Carol Emslie

Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial

Objectives To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer, with six month follow-up. Design Pragmatic randomised controlled prospective open trial. Setting Three National Health Service oncology clinics in Scotland and community exercise facilities. Participants 203 women entered the study; 177 completed the six month follow-up. Interventions Supervised 12 week group exercise programme in addition to usual care, compared with usual care. Main outcome measures Functional assessment of cancer therapy (FACT) questionnaire, Beck depression inventory, positive and negative affect scale, body mass index, seven day recall of physical activity, 12 minute walk test, and assessment of shoulder mobility. Results Mixed effects models with adjustment for baseline values, study site, treatment at baseline, and age gave intervention effect estimates (intervention minus control) at 12 weeks of 129 (95% confidence interval 83 to 176) for metres walked in 12 minutes, 182 (75 to 289) for minutes of moderate intensity activity reported in a week, 2.6 (1.6 to 3.7) for shoulder mobility, 2.5 (1.0 to 3.9) for breast cancer specific subscale of quality of life, and 4.0 (1.8 to 6.3) for positive mood. No significant effect was seen for general quality of life (FACT-G), which was the primary outcome. At the six month follow-up, most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged. No adverse effects were noted. Conclusion Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later. Clinicians should encourage activity for their patients. Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services. Trial registration Current controlled trials ISRCTN12587864.

Problematizing gender, work and health : the relationship between gender, occupational grade, working conditions and minor morbidity in full-time bank employees

It is commonly asserted that while women have longer life expectancy than men, they have higher rates of morbidity, particularly for minor and psychological conditions. However, most research on gender and health has taken only limited account of the gendered distribution of social roles. Here we investigate gender differences in morbidity whilst controlling, as far as possible, for one major role, namely participation in paid employment. There is substantial segregation of the labour market by gender; men and women typically work different hours in different occupations which involve varying conditions and differing rewards and costs. Here, we examine men and women working full-time for the same employer. This paper reports on a postal survey of employees (1112 men and 1064 women) of a large British bank. It addresses three main questions: do gender differences in minor morbidity remain if we compare men and women who are employed in similar circumstances (same industry and employer)? What is the relative importance of gender, grade of employment within the organisation, perceived working conditions and orientation to gender roles for minor morbidity? Finally, are these factors related to health differentially for men and women? There were statistically significant gender differences amongst these full-time employees in recent experience of malaise symptoms, but not in physical symptoms or GHQ scores. Controlling for other factors did not reduce the gender differences in malaise scores and produced a weak, but significant, gender difference in GHQ scores. However, gender explained only a small proportion of variance, particularly in comparison with working conditions. Generally similar relationships between experience of work and occupational grade and morbidity were observed for men and women. Throughout the paper, we attempt to problematize gender, recognising that there are similarities between women and men and diversity amongst women and amongst men. However, we conclude that the gendered nature of much of adult life, including paid work, continues to shape the experiences and health of men and women at the end of the twentieth century.

'Getting through' not 'going under': A qualitative study of gender and spousal support after diagnosis with colorectal cancer

Many studies have found that people with cancer value family support. Feminist work suggests that women carry most responsibility for practical and emotional support in families, but few qualitative cancer studies explicitly incorporate a gender perspective. We undertook secondary analysis of in-depth interviews with 33 married or cohabiting respondents with colorectal cancer in the UK to compare men and womens accounts of ‘spousal’ support. Both men and women described the vital role that their partners played in providing emotional and practical support. Mutual support and reciprocity were also key features of narratives; both men and women reported controlling their emotions to protect spouses and preserve ‘normal’ household routines. Traditional gender roles had some influence; some women organised ‘cover’ for domestic work and childcare when they were ill, while some men focused on making sure that their families were financially secure and partners were ‘protected’ from the effects of their stomas. Our findings illustrate the complexity of gendered constructions and performances of ‘care’ and contribute to debates about gender and emotional labour.

Understanding how men experience, express and cope with mental distress: where next?

In line with the shift towards prioritising lay accounts and narratives of chronic illness in sociology, there is an emerging literature on men, their subjectivities and experiences of mental distress. We argue in this paper that subjectivities and distress among men are an important area for critical sociological research. Very little is known about mens subjectivities or the meanings they give to - and how they cope with or seek help for - distress. At the same time, current theories of gender relations, performativity and wellbeing as they pertain to men are likely to shed further light on subjectivity and distress. However, current theories (and qualitative research involving men and women) are pointing to considerable complexity. In this paper, we outline what is known about distress and men, and consider the utility of gender relations, performativity, subjectivities and wellbeing for a better understanding of distress. We also ask: What other factors influence distress, and how should these be considered in relation to men and masculinities? What are the implications for research and policy?

Childhood Mental Ability and Adult Alcohol Intake and Alcohol Problems: The 1970 British Cohort Study

OBJECTIVES We examined the potential relation of mental ability test scores at age 10 years with alcohol problems and alcohol intake at age 30 years. METHODS We used data from a prospective observational study involving 8170 members of a birth cohort from Great Britain born in 1970. Data included mental ability scores at age 10 years and responses to inquiries about alcohol intake and problems at age 30 years. RESULTS After adjustment for potential mediating and confounding factors, cohort members with higher childhood mental ability scores had an increased prevalence of problem drinking in adulthood. This association was stronger among women (odds ratio [OR](1 SD increase in ability) = 1.38; 95% confidence interval [CI] = 1.16, 1.64) than men (OR(1 SD increase in ability) = 1.17; CI = 1.04, 1.28; P for interaction = .004). Childhood mental ability was also related to a higher average intake of alcohol and to drinking more frequently. Again, these gradients were stronger among women than among men. CONCLUSIONS In this large-scale cohort study, higher childhood mental ability was related to alcohol problems and higher alcohol intake in adult life. These unexpected results warrant examination in other studies.

Gender differences in mental health: evidence from three organisations

It is commonly observed that women report higher levels of minor psychiatric morbidity than men. However, most research fails to control for the gendered distribution of social roles (e.g. paid work and domestic work) and so does not compare men and women in similar positions. In this short report, we examine the distribution of minor psychiatric morbidity (measured by the 12 item General Health Questionnaire) amongst men and women working in similar jobs within three white-collar organisations in Britain, after controlling for domestic and socioeconomic circumstances. Data from self-completion questionnaires were collected in a Bank (n = 2,176), a University (n = 1,641) and the Civil Service (n = 6,171). In all three organisations women had higher levels of minor psychiatric morbidity than men, but the differences were not great; in only the Civil Service sample did this reach statistical significance. We conclude that generalisations about gender differences in minor psychiatric morbidity can be unhelpful, as these differences may vary depending on the context of the study.

Older and wiser? Men's and women's accounts of drinking in early mid-life.

Most qualitative research on alcohol focuses on younger rather than older adults. To explore older people’s relationship with alcohol, we conducted eight focus groups with 36 men and women aged 35 to 50 years in Scotland, UK. Initially, respondents suggested that older drinkers consume less alcohol, no longer drink to become drunk and are sociable drinkers more interested in the taste than the effects of alcohol. However, as discussions progressed, respondents collectively recounted recent drunken escapades, challenged accounts of moderate drinking, and suggested there was still peer pressure to drink. Some described how their drinking had increased in mid-life but worked hard discursively to emphasise that it was age and stage appropriate (i.e. they still met their responsibilities as workers and parents). Women presented themselves as staying in control of their drinking while men described going out with the intention of getting drunk (although still claiming to meet their responsibilities). While women experienced peer pressure to drink, they seemed to have more options for socialising without alcohol than did men. Choosing not to drink alcohol is a behaviour that still requires explanation in early mid-life. Harm reduction strategies should pay more attention to drinking in this age group.

The weaker sex? Exploring lay understandings of gender differences in life expectancy: A qualitative study

Despite increasing interest in gender and health, ‘lay’ perceptions of gender differences in mortality have been neglected. Drawing on semi-structured interview data from 45 men and women in two age cohorts (born in the early 1950s and 1970s) in the UK, we investigated lay explanations for womens longer life expectancy. Our data suggest that respondents were aware of womens increased longevity, but found this difficult to explain. While many accounts were multifactorial, socio-cultural explanations were more common, more detailed and less tentative than biological explanations. Different socio-cultural explanations (i.e. gendered social roles, ‘macho’ constraints on men and gender differences in health-related behaviours) were linked by the perception that life expectancy would converge as men and womens lives became more similar. Health behaviours such as going to the doctor or drinking alcohol were often located within wider structural contexts. Female respondents were more likely to focus on womens reproductive and caring roles, while male respondents were more likely to focus on how men were disadvantaged by their ‘provider’ role. We locate these narratives within academic debates about conceptualising gender: e.g. ‘gender as structure’ versus ‘gender as performance’, ‘gender as difference’ versus ‘gender as diversity’.

Staying 'in the zone' but not passing the 'point of no return': embodiment, gender and drinking in mid-life

Public health approaches have frequently conceptualised alcohol consumption as an individual behaviour resulting from rational choice. We argue that drinking alcohol needs to be understood as an embodied social practice embedded in gendered social relationships and environments. We draw on data from 14 focus groups with pre-existing groups of friends and work colleagues in which men and women in mid-life discussed their drinking behaviour. Analysis demonstrated that drinking alcohol marked a transitory time and space that altered both womens and mens subjective embodied experience of everyday gendered roles and responsibilities. The participants positioned themselves as experienced drinkers who, through accumulated knowledge of their own physical bodies, could achieve enjoyable bodily sensations by reaching a desired level of intoxication (being in the zone). These mid-life adults, particularly women, discussed knowing when they were approaching their limit and needed to stop drinking. Experiential and gendered embodied knowledge was more important in regulating consumption than health promotion advice. These findings foreground the relational and gendered nature of drinking and reinforce the need to critically interrogate the concept of alcohol consumption as a simple health behaviour. Broader theorising around notions of gendered embodiment may be helpful for more sophisticated conceptualisations of health practices.

Masculinities in older men: a qualitative study in the West of Scotland

Despite the recent interest in multiple “masculinities,” previous research has either ignored older men or implicitly treated them as without gender. In order to fill this gap in the literature, we conducted semi-structured interviews with men born in the early 1930s living in the west of Scotland. Disruptions to individual biographies (due to the illness or death of a spouse or loss of their job through redundancy) forced men to re-evaluate previously taken-for-granted attitudes to gender roles. Social class trajectories were important in shaping mens attitudes to paid work and gender roles; for example, men who were upwardly mobile were most egalitarian about the gendered division of labor in the household. More privileged men also constructed masculinity differently from less privileged men. Our findings suggest that more attention should be paid to the variety of ways in which older men “do” gender.