THE UNIVERSITY OF ZAMBIA

SCHOOL OF HUMANITIES AND SOCIAL SCIENCES

DEMOGRAPHY DEVISION

NAME: GIFT PHIRI

COMP#: 27051927

LECTURER: MR CHISUMPA

COURSE: DE 935

DUE DATE: 06/09/10

TASK: ASSIGNMENT ONE

QUE:
The aim of this essay is to examine the influence of age, sex, marital status, income, education,
occupation, employment status, residence, and religion on health behavior and the utilization of
health services. It will start by giving some definitions, later on show the relationship between
health behavior and utilization, and the factors mentioned above, and lastly a conclusion will be
drawn.

Health behavior is defined as any activity undertaken by an individual regardless of actual or

perceived health status, for the purpose of promoting, protecting or maintaining health, whether
or not such behavior is objectively effective toward that end
(http://www.definitionofwellness.com/dictionary/health-behavior.html).

AGE

Age is one factor that influences health behavior and utilization of health services. A study was
carried out in the United States to see if there is a relationship among cervical cancer screening
and age, health and hysterectomy status. Women of ages 35-64 and, 65 and above were used to
examine the relationship between health and pap testing among older women. Results showed
that there was lower use of pap among older women of age 65 and above as compared to
younger women regardless of their hysterectomy status, further, screening was lower among
older women were results showed being fair or poor health, having a chronic disability, or a
higher CCI score of 4 and above (Meissner, 2008:1).

According to Chaibva C. N., (2008), the age of a woman might influence her decision to start
ANC late or not to attend ANC at all. She stated that pregnant adolescents might tend to conceal
their pregnancies because they might not get married, attending school, afraid of health care
providers or they might be simply too young and lack the knowledge on the value of ANC.

SEX

Since males and females have different reproductive organs, it follows therefore, that they have
different health needs and different risks for specific diseases and disabilities. According to the
study which was carried out in the European Union and the United States, it was found out that
men are less likely to be at risk of most health related problems risk activities such as physically
dangerous sports and physical fighting. Besides that, in the United States, it was seen that men
and boys were more likely than women and girls to adopt unhealthy beliefs, instead, engaged in
risk-taking behavior and were less likely to embrace health promoting behavior. Further, men’s
and women’s health are interrelated, for instance, men are the causers of most deadly automobile
crashes in which women are the ones who are killed, and female spouses foster health promoting
behavior in men (Courtenay.W,2002:1-13).

Besides that, it was reviewed in one study carried out in the United States that men and boys are
more likely to engage in more than 30 behaviors that increase the risk of disease, injury and
death than do women and girls. Further, concerning health promoting behavior, men and boys
engage less in health lifestyles than do women and girls, and they rarely engage in health
promoting behaviors. Men usually eat more meat, fat, and salt and eat less fiber, fruits and
vegetables than women. In addition, men seldom conduct self-examinations, as a result have
higher cholesterol and blood pressure, and they do not bother to reduce them, rarely protect
themselves from the sun, rarely wear safety belts, use fewer medications, vitamins and dietary
supplements, they sleep fewer hours and only stay in bed to recover from an illness for shorter
periods of time than do women (Courtenay. W, 2003:2-3).

MARITAL STATUS

Marital status is another factor that affects health behavior and utilization. Unmarried men are
said to have higher health risks than married men, and they engage in poor health behaviors.
Unmarried men include those that are single, separated, widowed and divorced. Unmarried men
are said to drink and smoke a lot more than married men, they rarely eat fruits and vegetables,
they have a higher probability of contracting STIs, they rarely utilize medical services, they are
unlikely to have had a blood pressure test, and they are more likely to commit suicide. Further,
marriage is said to be positively associated with longevity (Ibid, 2003:11-12).

Marital Status could also influence health care seeking behaviors. According to WHO (2003) as
stated by Chaibva C.N (2008), unmarried pregnant women are not likely to seek ANC services
because of the lack of both economic and social support from their parents, guardians and
spouses. Married and pregnant adolescents may also lack social independence and the power to
make decisions to seek ANC. There may also be pressure or oppression from the husband or
some influential members of the extended family persuading pregnant women to concur with the
decision made on their behalf (WHO 2003).

EDUCATION

In an article by Elo (1992:1), he suggested that education improves the beliefs of women about
the causes and cure of diseases and as a result influences both domestic child-care practices and
the use of modern health-care services. He further suggested that education modifies a woman’s
knowledge of modern health-care facilities, enhances her ability to communicate with modern
health-care providers and increasing the value she places on good health thereby resulting in
higher demand for modern health-care services.

In addition, it has been argued that educated mothers are more likely to make use of modern
medicine and conform to the recommended treatment than less or non-educated mothers, this is
because education changes a mother’s knowledge and her understanding of the importance of
modern medicine for the care of her children. Furthermore, in a research carried out in the
Philippines on child nutrition, results showed that children of educated mothers benefited more
from the access to health-care services than their counterparts of uneducated mothers, this was
due to the fact that educated mothers were more likely to take advantage of available public
health-care services than did uneducated mothers (Ibid, 1992:2).

Further, the level of education of the client could also influence pregnant women’s utilization of
the health facilities and the understanding of the importance of seeking health care as quickly as
possible. Low educational status of an individual has been identified as a major limitation to the
utilization of health care services such as ANC. These women could easily be compelled by their
grandmothers or TBA’s to shun ANC and to deliver their babies at out of the hospitals or at
home. Further, lack of education can also negatively influence the women’s understanding of
vital information and the power to make informed decisions including the awareness of their own
rights. These findings meant that pregnant adolescents who might have attained only low level
education would not see the importance of utilizing ANC services. High educational levels of the
husband and wife have been noted to promote positive health seeking behaviors according to
Mulholland, (1999) and Matha (2004).
Multivariate analysis confirmed the positive and substantial influence of mother’s education on
maternal-care utilization. Education appeared as the single most important determinant of
maternal health-care utilization in India when the influence of other intervening factors are held
constant. For instance, educated women with at least middle schooling are nearly eight times as
likely to receive antenatal care for their births as uneducated women, and educated women with
less than middle schooling are more than three times as likely. The pattern is similar for utilization of
the other maternal health-care services. In general, births to educated women with less than
middle-school education are about three times as likely to receive maternal care services as births
to uneducated women. Similarly, births to women who have completed middle school are five to
eight times as likely to receive maternal care as births to uneducated women. While other
socioeconomic factors, especially residing in an urban area, are substantial and vital, education
by itself has the strongest impact on maternal health-care utilization.
OCCUPATION

According to Hadi et al, (2007) in their research on “the inaccessibility and utilization of
antenatal health care services in Balkh Province of Afghanistan”, results revealed that the
utilization of Antenatal care (ANC) services was distinguished by the women’s involvement in
activities. The use of each of the ANC services was very low among women who were involved
in economic activities as compared to those who were not economically active. This indicated
that involvement in such activities might have created extra load on them and reduced the time
they had available for the reception of such services.

In another article of occupational medicine and sociology literatures it was indicated that
occupation can affect health through job conditions such as job stress, latitude on the job, risk of
injury and other workplace hazards as well as others (Rom and Markowitz, 2006). A number of
studies use PSID data from 1968 to 1991 to examine the role of job stress and job control on
mortality. They found that cumulative exposure to adverse working conditions, low control jobs,
and passive work to a larger extent increases mortality. The studies indicate the importance of
considering health determinants from a life course approach (Fletcher,2009:5).
INCOME

In a research which was undertaken in Armenia to see if there is a relationship between income
and health-care utilization, it was found out that the well to do individuals were more likely to
report themselves as sick. Further in the second round of the research, it was seen that there is a
U-shaped relationship between income and health-care utilization, that is the poorest and the
richest individuals were more likely to report illnesses or utilized more health services
(Chaudhury.W, 2003:5).

In another study which was conducted in India to examine factors behind maternal health
services in the rural areas, it was found that, there is a positive relationship between household
income and utilization of maternal health services (Sharif and Singh, 2002). It was also evident
that due to lack of productive resources for women, income earned by women had impacted
negatively on the utilization of Antenatal care and post natal care.

In addition, in a study conducted in Ghana to compare the utilization of health services in Urban
and Rural areas it was revealed that cost of health facilities hindered the poor from accessing
health care facilities. Further, results revealed that women from low-income families were less
likely to go for prenatal care, visit the public health centre or local private clinic, whereas women
from high-income families used country hospitals or higher medical institutions to access health
facilities which could provide them with better quality health care. These results led to the
conclusion that low income families should be taken as “high-risk factor” for poor maternal
health (World Bank, 1993).

EMPLOYMENT STATUS

In a study which was conducted in Canada to examine the relationship between work hours and
the utilization of general practitioners. Results showed that there was an inverse relationship
between work hours and the utilization of health-care services; this is because of the fact that
making medical appointments was time consuming. Lost wages for time off work may as well
prevented workers from accessing health care services. The table below shows the Adjusted
Incidence Rate Ratio (IRR) for the relationship between work hours and the utilization of general
practitioner of health services.
Adjusted Incidence Rate Ratio and 95% Confidence Interval for Work Hours and Utilization of
GP Services

Adjusted IRR (95% CI)

Variable Men (n53,008) Women

(n52,609)

Work hours
Part time 1.15 (0.98–1.34) 1.00
(0.92–
1.09)

Full time, standard 1.00 1.00

Full time, nonstandard 1.03 (0.90–1.19) 0.99

(0.86–
1.14)

Long, standard 0.82 (0.74–0.92) 0.77

(0.68–
0.88)

Long, nonstandard 0.87 (0.75–1.00) 1.00

(0.82–
1.21)

White collar 1.00 1.00

Pink collar 1.01 (0.89–1.15) 0.96

(0.89–
1.04)

Blue collar 1.09 (0.98–1.21) 0.93

(0.82–
 1.07)

From the table above, 79% of men and 92% of women visited the general practitioner only once
a year. Men and women who worked long hours had the lowest incidence rate of incidence of
general practitioner. Further, there was a negative relationship between health status in men and
women and the rate at which the general practitioner is utilized, that is men and women who
reported fair or poor health status had rates of 46% and 60% higher than those who reported
excellent health status. Also men and women who reported two or more chronic illnesses had
higher rates compared to those without chronic illnesses (Fell et al, 2007:1488-1490).
\

Further, an influential longitudinal study was carried out to examine how current occupation
affects contemporaneous health. Results showed that lower employment status is associated with
worse health, when demographics, health habits and income, among other factors are held
constant. This paper focus on social position, occupational stress, and job control as mechanisms
for the effect on multiple measures of health, coronary heart disease, self-reported health,
morbidity and health related behaviors inclusive. Both health and employment were measured
contemporaneously, leaving open the question of simultaneity.

RESIDENCE

Jayaraman. A, (2008) carried out a research in Rwanda to investigate factors affecting maternal
health care seeking behavior. Results showed that in urban areas, greater proportion of births
occurred in a health facility than in rural areas. The 1992 survey showed that 68% of urban births
took place in health facility as compared to only 24% in rural areas. The same happened in the
2005 survey, a greater proportion of urban births occurred in health facility as compared to rural
areas where only a small proportion of births occurred in health facility. Besides, residents in
urban areas have greater access to health facilities because of the availability of health centers
and this increases their utilization of health services as compared to those in rural areas.
RELIGION

Religion is another factor that influences both health behavior and utilization of health services.
A number of models and theories have been established to help us better understand the
relationship between religion and health behavior and utilization of health services. One of the
models is as follows:

Religion within a social-cognitive model of health behavior.

According to this model, it was suggested that religion has positive effects on both physical and
mental health. Further, it was suggested that religion has both direct and indirect roles on health,
for that reason it was seen that religion could be conceptualized within social-cognitive model of
health behavior because of the fact that religious beliefs and practices often influence
cost/benefit analyses, value perception, perceived behavioral control, and social influence. It has
also been said that the effect of religion on behavior could be mediated by both personal beliefs
expectancies, by the communities that strengthen perceived moral behavior, and through the
desired health results that cope with life difficulties. In addition, it has been suggested that for the
relationship between religion and health to be powerful, both personal belief system and
religious-based social influences need to be in agreement with each other (Creel.D, 2007:5-6).

Below are some of the theories showing the relationships between religion and common health
behaviors?

Religious influence on cigarette smoking.

In a research to examine the relationship between religiosity and smoking, results showed that
96% of the religious participants reported less smoking. In addition, most regular church goers
were more likely to quit smoking after developing the habit of smoking because of the belief that
God will punish them if they do bad things that do not please him (Ibid, 2007:6-7).

Religiosity and alcohol consumption.

Some studies have reported a negative relationship between religion and alcohol consumption. It
was found that higher levels of religiosity are associated with low alcohol consumption. In
another study, which was conducted on adult population, it was found that religious participation
with less likelihood that individuals would seek emergence medical attention had drunk alcohol
in the six hours prior to their medical visit. In another study, to investigate the relationship
between religiosity, stress and abstinence from alcohol in individuals of age 60 years and above.
Results showed that health problems were positively related to abstinence from alcohol (Ibid,
2007:8).

Religion and diet

Some religious denominations do not allow eating certain foods. For instance, the Mormons and
Seventh-Day Adventists. Mormons are said to have lower rates of cancer and heart diseases than
the general public because of the fact that they encourage the consumption of whole grains, fruits
and vegetables. Seventh-Day Adventists usually discourage eating of meat; rather encourage
eating a diet low in saturated and high in nutrients density

From that it seen that religion is associated with healthier behaviors. Further, in many
congregations the pastor will remind his congregation to take good care of their body because the
Bible says “the body is temple of God” and exhort individuals to “honor God with their body”(1
corinthians,6:19-20).

In conclusion, it is evident from above that a number of articles, theories and models have been
established to examine how the factors; age, sex, marital status, income, education, occupation,
employment status, residence, and religion influence both health behavior and utilization of
health services. It has been seen also that these factors have significant impact on health behavior
and utilization.
 REFERENCES

Chaudhury.N, The effects of free-waiver program on health care utilization among the poor
(2003).

Courtenay, International journal of men’s health. A global perspective on the field of men’s
health vol 1(2002).

Courtenay, International journal of men’s health. Key determinants of the health and wellbeing
of men and boys, vol 2 (2003).

Creel.B.D, assessing the influence of religion on health behavior (2007).

Elo.I, population studies centre. Utilization of maternal health-care services in Peru: The role of
women’s education. University of pennyslovania (1992).

Fell.D, Health research and education trust.

Fletcher, National bureau of economic research. Estimating the causal effect of early
occupational choice on later health (2009).

Govindasamy.P, National family health survey subject reports, number 5. Maternal education
and utilization of maternal and child health services in India (1997).

http://www.definitionofwellbeing.com/dictionary/health-behavior.html

Meisser et al, cervical screening in older women.