Health and Families

A growing body of research has shown that family plays an important role, if not the most important role (Doherty 1993), in shaping our health attitudes and behaviors. This is important because positive health behaviors have been shown to significantly affect physical and mental health (Grzywacz and Marks 1999).

Prior to understanding the role the family plays in the adoption of health attitudes and beliefs, it is important to identify what health is. The World Health Organization (1986) defines health as

. . . the extent to which an individual or group is able, on the one hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, as well as physical capacities. (p. 73)

The Impact of Marriage and Children on Adults' Health Behaviors

Being married and/or having children affects whether one engages in healthy behavior. Lois Verbrugge (1979) found that married people were healthier than single, widowed, divorced, or separated individuals. She suggested three possible explanations for her findings. First, married and unmarried people have different lifestyles that are associated with higher and lower risk behaviors (e.g., unmarried individuals have a higher number of sexual partners). Second, it is possible that those with poor health are less likely to marry. Third, married people may be less likely to label themselves as ill. Thus, it is unclear whether being married leads to better health or better health leads to marriage.

Debra Umberson's (1987, 1992) research has indicated that the family ties of marriage and parenthood are associated with more positive health behaviors and fewer risk behaviors. Joseph Grzywacz and Nadine Marks (1999) found that having children was associated with a healthier use of alcohol. Moreover, the Israel Ischemic Heart Disease Project found that for men with high levels of anxiety, their wives' love and support appeared to protect them against angina.

Umberson (1987) states that family members influence health behaviors through indirect and direct control mechanisms. Specifically, positive family ties lead to a greater sense of responsibility for one's self and one's family, and thus individuals with positive family ties are more motivated to engage in behaviors that lead to better health. Family members may also directly regulate one's health behavior by physically means (e.g., preparing healthy food), supportive behaviors (e.g., support the adoption of an exercise regime), or social sanctions (e.g., threaten to leave the marriage if spouse continues to smoke) (Orford et al. 1977). It is interesting to note that although married men's health behavior was influenced more by their spouse than married women's health behaviors, married women's health behavior was more influenced by their parents and their children (Umberson 1992).

However, being married and having a family does not always lead to more positive health behaviors. Cathleen Connell (1994) found that taking care of family members is associated with fewer positive health behaviors and more risk behaviors (e.g., smoking) due to the stress associated with being a caregiver. Also, stressful marriages are related to poorer immune functioning (Burman and Margolin 1989). Specifically, Robert Levenson and John Gottman (1983) found that the physiological stress (e.g., nerves, increased heart rate) that accompanied marital conflict predicted a decline in health. Spousal criticism was also found to affect one's health; it has been linked to lower success rates for quitting smoking (Coppotelli and Orleans 1985).

The Impact of Family on Children's Health Behaviors

Family also influences children's health behavior in several ways. Several international studies (see Wold and Anderssen 1992 for references) have found that health programs aimed at decreasing smoking and engaging in dental hygiene were more effective when the parents were involved. Sandra Hunter and her colleagues (1982), however, found that for some ethnic groups in the United States, family members played a more important role in the prevention of smoking than for other ethnic groups. Specifically, they found that close parent-child relationships and the time children and parents spent together were more significant predictors of smoking for African Americans than for Hispanic Americans or white Americans. This finding may be due to the attitudes held about the role of parents in a smoking prevention program. Both African-American children and their parents were more likely than others to think it is important that the parents be involved in a smoking prevention program (Koepke, Flay, and Johnson 1990).

In addition to involvement in health promotions, family members can model appropriate health behaviors. Albert R. Marston and his colleagues (1988) reported that adolescents who did not use drugs were more likely to have parents who were not drug or alcohol users. Moreover, David Koepke and his colleagues (1990) found that African-American adolescents had a higher rate of smoking than other ethnic groups. They also reported that African-American children and adolescents were more likely to come from a household where others smoked and to live in a household where smoking was permitted.

Family members can support our decision to enact healthier behaviors. Robert Coombs and his colleagues (1991) found that adolescents who abstained from drug use felt better understood by their parents than adolescents who used drugs. Furthermore, those who abstained from drug use reported that their parents influenced them the most, whereas those who used drugs indicated that their friends influenced them the most.

In addition to modeling, families can influence health behaviors by affecting what is available to children. For example, Michael Resnick and his colleagues (1997) found that in the United States, adolescent use of cigarettes, alcohol, and marijuana was associated with how easily accessible these substances were in their own homes. Koepke and his colleagues (1990) found that African-American adolescents were more likely to come from a household where others smoked and to live in a household where smoking was permitted.

Jess Alberts and her colleagues (1991) and Michael Hecht and his colleagues (1997) found that occasionally adolescents were offered drugs by family members. Melanie Trost and her colleagues (1999) reported that the adolescent boys in their study found it most difficult to resist a drug offer from an elderly relative (aunts, uncles, or grandparents) and that adolescent girls in their study found it most difficult to resist a drug offer from brothers or male cousins.

Many researchers have found that during adolescence, family, friends, and school influence one's health attitudes and behaviors. Resnick and his colleagues (1997), in their longitudinal U.S. study on adolescent health, found that parent-family connectedness and perceived school connectedness were protection against every health risk behavior measured (emotional distress; suicidal thoughts and behaviors; violence; substance use; and sexual-risk behaviors) except the history of pregnancy. Koepke and his colleagues (1990) found that although family influenced whether an adolescent smoked, peers and the adolescent's own attitudes toward risk taking were also significant determinants. Bente Wold and N. Anderssen (1992), who looked at sports participation in ten European countries, also reported that the sport participation of parents, siblings, and peers was related to an adolescent's participation in sports. Also, older siblings who do not take part in sports have a negative influence on sport participation of their young adolescent siblings.

The Impact of Family on Other Family Members' Health Behaviors

Every family member can influence another family member's health attitudes and behaviors through communication. As stated earlier, conflict amongst spouses can affect physical health. Research on mental health has shown that critical comments from family members predicts the chance of relapse in depression, eating disorders, and schizophrenia (Fiscella and Campell 1999; Franks, Campbell, and Shields 1992). This is important because depression and hostility were associated with poor diet, lack of exercise, and a small chance in increased smoking (Fiscella and Campbell 1999). Kevin Fiscella and Thomas Campbell explained that the enactment of these unhealthy behaviors may represent some attempt to cope with these negative feelings (depression and hostility). After controlling for potentially confounding variables such as age, sex, race, marital status, income, education, and physical health, perceived criticism (not actual criticism) was significantly associated with fat consumption and lack of exercise (Fiscella and Campbell 1999). Other researchers have also found that family criticism is associated with physical health problems such as poor glucose control by patients with type 1 diabetes (Koenigsberg et al. 1993), less success with weight loss (Fischmann-Havstad and Marston 1984), and problems with asthma (Hermanns et al. 1989).

Conclusion

The family is the basic social context in which health behaviors are learned and performed (Ford-Gilboe 1997). Research in several different countries has found that families directly or indirectly influence one's mental health, physical health, drug use (including cigarettes and alcohol), diet, exercise (including participation in sports), dental hygiene habits, and sexual risk-taking behavior. This influence lasts a lifetime.

See also:Acquired Immunodeficiency Syndrome (AIDS); Alzheimer's Disease; Caregiving: Informal; Children of Alcoholics; Chronic Illness; Death and Dying; Decision Making; Dementia; Depression: Adults; Developmental Disabilities; Disabilities; Eating Disorders; Family and Relational Rules; Grief, Loss, and Bereavement; Homeless Families; Hospice; Religion; Single-Parent Families; Schizophrenia; Stress; Substance Abuse; Widowhood

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yvonne kellar-guenther