Biopsychosocial Determinants of the Health of Boys and Men Across the Lifespan

KEYWORDS:

• biopsychosocial
• boys
• health disparities
• men's health

Over the past two decades, there has been a substantial increase in attention toward boy's and men's health globally.^1–3 Thus heightened awareness, in part, is attributed to the emergence of reports documenting the poor health outcomes of boys and men in Europe, Asia, and other parts of the world.^2–5 Despite these public health realities, there continues to be a relatively small amount of research, practice, and advocacy focused on improving the lives of boys and men worldwide and within the United States.

Males experience premature death,^2,3,6,7 poorer health outcomes,^8,9 are more likely to engage in risky behaviors,¹⁰ and are less likely to engage in the health care system.^11,12 This is particularly true for males who are also members of vulnerable populations such as racial/ethnic groups; those who belong to low socioeconomic backgrounds; incarcerated males; gay, bisexual, and transgender males; and males who live in rural areas. This is largely because the health of boys and men represents a complex interaction between individual, behavioral, social, and structural factors requires a life course approach^13,14 and with attention to the issues of gender identity, sexual identity, and masculinity, nested within the “norms” of society, which may shape the health behaviors of boys and men. An understanding of the how these factors operate is fundamental to adding to the burgeoning body of evidence focusing on the health of boys and men. Yet, to date much of understanding is severely limited.

The editors of this special issue of Behavioral Medicine set out to publish a collection of peer-reviewed articles that would examine individual- and population-level factors that contribute to the health of boys and men. A particular focus is on how of structural, economic, political, behavioral, and psychosocial factors contribute to shaping the health, health behaviors, and health disparities between and among males across the life course. Our goal was to include articles that are representative of the diversity of the population of boys and men as well as a wide variety of health struggles faced by boys and men.

In the first article, Koelmeyer and colleagues examine the health of boys and men across the lifespan and delineate the generational effects on the relationship between health-related characteristics and self-rated health in a sample of Australian males. These authors underscore the importance of addressing two chronic conditions—obesity and depression—for improving Australian males of all ages.

Next Reynolds and his coauthors seek to delineate the association between masculine and feminine norm and health service usage. Applying Bem Sex Roles Inventory and the Klein Sexual Orientation Grid, the authors note that sex roles are key to understanding health services use. Such findings indicate the importance of raising awareness and training practitioners in matters of sexual and gender identity.

Further seeking to understand the role of socially produced conditions in the health of boys and men, Powell and colleagues test a theory-driven model of barriers of help-seeking behavior among African American men examining the impact of masculinity, race-related factors such as racial discrimination, John Henryism, sense of control, and everyday racism that have been documented as a potential barrier. Their findings suggest that addressing experiences in everyday discrimination and racism may be key to increasing their help-seeking motivations.

Thereafter, Cook and Calebs propose a framework for understanding the health of sexual minority men through the lenses of attachment and within the context of sexual minority stress. The authors emphasize where future research can further develop the model as it relates to how developmental processes of attachment and sexual minority stress can impact health and health behaviors of sexual minority young adult men.

In the fifth article, Dryer and colleagues examine the mediating role of self-oriented and socially prescribed perfectionism between sociocultural influences and symptoms of muscle dysmorphia and eating disorders, which are understudied areas of men's health. Findings indicate that self-oriented and socially prescribed perfectionism fully explained the relationship, suggesting that preexisting perfectionistic attitudes play a role in both muscle dysmorphia and eating disorders.

Bruce and colleagues examine the relationship between religiosity and spirituality with obesity-related behaviors in African American males aged 12–19 years. The findings provide evidence that spirituality is an important factor in health education and health promotion efforts to reduce risks for obesity-related behaviors among young African American males.

Mereish and colleagues examine how ethnicity mediates effects of self-esteem on the relationship between discrimination and depressive symptoms among a nationally representative sample of African American and Afro-Caribbean American men in the National Survey of American Life. Findings indicated that the mediating effect of self-esteem on the relationship between discrimination and depressive symptoms operated differently for African American and Afro-Caribbean men. This work underscores the importance of better understanding the heterogeneity in health among black men.

Examining the role of contexts, Bauermeister, Eaton, and Stepherson seek to determine whether transactional sex with casual partners is associated with neighborhood-level socioeconomic disadvantage and individual-level factors (race/ethnicity and sexual identity, socioeconomic status, HIV/sexually transmitted infection [STI] diagnoses, and substance use) among young men aged 18–29 years living in the greater Detroit metropolitan area. The authors report that neighborhood socioeconomic disadvantage is associated with HIV/STI risk behaviors and may operate through individual-level indicators of socioeconomic vulnerability.

Next, Grace-Leitch and Shneyderman examine the connection between Human Papillomavirus (HPV) knowledge and self-efficacy for preventive behaviors at a 2-year college in New York City. The authors find that among the largely minority young men sampled in this study, they exhibited high awareness of HPV, but low levels of knowledge about the risks, symptoms, and consequences of HPV, which represents a missed opportunity for a highly preventable disease.

The final article by Derek M. Griffith in this special issue concludes with a synthesis of the articles and future directions to improve the health and well-being of boys and men globally.

All the articles in this special issue make key contributions to approaches to improving the health and well-being of boys and men around the world. What is clear from this body of research is that improving the health of boys and men is complex as it requires an understanding of several factors on different levels to be understood and requires that we examine health using a biopsychosocial perspective. To develop health-promoting strategies and interventions that improve the health of boys and men, it will be critical to continue to explore and articulate how gendered and nongendered factors shape boy's and men's health independently and in combination,¹⁵ and how these gendered factors interact with race, ethnicity, culture, sexual identity, gender identity, and age in driving health behaviors with an eye to the influences of context and structural factors that may shape identity and behavior. To this end, we must begin to develop health promoting strategies, intervention, and policies that respect the lives and diversity of boys and men and that can directly improve the health of this population. This work should not be done in silos nor without engaging and understanding the lives of boys and men. Rather this should be a collaborative effort of researchers, practitioners, activities, political leaders, and members of the population with a clear and targeted effort to increase life expectancy and well-being for all boys and men.

Funding

Dr. Thorpe is supported by the Program for Research on Men's Health in the Hopkins Center for Health Disparities Solutions (P60MD000214), the Johns Hopkins Catalyst Award, Johns Hopkins Bloomberg Faculty Innovation Fund, and the National Institute on Aging (3U01AG032947-07S2).