study attempted to provide insights for
further cross-cultural psychological studies on the mediating effect of self-
reported conformity to gender norms on health rather than focusing only on
sex. Gender socialization may play a significant role in explaining Spanish
women and men’s health, despite the fact that the measures were devel-
oped for U.S. samples, rather than Spanish samples, and that the differences
between women and men in health and substance use were smaller for
university-educated and young people (Bacigalupe & Martín, 2007; Hernán-
dez–Pedreño, 2002). The findings from this study should be replicated in the
future with populations of different ages and educational levels to further
verify its explanatory capacity for assessing gender with regard to Spanish
people’s health.
These conclusions have significant implications for psycho-educational
efforts with men and women because they reveal the importance of gender
roles in substance use and the acknowledgement of diseases. Identifying the
association between people’s constructions of femininity and masculinity
and their health may contribute to changing problematic constructions of
gender norms using cognitive techniques. These efforts may contribute to
interventions to promote healthier behaviors both in Spain and in other
countries.
LIMITATIONS AND FUTURE RESEARCH
This study does not exhaust the topic and had some limitations. The first
limitation was the nature of the sample studied. Because only a sample of
university students was analyzed, the results may not be representative of
or generalizable to the general population. Second, this study was cross-
sectional. Therefore, changes in the participants’ health over time cannot be
analyzed to assess the temporal sequence of variables related to masculinity,
femininity, diseases, and alcohol and tobacco consumption. Another limita-
tion was the use of self-reported measures to evaluate diseases, which pro-
vides the potential for misclassification of these outcomes and for social ac-
ceptability bias. Future studies could include objective measures of diseases,
in addition to subjective measures to verify whether the subjective and objec-
tive measures are correlated (e.g., laboratory tests that confirm the diagnosis
of diseases, indicators of the immunological system, and blood pressure).
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The Impact of Gender Roles on Health

Article in Women & Health · March 2012

Maria Pilar Sánchez-López Virginia Dresch

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The Impact of Gender Roles on Health

MARÍA DEL PILAR SÁNCHEZ–LÓPEZ, PhD

and Health, Madrid, Spain

VIRGINIA DRESCH, PhD

The present research focused on a sample of Spanish undergrad-

KEYWORDS gender norms, gender and health, femininity, mas-

Health studies of men and women have revealed differences in morbidity

packets to complete and return to the researcher. Ninety percent of the

To assess health status and health-related behaviors, questions were included

CONFORMITY TO GENDER NORMS

researchers. All participants completed the health data. To measure confor-

TABLE 1 Sociodemographic Characteristics of the Participants

Age Age t D 5.11(***)

Employment Employment 2 D 4.40 (n.s)

Note. ***p  .001, ns D not significant.

Number of cigarettes/day 2.54 (5.48) 3.63 (7.10) 4.49* .02 (low)

male was related to greater consumption of alcohol (F D 19.50; p < .001)

TABLE 3 Unadjusted Regression Analyses: Relation of Sex to

Frequency of alcohol consumption/week

2. Emotional control 14.53 (5.20)

explained 10% of the variance (F D 9.12; p < .001). Furthermore, supporting

TABLE 5 Multivariable Regression Analyses: Relation of Men’s Health to Conformity to

Frequency of alcohol consumption/week

1 Playboy .19 .04 .04 .10 .03 224 9.22**

Winning C .23 .07 .02 .16 .05 7.28***

TABLE 6 Multivariable Regression Analyses: Relation of Women’s Health to Conformity to

Frequency of alcohol consumption/week

1 Romantic relationship .33 .10 .10 19 .03 232 28.46***

1 Invest in appearance .23 .05 .05 .38 .10 232 13.67***

Total number of diseases

1 Domestic .13 .01 .01 .07 .03 232 4.33*

LIMITATIONS AND FUTURE RESEARCH

Arias, E., R. N. Anderson, H. C. Kung, S. L. Murphy, and K. D. Kochanek. 2003.

declines. NBER Working Paper 9821.

Development of the conformity to masculine norms inventory. Psych of Men

Williams, P. G., and D. J. Wiebe. 2000. Individual differences in self-assessed health:

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Employment Employment 2 D 4.40 (n.s)

Note. ***p .001, ns D not significant.