Real Life Issues Instruction Attending to Gender

Annann Hong, Ph.D., M.P.H.

Strengths and challenges related to gender issues

Of any group designation, making generalizations of difference or similarity across gender is perhaps the most difficult since gender is one of the most basic divisions of humanity and encompasses such broad diversity across other variables such as religion, race and ethnicity, age, and sexual orientation. However, this article will present at least some initial thoughts that will hopefully stimulate further discussion and exploration on the complexity of this topic. It is important to first note that gender for the purposes of this article will refer to a cross between what is more commonly identified as biological sex, that being male or female, and the more traditional definition of gender being socially-constructed notions of what it means to be a man versus a woman (e.g., masculine versus feminine). Furthermore, this discussion of gender will assume a dichotomous construction. While not meant to ignore the reality that there are individuals that consider themselves across a continuum of gender identity, as well as the fact that our society is generally becoming more accepting of androgynous behavior (for example, the recent birth of the “metrosexual,” a male who is in touch with his feminine side), using the most tangible distinctions between the two sexes will serve as the organization of this article. Finally, while debates about the role of nature versus nurture in gender differences abound, suffice to say for our purposes here that both aspects are the likely suspects in the development of gender identity, although the socialization aspect is one which we have a much greater likelihood of changing and therefore is the focus of attention when discussing how we as educators can best influence real life issues as they affect young women and men.

At present, there are 96.3 men for every 100 women in the U.S., with women outnumbering men across all ethnic groups except among Native Hawaiian/Pacific Islanders, Hispanic/Latinos, and those of other or multiple racial groups (U.S. Census, 2000). This imbalance of the sexes has persisted over time despite the fact that there are 1,048 live male births per 1,000 female birth due, in part, to the longer life span of women (CDC, 2003).

While there has long been a history of male dominance in the academic world, women now are advancing as students, teachers, faculty members, and school administrators. Conlin (2003) notes, “[f]rom kindergarten to graduate school, boys are fast becoming the second sex.” Given increasing opportunities to excel, female students are closing what has traditionally been a gender gap in education. In fact, in a recent study of the Class of 2003 from the Boston public school system, more than half of the graduates (56%) were women due to an increasing number of male drop-outs. Additionally, more women than men (80.8% versus 65.7%) were pursuing post-secondary education at the time of the survey (Boston Private Industry Group, 2004).

These trends are not unlike those seen by other school systems and institutions of higher education across the country. At campuses like the University of North Carolina, Boston University, and New York University, the female-to-male ratio is already 60-40 (Business Week, 2003). According to a recent 2003 cover story in Business Week,

[f]or 350 years, men outnumbered women on college campuses. Now, in every state, every income bracket, every racial and ethnic group, and most industrialized Western nations, women reign, earning an average 57% of all BAs and 58% of all master's degrees in the U.S. alone. There are 133 girls getting BAs for every 100 guys -- a number that's projected to grow to 142 women per 100 men by 2010, according to the U.S. Education Dept. If current trends continue, demographers say, there will be 156 women per 100 men earning degrees by 2020.

This growing gender imbalance was also recently confirmed by a 2006 report released by the American Council on Education (ACE), which found the disparity greatest among low-income white and Hispanic students. However, regardless of this gender imbalance, the number of degrees awarded to both men and women is on the rise, so women are not making gains in higher education at the expense of men; rather, women appear to be outpacing men in the rate at which they pursue and earn degrees in higher education (ACE, 2006).

When the so-called “Girl Project” was launched thirty years ago in an attempt to foster greater self-esteem and decrease inequalities particularly in the fields of math and science, teachers were encouraged to incorporate teaching styles that were more girl-friendly (Business Week, 2003). While the results seem astonishing, the progress young women have made in education does not erase the many years of inequity and ingrained gender role socialization processes that result in very gender-specific behaviors that define the way in which we continue to stereotype the sexes today in ways that constrain both.

Both men and women face unique strengths and challenges in regard to health behaviors and risks. However, perhaps one of the most salient issues particularly in the school-based setting is the reality that most of the country’s teachers are women. As men tend not to take positions as teachers, there are enormous social ramifications for young men, including the diminishing presence of day-to-day male role models upon which young men can learn about appropriate. The proportion of men in teaching today is at its lowest level in 40 years, according to the National Education Association, the country's largest teachers union. Only 21 percent of teachers in U.S. public schools are men. In early grades, the gender ratio is even more imbalanced -- just 9 percent of elementary school teachers are men. Perhaps not surprising, despite their high representation among public school teachers, women account for a disproportionately low percentage of the principalships in public schools, although that disparity is shrinking. While only 21.4% of the principals in the U.S. were women during the 1984-85 academic year (NCES, 1994), that number has doubled to 46.4% in 1999-2000 (NCES, 2004). The gender disparity not only in teacher representation but also in principalship, alone, sends important and reinforcing messages to young men and women about career opportunities and limitations.

Vulnerability to real life issues

While gender alone cannot be an accurate predictor of health behavior and risk, there are certainly some generalizations that can be made that assist in identifying the likely areas of vulnerability for men and women. This section will highlight some of the major real life issues, including violence, alcohol and other drugs, as well as sexual health behavior.

As the topic of violence has drawn more attention in the health promotion field, it has often been limited to discussion around sexual violence. In this regard, women have been the primary victims and men have more commonly been the primary perpetrators. Based on self-report data, the CDC (1997) found that that one in five undergraduate women have ever been raped in their lifetime, while Koss, et.al. (1987) found that one in 12 college men admit to committing acts which meet the legal definition of rape. In fact, while not to discredit the reality of sexual violence, violence as a public health issue encompasses a much larger scope of behavioral issues that warrants greater attention because of its troubled relationship with masculinity in the U.S. Behaviors such as bullying and fist-fighting to incidents involving firearms are not exclusively found among young men; however, young men are disproportionately involved as both perpetrators and victims in such incidents of school-related violence.

The school shootings in the last decade are troubling examples that reveal that what we have come to associate as appropriately masculine may, in fact, be harmful to our young men. According to Katz and Jhally (1999), “[w]hat [Littleton, Colorado; Jonesboro, Arkansas; Peducah, Kentucky; Pearl, Mississippi; and Springfield, Oregon] reveal is not a crisis in youth culture but a crisis in masculinity. The shootings -- all by white adolescent males -- are telling us something about how we are doing as a society, much like the canaries in coal mines, whose deaths were a warning to the miners that the caves were unsafe.” Being masculine in the U.S. has become synonymous with such adjectives as tough, macho, and aggressive. Young men are arriving at our schools with a history of physical violence, both as perpetrators and recipients, resulting in many reinforcing messages about what might be considered appropriate methods of resolving conflict and expressing oneself.

For example, while three-quarters of the victims of family violence are women, three-quarters of the perpetrators of family violence are men (US Department of Justice, 2005). By age 16, one in 10 boys has been kicked in the groin by the age of 16, with 25% of those kicks resulting in injury (Finkelhor & Welak, 1995). Kivel (1992) reports that half of all boys have been beaten up by a father or adult male caretaker, while nearly half of all adult men report having been punched or beaten (US Department of Justice, 1994). More recently, the US Department of Justice (2000) found that physical violence overall is fairly prevalent, with nearly two-thirds of men in comparison to just over half of women reporting lifetime occurrence of physical assault either by a caretaker while as a child or some other attacker as an adult. Annually, it is estimated that men are about one and a half times more likely to experience physical assault each year than women (3.2 millions versus 1.9 million women) (US Department of Justice, 2000).

This history of violence seems to translate into an expectation of violent behavior and an attitude that violence is an appropriate vehicle through which to resolve problems and disputes -- a perspective that is exacerbated by entertainment media messages that legitimize violent behavior. Twice as many boys as girls believe physical fighting is appropriate when someone insults you in front of friends, steals from you, or flirts with someone you like, while three and a half times more males believe fighting is an appropriate response when someone cuts in line (American School Health Association, 1989). In 2003, boys were twice as likely as girls (12% versus 6%) to report experiencing a threat or injury while at school (U.S. Department of Justice, 2004). The research has consistently found that young men in schools and institutions of higher education are disproportionately involved in physical fighting as compared to their female counterparts (at least twice as likely). And “while boys may act out with their fists, girls, given their superior verbal skills, often do so with their mouths in the form of vicious gossip and female bullying” (Business Week, 2003), a form of interpersonal violence that may be less likely detected by teachers and administrators yet nonetheless problematic.

In addition to other forms of violence, epidemiological studies of both homicide and suicide reveal further gender discrepancies. For example, homicide is the second leading cause of death among White males ages 15-24, and the leading cause of death for African American and Hispanic males ages 15-24 (NCHS, 1996). Nearly 90% of the 40,000 firearm-related deaths which occur each year are among men, while 80% of firearm-related homicide victims ages 15-19 are male (CDC, 1995; 1994). In sum, the homicide rate is four times greater for men than for women.

If homicide is a form of outward violence, suicide is a form of self-directed violence. Suicide is the third leading cause of death for children ages 10-14 and adolescents ages 15-24. While the suicide completion rate is at least 4 times higher among men, it is also important to note that there are an estimated 8-25 attempted suicides for each suicide death, with women outnumbering men at a ratio of 3:1 for a history of attempted suicide (NIMH, 2003).

Another salient example of violent behavior is hate crime, the majority of which is committed by groups of young men (Levin, 1993). While half of campus hate crimes reported in 1997 were motivated by a victim’s race or ethnicity, 36% were motivated by the victim’s perceived sexual orientation (FBI, 1997). Among adolescents, 45% of gay males and 20% of gay females experience verbal harassment or physical attacks by their peers, forcing 28% of them to drop out of school (National Gay & Lesbian Task Force, 1987).

Violence among youth is also often associated with the use of alcohol and other drugs, another health issue that reveals some general differences across gender. In the 2003 YRBS, high school women actually reported a slightly higher lifetime alcohol use than men (76.1% versus 73.7%) and a slightly higher current alcohol use rate (45.8% versus 43.8%). However, in regard to episodic drinking (defined as 5 or more drinks in a row on at least one day of the preceding 30 days), men outpaced women slightly at 29% versus 27.5% (CDC, 2004). SAMHSA’s 1998 National Household Survey on Drug Abuse also found a similar gender pattern that starts from an even earlier age, with nearly 9 percent of boys and 7 percent of girls ages 12 to 17 reporting binge drinking in the previous month (US DHHS, n.d.). Binge drinking during high school, especially among males, is a strong predictor of binge drinking in college, and one recent study found that while 39 percent of college women binge drank within a 2-week period, that figure was much higher at 50 percent of college men, suggesting that the gender differences displayed during the high school years becomes exacerbated in college (US DHHS, n.d.).

While young men have typically used and abuse alcohol and other drugs at higher rates than young women, a recent press release by the Office of National Drug Control Policy (ONDCP) indicates that:

girls have caught up with boys in illicit drug and alcohol use and have actually surpassed boys in cigarette and prescription drug use. There are also more girls who are new users of substances than boys…The findings show that when girls use illicit drugs, marijuana is the most commonly used substance. Marijuana is used more than cocaine, heroin, Ecstasy, and all other illicit drugs combined. And for the last two years that research is available (2003–2004), more teenage girls than boys started using marijuana, alcohol, and cigarettes… Research [also] shows that teenage girls use drugs and alcohol for different reasons than boys. Many girls experience a dramatic transition during early adolescence, marked by a decline in their self-esteem and self-confidence. And girls are more than twice as likely as boys to report depression. Indeed, surveys show that young females tend to use alcohol or drugs to improve mood, increase confidence, reduce tension, cope with problems or lose inhibitions. Another often-cited reason among girls for their substance abuse is weight loss. In fact, girls' use of diet pills is up to four times that of boys… Adolescent girls are particularly susceptible to the physical and mental consequences of substance use, especially at a critical time in life, when their bodies and brains are still developing. Recent studies show that marijuana use may in fact increase the risk of depression. One study showed that girls (ages 14–15) who used marijuana daily were five times more likely to face depression at age 21. Weekly use among all teens studied doubled the risk for depression. [Additionally,] [g]irls may develop symptoms of nicotine addiction faster than boys. [Finally,] [a]dolescent girls who consume even moderate amounts of alcohol may experience disrupted growth and puberty. (ONDCP, 2006).

These data all suggest a greater need to pay attention to alcohol and other drug use and abuse particularly among young women.

Despite this newly released report, the data does more often show gender disparity in alcohol consumption that favors men. However, it is also important to note that physiologically, men can tolerate more alcohol than women even at the same body weight due to naturally occurring differences in body fat (lower in men), the hormone estrogen (higher in women), and the presence of the enzyme alcohol dehydrogenase (higher in men) – all of which influence the rate and efficiency of metabolization, or the process of breaking down the alcohol. Therefore, even the definition of binge drinking (which has some variation) has been made more gender-specific by the Harvard School of Public Health’s research, distinguishing a rate of five or more drinks in a sitting for men and four or more drinks in a sitting for women in order to take into account the different tolerance by gender. As a result, it is not always easy to say that a higher consumption by men is in itself a problematic difference by gender; similarly, lower rates of consumption by women should not suggest an absence of a problem.

The research does show a general pattern of difference by gender in regard to consequences of drinking. While men tend to act outwardly in a more belligerent manner as a result of severe intoxication, women tend to turn inward with their intoxication. Therefore, men might be more likely to be noticed as trouble-makers due to their drinking by getting into fights and other kinds of interpersonal altercations. Women, on the other hand, might become more withdrawn and depressed as a result of higher levels of intoxication. As a result, their over-use of alcohol might be more likely overlooked because it is less likely to cause the kind of overt problems associated with male drinking. Furthermore, there is perhaps less social approval for women drinking heavily or having problems with alcohol, which may drive the behavior further into the closet and not be as readily identified as a problem by helping professionals. Women also face unique health risks associated with heavy alcohol use, drawing debate around the consumption of alcohol during pregnancy due to the increased risks of fetal alcohol syndrome (FAS).

While there are many more drugs being used by youth (with men typically consuming at higher rates than women), another drug of interest in the discussion of gender-specific risk is tobacco. Because of the appetite suppressant effects of nicotine, young girls, especially white adolescents who are particularly prone to eating disorders, seem susceptible to the lure of cigarettes. In the 2003 YRBS, lifetime daily cigarette use was almost 20% among white girls in high school, while only 11% of black males (and an even lower percentage of black women at 5%) reported lifetime daily cigarette use (CDC, 2004). The trend in cigarette use over the years has been on the rise particularly among young girls, perhaps no accidental result of targeted marketing by the tobacco industry.

In regard to sexual behavior, there may be no other health behavior more influenced by gender. We live in a heterosexist and androcentric Western culture that glorifies that which is masculine (which is not to say that these messages are not without their challenges for young men to navigate), while offering little in the way of positive messages regarding femininity, all of which play out in the sexual arena. While Katz and Jhally suggested that youth violence is a reflection of a current crisis in masculinity, perhaps a similar crisis in femininity is most dramatically played out in the sexual arena, with alcohol and other drugs often playing a pivotal and exacerbating role in both scenarios. Whereas the more archaic expectations for young women sexually were to remain untouched and innocent, young women today navigate an even more complex sexual landscape that now considers women frigid if they choose not to be sexually active and sexually loose if they do make choices to be sexually active: a lose-lose situation. The situation is not especially better for young men either. Young men have almost always faced sexual pressures and expectations that presume that they maintain a constant and highly sexualized outlook while they also possess both a certain amount of sexual prowess and a constant readiness to perform – all of which can lead to sexual stress for young men, as well.

However, the truth of the matter is that despite social and technological advances in modern Western society, the sexual double standard persists (Lees, 1993). The ways in which young men and women learn about sex, as well as how they experience sex with each other, are products and precipitators of a great gender divide in adolescent sexual development. When men and women are sexually socialized with drastically different expectations about sex, miscommunication, misinterpretation, and negative sexual experiences are more likely to occur (Muehlenhard, 1988). For example, in a study of college students, men reported expectations of sex much earlier in a dating relationship than women and a greater likelihood to engage in sex without emotional attachment, contrary to women’s expectations of emotional attachment prior to sex (Cohen & Shotland, 1996). Such differing expectations, especially if these are not adequately communicated between partners, can yield disastrous results, both emotionally and physically.

Additionally, a majority of first sexual experiences, particularly among teenage girls, occur under the influence of alcohol (Strunin & Hingson, 1992). In fact, a majority of teenage women report that they feel it is actually easier to have sex when using alcohol or other drugs (Millstein, Moscicki & Broering, 1993). Frank and Lank (1990) found that young college women reported heightened subjective appraisals of sexual arousal even when their blood alcohol levels were such that their physiological response should have been depressed. Men, on the other hand, reported subjective appraisals much more consistent with their physiological condition. The authors conclude that women are perhaps more likely to engage in sex under the influence because of anxious feelings over sexuality, and that through a conditioning process, young women then come to associate intoxication with a state of sexual arousal despite its contradiction to the true effects on the physical body. Studies have found that use of alcohol and other substances poses a particular risk for earlier initiation into sexual activity and increased likelihood of multiple partners, thereby increasing potential exposure to a variety of sexually transmitted diseases (Fortenberry, 1995; Graves & Leigh, 1995; Orr & Ingersoll, 1991; Parrillo et al., 1997; Santelli et al., 1998).

Studies have confirmed that a large proportion of campus sexual assaults occur when one or both individuals are intoxicated. Among the most well known and frequently cited studies is the 1988 Ms. study conducted by Mary Koss and her colleagues. This study, funded by the National Institute for Mental Health (NIMH), surveyed 6,100 undergraduate women and men at 32 college campuses. Koss’ study found that 75% of victims and 55% of perpetrators in college date rape situations had been consuming alcohol prior to the incident (Warshaw, 1998). In a report recently released by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), it was estimated that alcohol use and abuse on college campuses was associated with 70,000 cases of sexual assault and acquaintance rape nationally each year (NIAAA, 2002).

At present, self-reported youth initiation into sexual activity occurs earlier for men than it does for women. The average age of first intercourse in the US is about 16 for boys and 17 for girls, although these ages seem to drop among minority and underserved youth. In the 2003 Youth Risk Behavior Survey, the percentage of boys under 13 who had engaged in sexual intercourse was much higher than it was for girls (10.7% versus 4.2%), and boys were also more likely to report four or more lifetime sexual partners (17.5% versus 11.2%) (CDC, 2004). Currently, about 45% of girls and 48% of boys in high school report ever engaging in sexual intercourse (CDC, 2003)

An individual’s first partner sex experience is widely thought to be a major life event affecting one’s self-concept and changing one’s interpersonal relationships (Weis, 1983). Given our heterosexist culture, it is also important to note that first sex experience is typically defined as vaginal intercourse for both men and women, which delimits what is considered more acceptable sexual role-playing for both genders from an early age, further exacerbating the challenges of identity development for individuals that do not identify as heterosexual. Furthermore, variables surrounding sexual initiation are important for other reasons. For one, it is often associated with the onset of observable secondary sex characteristics associated with puberty. In other words, other people then begin to perceive an individual as having sexual potential because of the way in which that person might appear to be sexually mature, which then changes interpersonal interactions and affects that individual’s own perception of self. This process of physical change takes place at an already an awkward time of adolescent development when general identity formation is taking place.

Adolescent women seem to face a particularly daunting negotiation of puberty. Young women who experience puberty early and specifically develop (observable) secondary sex characteristics are more likely to experience social adjustment problems (Kimmel & Rudolph, 1993). It affects women’s body image and self-esteem because they tend to see the changes of their body in puberty (increased weight and body fat) in a negative light (Petersen, Leffert & Graham, 1995). It is not surprising that eating disorders often develop during this critical stage of puberty as a result of changing self-perceptions around body. However, it is also important to note that the negative perception of these changes is a socially constructed phenomenon that is very gender-specific: just as women become most concerned with appearances and internalize society’s message of what is considered most feminine and most attractive (namely, being stick thin), this awareness is in opposition to what is happening naturally to her body. It seems like something more than an unfortunate coincidence that the timing of these should coincide. Travis, Meginnis & Bardari (2000) argue that the “conflation of physical appearance and sexuality is detrimental to women on individual, interpersonal, and systemic levels and…ultimately sustains gender-based oppression” (p. 237). This arena of female sexuality cannot go unexamined because of its intimate connection to poor self-concept and other health issues such as eating disorders.

First sexual experience of intercourse is also important because it serves as an important rehearsal for subsequent sexual behavior, so the dynamics of this first experience can influence future experiences. For women, this transition is often more difficult than it is for men, with common feelings of fear, guilt, anxiety, and embarrassment (Weis, 1983). Research shows that typical first partner sex for women is, in fact, a negative experience (Dickson et al., 1998; Ingham et al., 1991; Sprecher et al., 1995; Wight et al., 2000). For example, when asked “At the time, how pleasurable was your first sexual intercourse experience for you?,” using a scale of 1 (not at all) to 7 (a great deal), women rated their first intercourse at a mean score of 2.95 while men rated their first intercourse at 5.0 (Sprecher et al., 1995). Wight et al. (2000) found that feelings of regret over intercourse was most associated with a perceived lack of control, while Dickson et al. (1998) found that women who had had first intercourse prior to age 16 were more likely to regret this experience and to have more negative outcomes in regard to STD risk and unplanned pregnancies. Overall, the age of first sexual activity is an important variable because it can be correlated with such health issues as HIV prevalence (DeLay, 2004), lifetime number of partners, and overall STD risk among youth.

Principles for design and implementation of real life issues curriculum infusion

Several principles for instruction guide the implementation of research-based prevention strategies directed towards students of either gender, although many principles also apply regardless of specific gender.

• Examine your own sources of gender bias and gender stereotyping; in addition, consider how these actions might affect health-related behaviors among students.

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-Submitted May, 2006

-Revised July, 2006