HEALTH & LIFE-CYCLE CHANGES

THE RELATIONSHIP BETWEEN HEALTH STATUS AND CHANGES IN THE LIFE-CYCLE OF YOUNG WOMEN

G.L.M. Damen (ANR 543601)

Faculty of Humanities, University of Tilburg, the Netherlands

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1. INTRODUCTION
Due to scientific research, which presents knowledge about health, health status, relationships between nutrition, health and illness, and so on, health status is one of the most significant issues in the modern world. Talk shows, television programmes, fitness centres and public health policies are some examples of contributors to keep us aware of the importance of good health and healthy behaviour. Therefore, we all know that exercising and eating well will make you happier and that looking and feeling good thus have very little to do with cosmetics or high heels. According to recent studies, socio-demographic factors provide a basis to measure differences between people in terms of health status. Hoeymans, Van Lindert, and Westert (2005) reported that employment and educational status, as well as family structure are related to health status. Furthermore, health status as such is important. Research showed results on health status as well as differences and correlations between health status and socio-demographic factors. Hoeymans et al. (2005) reported that women between the ages of 20-29 have significantly more problems than younger women. Furthermore, they reported that women are, in general, less healthy than men. In line with these findings, Eriksson, Dellve, Eklf, and Hagberg (2007) reported that this also concerns young women. Segovia, Bartlett, and Edwards (1989) reported that women are not only likely to worry more about health, but that they also suffer more from chronic pain. Similar findings emerged from Eriksson et al. (2007) who mentioned pain and discomfort as the most prevalent problems. Wyn and Solis (2001) argued that young women suffer from several symptoms of stress and depression. Besides that, Wyn and Solis (2001) also referred to an undefined period of life, which is called the transitional period, as an important feature for the large number of symptoms of ill health, for example depression and anxiety or limitations in activities. The transitional period defines, among others, the completion of an education, the start of a family or the entrance in the labour market. However, they did not investigate this contribution of life-cycle changes on health status. Because research showed that women, especially women in the age of 20-29, are less healthy, this study examines the relationship between health status and changes in the life-cycle of young adult women. Based on both experiences and previous research, it might be expected that the majority of the participants will report no health problems in any dimension. If health problems are reported, pain/discomfort and/or anxiety/depression will be most likely to be chosen. Further hypotheses regarding life-cycle changes will not be made, because of the variety of possible dimensions.

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2. METHOD
2.1 Study population Since several socio-demographic factors might influence the results, this study was carried out in a selection of a group of participants which was defined by gender, age and education. Only females between the ages of 20-29, who study or already obtained a diploma or degree at a Dutch HBO or University and are native speakers of the Dutch language were recruited for this study.

2.2 Instruments A questionnaire was administered and composed of three parts including socio-demographic factors, the measurement of health status and the measurement of the impact of life-cycle changes. In advance, a short introduction was given to inform the subjects about the topic, the classification of the questions and their anonymity. First of all, because of the definition of the population, household composition, relationship status and prior daily life activity were the only socio-demographic variables included in the questionnaire. Furthermore, the EQ-6D, which is a standardised instrument for use as a measure of health outcome, was used to describe the health status of young women (EuroQol Group, n.d.). According to the EuroQol Group, the EQ-6D provides a simple descriptive profile and a single index value for health status. Therefore, the instrument is based on six short questions regarding mobility, self-care, usual activities, pain or discomfort, anxiety or depression and cognitive functioning. Each question provides three possible answers: no problems, some problems and extreme problems. Because, in my opinion, the gap between some problems and extreme problems is significant, the option moderate problems was added to provide the participant more suitable answers (see appendix I). Although the EQ-6D is short and not detailed, research proved that the questionnaire is suitable to measure the health status of a population in general (Hoeymans et al., 2005). Finally, to measure life-cycle changes, a large number of imaginary life events of an individual were added in the questionnaire. These events were based on five domains of life including body and spirit, social relationships, material consistency, work, study and achievements and the significance of values (Stade Avies BV, n.d.). To realize the concrete questions, the Social Readjustment Rating Scale, which was created by Thomas Holmes and Richard Rahe, was used (Huczynski & Buchanan, 2007). The characteristics of this scale, which provide, in general, the measurement of common stressors in life, were divided among the domains. By doing so, they served as an important directory to fulfil the measurement of life-cycle changes.

2.3 Procedure The data were collected between 1 and 10 March 2010 via www.thesistools.nl. An online study was preferred, because the topic of this study is quite personal and online data collection guaranteed the privacy of the subjects. Apart from that, the data procession was easier, because during the online response, the website registered all data in one Excel-file. Potential subjects were approached by e-mail and on Hyves and Facebook. It took about fifteen minutes to fill in the questionnaire, which consisted of 54 items and concerned the topics, mentioned in the previous paragraph. Multiple-choice
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questions were used for the EQ-6D; likert-questions were applied for the measurement of life-cycle changes. For both, an even scale of options was used. The main reason for this was that subjects could not choose for a central option. Finally, there were a few open-ended questions. The data collection was copied and pasted from Excel into SPSS for statistical analysis. Because of the large number of variables, no distinction was made between the independent variables, e.g. the socio-demographic factors. All items of the EQ-6D and the measurement of life-cycle changes, except for the open-ended questions, were analyzed with frequency tables for each variable. Apart from that, all items for each domain were combined to examine the differences between the five domains of life. Therefore, averages were estimated and outlined in comparison with each other.

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3. RESULTS
3.1 Socio-demographic factors The socio-demographic questions showed that the division was about equal for the variable work/education; exactly 42.9% finished school, while the other 57.1% still attends HBO or University. More than three-quarters of the population is in a relationship of whom 46.4% lives together.

3.2 Health status The EQ-6D suggested six dimensions for the measurement of health status in general. Table 1 shows the percentages of respondents reporting their degree of a problem in each EQ-6D dimension. On average, self-care reported the fewest problems. Subsequently, almost all respondents stated no problems in anxiety/depression; only 25.0% pointed out that they had moderate problems in anxiety/depression. Regarding cognition/cognitive functioning, e.g. memory, concentration and IQ, the experiences were more divided. Exactly 50.0% of all women reported no problems in cognitive functioning. However, 42.7% stated some problems and 7.1% even regular problems in cognitive functioning. Furthermore, the majority reported some problems in mobility/energy, usual activities and pain/discomfort. Only one quarter of the respondents reported no problems in usual activities, for example work, study, homework, family or leisure activities. Finally, the majority of the respondents reported some problems in mobility/energy (85.7%) and pain/discomfort (92.9%). Some women said problems in these dimensions are even moderate or extreme.
Table 1. Percentages of respondents reporting their degree of a problem in each EQ-6D dimension

EQ-6D Mobility/energy Self-care Usual activities Pain/discomfort Anxiety/depression Cognition

Degree of problems No problems 10.7 89.3 25.0 7.1 75.0 50.0 Some problems 85.7 10.7 64.3 92.9 25.0 42.9 Moderate problems 3.6 0.0 7.1 0.0 0.0 7.1 Extreme problems 0.0 0.0 3.6 0.0 0.0 0.0

3.3 Life-cycle changes The measurement of life-cycle changes described questions on five domains of life: body and spirit, social relationships, material consistency, work, study and achievements and the significance of values. On average, regarding the amount of impact, five answers stood out in the category of body and spirit: changes in eating habits, satisfaction with personality, satisfaction with body/looks, complete self-esteem and amount of sports and exercise. Though changes in eating habits was, in this case, the dimension with the least impact, it stood out compared to the other dimensions. Namely, the other four dimensions scored about equal; approximately 50.0% of the women reported that these life-cycle changes had a high or moderate amount of impact on their life.
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Table 2. Percentages of respondents reporting their degree of impact on the domain of body and spirit

Life-cycle changes Changes in eating habits Satisfaction with personality Satisfaction with body/looks Complete self-esteem Amount of sports and exercise

Degree of impact Very low impact 17.9 10.7 7.1 7.1 7.1 7.1 21.4 25.0 17.9 25.0 3.6 0.0 3.6 3.6 7.1 32.1 17.9 21.4 21.4 21.4 Very high impact 3.6 32.1 28.6 28.6 35.7 3.6 3.6 7.1 7.1 3.6 NA 32.1 14.3 7.1 14.3 0.0

Regarding the category of social relationships, more than 75% of the women responded that engagement, ending a relationship, marital separation of parents and the start of a new relationship between a parent and stepparent are not applicable. Furthermore, the majority also stated that the start of a new relationship (71.4%), dating (67.9%) and death or changes in health of a close friend/family member (60.7%) are not applicable. Thus, close friendships, disagreements with friends and family, the amount of social activities and hours of free time, are the most important dimensions. Almost half of the respondents stated that close friendships had a moderately high impact. Social activities and free time scored slightly lower. About one-third of the respondents reported that these dimensions had a moderately high impact, while respectively 46.1% and 39.3% of the population reported social activities and free time had a high impact.
Table 3. Percentages of respondents reporting their degree of impact on the domain of social relationships

Life-cycle changes Close friendships Disagreements with .. Amount of social activities Hours of free time

Degree of impact Very low impact 0.0 3.6 0.0 0.0 0.0 14.3 7.1 3.6 7.1 10.7 3.6 10.7 28.6 28.6 46.4 39.3 Very high impact 46.4 17.9 35.7 32.1 7.1 7.1 3.6 10.7 NA 10.7 17.9 3.6 3.6

The majority of the respondents reported that changes in parents financial status, debts or loans and buying a house are not applicable in the category of material consistency. The other dimensions (table 4) on the other hand, had a various and high impact. On average, all these dimensions scored as dimensions with a high impact. Living situation and lifestyle as well as work and working hours seemed to be the two dimensions with the highest impact.
Table 4. Percentages of respondents reporting their degree of impact on the domain of material consistency

Life-cycle changes Amount of money/income Work and working hours Partner Living situation and lifestyle

Degree of impact Very low impact 3.6 3.6 7.1 7.1 0.0 0.0 0.0 0.0 0.0 7.1 0.0 0.0 42.9 14.3 35.7 14.3 Very high impact 39.3 46.4 25.0 46.4 10.7 14.3 14.3 21.4 NA 3.6 14.3 17.9 10.7

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Regarding the category of work, study and achievement, approximately 50% or more subjects reported the start/end of a programme, the change of employer/school, problems with the boss/teacher or not receiving success are not applicable dimensions. The other dimensions scored quite various. The table shows that women reported adjustments and responsibilities as the main dimensions which had a high impact on their lives. More than 40% reported adjustments had a moderately high impact, while responsibilities had a moderately high impact for even more than 60% of the women. A shift from one job to another also has a significant impact; almost one-quarter of the women even pointed out this change had a very high impact. Finally, working hours also stand out, because almost 60% of the women reported working hours had a high or very high impact.
Table 5. Percentages of respondents reporting their degree of impact on the domain of work, study and achievements

Life-cycle changes Large adjustments Responsibilities Begin/end work Working hours

Degree of impact Very low impact 3.6 7.1 7.1 10.7 0.0 0.0 3.6 3.6 0.0 3.6 3.6 7.1 17.9 21.4 10.7 28.6 Very high impact 42.9 60.7 28.6 17.9 17.9 0.0 21.4 14.3 NA 17.9 7.1 25.0 17.9

Within the category of values, no dimension showed that the majority reported the dimension was not applicable. Volunteer work had the least impact; exactly 39.3% of the respondents did not volunteer. If women volunteered, it had low or high impact. The other dimensions on the other hand, obviously reported a high impact. The main dimensions were personal achievements, social well-being and direction in life. Half of the women pointed out that personal achievement as well as direction in life had a moderately high impact; more than 40% reported social well-being also had a moderately high impact.
Table 6. Percentages of respondents reporting their degree of impact on the domain of values

Life-cycle changes Personal achievements Social well-being Direction in life

Degree of impact Very low impact 7.1 3.6 3.6 7.1 10.7 0.0 7.1 3.6 7.1 25.0 28.6 21.4 Very high impact 50.0 42.9 50.0 3.6 3.6 0.0 NA 0.0 7.1 17.9

3.4 Other Some women reported other life-cycle changes which still have an impact on their lives. These occurrences included among others: loss of a girlfriend in high school, loss of a family member, bullying, living together, moving and the divorce of parents. Most of the women pointed out that these occurrences made them think about life and they made them more sure to get the most out of their lives as possible. However, some of the women reported that the occurrence made them sad, depressed and negative in their attitude towards life.

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4. DISCUSSION AND CONCLUSION

This study describes the health status of young adult women in relation to life-cycle changes. Overall, the results showed that young adult women suffer from health problems in all dimensions of the EQ-6D. Above all, mobility/energy and pain/discomfort stood out. Apart from these dimensions though, usual activities also provided young adult women an unhealthier status. Regarding life-cycle changes, the domain of values reported the highest degree of impact; in general, the degree of impact lay between high and moderately high impact. However, this domain also contained fewer questions than other domains. Furthermore, material consistency and work, study and achievement had an average degree of impact between low impact en high impact. Overall, the domains regarding body and spirit and social relationships obtained the lowest scores. However, these domains also had variables that really stood out in their high degree of impact. The results seem to indicate that young adult women do not always have a healthy status. These findings are similar to those emerged from Eriksson et al. (2007), Segovia et al. (1989) and Wyn and Solis (2001) who reported pain/discomfort and stress and depression as important health problems. However, it is interesting to note that there are also women who reported no problems in some dimensions. This is supported by Hoeymans et al.s (2004) results that mentioned that the majority of the respondents (56.8%) reported no health problems in any dimension (p.657). Regarding life-cycle changes, possible causes for a less healthy status probably lie within each domain. It cannot be said which domain stands out, because the number of questions for each domain was not equal. Therefore, the domains could not be equally weighted. However, the variables which scored a high impact (see paragraph 3.3), are those that, based on my own experiences, might be expected to be, in general, important factors in someones life-cycle. This is supported by the results of Tausig (2010) as were change in eating, sleeping and personal habits as well as the type of recreation and social activities were the most important variables. Furthermore, Harmon, Masuda, and Holmes (1970) reported that personal achievement, begin/end of a programme and vacation had a high impact; these results are also in line with the findings of this study. However, the current findings are no powerful predictor of health. Namely, there are some factors which might have affected the results. First of all, some of the imaginable life events could be associated with each other. Therefore, some variables, for example begin/end work, adjustments and responsibilities, might overlapped each other. Secondly, the significant number of life events made it more likely to observe a subsequent less healthy status. Furthermore, it is likely that undesirable events, e.g. death of a family member, changes in health of relatives or disagreements, are more highly related to a negative health status. Finally, personality can also influence the impact of life events. As a consequence, weighted measure of life events and a sound research instrument are necessary to explain the relationship between health status and life-cycle changes. Otherwise it is only possible to point out the main life-cycle changes as indicators for health problems. Given the small-scale of this study, further research should therefore be considered.

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REFERENCES
Eriksson, J., Dellve, L., Eklf, M., & Hagberg, M. (2007). Early inequalities in excellent health and performance among young adult women and men in Sweden. Gender Medicine, 2, 170-181. Harmon, D., Masuda, M., & Holmes, T. (1970). The Social Readjustment Rating Scale: A cross-cultural study of Western Europeans and Americans. Journal of Psychosomatic Research, 14, 391-400. Retrieved April 23, 2010, from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8V-45WYTYT36&_user=10&_coverDate=12%2F31%2F1970&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view= c&_searchStrId=1313250132&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10& md5=0cca9feb1b2d17ea55bb955b34e95955 Hoeymans, N., Lindert, H. van, & Mestert, G. (2005). The health status of the Dutch population as assessed by the EQ-6D. Quality of Life Research, 14, 655-663. Huczynski, A. & Buchanan, D. (2007). Organizational Behaviour: An Introductory Text (6th ed.). Harlow: Pearson Education Limited Stade Advies BV. (n.d.). Regie over eigen leven. Retrieved April 27, 2010, from http://www.stadeadvies.nl/stadeadvies_nl/497af2d96e69031f9ca686d6c7803add.php Tausig, M. (2010). Measuring Life Events. Journal of Health and Social Behaviour, 1, 52-64. Retrieved April 23, 2010, from http://www.jstor.org/stable/2136389 Wyn, R., & Solis, B. Womens health issues across the lifespan. Womens Health Issues, 11, 148-159.

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APPENDIX I: QUESTIONNAIRE

Beste chica, Voor mijn opleiding ben ik bezig met een onderzoek naar de gezondheid van jong volwassen vrouwen. Vaak wordt een slechte gezondheid toegewezen aan socio-demografische factoren, zoals opleiding of inkomen, of slecht gezondheidsgedrag. Zelden echter wordt er gekeken naar de manier waarop veranderingen in ons leven invloed hebben op onze gezondheid. En dat terwijl onze doelgroep onderhevig is aan zoveel (nieuwe) ervaringen! Om een eventuele relatie te onderzoeken, wil ik je vragen om mijn enqute in te vullen. De vragenlijst bestaat uit 3 delen. In het eerste deel worden enkele algemene vragen gesteld. Daarna ga ik in op de manier waarop jij je gezondheid ervaart en tot slot wil ik graag weten hoe veranderingen in verschillende levensdomeinen het afgelopen jaar een impact hebben gehad in jouw leven. Het invullen van de enqute vraagt ongeveer 10 minuutjes en kan geheel anoniem via: .. Alvast ontzettend bedankt! Groetjes Trudy

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Hieronder volgt het eerste deel van de vragenlijst wat bestaat uit enkele algemene vragen. 1. In welke fase van je opleiding bevindt jij je? Bachelor Premaster Master/doctoraal Post-doctoraal Afgerond Anders, namelijk

2. Wat is je burgerlijke staat? Alleenstaand In een relatie Samenwonend Getrouwd

3. Hoe ziet je woonsituatie er uit? Alleen Bij mijn ouders Met vrienden/bekenden Met een partner

4. Wat is je belangrijkste dagelijkse bezigheid? Werk Studie Gezin/huishouden

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Dit is het tweede deel van de vragenlijst. Er volgen nu zes basisvragen om je gezondheidsstatus te toetsen. 5. In welke mate ervaar je problemen tijdens je dagelijkse bezigheden, bijvoorbeeld dat je dingen moet laten in je werk, studie of vrije tijd? Nooit Af en toe Redelijk vaak Extreem vaak

6. In welke mate ervaar je problemen wat betreft je verzorging, bijvoorbeeld dat je jezelf kunt aankleden en wassen? Nooit Af en toe Redelijk vaak Extreem vaak

7. In welke mate ervaar je problemen met je cognitie en denkvermogen, bijvoorbeeld wat betreft je geheugen, kennis of concentratievermogen? Nooit Af en toe Redelijk vaak Extreem vaak

8. In welke mate voel je jezelf energiek? Nooit Af en toe Redelijk vaak Extreem vaak

9. In welke mate heb je last van pijn of ongemak? Nooit Af en toe Redelijk vaak Extreem vaak

10. In welke mate voel je jezelf depressief? Nooit Af en toe Redelijk vaak Extreem vaak

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Dit is het derde en laatste deel van de vragenlijst. Deze vragen gaan over veranderingen in 5 domeinen van je leven. Ze moeten het afgelopen jaar (in 2009) hebben plaatsgevonden. Ik wil graag weten welke impact (zeer negatief zeer positief) deze veranderingen hebben gehad voor jou. Indien een verandering niet van toepassing is, kun je dit aankruisen. Zeer negatief Lichaam en geest Persoonlijke verwondingen of ziekte (Onverwachte) zwangerschap Seksuele problemen Veranderingen in slaapgewoonten Veranderingen in eetgewoonten Gebruik van drugs/alcohol Tevredenheid met persoonlijkheid Tevredenheid met uiterlijk Totale zelfwaardering Hoeveelheid sport en beweging O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Zeer positief N.v.t.

Sociale relaties Overlijden naast familielid of vriend(in) Verloving/trouwen met je partner Begin van een nieuwe relatie (partner) Einde van een relatie (partner) Daten Hechte vriendschappen Scheiding/uit elkaar gaan van je ouders Hoeveelheid sociale activiteiten Aantal uren vrije tijd O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Verslechterde gezondheid familie, vriend(in), partner

Woordenwisselingen/ruzies met vrienden, partner of familie Begin van nieuwe relatie tussen ouder-partner O

Materile zekerheid Hoeveelheid geld/inkomen Werk of bijbaan en aantal uren Partner Woonsituatie en leefstijl Veranderingen in financile status ouders Schulden of leningen O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

Arbeid, studie en prestatie

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Grote aanpassingen Verantwoordelijkheden Begin of einde van studie Begin of einde van werk Verandering van werkgever of school Problemen met baas/leraar Werktijden Geen succes behalen

O O O O O O O O

O O O O O O O O

O O O O O O O O

O O O O O O O O

O O O O O O O O

O O O O O O O O

O O O O O O O O

Waarden en zingeving Persoonlijke prestaties Sociaal welbevinden Zingeving voor anderen Vrijwilligerswerk Regie over eigen leven O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

Hebben er eerder in je leven veranderingen plaatsgevonden die nog steeds een impact hebben? Zo ja, welke. . . . Overige opmerkingen . . .

Bedankt!

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