No.11, 2021 - Anthropological Researches and Studies

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No.11, 2021

ANTHROPOLOGICAL RESEARCHES AND STUDIES No.11, 2021

Editorial Team:

Honorary Editor: Gheorghiță Geană

Editor-in-Chief: Cornelia Rada

Assistant Editor: Alexandru Teodor Ispas

Specialist Editors:

Adina-Brândușa Baciu (biomedical anthropology, medicine, psychology)

Cornelia Rada (biomedical anthropology, medicine, psychology)

Mihaela Suzana Turcu (biomedical anthropology, medicine, psychology)

Valentina Marinescu (cultural anthropology, sociology, qualitative research methods)

Responsible for final proofreading:

Constanța Nicoleta Urzeală

Costin-Marian Crînguș

Technical Editors:

Mihaela Suzana Turcu

Costin-Marian Crînguș

Consulting editors and experts:

• Abdellatif Baali, Cadi Ayyad University, Department of Biology, Morroco; e-mail:

[email protected]

• Adina-Brânduşa Baciu, "Francisc I. Rainer" Anthropology Institute of the

Romanian Academy, Bucharest, Romania; e-mail: [email protected]

• Adriana Albu, University of Medicine and Pharmacy, Iasi, Romania; e-

mail: [email protected]

• Alexandra Elena Neagu, "Francisc I. Rainer" Anthropology Institute of the Romanian

Academy, Bucharest, Romania; e-mail: [email protected]

• Antoaneta Pungă, "Carol Davila" University of Medicine and Pharmacy, Discipline of

Physiology, Bucharest, Romania; e-mail: [email protected]

• Bianca Fox, University of Wolverhampton, Faculty of Arts, Department of Film, Media and

Broadcasting, Wolverhampton, United Kingdom; e-mail: [email protected]

• Ciprian Ion Isacu, The Grand Hospital of Charleroi, Belgium; e-mail: [email protected]

• Consuelo Prado, Department of Biology, Autonomous University of Madrid, Spain; e-mail:

[email protected]

• Corina Bistriceanu Pantelimon, "Spiru Haret" University, Romania; e-mail:

[email protected]

• Cornelia Rada, "Francisc I. Rainer" Anthropology Institute of the Romanian Academy,

Bucharest, Romania; e-mail: [email protected]

• Cristina Faludi, Faculty of Sociology and Social Work, "Babeș-Bolyai" University, Cluj-

Napoca, Romania; e-mail: [email protected]

• Elena Doldor, Queen Mary University of London, School of Business and Management,

United Kingdom; e-mail: [email protected]

• Emma Surman, Keele Management School, Keele University and Research Institute for

Social Sciences, United Kingdom; e-mail: [email protected]

• Ergyul Tair, Institute for Population and Human Studies, Bulgarian Academy of Sciences,

Sofia, Bulgaria, e-mail: [email protected]

• Eugen Tarța-Arsene, "Carol Davila" University of Medicine and Pharmacy, Bucharest,

Romania; e-mail: [email protected]

• Françoise Rovillé-Sausse, Muséum national d'histoire naturelle, Paris, France; e-mail:

mailto:[email protected]
















[email protected]

• Gabriel Ionuț Stoiciu, "Francisc I. Rainer" Anthropology Institute of the Romanian Academy,

Bucharest, Romania; e-mail: [email protected]

• Ilaria Buonomo, Lumsa University, Rome, Italy; e-mail: [email protected]

• Konstantin S. Khroutski, Institute of Medical Education, Novgorod State University after

Yaroslav-the-Wise, Novgorod the Great, Russia; e-mail: [email protected]; [email protected]

• Laura-Oana Stroică, "Carol Davila" University of Medicine and Pharmacy, Bucharest,


• Luminita Bejenaru, Faculty of Biology, Alexandru Ioan Cuza University of Iaşi, Romania;

e- mail: [email protected]

• Martin Frisher, School of Pharmacy, Keele University, Staffordshire, UK; e-mail: [email protected]

• Mihaela Kelemen, Keele Management School, Faculty of Humanities and Social Sciences,

United Kingdom; e-mail: [email protected]

• Mihaela-Camelia Popa, "Constantin Rădulescu-Motru" Institute of Philosophy and

Psychology, Department of Psychology, Romanian Academy, Bucharest, Romania; e-mail:

[email protected]

• Mihaela Suzana Turcu, "Francisc I. Rainer" Anthropology Institute of the Romanian

Academy, Bucharest, Romania, e-mail: [email protected]

• Mirko Spiroski, Department of Hematology University Medical Center Skopje, Faculty of

Medicine, Skopje, Republic of Macedonia; e-mail: [email protected]

• Monica Tarcea, University of Medicine and Pharmacy Targu-Mures, Faculty of Medicine,

Romania; e-mail: [email protected]; [email protected]

• Rodney J. Reynolds, University College London’s Institute for Global Health (IGH),

England; e-mail: [email protected]

• Serghei Suman, State University of Medicine and Pharmacy "Nicolae Testemitanu",

Chișinau, Republic of Moldova; e-mail: [email protected]; [email protected]

• Svetoslav Handjiev, Bulgarian Association for the Study of Obesity and Related Diseases

(BASORD); Bulgarian Society for the Healthy Foods and Nutrition, Bulgaria; e-mail:

[email protected]

• Tatjana Pavlica, Faculty for Sciences Department for Biology and Ecology, Novi Sad,

Serbia; e-mail: [email protected]

• Tudor B. Marinescu, "Carol Davila" University of Medicine and Pharmacy, Bucharest,


• Zofia Dworakowska, Institute of Polish Culture, Warsaw University, Poland; e- mail: [email protected]























Table of Contents

Santiago BOIRA, Maria Teresa MUNOZ, Anita NUDELMAN, SEXUAL VIOLENCE AGAINST

WOMEN IN ECUADOR: AN OVERVIEW FROM THE RURAL AND INDIGENOUS

AREAS OF IMBABURA .............................................................................................................1-14

Elisabeta NIȚĂ, Diana BRADU, Mihaela Camelia POPA, THE ROLE OF PSYCHOLOGICAL

SUPPORT FOR ADOLESCENTS WITH CANCER .............................................................15-23

Flavia-Elena CIURBEA, Marco CAVANNA, Cornelia RADA, PREDICTORS OF

ADOLESCENT INVOLVEMENT IN CLIQUES AND GANGS ..........................................24-48

Thi Kim Dung LE, CHARACTERISTICS OF TRADITIONAL VIETNAMESE FAMILY AND

ITS INFLUENCE ON COMMUNICATION CULTURE IN THE FAMILY ......................49-64

Gopal Chandra MANDAL, Saheli BISWAS, Pijush Kanti ROY, Kaushik BOSE, AGE

VARIATIONS AND SEXUAL DIMORPHISM IN ADIPOSITY AND BODY COMPOSITION

AMONG TRIBAL ADOLESCENTS OF KHARAGPUR, WEST BENGAL, INDIA .........65-77

Zahouo Pascale Ghislaine KOUAME, Adou Serge Judicael ANOUA, N'Doumy Noel ABE, HIGH

RISK OF POSTPARTUM HAEMORRHAGE AT BOUAKÉ UNIVERSITY HOSPITAL

(NORTH-CENTRAL CÔTE D’IVOIRE) ................................................................................78-91

Miana DINA, Jose Manuel Rodriguez GOMEZ, Cornelia RADA, DIMENSIONS OF CRIME

INVOLVING WOMEN IN DRUG TRAFFICKING - LITERATURE REVIEW FROM

DEPENDENT BEHAVIOR TO RELAPSE ...........................................................................92-116

Yahir GONZALEZ, Diego-Oswaldo CAMACHO-VEGA, THE IMPORTANCE OF WELL-

BEING AND SATISFACTION WITH LIFE IN READING-COMPREHENSION AND

MATHEMATICAL ABILITIES IN DEAF AND HEARING INDIVIDUALS ................117-128

Raja ZAKARIA, Hakima AMOR, Abdellatif BAALI, Noureddine ELKHOUDRI, BODY IMAGE

AVOIDANCE QUESTIONNAIRE AND ASSOCIATED FACTORS: A STUDY OF A GROUP

OF MOROCCAN ADOLESCENTS .....................................................................................129-138

Mihaela LUNGU, Elena Lucreția NEACȘU, Cornelia RADA, ANXIETY, DEPRESSION,

STRESS, EMOTIONALITY AND AGGRESSIVITY - FACTORS THAT MAY INFLUENCE

IRRATIONAL ALCOHOL CONSUMPTION AND RISKY SEXUAL BEHAVIOR ....139-164

Abdellatif BAALI, Hakima AMOR, Raja ZAKARIA, Noureddine EL KHOUDRI, Nadia FATHI,

Nadia EL KADMIRI, ASSESSMENT OF THE QUALITY OF LIFE OF A GROUP OF

SUBJECTS AGED 65 AND OVER (MOROCCO) .............................................................165-178

SPECIALISTS INVOLVED IN THE REVIEW OF ARTICLES AND ABSTRACTS IN THE

PERIOD 2012-2020 .................................................................................................................179-182


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SEXUAL VIOLENCE AGAINST WOMEN IN ECUADOR: AN OVERVIEW FROM THE

RURAL AND INDIGENOUS AREAS OF IMBABURA

DOI: http://doi.org/10.26758/11.1.1

Santiago BOIRA (1), Maria Teresa MUÑOZ (2), Anita NUDELMAN (3)

(1) University of Zaragoza, Faculty of Social Sciences and Labor, Spain; E-mail:

[email protected]

(2) Medicusmundi in Aragón, Spain; E-mail: [email protected]

(3) Ben Gurion University, Faculty of Medical Sciences, Israel

Adress correspondence to: Santiago Boira, Facultad de Ciencias Sociales y del Trabajo, University

of Zaragoza. C/Violante de Hungría, 23, 50009 Zaragoza, Spain. Ph.: +0034976761000; E-mail:

[email protected]

Abstract

Objectives. Sexual violence against women is a major social problem for governments and

institutions. International reports warn about its magnitude and its global nature and findings from

Latin America have also confirmed the seriousness of the issue. The objective of this article is to

address the problem of sexual violence against women in Ecuador, with emphasis on rural and

indigenous areas.

Material and methods. The official data offered by the Attorney General of the State of Ecuador is

analyzed. Likewise, the qualitative information provided by professionals in the province of

Imbabura through interviews and focus groups.

Results. Quantitative data shows a very significant increase in the number of crimes of sexual

violence against women in practically all the provinces of Ecuador in the past three years. Likewise,

from a qualitative perspective, patriarchal culture is very present as one of the causes that explain

violence. As for the manifestation of sexual violence, its most frequent form is within partner

relationships. However, cases of incest, sexual abuse and aggression against minors within the family

environment are also common.

Conclusions. Data for disaggregated and specific monitoring of sexual violence in Ecuador is limited.

In this regard, the use of qualitative methodology to complement such information is recommended.

This study identifies a serious situation both in terms of the prevalence and of the impact of sexual

violence in Ecuador.

Keywords: sexual violence, Ecuador, abuse, rural areas, violence against women.

Introduction

The impact of sexual violence is a global issue which affects millions of girls and women

(World Health Organization, 2013). The World Health Organization (WHO) defines sexual violence

as "any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to

traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless

of their relationship to the victim, in any setting, including but not limited to home and work" (WHO,

2002, p. 149). Likewise, it specifies different forms and contexts where sexual violence, which may

include: "rape within marriage or dating relationships; rape by strangers; systematic rape during

armed conflict; unwanted sexual advances or sexual harassment, including demanding sex in return

for favours; sexual abuse of mentally or physically disabled people; sexual abuse of children; forced

https://www.journalstudiesanthropology.ro/en/sexual-violence-against-women-in-ecuador-an-overview-from-the-rural-and-indigenous-areas-of-imbabura/a158/



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marriage or cohabitation, including the marriage of children; denial of the right to use contraception

or to adopt other measures to protect against sexually transmitted diseases; forced abortion; violent

acts against the sexual integrity of women, including female genital mutilation and obligatory

inspections for virginity; forced prostitution and trafficking of people for the purpose of sexual

exploitation" (WHO, 2002, p. 149-150).

Taking this into account, the Integral Organic Law for the Prevention and Eradication of

Gender Violence against Women in Ecuador (2018), defines sexual violence as: "Any action that

implies the violation or restriction of the right to sexual integrity and to voluntary decisions about

their sexual and reproductive life, by means of threats, coercion, use of force or intimidation,

including rape within marriage or other related kinship relationships - whether or not there is

cohabitation - the intentional transmission of sexually transmitted infections (STIs), as well as forced

prostitution, trafficking for the purpose of sexual exploitation, sexual harassment and other similar

practices. Sexual violence also includes the involvement of children in sexual activities with an adult

or any other person who is in a position of advantage over them, either because of their age, their

greater physical or mental development, or because of a kinship, affective or trusting relationship,

which binds them to the child, due to their position of authority or power. Sexual abuse, sexual

exploitation and the use of the image of children and adolescents in pornography also constitute,

among others, forms of sexual violence. Furthermore, this type of violence includes child pregnancy".

In Latin America, various studies have been conducted to try to establish the prevalence of

the phenomenon in the region and have demonstrated the seriousness of the problem of gender and

sexual violence (Contreras, Bott, Guedes, & Dartnall, 2010; Bott, Guedes, Goodwin, & Mendoza,

2012; WHO, 2013). Contreras et al. (2010) reviewed more than 200 published and unpublished

documents on sexual violence in Latin America and the Caribbean concluding that sexual violence is

a serious problem in the region and that it is most prevalent within a couple's relationship. Moreover,

according to these authors, if sexual violence is caused by someone other than a partner, its most

frequent forms are sexual abuse of children and youth, trafficking and sexual exploitation, sexual

violence in the migration process, sexual harassment at work and sexual violence as a result of

emergencies or armed conflict. The aforementioned study also shows that this type of violence has

its origin in a social order based on gender inequality and power relations between men and women,

where there is a tendency to legitimize violence against women in intimate relationships, to blame

women, to justify men or to consider women as sexual objects.

In terms of the prevalence of the problem in Ecuador, the Demographic and Maternal and

Child Health Survey (CEPAR, 2005) noted that 31% of Ecuadorian women of reproductive age

reported that they had ever been physically, psychologically, or sexually abused. Similarly, the

National Survey on Family Relations and Gender Violence against Women indicated that 6 out of

every 10 women in Ecuador have experienced some type of gender violence. On the other hand,

25.70% have experienced some type of sexual violence and 14.5% have suffered sexual violence

from their partner (National Institute of Statistics and Censuses of Ecuador, 2011; Camacho, 2014).

In Ecuador, this problem has been contextualized from different perspectives. For example,

Friederic (2013) analyzes women's rights including their sexual and reproductive ones. Likewise,

Goicolea (2001) and Goicolea, Wulff, Öhman and Sebastian (2009) explore issues such as women's

needs or the risk of teenage pregnancy. Also, Boira, Tomas-Aragones and Rivera (2017) and Boira

and Brunke (2018) examine the professional response and the context of impunity in which many of

these crimes occur. Among the studies relevant to the context of this article are those which focus on

the differences between the rural areas and the city (Astete & García, 2012; Boira, Carbajosa, &

Méndez, 2015; Cuvi, Ferraro, & Martínez, 2001), or on violence in relation to racial diversity in areas

where mestizo, Ecuadorian and Afro-descendant communities live together (Prieto, Cuminao, Flores,

Maldonado, & Pequeño, 2005; Salgado, 2009).


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As Boira et al. (2015) point out, a markedly sexist and patriarchal culture persists in Ecuador,

with a particular incidence in the rural areas where social pressure is strongest, thus increasing the

vulnerability of women and making it difficult for them to speak out or to denounce.

This study was carried out in the province of Imbabura, located in the Andean region of

Zone 1, in the north of Ecuador. It has an area of 4599 km2 and a population of 398,244. According

to the last available census, the average age is 29. In addition, 65.7% of its inhabitants are considered

mestizo, 25.8% indigenous and 5.4% Afro-Ecuadorian, and the illiteracy rate is 10.6% (National

Institute of Statistics and Censuses of Ecuador, 2010).

The objective of this article is to provide an overview of the issue of sexual violence against

women in Ecuador, with an emphasis on rural and indigenous areas such as Imbabura. To this end,

the data offered by the Ecuadorian Attorney General's Office will be examined together with relevant

findings related to this type of violence, based on previous research carried out by the authors of this

article.

Material and methods

For the purpose of this article, a mixed quantitative and qualitative strategy has been used.

The following sections outline the central aspects of the analysis carried out in our study.

Quantitative analysis

In order to assess the data on the prevalence of sexual violence, a quantitative analysis of

has been carried out concerning the different manifestations of sexual violence in each of Ecuador's

provinces. The data was obtained from reports of the Ecuadorian Attorney General's Office (2018).

For this work, we have analyzed the total sexual crimes reported by the Prosecutor's Office, as well

as the categories of rape, sexual abuse and sexual harassment. One of the limitations of the data

presented is that when violence against women or against a member of the family unit is discussed,

not only women are included, and the motivations for such violence sometimes may be others than

gender-based violence.

Qualitative analysis

The qualitative analysis is based on the first author’s involvement in the field, as a

Prometheus Researcher for the Ecuadorian Government during the years 2014 and 2015. As a result

of his work in Ecuador, several publications were produced that addressed different aspects of gender

violence in the country, mainly in the province of Imbabura: violence in rural areas (Boira et al.,

2015), violence from the point of view of the professionals involved (Boira, et al., 2017), femicide

(Boira & Rivera, 2016), and impunity (Boira & Brunke, 2018). In recent years, and as a result of

different training processes carried out in the country, there is a growing concern about sexual

violence towards women. This article uses primary materials from the articles cited above addressing

the specific issue of sexual violence against women and girls. Specifically, it gathers the transcriptions

of the interviews and focus groups carried out in Imbabura with professionals involved in addressing

violence against women, both from the public and private spheres. From the set of research

interviews, four are incorporated for this article, in which the participants were an activist from a

women's organization, a social worker, a doctor from a judicial team and a judge. Regarding the focus

groups, information is collected from four of them. Table 1 shows their main characteristics.


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Table 1

Characteristics of the Focus Groups

Group Site

Number of

participants Gender

Mean age (in

years) Ethnicity

1 Peña

Herrera 5 6 women 42.4 Mestizo

2 Ambuquí 10 2 women

8 men 36.4

Mestizo/indigen

ous/ of African

descent

3 Peña

Herrera 6 6 men 43.1 Mestizo

4 García

Moreno 10

6 women

4 men 36.7 Mestizo

Results

Contextualization of crime and violence in Ecuador

According to 2018 data, the most populated provinces of Ecuador are: first Guayas, with

25.07% of the national population, second Pichincha with 18.30% of the population and third Manabí,

where a little more than 9.03% reside. These three provinces concentrate more than half of the

country's population (52.4%), which is why when we reviewed the number of crimes which amounted

to 347,819 in 2018; these three provinces concentrated more than half of them (57%): Guayas with

29%, Pichincha with 21% and Manabí 7%. In the case of the Province of Imbabura, 9,015 crimes

were committed in 2018, representing 8.8% of the crimes in the whole country. When examining the

typologies of the major crimes, it was found that among the ten most prominent are two related to

sexual violence: psychological violence against women or nuclear family members in third place with

13% and sexual abuse in the ninth place with 3%. In the case of Imbabura, the crime of psychological

violence against women or nuclear family members is the second most frequent, with 1,225 cases,

and the category of rape, abuse, and sexual harassment is the fifth most frequent, with 515 crimes. It

is significant that the most common typology is psychological violence and this type of violence tends

to figure between the first and third places in all provinces. This fact leads us to reflect that the major

type of violence in Ecuador is a violence that does not leave a physical mark on the victim, but

certainly affects their self-esteem, reducing their ability to react, which indicates a clear relationship

of inequality between the aggressor and the victim.

Impact and prevalence of sexual violence

When observing the data of cases of sexual violence against women in the country, it is

noteworthy that of the total crimes for 2018, almost 15% are about sexual violence (51,900 of a total

of 347,819). The province where the greatest number of news items on crimes of sexual violence

collected is Guayas with 19,032, which in this case represents 18.84% of the provincial total. If we

analyze the percentage of sexual violence crimes in relation to the total crimes in each province, the

provinces of Morona Santiago (30.38%) and Manabí (26.70%) have the highest percentage. In the

case of Imbabura, the percentage is close to 20% and thus clearly above the average of Ecuador as a

whole. Figure 1 shows the percentage of sexual violence crimes related to the total of crimes in the

country.


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Figure 1

Percentage of crimes of sexual violence over total crimes

Source: developed base on data from the Public Prosecutor's Office

When relating to the different types of violence against women or members of the nuclear

family, including physical, psychological, and sexual violence, it is clear that sexual violence is the

most represented type of crimes, with Guayas having the highest percentage (30.68%).

In reviewing the 2018 data on sexual harassment in Ecuador, it is necessary to bear in mind

the differentiation between harassment of minors (18 years of age) and of adults. It is important to

emphasize the fact that the breakdown of the data into harassment of minors and adults indicates that

minors are being victims of this crime in a significant way. Out of a total of 2,401 sexual harassment

crimes in 2018, Guayas and Pichincha again are the provinces with the highest number of victims of

this crime. However, if analyzed according to the percentage of the population, the provinces with

the greatest number of reports of crimes of harassment are Galapagos and Pastaza.

In the case of rape, Guayas and Pichincha are again the provinces where this crime mostly

occurs. But it is important to look at the percentage of the population that these provinces represent

and the percentage of this type of crimes in relation to it, in order to know exactly if the degree is

higher.

In 2018, in the province of Imbabura, there were 227 sexual abuse crimes and 209 rape ones,

which represent 2.5% and 3.5% of the crimes of this type that occur in the country.

As for sexual abuse against women, an increase over time of this crime can be observed and

unfortunately more so over recent years, even doubling among some populations. This may be due

to its being underreported before or perhaps because they were not aware that this was a crime, having

"normalized" it, since women tend to suffer in silence, often without making the crime visible.

Table 2 illustrates the evolution of the crimes of sexual abuse and rape in Ecuador between

the years 2016 and 2018, and shows a significant increase in practically all the provinces of the

country in these two forms of crime.

0%

5%

10%

15%

20%

25%

30%

35%


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Table 2

Evolution of the crimes of sexual abuse and rape in Ecuador

Sexual Abuse Rape

Year/ province 2016 2017 2018 2016 2017 2018

Azuay 262 463 659 293 338 412

Bolívar 11 46 53 49 84 62

Cañar 81 88 128 84 114 124

Carchi 27 57 67 47 49 36

Chimborazo 114 145 144 136 165 205

Cotopaxi 58 122 159 99 131 140

El Oro 252 371 390 269 317 304

Esmeraldas 135 211 286 210 212 224

Galápagos 16 15 26 12 17 20

Guayas 818 1320 2070 912 1014 1110

Imbabura 127 212 227 132 175 209

Loja 114 187 235 157 164 177

Los Ríos 167 237 297 246 268 226

Manabí 356 516 604 329 422 476

Morona Santiago 82 156 239 198 229 234

Napo 39 64 107 87 86 77

Orellana 73 98 140 80 101 99

Pastaza 42 46 117 51 47 87

Pichincha 1028 1416 2101 879 938 921

Santa Elena 59 126 145 79 88 109

Santo Domingo de los

Tsáchilas 139 295 278 195 241 225

Sucumbíos 39 73 114 111 157 167

Tungurahua 96 98 201 101 132 158

Zamora Chinchipe 66 109 124 59 48 70

TOTAL FOR ECUADOR 4201 6471 8911 4815 5538 5873

Source: Author’s compilation based on data provided by the Public Prosecutor's Office

Sexual violence in rural and indigenous areas of Imbabura

This section reviews some emerging issues related to sexual violence in the context of the

above-mentioned research and, in particular, based on the focus groups carried out. Thus, it first

addresses the role of patriarchal culture and traditional and modern values in explaining sexual

violence. Secondly, the most common manifestations of sexual violence are characterized and finally,

the consequences of violence for the victims, low reporting rates and impunity are analyzed.


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Patriarchal culture, tradition and modernity

In the descriptions made by informants, sexist attitudes and machismo frequently appear in

the context of violence suffered by women. However, most of the time these attitudes and behaviors

are only seen as affecting specific individuals, and not as a cultural manifestation that permeates

institutions and constitutes a background structure which models interpersonal relationships at all

levels of the social structure.

On the other hand, in addition to the transmission of patriarchal values, some narratives

explain the violence that occurs in the communities as a result of issues such as poverty,

overcrowding, or the influence of religious values related to sexual education. To illustrate, this is

this how a teacher narrated his conversation with a young boy on the school bus:

"Just yesterday I was talking to a boy and he said, 'The girl over there is my girlfriend'; well,

what is a girlfriend to you?"My girlfriend is my female", ah interesting, and what do you do with the

female, ah I go out to take a chance [...] I see, my son: And what is a chance? This is "chancear"

[making a gesture like having sexual relations]. I didn't know this. Well, who teaches you? Who

teaches you this? My daddy... [...] Many times it is not that the father or the mother teaches him.

Unfortunately the economic situation of the homes, they are poor and they share their room with the

children [...] The father and the mother, like in a normal home, are going to have their intimacy, and

they think that the children are already asleep; but the children are not asleep" (Ambuquí

professionals Group).

Similarly, some informants see the problem of violence in relation to the loss of traditional

values and in the confrontation between the new and the old, as well as in the double standards, which

some call: "prudishness" in social relationships. This confrontation of the new and the old also

incorporates other elements, such as the value of the indigenous perspective or the influence of the

Catholic Church.

The cultural narratives of these traditions are very powerful and can make it difficult for

women who suffer violence to get out of the situation and to report the aggression. In this regard, the

role of professionals can be decisive:

"In the end, both for the priest and the psychologists the message is: stay [together], marriage

is forever! If you won't go back to your husband, your child will have low grades, you can hurt

yourself or want to kill yourself, [instead] you should make a healthy family environment. What does

the woman do then, (she) endures" (Women's activist organization).

Characterization of sexual violence

This type of violence is significantly present in rural and indigenous areas. The types of

sexual violence that appear in the informants' narratives are primarily sexual abuse and assault among

adults both within and outside the couple, and sexual abuse of minors, especially girls. A type of

harassment and abuse that occurs in the educational setting is also mentioned.

These situations tend to be hidden in the "public narrative" of community members because

they are considered taboo. However, the professionals who work in these areas also refer to cases that

allude to situations of incest and stepfather’s relationships with their stepdaughters, who are girls or

adolescents.

"Here in the parish I am the authority in charge. It is really a social problem that is difficult

to deal with, not only here in the parish, and much more difficult in the rural areas where we live [...]

Domestic violence is not only towards the wife but also towards the children, and it is not only


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physical violence and beating, there are also rapes from fathers to daughters. There are very serious

cases that have really worried us a lot, and many girls have committed suicide here, according to

investigations that have been carried out in cases in which were abused by parents, uncles, cousins...”

(Group of Garcia Moreno professionals).

In another testimony, a professional from the judicial units comments:

"I have worked in rural communities, let's say with a mestizo population, an indigenous

population, an Afro population... I don't have any data on that, but the abuse has been seen from

grandparents to granddaughters, from fathers to daughters, from stepfathers to stepdaughters"

(Social worker, judicial team).

In some of these narratives about sexual abuse the idea of "complicity" of some mothers in

these situations is mentioned, in which even their social role as a mother begins to be performed by

their daughter, leading to dramatic consequences that can result in suicide.

When relating to the sexual violence suffered by many women at the hands of their partners,

a doctor from the judicial team comments:

"In that case that I was telling you about, you see, the couple has been drinking alcohol

among friends and an argument erupts and they hit each other […]. In the evening, he wants to have

sex, and she is his wife, and because they have fought and she doesn't want to and she says, 'No, we're

not going to fight, don't even look at me. And he takes her and forces her and has forced penetration

and that is already a violation" (Medical judicial team).

Another form of abuse that appears in some narratives of different groups occurs from

teachers against students in educational settings, mostly relationships between secondary school

students (mainly girls) and teachers. These issues are well-known by the community, although, the

same as regarding incest, they are covered up and do not initially emerge:

"The Rector has been told not to allow that [the relationship between students and teachers].

Here we have the example of a 15-year-old girl who got pregnant by a teacher, now they live

together" (Group of Peña Herrera professionals).

This form of inter-generational abuse is reinforced in another one of the groups:

"Yes, exactly, for example, this is what it has been like here in the Educational Unit for many

years, I remember since I was a student myself. There were relationships between teachers and

students, many of them even made it to..., they didn't get married, the student and the teacher had

their home and their family, and soon afterwards they [usually] separated as a result of their age

gap, because imagine a graduate getting married: a 40-year-old man with a 16-year-old girl" (Group

of Ambuquí professionals).

Consequences of violence for victims, lack of complaints, reporting and impunity

The consequences for girls and women who suffer this type of violence are always very

serious often leading to psychological repercussions, low school performance, premature

pregnancies, suicide and femicide. It is also necessary to consider that situations of sexual abuse

usually continue over time and the consequences can be irreversible. One informant describes the

following:


9

"We have to sensitize the parents, and also students from the age of twelve or thirteen we

should sensitize them so that they are they themselves are the spokespersons who warn or report,

because [now] they remain silent out of fear so they never warn others [...] When we made a survey

we realized by these students’ performance, their low performance, they also seem to be distracted,

and while the rest are playing games they suddenly leave" (Group of professionals García Moreno).

Regarding the influence of the experience of violence and sexuality on victims’ body image,

one of the professionals explains that women who suffer continuous sexual abuse feel that their body

does not belong to them and may even feel it is alien to them.

"[When you talk to women] you shift from cultural issues to sexuality and even to the issue

of intimacy. They say, for example, that they don't undress [to have sexual relations], so that their

body doesn't belong to them. We wondered why they don't plan anything: first, because men don't

allow them to take any contraceptives and because there is a taboo on the subject of ligatures, if a

woman is going to have ligature it is because she is going to have another guy, they are going to be

betrayed and all that. ... They don't make violence visible in their bodies" (Women's activist

organization).

An issue that is often closely related to violence is early pregnancy among teenagers. There

are many young girls who become mothers at a very early age and are left alone, as in most instances

the father of their child disappears. Thus, in these cases, the bonding of the sons and daughters is

usually with the mother and not with the father. It is also common for a single mother to bring her

children into a new relationship. In other instances, these young mothers remain in relationships that

can become violent at an early stage and the presence of the children may act as a deterrent to leaving

the relationship, radically conditioning their way of life and hindering any type of decision.

The low rates of reporting and the impunity for many of these aggressions is another aspect

that transpires from the narratives of the informants. The difficulty in reporting is due to different

causes. On one hand, because it involves a complaint against family members, often questioning the

credibility of the girl's testimony or even blaming her for what happened:

"I have seen cases of mothers who beat their daughters because they don't believe the

daughters when they tell them that the father or stepfather is raping them" (Group of García Moreno

professionals).

On the other hand, another reason for not filing a complaint is that it is usually not going to

succeed due to a lack of institutional support. However, it seems that professionals are well aware of

cases of violence in the communities where they are working. One of them even asked himself: well,

we are here, what can we do? Thus, expressing his tiredness and frustration:

"I know the problems of each of the homes, even if you don't believe it, one already knows

what is happening here or what is happening there [...]. Here are all the authorities: what do we do?

It's not just about telling the truth. Sometimes you feel powerless, as a teacher, because you don't

have money and support of the other institutions, because in effect we are told: 'you have to do this,

you have to fight against this, you have to finish this'. I always disagree with this, because these are

nice words that they are telling us, and I ask, but how?" (Group of Ambuquí professionals).

Regarding the impunity in some of the narratives, the question of the 'role played by the

indigenous justice system' appears. Although it is a right recognized in the Constitution, it is possible

that it could have negative effects in addressing violence against women, provoking processes of re-

victimization or even protecting the aggressor, is noted.


10

"The issue of indigenous justice is very sensitive because the national legal framework

grants indigenous communities the power to apply their tradition and customs and to enforce justice

[...]. I was about 10 years into my professional career there, and unfortunately I must say that in

cases of domestic violence, people are re-victimized, especially women. I was in some meetings,

especially those of the town councils where women were accused of these aggressions [...], those that

are there are all men and they are older people y they tend to advise the woman:"don't do this because

if you do it, he will punish you" or, "why did you do that? that's why he punished you", "and then

comes the matter of keeping the family (together) despite everything" (Judge).

Discussions

The problem of the lack or inconsistency of statistical series showing the true impact of

sexual violence is also an issue in other Latin American countries. Alméras and Calderón (2012)

identify this situation, emphasizing that these countries do not have a system of indicators that can be

standardized and compared over time. They also point out that the statistics do not show the real

impact of the problem due to the low rate of complaints.

On the other hand, as already noted by the WHO (2002) the available data only reflect the

cases reported, so it is to be expected that the severity of the problem may be much greater due to, as

already noted in this article, the difficulty in reporting this type of violence. In line with the WHO

report, sexual violence can be visualized as an iceberg floating in the water, where the small visible

tip represents the cases reported to the police, but below the surface a significant unquantified part of

the problem remains. In this regard, the use of qualitative methodology such as in-depth interviews

with victims and, above all, the way in which information is obtained, are very important

considerations when assessing the impact and depth of the phenomenon (Nudelman, Boira, Tsomaia,

Balica, & Tabagua, 2017).

In accordance with what has already been noted in the review by Contreras et al. (2010), the

quantitative data available for Ecuador shows a very significant increase in the number of reports of

crimes of sexual violence against women in practically all provinces in the last three years. The

specific case of Imbabura province is no exception, as the data indicates that this type of crime has

virtually doubled. For example, regarding sexual abuse, the number of crime reports has increased

from 127 in 2016 to 227 in 2018. Likewise, the data on rape has risen from 132 in 2016, to 209 in

2018.

Patriarchal culture as a cause of violence is clearly evident in the findings of this study, thus

supporting the conclusions of some of the most relevant authors who have studied this topic in the

last decades at an international level (Dobash & Dobash, 1979; Connell, 2013; Mshweshwe, 2020;

Tonsing &Tonsing, 2019). Patriarchal culture defines, in a very powerful way, the gender and sexual

roles of what it means to be a man and a woman, their modes of behavior and social mandates, as

well as what is and is not allowed for both men and women in emotional relationships and in sexual

behavior. The loss of family and community values and the incorporation of individualism due to

globalization and neoliberalism are also seen as the origin of dysfunctions within the family and of

violence. However within this perspective, traditions can always mask a patriarchal vision that opts

for permanence and asymmetry in gender relation.

The events of violence reported by the informants do not differ from those in other settings

and the most common one is sexual violence in the context of partner relationships. However, cases

of incest, as well as sexual abuse and aggression against minors in the family environment also stand

out (Boira et al., 2015). Finally, the low rate of complaints and the ambivalent role of the so-called

"indigenous justice" draw a scenario of impunity and reinforce the passivity and the silence of the

victims. Regarding the low level of complaints, Bravo (2011) emphasizes that sometimes

professionals themselves use arguments in defense of family stability that may deter reporting. He


11

also underlines the lack of strong evidence and of objective witnesses, the slowness of the proceedings

and the rigidity and complexity of criminal proceedings as additional causes of these situations.

Both the analysis of the reports of the Prosecutor's Office and the qualitative data from the

field work indicate the seriousness of the prevalence of sexual violence as well as its impact on

women, which are recognized as a political and social problem, affecting the Ecuadorian society. In

this regard, the State has promoted different measures such as the recent legislation on gender

violence (Integral Organic Law for the Eradication of Violence against Women, 2018); the creation

of a specialty at the Public Prosecutor's Office on the issue of gender violence and the training and

capacity building that some provinces are receiving on these issues. Nevertheless, the influence of

the patriarchal culture on violence continues to be important in Ecuador, and therefore, it is crucial

to increase the visibility of the sexual abuse experienced by women as well as the sex education they

receive (Jerves et al., 2014).

Overall, in the Latin American region there have been important advances in national

legislation in recent years. Nevertheless, there are still challenges to be faced in addressing violence

prevention against women in all its forms. Likewise, as noted by the WHO (2006), it is necessary to

continue fighting against the lack of impunity in which many of these crimes remain, shifting from

words to actions and considering the crucial responsibility that States have in this matter.

Regarding the limitations of the study, the qualitative analysis is focused on a specific region,

which makes it difficult to generalize the results to other areas of Ecuador. The objective of future

research would be to expand the analysis to other areas of the country. In addition, it will be important

to specifically analyze the roles played by the Catholic Church and by other cultural traditions in

relation to sexual violence.

Conclusions

Even though different sources of information were used, our study has shown that there still

is a lack of data on sexual violence in the Ecuadorian context and specifically of permanent and

conveniently disaggregated series over time that would allow for specific monitoring of crimes of

sexual violence against women. This is a fundamental factor, not only to assess the real impact of the

problem, but also to promote and guide public policies.

In terms of the crimes of sexual abuse and rape in Ecuador, they have increased significantly

in recent years both in Imbabura and in practically all the provinces of the country.

From a qualitative research point of view, and based on the discourses and narratives

gathered in this study, patriarchal culture is very evident as one of the critical causes that explain

violence. Regarding the characterization of sexual violence, the study concludes that among adults,

women are sexually abused and assaulted both by their partner, as well as outside the couple relation,

while minors, especially girls, are also sexually abused. Additional conclusions that can be drawn

from the qualitative analysis are the low rate of reporting by victims and the impunity in which many

of the perpetrators remain.

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1&isAllowed=y


15

THE ROLE OF PSYCHOLOGICAL SUPPORT FOR ADOLESCENTS WITH CANCER

DOI: http://doi.org/10.26758/11.1.2

Elisabeta NIȚĂ (1), Diana BRADU (2), Mihaela Camelia POPA (3)

(1) PhD. Student, School of Advanced Studies of the Romanian Academy, "Constantin Rădulescu-

Motru" Institute of Philosophy and Psychology, Department of Psychology, Romanian Academy,

Bucharest, Romania;

(2) Pilot Complex of Curative Pedagogy "Orpheus" Chișinau, Moldova; E-mail:

[email protected]

(3) "Constantin Rădulescu-Motru" Institute of Philosophy and Psychology, Department of

Psychology, Romanian Academy, Bucharest, Romania; E-mail: [email protected]

Address correspondence to: Elisabeta Niță, School of Advanced Studies of the Romanian Academy,

"Constantin Rădulescu-Motru" Institute of Philosophy and Psychology, Department of Psychology,

Romanian Academy, Calea Victoriei 125, Sector 1, 010071, Bucharest, Romania. Ph.: + 40-720-100-

692; Fax + 40-21-312-02-09; E-mail: [email protected]

Abstract

Objectives. The aim of the study was to identify specific elements of stress for adolescents surviving

cancer, and the working hypothesis was that there are statistically significant correlations between

the items of the three scales used in the study.

Material and methods. Between January and February 2020, 45 adolescents participated (13-18

years), 26 girls and 19 boys, in a survey in which three tests were used: Child Depression Inventory -

CDI 10 items, Scale of irrationality for children and adolescents-CASI with 28 items in four subscales

(Intolerance to frustration given by rules, Global self-assessment, Absolutist requirement for justice,

Intolerance to frustration given to work) and post-traumatic developmental scale-SRGS with 15

items.

Results. Statistically significant associations were identified between certain items from the scales

used in the study and the result very highly statistically significant is given by associating item "I

realized it was better to have more trust in me" with item "I learned to defend my personal rights" ( p

<0.05, χ 2 t east). The interaction between the dependent variable "I learned to defend my personal

rights" with the independent variables "It's awful to be wrongfully blamed by the teacher" and "There

are things that bother me" through the regression model and the result was statistically significant (p

<0.05, F test).

Conclusions. The associations and the results obtained indicate the need for effective communication

with adolescents with cancer to identify psycho-emotional needs and stress management.

Keywords: cancer, depression, anxiety, adolescence, stress.

Introduction

In the treatment of anxiety, depression, fear, pain of children/adolescents with cancer,

paediatric medical traumatic stress, cognitive behavioural various therapy techniques are

applied: pre-exposure, positive reinforcement, relaxation and breathing exercises, modelling,

systematic desensitization, guided imaging. One of the most common psychiatric symptoms in the

acute phase of cancer diagnosis and treatment is anxiety. Most of this anxiety is situational and does

not meet the diagnostic criteria for a specific syndrome. Specific types of anxiety include separation

https://www.journalstudiesanthropology.ro/en/the-role-of-psychological-support-for-adolescents-with-cancer/a160/


16

anxiety, defined as inadequate and excessive separation anxiety from home or from those to whom

the child is attached. Younger children, children who have not been away from home overnight

or children with pre-existing anxiety disorders will certainly develop symptoms of separation

anxiety (Kreitler, Weyl Ben-Arush, & Martin, 2012, p. 23).

Acute Stress Disorder (ASD) is a physiological and emotional response to an event involving

the child or to a death or injury threatening event of intense fear, horror or helplessness. Like post-

traumatic stress disorder (PTSD), ASD includes physical symptoms, memory avoidance, and

intrusive thoughts of the event that was traumatic. ASD differs from PTSD in three ways: (1) it

is limited in time (not less than 2 days, not more than 4 weeks); (2) it is acute (within 4 weeks of the

traumatic event); and (3) it involves dissociative amnesia, numbness, depersonalization, derealisation

or feeling dizzy/dizziness. In children /adolescents agitation and disorganized behaviour ASD can

manifest itself through agitation and disorganized behaviour, particularly as a response to a perceived

threat. Children and adolescents with pre-existing anxiety disorders are at higher risk for both ASD

and PTSD. Given the overlap of the symptoms, the ASD may be confused with depression, anxiety or

delirium (American Psychiatric Association, 2016, p. 280).

Delirium is a fluctuating neuropsychiatric disorder due to encephalopathy. This type of

brain disorder often reflects an electrolyte imbalance, drug toxicity or organ failure and it is a poor

prognosis sign with hospitalized patients. The symptoms of apathy, anxiety, disorientation,

hallucinations, and delusions appear to be similar in adults and in children with delirium. Wake-up

disorder-sleep, impaired attention, irritability, agitation, emotional labiality and confusion are more

commonly seen in children / adolescents , while impaired memory, depressed mood, speech disorder,

delusions and paranoia are more commonly seen in adults. Although delirium in adults is a significant

concern, literature on delirium in children is still quite limited. A study published in 2010 examined

the literature of the period 1980 - March 2009 and found data on 217 paediatric patients with delirium

defined and 136 with "probably delirium". Among children / adolescents with delirium, 7%

had cancer (Kreitler et al., 2012, p. 43).

It is difficult to determine whether a child / adolescent with cancer is depressed or

not. Common symptoms of depression, such as changes in sleep or appetite, can be attributed to

illness or treatment. Boredom and energy conservation can be confused with anhedonia. They can

experience the fatigue related to chemotherapy, may have symptoms of energy decline, lack of

interest in activities they enjoyed before illness and social withdrawal. Despite these problems, recent

studies have found that in the case of chemotherapy, it is possible to distinguish between fatigue and

depression and to be able to continue with an appropriate intervention. There is also evidence that

self-reporting measures can be used to identify children who need interventions for anxiety,

depression, post-traumatic stress, both for themselves and for their parents and siblings (Kreitler et

al., 2012, p. 49).

Structured monitoring is needed throughout the history of cancer and not just during active

treatment. A child-cantered care philosophy would guide the child to achieve a state of health and

welfare (Darcy, Enskär, & Björk, 2019, p. 2).

Paediatric cancer has many challenges for the life of the child and his family. Among the

studies investigating risk and protection factors, social support has emerged as an important

construct. However, not much is known about how family members support each other in this

particular context. This process was explored in a qualitative study in which interviews were

conducted separately with mothers, fathers and siblings. Data analysis revealed three themes: being

together-families identified the need to be together physically; finding support in communication -

the complexity of sharing emotions; working together as a team-the families described work

together. The study broadens the understanding of the interpersonal process of providing family

support when dealing with paediatric cancer, and clinicians should be sensitive to the various

communication needs related to cancer within the family (for example, the need to speak or not to


17

speak); to incorporate this type of knowledge into their care giving practice (Schoors, Mol,

Verhofstadt, Goubert, & Parys, 2019, p. 6).

Given the above-mentioned circumstances, this study aims to identify specific elements of

stress for adolescents surviving cancer.


Between January and February 2020, a survey used three tests as follows: the Child

Depression Inventory test, the short version-CDI with 10 items (Kovacs, 2012 , p. 79), the

Irrationality Scale for children and adolescents-CASI with 28 items in four subscales (Intolerance to

frustration given by rules, Global self-assessment, Absolutist requirement for justice, Intolerance to

frustration given to work) (Bernard & Cronan, 2007, p. 4), Post-traumatic development scale -SRGS

with 15 items (Park, Cohen, & Murch, 2007 , p. 5). The study also included an open-ended question

in which respondents were asked to write the words they wanted to hear and the words they did not

want to hear from adults.

The study involved 45 adolescents, 13-18 years, 26 girls and 19 boys, of whom 11 were

about one year after diagnosis, 8 about two years after diagnosis, 12 about three years after diagnosis,

14 about four years after diagnosis.

The working hypothesis was that there are statistically significant correlations between the

items of the depression scale, the irrationality scale for children and adolescents and the post-

traumatic development scale for adolescents (13-18 years old) cancer survivors.

For the statistical analysis of the results obtained from the two tests, the statistical program

Epi Info was used, a statistical software developed by the Centers for Disease Control and Prevention

(CDC) in Atlanta, Georgia (USA) and licensed as a public domain (Epi Info™ , 2019, para. 1).

The association between the response categories was analyzed using the chi-squared test, a

contingency table between the items in the scales. Linear regression was also used to

identify which variables are, in particular, significant predictors of the resulting variable and to

explain the relationship between a dependent variable and one or more independent

variables. Regression analysis has helped to put out how much the dependency variable changes with

a change in one or more independent variables.

Results

The items on the post-traumatic scale with the highest score were: "I realized that it is

good to have more confidence in myself and I learned to defend my personal rights".

From the irrationality scale for children and adolescents the items with the highest

score were: "It is awful to be wrongfully blamed by the teacher/A teacher who wrongfully blames a

student is totally bad /Teachers should be correct all the time /I need to be rested and relaxed before

I start working hard".

The subscale absolutist requirement for righteousness had a higher score, the subscales

overall assessment of oneself and intolerance to the frustration caused by the rules scored on average

and the subscale intolerance to frustration of the work scored low.

A statistically significant association was found between the item "I realized that it is good

to have more confidence in myself" from the post-traumatic development scale with "I learned to

defend my personal rights" (p = 0.0001, chi-squared = 23.06, df = 4) (table 1).

https://translate.google.com/translate?hl=ro&prev=_t&sl=ro&tl=en&u=https://www.cdc.gov/epiinfo/index.html


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Table 1

Association of items from the post-traumatic development scale

Items/Answer variants Disagreement To some extent

agree

Strongly agree

n % n % n %

I learned to defend myself

personal rightsa

3 6.67 7 15.56 35 77.7

I realized it was

good to have more confidence in

myself a

3 6.67 7 15.56 35 77.7

Note. N = 45 participants aged between 13 and 18 years areflect the number and percentage of participants for each response variant

A statistically significant association was found between the item "It is awful to be

wrongfully blamed by the teacher" on the irrationality scale for children and adolescents with

the item "Teachers should be correct at all times" (p=0.0179, chi-squared=24.40, df=12) (table 2).

Table 2

Associating items from the irrationality scale for children and adolescents

Items/Answer

variants

Strongly

against

Against Uncertain I agree Strongly agree

n % n % n % n % n %

It is awful

to be blamed

unjustly by the

teacher a

2 4.44 2 4.44 1 2.22 22 48.9 18 40

Teachers should be

correct all the time 0 0 2 4.44 5 11.11 2. 3 51.11 1 5 33.34

Note. N = 45 participants aged between 13 and 18 years a reflect the number and percentage of participants for each response variant

A statistically significant association was identified between the item "I'm not sure if things

go well" inventory of depression Child Depression Inventory with the item "There are things that

bother me" (p = 0.0076, chi-squared = 13.89, df = 4) (table 3).


19

Table 3

Associating items from the depression inventory

Items / Answer variants Always Often Occasionally

n % n % n %

There are things that bother me a 27 60 5 28.89 5 11.11

I'm not sure if things go well a 22 48.89 22 48.89 1 2.22

Note: N = 45 participants aged between 13 and 18 years a reflect the number and percentage of participants for each response variant

Also the regression model has been analyzed the interaction between the dependent

variable "I learned to defend my personal rights" with the independent variable "It is awful to be

wrongfully blamed by the teacher" (table 4) and "There are things that bother me" (table 5), and the

result obtained was statistically significant (p <0.05, F-test).

The connection between the variables independently of it and the dependent

variable was synthesized by the equations of the straight lines of regression as follows: For any value

of the variables "It is awful to be wrongfully blamed by the teacher" and "There are things that bother

me" a value of the variable can be predicted "I learned to defend my personal rights"; thus for the

average level of the variable "It is awful to be wrongfully blamed by the teacher" of 9.5345 the value

of 3.0611 was obtained. For the variable "I learned to defend my personal rights", and for

the average level of the variable "There are things that bother me" about 4.1782; the value of 0.787

was obtained for the variable "I learned to defend my personal rights".

Table 4

Linear regression- I learned to defend my personal rights

effect Estimated

coefficients

SE 95% CI p

LL UL

Fixed effects

Intercept

0. 668

0. 347

0. 032

1. 368

0. 06

Random

effects

It is awful to

be

wrongfully

blamed by

the teacher

0. 251

0. 081

0. 087

0. 414

0. 03

Note. N = 45, SE = standard deviation of the coefficient distribution, CI = confidence interval, LL =

lower limit, UL = upper limit

The correlation coefficient indicated that 18% of the variability "I learned to defend my

personal rights" can be explained by the variable "It is awful to be wrongfully blamed by

the teacher" and that 9% of the variability "I learned to defend my personal rights" can be explained

through the variable "There are things that bother me" (table 5).


20

Table 5

Linear regression- I learned to defend my personal rights

effect Estimated

coefficients

SE 95% CI p

LL UL

Fixed effects

Intercept

1. 839

0. 105

1. 626

2 . 052

0.00

Random

effects

There are

things that

bother me

-0. 252

0. 123

-0. 50

-0. 000

0.04

Note. N = 45, SE = standard deviation of the coefficient distribution, CI = confidence interval, LL =

lower limit, UL = upper limit

Looking at the words that teenagers diagnosed with cancer want to hear from adults, the

following stood out: you will succeed /I support you / I am with you / I am proud of you / I love you/

thank you/I will be with you/you are right/ well done. Also the words respondents do not want to hear

from adults were: it is not possible/ You will not succeed / does it still hurt? are you sick?/ wait / that's

it / nothing is going well / it could be even worse / you don't know anything / you're not good at

anything / you have no ambition / that it will be fine when things are getting worse and worse.

Discussions

Childhood cancer is a disease that has an impact on the lives of the whole family. Supporting

families to cope with these stressful experiences should be a priority during treatment. However,

psychological support is sometimes inadequate in hospitals. Families also reported that the support

they receive decreases when the child/adolescent completes treatment, a time when family members

have few resources to cope with new stressors, adjusting to normal life (Marusak, 2018, para. 4). The

fact that patients in the study identified a correlation between self-confidence and personal rights

denotes the fact that in the efforts to cure cancer psychological support as standard of care for the

whole family, both during and after the treatment, should be supported.

Also the correlation obtained in the study between self-confidence and various things that

bother highlighted/ emphasized an uncovered need for psychological support among families of

children/adolescents treated for cancer. For example, parents of children/adolescents with cancer face

existential, physical, psychological and social struggles. They describe an unstable situation after

diagnosis and have focused on protecting the child during treatment. After completing the curative

treatment, they face challenges in daily life, as it was before the diagnosis, namely to deal with their

own emotional scars and fears related to child cancer (Carlsson, Kukkola, Ljungman, Hove´n, & von

Essen, 2019, p. 6).

Moreover, the existence of family dynamics and the natural difference in authority between

children and caregivers can complicate the treatment decision-making process. Clinicians need to

continually assess the extent to which children are given their own "voice" in the family system, the

degree to which children are aware and want to support their caregiver's preferences, and any

discrepancies in the amount and type of information provided to both parties since all the factors can

significantly influence the outcome of the decision level (Abrams, Muriel, & Wiener, 2016, p. 9).


21

The present study was done before the Covid-19 pandemic and highlights elements of

stress, another study during the emergency of the Covid-19 pandemic on a diverse population of

Romania indicates statistically significant associations between terrified, destroyed emotions and the

statement "I have thoughts which I try to avoid", between happy emotion and utterance sometimes "I

try to keep myself busy just to keep thoughts from taking over my

mind", between satisfied emotion and utterance "I often do various things to distract myself from the

thought", both studies in fact highlighting landmarks for psychologists and not only for efficiency in

the psycho-emotional analysis of patients in crisis situations in the intervention stage (Sîrbu, Niță, &

Șchiopu, 2020, p. 16).

Soothing approaches, individual and group therapy and how to communicate about the

medical activities in which they are involved are important for managing stress in adolescents (Yildizi

& Oğuz, 2020, p.81) and living with cancer and the possibility of recurrence requires well-being and

psychological resilience to cope with treatment, the effects of disease and uncertainty about the future

(Booth, et al., 2018, p. 6).

The individual, family and social vulnerability of adolescents, as well as the individual and

family coping skills, are factors related to the mental health of adolescents in times of

crisis. Adolescents are often vulnerable, require increased care from caregivers, adaptations to the

health system, future research on adolescent psychiatric disorders during pandemics, as such a global

situation could be prolonged or repeated (Guessoum et al., 2020, p. 291).

A 2019 study identified three important topics related to the disease experience of

adolescents with cancer, namely: "Loss of what I know-that makes me different", "Communication

and exchange of information-the need to know" and "The importance of friends, colleagues and

relationships" (Drew, Kable & Van der Riet, 2019, p. 492). The results of the 2019 study and those

in this article highlight that accessing this information will allow health care providers to provide

more appropriate care when these adolescents feel most vulnerable.

Adolescents with cancer experience a continuous and dynamic process of growth and

maturity between the intrapersonal, interpersonal and environmental dimensions, and the goal of their

health care is to achieve internal integration, positive changes in their environment, a harmonious and

balanced existence with the outside world (Eunji & Sharron, 2020, p. 172).

There is a clear need for further research on rehabilitation interventions and care models for

children / adolescents with cancer. Incorporating rehabilitation into paediatric cancer care requires an

interdisciplinary effort and depends on greater involvement of all health care providers and healthcare

professionals, as well as familiarity with the tools and resources that can be used to improve the

quality of life in this population (Tanner et al., 2020, p. 14).

Conclusions

Participants in the current research greatly appreciated that the injustice and blame on

the part of teachers is particularly disturbing, which indicates that adolescents with cancer have a

great need for understanding, adequate communication to avoid stigma and psychological

suffering. For them lack of self-confidence, the different things that disturb and the vulnerable

situations have indicated the need for support for adaptive operation, and to reduce the effects of

chronic stress self-effectiveness and psychological well-being can be developed through specific

actions and personalized care. The statistically significant associations in the present study and the

results obtained at the three scales used in the survey provide benchmarks for effective

communication with adolescents with cancer, possibly also for identifying psycho-emotional needs

and stress management.

The results of this study highlighted some important elements of psychological

interventions for adolescents with cancer that lead to lower levels of psychological well-being, mood,


22

liveliness, self-esteem and motor and physical functioning, such as increased anxiety and problematic

behaviours.

Acknowledgements

This study is part of the doctoral research project entitled "The impact of pediatric neoplastic

disease on family life", coordinated by PhD. Camelia Mihaela Popa, at the School of Advanced

Studies of the Romanian Academy, "Constantin Rădulescu-Motru" Institute of Philosophy and

Psychology, Department of Psychology, Romanian Academy, Bucharest, Romania.

References

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24

PREDICTORS OF ADOLESCENT INVOLVEMENT IN CLIQUES AND GANGS

DOI: http://doi.org/10.26758/11.1.3

Flavia-Elena CIURBEA (1), Marco CAVANNA (2), Cornelia RADA (3)

All authors of article have contributed equally.



Bucharest, Romania;

(2) University of Padua, School of Psychology, Department of Developmental Psychology and

Socialization, Italy; E-mail: [email protected]

(3) "Francisc I. Rainer" Anthropology Institute of the Romanian Academy, Romania; E-mail:

[email protected]

Address correspondence to: Flavia-Elena Ciurbea, School of Advanced Studies of the Romanian

Academy, "Constantin Rădulescu-Motru" Institute of Philosophy and Psychology, Department of

Psychology, Romanian Academy, Bucharest, Romania, 13 September Avenue, No.13, 5th District,

Bucharest, 050711, Romania. Ph.: +40-746-692-576; E-mail: [email protected]

Abstract

Objectives. The gangs came to the attention of the authorities because of the criminal nature of some

of them. To understand which are the appropriate measures to prevent and reduce gang delinquency,

this paper aimed at identifying the predictors of adolescents' belonging to such groups.

Material and methods. Relevant articles published between 2010 and 2020, were searched in three

access platforms to the scientific literature. The papers based on the quantitative analysis of the data,

which evaluated the predictors of the involvement of adolescents aged 14-21 in gangs, were

preserved.

Results. Resulting in 33 significant articles, with samples between 75-26232 participants, 11 studies

had a longitudinal design, the rest being cross-sectional. Most studies were conducted in the USA,

and the rest in European, American, African, and Asian countries. Three categories of predictors were

distinguished: familial factors (e.g. deficient parenting, domestic violence), personal factors (e.g.

trauma history, low level of self-control), social and economic factors (e.g. criminogenic

neighborhood, material and financial instability). The most common predictor was the criminogenic

neighborhood, identified by 16 studies. There were also highlighted gender differences regarding

gang membership, adolescent boys being more likely to be gang members.

Conclusions. This systematic review highlighted that the main factors that can compete to adolescent

gang involvement are: criminogenic social environment, low level of self-control, dysfunctional

family-educational environment, and low socioeconomic level. As research has shown that many of

these can be risk factors for violence, it is necessary to develop coping strategies and heal traumas to

prevent the formation and maintenance of the antisocial identity of adolescent gangs.

Keywords: gang, clique, adolescents, violence.

https://www.journalstudiesanthropology.ro/en/predictors-of-adolescent-involvement-in-cliques-and-gangs/a161/





25

Introduction

For adolescents, entering this period of development brings with it changes, from which

social relations are no exception. Adolescence corresponds to a period of biological, mental, and

social vulnerability (Selosse, 1978, pp. 503-511, as cited in Săucan, Liiceanu, & Micle, 2009, p.11). Even if they continue to have friends in the form of a dyad, it can be noticed the importance that

adolescents give to the type of community called clique, respectively to the larger ensemble, specific

to adolescence - the gang - whose purpose is to gives its members identity, image or a certain

reputation (Papalia, Olds, & Feldman, 1978/2010, p. 411). "Sitting between two chairs, between his

family of origin, from which he separates, and the one he has not yet founded, between the school

that, most of the time, no longer interests him, and the labor market, which receives him reluctantly,

the adolescent often takes advantage of the freedom that adults give him and their vaguely worried

tolerance" (Cusson, 2002, as cited in Săucan, Liiceanu, & Micle, 2009, p.11).

The "gang" concept refers to a phenomenon that initially appeared in North American cities

in the twentieth century, and its meaning differs slightly from one country to another (Smith & Egan,

2014). According to the National Gang Intelligence Center (2015), "street gangs are criminal

organizations that formed on the street and operate in neighborhoods throughout the United States"

(p. 11). In Europe, however, "an annoying group of young people" may correspond to the term "gang"

with the characteristic of sustainability, street orientation, and an identity shaped including by

involvement in illegal activities (Klein, Weerman, & Thornberry, 2006, p. 418). A particular type of

gang is the prison gang, which is formed in the criminal system, but which continues to act outside

the prisons (National Gang Intelligence Center, 2015). The clique, on the other hand, is a concept

which designates "a small group of people who spend their time together and do not welcome other

people into that group" (Cambridge Dictionary, n.d.).

Gangs are generally formed according to age and neighborhood criteria (Cristea, 2011, p.

101). Within the gang, adolescents undertake common activities (walks in nature, hangs out in the

city, 18th birthday parties, meals served in fast-food restaurants, gossip etc.), reaching in some cases

to the manifestation of some antisocial behaviors (sometimes with a criminal character) who are

approved by the group of friends who constitutes the gang, such as smoking, alcohol and drug use,

truancy etc. (Dobrescu, 2016, pp. 108-109; Papalia et al., 1978/2010, pp. 411-412; Baciu, 2019). In

the literature, the gang can also be found under the name of the "band" (bandă, in the Romanian

language), the latter being used more frequently in the context of delinquency (Papalia et al.,

1978/2010; Heywood, 2001/2017; Cristea, 2011). In other words, when the criminal characteristics

are added to the general characteristics of a gang, the group can be seen as a band. The bands are

organized hierarchically and do not tolerate deviations from group norms (Rodríguez et al., 2016).

Zimbardo (2009) presented the initiation process into a band, providing examples from his own

experience as an adolescent: theft, beatings between children, and intimidation were forms of

compliance with the rules of the band and a way of subordination to its leader (p. 11).

Cliques, usually hostile, are formed as a result of the subdivision of a larger group, this

separation being a consequence of the divergences between the members of the initial group

(Maisonneuve, 1996). Similar to gangs, cliques may involve a certain level of delinquency, but the

average delinquency tends to be lower among clique members, as opposed to gang members (Klein

et al., 2006).

From the perspective of social psychology, the cliques and gangs formed by adolescents

represent primary and belonging groups, which exert a considerable influence on the members who

identify with the group (Duduciuc, Ivan, & Chelcea, 2013, pp. 124-126). According to the same

authors, the group of affiliation can be simultaneously the reference group of the person. In this case,

adolescents compare themselves with the members of the cliques and gangs they belong to and

behave like them. In their turn, the reference groups can be positive or negative, depending on the

acceptance or rejection of their norms and values by society, this delimitation being a significant


26

condition in the study of delinquent subcultures.

Although the benefits of belonging to groups such as cliques and gangs are undeniable,

adolescents having the opportunity to experience new ways of relating, which contribute to the

development of self and self-image (Cristea, 2011, p. 101), the risks posed by such adolescent groups

have been highlighted. For example, gang membership has been recorded in the group of risk factors

for youth violence (World Health Organization - WHO, 2020). Another representative danger is the

war between the gangs, which falls into the category of collective violence (WHO, n.d.).

In developing countries, such as Barbados and Colombia has been recorded an upward

trajectory of gang violence and criminal acts (WHO, 2019a, 2019b). However, the activity of street

gangs has also been noticed in cities of developed countries, such as London, where gang members

are responsible for half of the incidents involving firearms and for 22% of all serious acts of violence

(HM Government, 2011, p. 3). In the United States of America (USA), the trends recorded in the

period 1996-2012 in relation to gang problems reflect their predominant occurrence in large cities,

the following in descending order of incidence being suburban areas, small towns, the lowest rate

being registered for rural areas (National Gang Center, n.d.). Also in the USA, according to data

obtained from victims in a nationwide study, approximately 6% of violent crimes recorded between

1998 and 2003 were committed by members of some gangs (Harrell, 2005). Also, according to

estimates of law enforcement structures, there are around 30,000 gangs in the USA, totaling about

850,000 members (Mora, 2020). Looking towards Central America, the information available at the

El Salvador country-level indicates that of the 262 municipalities, in more than 247 of them exist

gang members exercising control (Human Rights Watch, 2019).

Illegal activities of the gangs have also been recorded in the European Union. The year 2019

marked an increase in violence caused by them in Copenhagen, the Danish authorities suspecting a

link between local and Swedish gangs (Overseas Security Advisory Council, 2020). Delinquent

behaviors have also been reported in youth gangs in countries such as Greece, France, Italy, and

Romania (Smith & Egan, 2014). In 2009, 222 violent gangs were identified in France, amounting to

2500 ordinary members, to which was adding an approximately equal number of affiliated members

(Pillet, 2009, as cited in Smith & Egan, 2014). According to the same source, between 2008 and 2009,

there were 366 gang confrontations on the territory of France, resulting in six deaths, and another 143

people were seriously injured. In Romania, according to data provided by the police, 140

neighborhood groups and gangs were detected in 2005 only at the level of Bucharest municipality,

89 of them having a criminal history (National Anty-drug Agency, 2006). Regarding existing data at

the level of Greece, in a study conducted in Crete with 305 pupils, 10.9% of them reported being part

of a youth gang, and the majority (74.3%) had knowledge of such groups (Riga, 2012, as cited in

Smith & Egan, 2014). On the territory of Italy operate the so-called "baby gang", which are groups

made up mainly of adolescents, which are formed on ethnic criteria and which exhibit a dynamic

specific to small organized crime, the phenomenon being significantly increasing in the peninsula

(Commissione parlamentare per l'infanzia e l'adolescenza, 2000) [Parliamentary Commission for

Children and Adolescents].

The phenomenon of juvenile delinquency began to be officially recognized in Romania in

1646, when Vasile Lupu initiated the first code of laws, called the "Romanian Book of Teaching"

(Colectivul pentru Vechiul Drept Romînesc al Academiei R.P.R., 1961 [Collective for the Old

Romanian Law of the Academy R.P.R.]. Both the first code of laws and the "Îndreptarea Legii" ["Law

Guide"] from 1652 of Matei Basarab (Colectivul de Drept Vechi Romînesc, 1962 [Collective of Old

Romanian Law], differentiated the criminal liability of the person according to his age and his ability

to discern. With the advent of the "Condica Criminaliscească" ["Criminal Codex"] of Şuțu and

Sturdza, in 1826, as well as the Ghica-Ştirbei Code, called "Condica Criminală" ["Criminal Codex"]

(1852), the age limit for criminal liability changed from seven to eight years, eliminating the

distinction between boys and girls previously established (Dvoracek & Stihan, 1984, as cited in

Lefterache, 2011). The minority was legislated in the Criminal Code of 1865, and the Criminal Code


27

of 1936 replaced understanding and moral development with the criterion of discernment (Brezeanu,

1998).

In Romania, starting from 1646, until 1969, the minimum age of criminal liability varied,

and with the entry into force of the Criminal Code from 1969, it stabilized at 14 years (Lefterache,

2011; Petruț, 2014). National legislation considers convicted persons between the ages of 14 and 21

to be young, and if the educational measure of deprivation of liberty is required, they are interned in

educational or detention centers, where adolescents are included in recovery programs, depending on

the particularities of each person's age and personality (Petruț, 2014; Parlamentul României, 2013)

[Parliament of Romania].

Starting from the problems raised by the antisocial behaviors carried out by adolescents in

group, this meta-analysis aims to investigate the characteristics of adolescents who adhere to social

structures such as cliques and gangs, to provide a broad understanding of their prejudicial

manifestations.

Purpose and objectives of the study

The aim of this meta-analysis was to highlight the factors that announce the involvement of

adolescents in cliques and gangs. The results of the study could contribute to the development of

prevention and combat directions for juvenile delinquency, taking into account both the needs of

adolescents in general and the needs of cliques and gangs in particular.

To achieve the intended purpose, the following objectives have been outlined: identification

of some factors that predict the involvement of adolescents in cliques and gangs; development of

recommendations to support the process of preventing and combating delinquency in adolescent

groups such as cliques and gangs.

Starting from these objectives, the following research questions have been formulated: what

are the most common factors in the literature that predict the membership of adolescents in groups

such as cliques and gangs? Can these predictors be considered risk factors for the delinquency of

adolescent gangs? Are there gender differences regarding adolescent involvement in cliques and

gangs?


Data sources

The strategy for identifying the literature relevant to the research involved searching for

papers related to adolescents and their membership in cliques and gangs in the following platforms

providing access to scientific literature: Web of Science, PubMed, and Oxford Journals. The

following keywords were used to obtain scientific publications of interest: adolescent, clică, and

gașcă. These have been translated into English by the following terms: adolescent, clique, and gang.

Three combinations were made using the three terms, these word combinations being used in

advanced search, as follows: "adolescent AND clique", "adolescent AND gang", "clique AND gang".

In the search performed on the Web of Science, as this is allowed, an asterisk was inserted after each

searched word, this symbol having the role of identifying articles including by the derivatives of the

words entered (e.g. cliques, gangs, gangster, adolescence etc.).

In order to refine the search process, the settings provided by the three platforms were used.

Research article and data article, written in English and published between 2010 and 2020, was

chosen. Studies published over the past 10 years have been chosen out of a desire to capture current

predictors, so that the recommendations address the needs of contemporary society. It was also taken

into account that the year of publication of a work does not always coincide with the year in which

the data were collected, thus there is the possibility of extending the results beyond the threshold

represented by 2010. Following the implementation of this strategy, 2281 search results were


28

obtained.

Inclusion criteria

The total search results were subsequently subjected to the selection procedure.

The criteria established for the inclusion of studies in the meta-analysis were the following:

participants were between 14 and 21 years of age at the time of the research, or at least the average

age of the participants was between 14 and 21 years; studies were based on quantitative analysis of

the data; studies referred to the factors that predicted the involvement of adolescents in cliques and

gangs.

Exclusion criteria

All the resulting items have been archived, this action being performed through the free

bibliography management program – Zotero (Corporation for Digital Scholarship, n.d.). This

program facilitated the alphabetical listing of the papers, their separate filing, and the identification

of duplicate items. The program also allowed viewing information (title, authors, publication name,

volume, pages etc.) about each selected record, as well as reading the abstract for each paper, without

having to open it in a separate file. It was also possible to keep track of both the original number of

papers and the one left after the application of the exclusion criteria by automatically generating the

number of records from each collection of titles (file). In this way, Zotero allowed the efficient

management of the time for the process of systematic review of the literature.

The first analysis involved the identification of duplicate records and their union. As a result

of this process, 217 items were excluded. For the remaining papers, the following sorting was based

on the exclusion according to the title, with the removal of those articles whose titles explicitly

indicated the absence of any link with the subject of the research (e.g. laboratory animal experiments;

studies on epilepsy, dysmenorrhea, heterosexuality, autism; studies with samples consisting of adults

or children; ganglion studies etc.), respectively clinical studies (e.g. studies involving patients with

bipolar disorder and mania or involving adolescent patients with HIV), literature or history studies,

theoretical studies, articles based on literature review and those involving therapeutic interventions

(e.g. research with adolescents with autism, studies involving group treatments etc.). At this stage,

1844 articles were excluded. The next phase involved studying the abstracts of the remaining articles,

117 articles being deleted for reasons such as: it was found that the subject was that of leaving the

gangs, the article was based on the content analysis (of films, rap songs etc.), the articles referred to

the effects of involvement in the gang, respectively to the effectiveness of psychological

interventions, the characteristics of the sample did not meet the criteria for inclusion in the meta-

analysis, the articles did not have a psychological component, or it was found that the approach of

the articles did not focus on cliques or gangs (e.g. some studies validating some psychological

assessment tools). Also at this stage were deleted articles based on the literature review that were not

removed at the previous stage and those based on qualitative analysis of the data. For the remaining

103 studies, the full-text analysis was used. Figure 1 exposes the entire article review process.


29

Figure 1

Diagram of the systematic review process

2281 articles extracted

from databases 217 duplicates

removed

2064 unique articles 1844 articles

excluded after the

analysis of the title

220 abstracts

analyzed

117 articles excluded, relating

to issues different from those

pursued (consequences of

joining, effectiveness of

therapeutic interventions,

different age of the sample etc.)

103 articles

analyzed in

extended version

70 articles excluded

8 did not provide information

about the age of participants

19 did not have average age

between 14-21 years

3 exceeded the range 14-21

years and did not specify the

average age

8 articles could not be

accessed for free

27 did not analyze predictors

of the involvement of

adolescents in cliques and

gangs

3 were qualitative studies

2 were theoretical studies

33 articles were included

in the analysis of the

predictors of adolescents'

adherence to gangs


30

Data analysis and extraction

In the analysis of the 33 articles, the following indicators were followed: sample size,

participants' ages or their average age, gender of participants included in the study, place where the

research was conducted, type of research (cross-sectional or longitudinal research), and results

regarding predictors of participants' involvement in clique or gang type groups. In addition to these

main indicators, information related to the particularities of the samples was also noted, such as:

people in detention, homeless people, people belonging to a certain subculture, the percentage of

affiliated participants versus the percentage of unaffiliated in the case of comparative studies, the

time interval in which data were collected in the context of longitudinal research that provided this

information.

This analysis aimed to identify predictors of adolescents' membership in cliques and gangs,

being selected only those factors that could explain the adherence of people in this age group to such

groups. In cases where it was not clear whether some variables are predictors or consequences that

arise as a result of the involvement of adolescents in cliques or gangs, their inclusion in Table 1 was

waived.

Results

Description of studies

Following the inclusion and exclusion criteria, 33 articles were found that addressed

predictors of adolescent involvement in gangs. None of the remaining articles addressed the concept

of "clique". These were largely excluded based on the age range of the participants, with the average

age of the adolescents being under 14 years. In the case of cross-sectional studies that did not provide

information on age, it was mentioned that the participants were enrolled in gymnasium studies (e.g.

Closson & Watanabe, 2016).

Of the 33 studies that analyzed predictors of adolescents' adherence to gangs, 11 were

conducted according to a longitudinal plan, and the rest were cross-sectional. Of the total studies, 23

were conducted in the USA, five studies were conducted in the United Kingdom (UK), one study was

conducted in Georgia, another in Trinidad and Tobago, one study in Asia, one in Africa, and for one

of the studies no location was mentioned. Of the 23 studies conducted in the USA, one study operated

on data obtained from both the USA and Canada. No studies have been identified to target the

involvement of adolescents in Romania in gangs.

In the cross-sectional studies, the youngest participants were 13 years old, and the oldest had

an average of 21.32 years old. For the longitudinal ones, the minimum age at wave 1 was 10 years,

and the highest at the last wave was 27 years. The highest percentage of participants was represented

by male, and among selected publications were included researches involving individuals belonging

to only one of the two genders (three studies focused exclusively on boys and four studies involving

only female persons). In most researches, a balanced relationship between boys and girls has been

maintained. The sample size ranged from 75 to 26232 participants. The information is presented in

detail in Table 1, after the conclusions of the article.

Familial predictors

Nine studies identified the following familial predictors of adolescent gang involvement:

• deficient parenting (low parental monitoring; low level of parental communication; parents

who favor antisocial behavior; and authoritarian, neglectful, and permissive parenting

styles);

• involvement of some family members in gangs;


31

• witness to family violence;

• with parents in military service (including military parents deployed in combat zones) in the

case of female.

Figure 2 illustrates the graphical representation of these predictors.

Figure 2

Diagram of family factors that predict adolescent gang involvement

Personal predictors

Personal predictors of adolescent involvement in gangs were analyzed in 30 studies. The data

obtained were grouped into seven subcategories:

• trauma history;

• personal values;

• low self-control;

• indicators of some psychological disorders;

• consumption or intention to consume alcohol or drugs;

• cognitive predictors;

• affective predictors.

A detailed description of these secondary categories of personal predictors can be consulted

Familial predictors

Low

monitoring

Parents who

favor antisocial

behavior

Low level of

communication

Negligence Permissiveness

Deficient

parenting

Involvement of

some family

members in

gangs

Witness to

family

violence

Parents in

military service

(in the case of

girls)


32

in Figure 3.

The low activity alleles of the monoamine oxidase A gene predicted involvement in gangs, but only

for boys (Beaver, DeLisi, Vaughn, & Barnes, 2010). High self-esteem and grandiose-manipulative

traits were predictors of becoming a high-level member in the gang, but only after the age of 17

(Dmitrieva, Gibson, Steinberg, Piquero, & Fagan, 2014).

Figure 3

Diagram of personal factors that predict adolescent gang involvement

Personal predictors

Moral

disengagemen

t

Low

responsibility

The value

attached to

social status

Dominant

social

orientation

Anti-authority

attitudes

Behavioral

school

disengagement Personal values

Low self-control

➢ delinquency

➢ impulsivity

Indicators of some

psychological disorders

➢ conduct problems

➢ antisocial tendencies

➢ depressive/anxiety

symptoms

Affective predictors

Low

self-

esteem

Reduced

empathy

Reduced

guilt

Consumption or

intention to

consume alcohol

or drugs

High level of

rationalisation

Perception of

racial

discrimination

Rumination

s

Cognitive predictors

Peer

victimization Physical

abuse

Sexual

abuse Physical

neglect

Trauma

history


33

Social and economic predictors

Criminogenic neighborhood, cultural factors, school climate, and instability of material and

financial resources are the four categories of social and economic factors that predicted the

involvement of adolescents in gangs. These subcategories were built on the results of 17 studies.

Figure 4 provides a detailed picture of how the four predictor classes are formed.

Figure 4

Diagram of social and economic factors that predict adolescent gang involvement

Social and economic predictors

Criminogenic

neighborhood

School climate

➢ poor connection

between student

and teacher

➢ limited exposure to

prosocial

behaviours in

school

Cultural factors

➢ belonging to an

ethnic minority

➢ low level of

acculturation

Instability of

material and

financial resources

Exposure to

community

violence

Deviant peers

and friends

Antisocial

neighborhood

Perceived

availability of

hand guns

Committing a

murder in the

neighborhood

Neighborhood

drug availability

Social

disorganization in

the neighborhood

Living with a

gang member

Low income

per family

member

Living with a

family member who

receives social

assistance

Housing

instability

Lack of

shelter


34

Discussions

This paper presents a comparative analysis of the concepts "clique" and "gang", as both were

considered important for the period of adolescence (Papalia et al., 1978/2010). The systematic

analysis of the literature published over the last 10 years highlighted, however, that clique-type groups

were not the subject of numerous research, unlike gangs, whose members were more frequently

included in analyses on adolescents. This may be due to the specifics of the cliques, which may be

characteristic of preadolescence or early adolescence. As for the gang, this is a model of organization

specific to the developmental period of adolescence (Papalia et al., 1978/2010; Dobrescu, 2016).

The systematic review of scientific articles has highlighted predictors of adolescent

involvement in gangs. The value of the paper is given by the diversity of data obtained both through

cross-sectional studies and through repeated measurements in the context of longitudinal research.

The 11 longitudinal studies are intended to support a potential causal link between certain factors and

adolescent gang involvement. According to the Institute for Work & Health (2015), longitudinal

studies are more likely to suggest a cause-and-effect relationship compared to cross-sectional studies,

as data collection is not limited to a single point in time, allowing the sequential division of a

particular event. In this way, a longitudinal design could explain the adolescent gang involvement

according to the course of their development, from preadolescence to mid-adolescence, respectively

from mid-adolescence to the end of this age period.

The most often analyzed predictor was the criminogenic neighborhood, supported by the

results of 16 studies. The following predictor in order of frequency of occurrence in processed studies

was low self-control, this factor being a significant predictor in 14 articles, followed by trauma

history, significantly in 13 studies. Deficient parenting, as a subcategory of familial predictors and

affective predictors, as a subcategory of personal predictors, predicted gang involvement in five

studies each. Consumption or intention to consume alcohol or drugs, as well as personal values,

predicted involvement in the gang in four studies each. The indicators of some psychological

disorders, subcategory represented by depressive symptoms, conduct problems, and antisocial

attitudes, were the subject of three articles. Other subcategories of predictors among the familial (the

affiliation of a family member to gangs, witnessing family violence), personal (personal values,

cognitive predictors), and social and economic ones (instability of material and financial resources,

school climate) significantly predicted the involvement of adolescents in gangs in two studies each.

However, differences between samples prevent generalizations. As some results were obtained

following the investigation of a population in a detention center (e.g. Wood, Alleyne, Mozona, &

James, 2014; Dmitrieva et al., 2014), those cannot be extended to the general population. In addition,

the research undertaken by Wood et al. (2014) followed the involvement of participants in the activity

of prison gangs, which may explain those unique predictors, which were not highlighted in any of the

other studies. In another study, a particular subculture called Jugallos was addressed, which,

according to Petering, Rhoades, Winetrobe, Dent, and Rice (2017), was the subject of a contradictory

discussion in the context of considering it to be a gang. It is also important to take cultural differences

into account, as the authors analyzed data from samples from different continents (America, Europe,

Asia, and Africa). However, in terms of the low level of emotional regulation, the data obtained

indicate that it is a predictor of involvement in gangs in both the USA (Lenzi, Sharkey, Wroblewski,

Furlong, & Santinello, 2018) and in Georgia (Voisin, King, Diclemente, & Carry, 2014), respectively

in South Africa (Mfidi, Thupayagale-Tshweneagae, & Akpor, 2018). This result may suggest that the

regulation of emotions is not a factor dependent on a particular culture when considering its role in

the adhesion of adolescents to gangs.

Although not included in this systematic review, it is worth mentioning an article from

another platform for access to academic literature (different from those used in this paper), with data

from 52,714 adolescents between 12 and 16 years old who lived in 1997 in the USA, which

highlighted that the low level of intelligence quotient is an important predictor of adolescent


35

participation in gang activities (Seals Jr. & Stern, 2013). Also, completing the category of family

predictors, the Child Walfare League of America recalls among the risk factors of gang involvement

parents' criminal history, belonging to a gang being a response of the child to the traumatic experience

represented by the incarceration of the parent (North Carolina Division of Social Services & Family

and Children’s Resource Program, 2002).

Regarding gender differences, some authors did not find significant differences between

girls and boys, while other authors found that people belonging to the male gender are more likely to

be affiliated with gangs (Voisin & Neilands, 2010; McDaniel, 2012; Vasquez, Osman, & Wood,

2012). Moreover, Beaver et al. (2010) demonstrated that only boys carrying alleles with low

monoamine oxidase A gene activity were at increased risk of joining such groups. In the research

conducted by Reed, Bell, and Edwards (2014), the military service of parents turned out to be a

significant predictor of gang membership only in the case of female participants.

Predictors resulting from this systematic analysis of literature can be considered risk factors

for the actions with attributes of some offenses, committed by adolescent gangs. Mfidi et al. (2018)

showed that adolescents' inability to emotional self-regulation predicted gang formation, which the

authors described as destructive groups. Comparative studies between adolescents involved in gangs

and those not involved in such groups have also shown that gang members were more likely to have

committed violent acts or exhibited other risky behaviors, such as drug use (Weitzel, Hopper, &

Herridge, 2020; Petering, 2016). Referring to the high levels of delinquency as a predictor of

adolescent involvement in gangs, the risk for antisocial actions committed with the gang is obvious

(Barnes, Beaver, & Miller, 2010; Lachman, Roman, & Cahill, 2012; McDaniel, 2012; Wood et al.,

2014; Ang, Huan, Chan, Cheong, & Leaw, 2015; Hennigan, Kolnick, Vindel, & Maxson, 2015;

Hautala, Sittner Hartshorn, & Whitbeck, 2016).

The results of the cross-sectional research conducted by Faus, de Moraes, Reichenheim, da

Matta Souza, and Taquette (2019) in Rio de Janeiro, with 699 participants, showed that traumatic

childhood experiences, especially emotional, sexual abuse, and physical neglect, increase the chances

for violence among adolescents. Based on the analysis of archival data, physical neglect in childhood

has been proved to be a predictor of violent behavior for male adolescents (12-19 years) in the custody

of a USA detention center (McGuigan, Luchette, & Atterholt, 2018).

It is noted that there is a need to intervene on the predictors that determine adolescents to get

involved in gang activities, to reduce the risks that these factors entail in such a collective. This

finding is based on the results of the experiment undertaken by Dimant (2019) with 185 participants

in Germany, which showed that social proximity increases the likelihood of transmission and taking

over of antisocial behavior, the contagion being much more significant than in the case of prosocial

behavior. Thus, if there are adolescents in the gang who exhibit violent behaviors, there is a risk that

other members to become violent. Cristea (2011) explained that the gang formation mechanism is

based, in addition to the age index, on neighborhood criteria. Most of the studies analyzed in this

paper showed that the criminogenic neighborhood predicted adolescent gang involvement. Therefore,

concentrating the findings of Cristea (2011) and Dimant (2019) in a macroscopic analysis, the

following reasoning can be configured: if the gang members live near neighbors who commit

undesirable actions, it could increase the risk that some of them take over this behavioral model,

which can later become an element of the value system of the gang.

Criss, Smith, Morris, Liu, and Hubbard (2017) found after a research conducted on a sample

of 206 adolescents from America (10-18 years) that violence and the threat posed by neighborhood

were associated with antisocial behavior. The same research revealed, however, that the emotional

regulation and prosocial behaviors of peers have reduced the link between violence in the

neighborhood and the antisocial behavior of adolescents, and the high quality of the relationship

between parents and adolescents has been shown to be a protective factor against danger and violence

in the neighborhood.

Other authors have stated that reducing the level of aggression could be a way to prevent


36

violent crime (Li, bt Roslan, binti Ahman, binti Omar, & Zhang, 2019). The study undertaken by

them with 60 participants between 18 and 19 years in China showed that the levels obtained on all

subscales of aggression decreased significantly for participants in the group involved in interpersonal

group psychotherapy. Further research is needed to indicate whether group psychotherapeutic

intervention on adolescent gangs leads to reducing levels of aggression of the members and whether

this is a prophylactic measure in preventing and spreading violence by adolescents through gangs.

Conclusions

The systematic review of the literature highlighted predictors of adolescent gang

involvement, which belong to the following categories: familial predictors, personal predictors, and

social and economic predictors. The most common predictor was a social environment factor

(criminogenic neighborhood). Personal predictors (low level of self-control and history of trauma)

were the next important factors in joining gangs. Less frequent in the investigated articles were shown

to be the familial predictors.

It was found that there were gender differences between adolescents regarding joining gangs.

The results of comparative research between girls and boys indicated a higher probability of males

being affiliated with such groups.

It is important to mention that following the search procedure described in the methodology

section, no scientific articles regarding the gangs of adolescents in Romania have been identified.

This needs to be taken into account by the policies for the prevention of juvenile delinquency at

national level, being recommended to undertake research on the phenomenon of involvement of

Romanian adolescents in gang activities. The results of such studies can provide useful information

to guide efforts to prevent the increase in crime rates across the country. The merits of forensic science

need recognition in the context of preventing, investigating, and combating crime, and at the same

time, there are still some reservations of forensics in this direction (Gheorghiță, 2016), so that the

research of adolescent gangs could contribute to the completion of the body of knowledge, according

to existing requests from the ever-changing society.

Most of the individual predictors identified in this paper can be considered risk factors for

antisocial actions perpetuated through adolescent gangs. The criminogenic neighborhood may

encourage adolescents to take up the antisocial behavior model within the gang. There is also the

possibility that the abuse suffered in childhood to be reproduced by gang members at the age of

adolescence. The low level of self-control may be a favoring factor in this picture of the perenniality

of violence and other risky behaviors.

The "broken windows" theory proposes a solution to reduce the negative impact of the

criminogenic neighborhood, namely lowering the level of physical disorder (Wilson & Kelling,

1982), however, it was found that this measure is not effective in all cities (Zimbardo, 2009).

Therefore, organizing support groups for adolescents and their carers, promoting both the quality of

the parent-child relationship and socially desirable behaviors, could be a more appropriate protective

measure against the spread of antisocial behavior from the neighborhood through gangs. Learning

and integrating effective coping mechanisms, with emphasis on emotional and behavioral self-

control, could also help reduce gang involvement in acts of violence. The implementation of personal

development programs in the form of psycho-educational groups could prove useful in this regard.

Finally, involving adolescent gangs in group psychotherapy programs can be a way to prevent and

reduce juvenile delinquency. The psychotherapeutic intervention could give gang members remedial

experiences so that the gang becomes a support group for each of its members and not a tool through

which traumatic events of childhood to spread in society.

In exposing measures to prevent and combat juvenile delinquency, it is worth remembering

the Tri-Agency Resource Gang Enforcement Team program, implemented since 1992 in Orange

County, California, and whose strategy was based on differentiated sanctions, depending on age, the


37

degree of violence, and the level of recidivism presented by gang members who committed crimes.

This program, which aimed to form multidisciplinary teams made up of gang investigators, a

probation officer, and two officials from the district attorney's office, led to a 47% drop in gang crime

over seven years (Kent, Donaldson, Wyrick, & Smith, 2000; National Gang Center, n.d.). Kent et al.

(2000) recommended that policymakers and researchers replicate this program in different

jurisdictions, both to test its effectiveness and to improve it. Therefore, adapting this program to

Romania's particularities, implementing the program at the country level, and evaluating the results,

could prove useful in the effort to prevent and reduce the negative consequences of adolescent gangs.

Other programs that have had an effect in reducing risky gang-related behaviors or in

preventing adolescents from joining groups of this type were presented by Howell (2010), who

divided them into two categories: a primary prevention program (Gang Resistance Education And

Training) and secondary prevention programs (Preventive Treatment Program; Aggression

Replacement Trening; CeaseFire–Chicago; The OJJDP Comprehensive Gang Prevention,

Intervention, and Suppression Model; Striving Together to Achieve Rewarding Tomorrows; Boys &

Girls Clubs Gang Prevention Through Targeted Outreach; Boys & Girls Clubs Gang Intervention

Through Targeted Outreach; The Broader Urban Involvement and Leadership Development

Detention Program; Movimiento Ascendencia etc.). These programs can serve as a starting point in

outlining efficacious directions for reducing delinquency among adolescents, including in Europe,

through the collaboration of European and American researchers in The Eurogang Project (n.d.).

As the present analysis shows, gangs are an important objective of intervention to prevent

and combat juvenile delinquency. In order to diminish the negative impact of the factors that predict

the joining of adolescents in gangs (neighborhood with criminogenic potential, low level of self-

control, and family with dysfunctional emotional-educational climate), it is recommended that the

intervention to be led by multidisciplinary teams (psychologists, social workers, teachers, police

officers etc.) and to be carried out at community, family, and individual level. In this complex

prophylactic approach, the support of institutions such as the school, the police, and the General

Directorate for Social Assistance and Child Protection is necessary. Non-governmental organizations

can also play a significant role in the joint effort to reduce risky actions undertaken by members of

adolescent gangs.

Table 1

Description of studies included in the meta-analysis

Authors and year

of publication

Sample size Gender Place of study Type of study

Wechsberg et al.

(2015)

237 female North Carolina Cross-sectional

Predictors of gang involvement: history of sexual abuse; history of physical abuse; low social

support; low emotional support; witness to gun battles; the occurrence of a murder in the

neighborhood.

Weitzel et al.

(2020)

2443 50.8% male UK Cross-sectional

Predictors of gang involvement: lack of shelter; staying in temporary housing.


38

Authors and year

of publication


Lachman et al.

(2012)

200 55% male Montgomery

County &

Washington, DC

Cross-sectional

Predictors of gang involvement: instrumental purposes (e.g. joining the group in order to obtain

protection).

Mendez, Mozley,

and Kerig (2020)

817 25.93% female Western USA Cross-sectional

Predictors of gang involvement: trauma exposure (callous-unemotionality being an explanatory

factor).

Cepeda, Valdez,

and Nowotny

(2014)

75 male West Side, San

Antonio, Texas

Cross-sectional

Predictor of gang involvement: physical neglect.

van Dommelen-

Gonzalez,

Deardorff, Herd,

and Minnis

(2015)

162 44.87 female

affiliated

57.14 female

unaffiliated

San Francisco Cross-sectional

Predictors of gang involvement: age (those affiliates were older than those unaffiliated); to live

with a family member who receives social assistance; affiliation of some family members to gangs;

having close deviant friends (truants, who spent a night in custody etc.).

Kubik, Docherty,

and Boxer (2019)

611 52% female USA Longitudinal

Predictors of gang involvement: childhood maltreatment; childhood neglect.

Ang et al. (2015) 1027 58.2% male Singapore Cross-sectional

Predictors of gang involvement: proactive aggression; delinquent behavior; behavioral

disengagement from school.

Reed et al.

(2014)

9952 2782 female Washington Cross-sectional


39

Authors and year

of publication


Predictors of gang involvement: having military parents (in the case of girls); having parents

deployed in combat zones (in the case of girls).

Katz and Fox

(2010)

2206 59.6% female Trinidad &

Tobago

Cross-sectional

Predictors of gang involvement: perceived availability of hand guns; high level of residential

mobility; parents who favor antisocial behaviour; early initiation into antisocial behaviours;

intention to use drugs; antisocial peers; peers who use drugs.

Gilman, Hill,

Hawkins,

Howell, and

Kosterman

(2014)

808 51% male Seattle Longitudinal

1985-1993

Predictors of gang involvement: living with a gang member; antisocial neighborhood; influences

of antisocial peers in the previous year.

Voisin and

Neilands (2010)

563 38.89% male Midwestern Cross-sectional

Predictors of gang involvement: lower levels of student-teacher connection; male gender; risky

rules imposed by colleagues.

Lenzi et al.

(2018)

11753 59.6% male California Cross-sectional

Predictors of gang involvement: low levels of behavioral self-control; low levels of emotional

regulation; low levels of empathy; limiting access to social support (within the school); limiting

exposure to prosocial behaviors (within the school).

Ventura Miller,

Barnes, and

Hartley (2011)

1633 66% male –

belonging to the

gang

South Texas Cross-sectional

Predictors of gang involvement: low level of grades obtained at school; drug availability in the

neighborhood; low levels of acculturation; low levels of school satisfaction; perceiving a higher

degree of marginalization based on ethnicity.

Beaver et al.

(2010)

2196 52.59% female USA Longitudinal

1994-2002


40

Authors and year

of publication


Predictors of gang involvement: low activity alleles of the monoamine oxidase A gene (only

carrier men are at increased risk of joining the gang).

Lenzi et al.

(2014)

26232 53.4% female California Cross-sectional

Predictors of gang involvement: associating with deviant peers; perceiving the school as an

unsafe environment; type of school (special, vocational, alternative vs. comprehensive).

Petering (2016) 505 27.72% female Los Angeles Cross-sectional

- homeless

population

Predictors of gang involvement: childhood sexual abuse; witness to family violence; childhood

physical abuse; witness to interpersonal violence.

Wood et al.

(2014)

188 male UK Cross-sectional

Predictors of gang involvement: the value attached to social status; levels of dominant social

orientation; anti-authority attitudes; moral disengagement; threat levels (before incarceration);

individual delinquency levels (before incarceration); levels of involvement in group crime (before

incarceration); group support on streets; longer current punishments.

Barnes et al.

(2010)

Wave 1 - 20745

adolescents,

17700 carers

Wave 2 - 14738

Wave 3 - 15197

50.51% female USA Longitudinal

Predictors of gang involvement: low levels of self-control; greater involvement in delinquency;

more victimization experiences.

Ha, Kim,

Christopher,

Caruthers, and

Dishion (2016)

998 52.7% male Northwestern USA Longitudinal

Predictor of gang involvement: maltreatment.


41

Authors and year

of publication


Gilman, Howell,

Hipwell, and

Stepp (2016)

2450 female Pittsburgh Longitudinal

2003-2011

Predictors of gang involvement: peer victimization.

Mfidi et al.

(2018)

347 169 male Eastern Cape,

South Africa

Cross-sectional

Predictors of gang involvement: improper handling of emotions (anger – the most common

emotion experienced).

Smith, Gomez

Auyong, and

Ferguson (2018)

15445 50.6% male Avon, UK Longitudinal

1991-2019

Predictors of gang involvement: delinquent peers; social disorganization in the neighbourhood

(graffiti, presence of stray dogs on the streets, vandalized objects etc.); drug use.

Dmitrieva et al.

(2014)

1354 male - in

detention

Maricopa &

Philadelphia

Longitudinal

Predictors to be a low-level gang member: low temperance; low perspective; low responsibility;

low self-esteem (in early adolescence).

Predictors to be a gang leader: low temperance; low self-esteem (after 19 years); high self-esteem

(after 17 years); grandiose-manipulative traits (after 17 years).

Hautala et al.

(2016)

646 50.5% female

USA & Canada Longitudinal

2002-2011

- Indigenous

population

Predictors of gang involvement: low income for each family member; low parental monitoring;

low links with school (increased risk only for gang initiation); early conduct problems in primary

school; risk factors at peer level (increased risk only for initiation); early negative events increase

the risk for initiation into the gang; early perception of racial discrimination; anger (risk for

initiation); depressive symptoms; hyperactivity / Impulsivity; substance use; high level of

delinquency before involvement in the gang.

Frisby-Osman,

and Wood (2020)

91 64.8% male England Cross-sectional


42

Authors and year

of publication


Predictors of gang involvement: high levels of conduct problems; moral disengagement;

ruminations; symptoms of anxiety; symptoms of depression; higher levels of exposure to violence

(being a victim of violent attacks).

McDaniel (2012) 4131 51.49% female - Cross-sectional

Predictors of gang involvement: belonging to an ethnic minority; male gender; depressive state;

reporting suicidal ideation; alcohol or drug use; delinquency; experiencing peer victimization.

Petering et al.

(2017)

495 71.30% male Los Angeles Cross-sectional

-Jugallos

Predictors of gang involvement: childhood sexual abuse; physical childhood abuse; exposure to

community violence; witnessing family violence.

Vasquez et al.

(2012)

310 185 male London Cross-sectional

Predictors of gang involvement: ruminal thinking about aversive events; male gender.

Vuk (2016) 5935 48% male USA Cross-sectional

Predictors of gang involvement: low self-esteem; authoritarian parents; negligent parents;

permissive parents; delinquent peers; low levels of self-control; increased levels of rationalization;

low levels of guilt.

Hennigan et al.

(2015)

391 67% male Los Angeles Longitudinal

Predictors of gang involvement: antisocial tendencies; impulsive risk-taking; neutralization of

guilt; parental monitoring; influence of the family gang; negative influence of friends; delinquency

of friends; critical life events in the last six months; self-reported delinquency.

Shelley and

Peterson (2018)

1730 55% female USA Longitudinal

2006-2012

Predictors of gang involvement: being a bully; being a victim of bullying; beying a bully-victim.

Voisin et al.

(2014)

188 female Atlanta Georgia Cross-sectional


43

Authors and year

of publication


Predictors of gang involvement: low self-esteem; emotional dysregulation; trauma history,

deviant colleagues; low parental monitoring; low level of parental communication; housing

instability; poor quality of the neighborhood.

Acknowledgements

This study is part of the doctoral research project entitled "Adolescents and Youth in

Educational and Detention Centers: Personality Dimensions and Psychological Factors", PhD.

Student Flavia-Elena Ciurbea, coordinated by PhD. Cornelia Rada, at the School of Advanced Studies

of the Romanian Academy, "Constantin Rădulescu-Motru" Institute of Philosophy and Psychology,

Department of Psychology, Romanian Academy, Bucharest, Romania.

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49

CHARACTERISTICS OF TRADITIONAL VIETNAMESE FAMILY AND ITS INFLUENCE

ON COMMUNICATION CULTURE IN THE FAMILY

DOI: http://doi.org/10.26758/11.1.4

Thi Kim Dung LE

Faculty of Sociology and Social work, Hue University of Sciences, Vietnam;

PhD student at Faculty of Sociology and Social work, Bucharest University, Romania

Address correspondence to: Thi Kim Dung Le, Faculty of Sociology and Social work, Hue University

of Sciences, 77 Nguyen Hue Street, Hue city, Vietnam; Ph.: +84987424920; E-mail:

[email protected]

Abstract

Objectives. Understanding the family's communication culture means understanding the ethnic

communication culture, therefore, research on communication culture in the family has an important

and practical meaning. The article aims to study generalize the basic characteristics of Vietnamese

traditional families, thereby understanding the communication culture in the family, which is the basis

for understanding the traditional communication culture of Vietnamese people.

Material and methods. This research is done based on the synthesis and analysis of documents

related to family and communication in family to make comparisons and make appropriate

judgments. 58 scientific value and reliable documents are searched on online databases, websites,

indexes and printed documents, typed files in the computer, and then classified by topic groups for

analysis. The documents mentioned or cited in the article are fully shown in the list of references.

Results. The traditional Vietnamese family has the characteristics of the traditional Asian family; this

family model that has dominated all the values and standards of the family, which has a profound

effect on the communication culture in the family. It is a type of communication that follows

hierarchical order and pattern from top to bottom, emphasis on factors of location, age, gender and

communication space.

Conclusions. Communication culture in the traditional Vietnamese family bears the imprint of wet

rice civilization as well as Confucian and Buddhist ideology creating a polite, flexible communication

style and cultural behavior, order and discipline in the family; however, its limitation is hesitation,

inhibits personal criticism; there are stricter stereotypes against some family members. Currently,

some of the traditional Vietnamese family’s foundations have been changed but the communication

culture in the family still needs to be preserved to preserve the communication culture of the nation.

Keywords: communication, culture, communication culture, communication in the family,

traditional Vietnamese family.

Introduction

Communication is a daily activity of people from birth to death. The family is the first

environment in which people perform communication, through communication between members,

the family performs the socialization function, helping each individual shape personality and integrate

into life society. Therefore, communication becomes a regular and essential activity for exchanging

information and transmitting culture from generation to generation, from individual to individual.

Understanding how people communicate means understanding the cultural identity of a certain

nation. Understanding the communication culture of a nation represents understanding the origin and

https://www.journalstudiesanthropology.ro/en/characteristics-of-traditional-vietnamese-family-and-its-influence-on-communication-culture-in-the-family/a162/


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root culture of that nation. Therefore, communication and communication culture are interesting

topics, attracting the research interests of many authors in the world as well as in Vietnam.

Communication topic has been studied in many studies from the 50s and 60s of 20th century to clarify

the meaning of communication concept (Stevens, 1950; Schachter, 1951; Hoben, 1954; Ayer, 1955;

Alex, 1959; Barnlund, 1962; Cartier & Hanvood, 1953; Miller, 1966; Andersen & Guerrero, 1997;

Ting-Toomey, 2018), then the concepts of communication was analyzed quite fully in the study of

Dance (1970) and Luhmann (1992). However, it must be admitted this is too broad a concept and

researchers often delve into smaller or specific aspects of communication, for example research on

family communication.

Research on family communication is also a topic of interest to many authors and mainly

focuses on interpersonal communication in the family (Robinson & Levy, 1986; Beebe, Bebee, &

Redmond, 2000; Guerrero, Andersen, & Afifi, 2007; Trenholm, 2008; DeVito, 2019). Studies of

interpersonal communication in the family focus on the models and theoretical frameworks that

characterize the communication occurring in the family, the role of family communication and the

influence of the family communication environment to the ability to communicate of individuals

(Moore & Moschis, 1981; Barnes & Olson, 1985; Moschis, Prahasto, & Mitchell, 1986; Carlson &

Grossbart, 1988; Fitzpatrick & Ritchie, 1994; Forehand et al., 1997; Koesten & Anderson, 2004;

Punyanunt-Carter, 2008; Schrodt et al., 2009). Through these studies, the issues of subjects, roles and

tools of measuring family communication are also addressed and clarified. The studies have shown

that family communication can be described as a combination of family members to balance and

control information and relationship goals. Family communication takes place in a home

environment. "The family communication environment is a set of norms governing the trade off

between information and relational objectives of communication" (Fitzpatrick & Ritchie, 1994, p.

524).

In Vietnam, family communication culture haved shown in many studies (Bùi, 1990, 1993,

1994; Đỗ, 1990; Nguyễn, 1993; Ngô, 2006; Phạm, 2012; Trương & Trần, 2012; Khuất, 2014; Lê,

2015; Nguyễn, 2015; Bùi, 2018; Nguyễn, 2018). Meanwhile, traditional family culture is mentioned

in many general studies on Vietnamese culture by some great scholars such as Trần (2001), Trần

(1996, 1997, 1998, 2016), Trần (2005), Huỳnh (2012), Đào (2014). The studies of culture

communication and communication in Vietnamese families have focused on cultural aspects

traditional Vietnamese communication on the use of vocation, communication skills, attitudes in

communication and the position between the speaker and the listener in communication. Thus, a

general study on traditional communication culture in Vietnamese families is almost not mentioned,

this became an inspiration for this research. The study aims to condense the basic characteristics in

the traditional communication culture of the Vietnamese families, from which each individual, family

has a sense of promoting good values, improving outdated elements, concomitant sharing a typical

communication culture of Vietnamese families around the world.


This article explores the basic characteristics of the traditional Vietnamese family, then learn

the communication culture in the traditional family, so the mainly materials of research based on

secondary sources. In order to identify, locate and create a secondary database for the research topic,

researcher conducted a search of publications by keywords (communication, culture, communication

culture, communication in the family, traditional Vietnamese family) in professional journals. There

are a total of 58 well-searches online databases and indexes, focusing mainly on "Google scholar",

"Research gate", "Jstor" with many other trusted websites and libraries (such as libraries of

universities, website of Ministry of culture - sport and tourism, local website etc.) and printed

documents, typed files in the computer to collect the most appropriate secondary source. After the

documents were collected, the researcher divided into groups of topics to analyzed and cited. The


51

documents on the same topic are also compared and collated to have a basis for making appropriate

and relevant judgments, ensure the science and reliability of the research.

Results

Traditional Vietnamese family characteristics

Family is a concept that is approached under many different angles. From a sociological

perspective, Giddens (2006) introduced the concept of "a family is a group of persons directly linked

by kin connections, the adult members of which assume responsibility for caring for children" (p.

206). According to Psychological Dictionary, author Vũ (2008) introduces the concept "the family is

the community of people living together under one roof, forming the smallest unit of society (also

known as social cells) bound together by marriage and blood"; "the family is a miniature society

consisting of one or more different generations living and working together in an organized,

principled or unwritten way. Peace is ensured by warmth, a sense of security and love". From a legal

perspective, "a family is a set of people bound together by marriage, blood relations or nurturing

relations, giving rise to obligations and rights between them" (Quốc hội Việt Nam, 2000). From a

cultural perspective, "family is a form of blood-relationship community - the earliest kind of human

gathering and association; forming specific cultural forms that the ancient Vietnamese called "gia

phong". "Gia phong" was understood as the lifestyle, habits, customs and manners of family members

to organize the family, educate people, especially spiritually. Each family in different regions has its

own nuances of family-style, which have its own characteristics of family organization, relationships

and behavioral standards, and educational methods (Ngô, 2006, p. 26). From the above connotations,

family is an overall widespread with biological, economic, social and cultural characteristics.

Therefore, when caring about the family in terms of culture and family, it cannot be separated from

its social and economic characteristics (Ngô, 2006, p. 27).

In general, the Vietnamese traditional family has many similarities with the common

characteristics of traditional families Asian but also has unique characteristics. The traditional

Vietnamese family has the characteristics of the traditional Asian family, always retaining the

traditional nuances even when the society has reached a high level of industrial civilization, this is

different from families in Western societies (Đỗ, 1990, p. 9). It is a family type characterized by an

agricultural economy growing wet rice - Asian production method and village organization as a base

(Lê, 2015, p. 20). However, the traditional concept also has many meanings, and in each different

approach, one can only share a few of them. In the most common sense, the traditional family is the

rural family, so the characteristic of Asian agrarian society is an important foundation for maintaining

the long-standing and almost immutable family type on many sides. However, there also exists

another way of understanding the concept of the traditional family, that is the type of family where

the characteristic values of the spirit, morality, culture and religion are always appreciated and

become a framework that defines standards and behaviors in the family. In this sense, the concept of

traditional family in Vietnam is often used almost identical with the concept of "Confucian family".

Thus, "people look for attributes of the traditional family in the influences of Confucian ideology that

encompass a long history in Asian societies from China, Japan, Korea and whole of Vietnam" (Đỗ,

1990, p. 9). Reality has proven that, the search for the true social logic of the East Asian family with

Confucian logic is a mistake. Although in China, Japan or Vietnam, the traditional family is all

influenced by Confucianism, equally stable and strict in nature, the differences can still be found

basic.

The traditional Chinese family carries the institution of "tu thân, tề gia, trị quốc, bình thiên

hạ" (means that a gentleman must first train himself well, then arrange a good family, then rule the

country and reassure the people) is the basic morality of gentleman to set the model of a family-like

organization with the dominant position from village to country. Accordingly, the name of a family


52

line has taken as the name of the village is popular. Yanfen cited by Đỗ (1990) mentioned "traditional

Chinese family is a large collection of many members living, it includes not only direct descendants

but also relatives, creating a family of three or four generations call tam đại đồng đường, tứ đại đồng

đường" (a three-generation family, a four-generation family also living under one roof), not just the

present nuclear family (p. 10). Meanwhile, Kurimolo Kazuo cited by Đỗ (1990) argued the traditional

Japanese IE family is seen as a social-economic institution rather than a community of bloodline (p.

10). Consequently, Confucian morality was originally directed towards political purposes in China,

here it was directed towards economic goals (Đỗ, 1990, p. 10). Although it is also influenced by

Confucian ideology, the traditional Vietnamese family does not have the characteristics of a socio-

political institution, which is a huge difference from the Chinese family. The Vietnamese family is

dependent and dominated by the village, the village unit is the foundation of the monarchy of

Vietnam, not the family unit.

In Vietnam, the characteristics of the economy create the cultural characteristics of the

family and community. 80% of Vietnamese people in the traditional society choose and associate

with the economic sector mainly in agriculture, the agricultural life in rural areas is linked to families

with villages. The pace of life of each individual and family revolves around symbols of banyan tree,

river wharf, communal courtyard, bamboo rampart - community and autonomy of traditional

Vietnamese village also formed from there. Although the agricultural life is worrisome and busy with

crops, the village's festival activities are still the focal point attracting the participation of everyone

in a relaxed and connected mind. That is also the basic root that shapes cultural values in the spiritual

life of the people. In that context, community and autonomy are two aspects that seem to be

contradictory but exist in parallel in all Vietnamese villages. Banyan tree, river wharf, communal

courtyard are symbols of community. It creates the morality of family and society in Vietnam,

upholding the spirit of solidarity, mutual reciprocity on the common order, on the interests of the

family and collectively, on covenants, on sacrifice, on peace and taking family as the most important.

The bamboo rampart is a symbol of autonomy, so many conventions and conventions that frame the

individual and family in the village's customary are such that "custom rules the law". Autonomy

encourages a spirit of hard work, independence and self-reliance, and it is fundamental to maintaining

a self-sufficient agricultural economy that has existed for centuries. Each traditional Vietnamese

family is considered as an agricultural production unit, due to its inclination to self-sufficiency, and

agricultural production activities that help each family satisfy the living needs of its members.

The traditional families in Vietnam take the form of a semi-nuclearized family as the basis

(Đỗ, 1990), so in terms of structure it can be divided into two main types of families: small family

(one or one generation) and large family (extended family of three generations or more). The big

family also follows the model of a three-generation family, a four-generation family also living under

one roof, when the children are mature and married, parents often live with the family of their eldest

son, other members of the family will live separately. In some families, due to economic conditions,

there are still many couples, kids and grandchildren living in the same house with their parents, but

basically still parents living with the eldest son. This is not required by law, but it is by default in all

Vietnamese villages. The most profoundly unifying element of traditional extended family is ancestor

worship, followed by sharing other big family events (wedding, birth, new house) and economic

aspects (supporting workers in the crop). Ancestor worship is performed in the family of the eldest

son, an event with ritual worshiping can take place within the family or the whole lineages. From the

characteristics of the lineages in Vietnam, it is appropriate to propose the concept of the lineage is

understood as the kind of family extending according to the blood relation, the strength of a lineage

is often expressed in aspects such as the success of the descendants and solidarity in the spirit of

emotional attachment as well as mutual assistance. Each family has a genealogy, which is a treasure,

although it does not have much meaning about the organization of life, but genealogy is the basis for

establishing and maintaining order and hierarchy in the lineages. Genealogy has a special meaning in

confirming whether a marriage relationship is allowed or not, because according to customary, in the


53

lineages, marriage is strictly prohibited within a fifth generation relationship. The customary of

relationships and behavior in the family, lineages are the implicit verbal defaults that didn’t be

expressed in writing. Although this customary is different in each locality or ethnic group (in

Vietnam), basically all Vietnamese people know, understand and obey under the influence of the

lineages.

The delineation of the position and hierarchy in the Vietnamese family is influenced by the

characteristics of the wet rice agricultural economy (Đỗ, 1990) and Confucianism, with the ideology

of promoting the role of men "nhất nam viết hữu, thập nữ viết vô" (having 1 son in a family means

having kid, but even having 10 girls is still considered to have no kid) and there are many strict

requirements for women such as "công dung ngôn hạnh", "tam tòng tứ đức". "Công dung ngôn hạnh"

mentions four basic women's standards: "công" means to be good at housework, good at taking care

of family; "dung" is formal beauty, appearance: loveliness, discreet, graceful; "ngôn" is a courteous,

discreet, small, easy-to-hear speech associated with a well-mannered gesture that shows modesty;

"hạnh" referring to morality, kindness, faithfulness and devotion, rich in love, keeping full family-

style. "Tam tòng tứ đức" means when a woman is at home, she has to listen to her father, until she

gets married must listen to her husband, and when her husband dies, must listen to her son. In the

family, to promote the role of men and to be strict with women so the upper and lower relationships

are clear: father - kid; older brother - younger brother; husband - wife. These relationships are adjusted

by the morality of "tam cương" (talk about three main relationships in society: king - citizen, father -

kid, wife – husband) and "ngũ thường" (refers to five ethics that a person should have and should

have: personality, polite, righteousness, intellect, reputation). The husband is the mainstay and is

usually the one who holds the name of all assets in the family, the wife has a lower status but has a

huge role in money management, revenue and expenditure - the woman is considered the person who

holds the hand of the key box, and manages the money in the family. Therefore, even though it is

patriarchal family, the wife is truly the ruler (Đỗ, 1990). This is explained that in Vietnamese villages,

besides Confucianism, there is another religion that is popular and has a great influence on the

spiritual life of the people, which is Buddhism. Buddhism has been regarded as the religion of women

and children for centuries, so it is the Buddhist teachings that soften Confucian notions of woman

(Đỗ, 1990, p. 10).

The above is the basis for looking for a specific sociological approach to analyzing

traditional Asian families in general and traditional Vietnamese families in particular. One thing has

to admit that, all values and standards of the family are governed by that traditional family pattern.

Therefore, in order to understand the traditional communication culture in a Vietnamese family, first

of all, it is necessary to understand the characteristics of Vietnamese traditional families.

Understanding this is also the basis for determining the changes of the traditional communication

culture in the current Vietnamese family and the decisive factors for that change.

Communication culture in traditional Vietnamese family

Culture is a multifaceted concept, so there are many different definitions of culture.

Parsonian cited by Lamont & Small (2008) mentions culture as unitary and internally coherent set of

attributes that characterizes a social group (p. 79). On the other hand, Ortner (1984) refers culture as

what people produce and act on their environment. Fiske (2002) considers culture as "a set of customs,

capacities, ideas, values, rules, institutions; cultural products created by society and passed down

from generation to generation". It can be seen that the common point reflected in the connotation of

most concepts of culture is the symbolic culture of the community. People create culture and on their

side culture carries the mark of people in it.

The concept of communication is clarified in many respects in studies from the mid-20th

century, that communication is related to: interaction/ relationship; reduction of uncertainty; process;

transfer; linking; commonality; channel/ means; replicating memories; response/ change; stimuli;


54

intentional; time/ situation; power. As such, the definitions of communication reflect all levels of

fields from all meaningful behavior and purpose of people in conscious interaction (Dance, 1970).

Thereby, it can be understood that communication is a process of transmitting information in a

conscious way of people through symbols and words. Communication is an important activity that

creates cultural values. In the family, communication plays an extremely important role, is a

fundamental activity in family relationships, creating the culture of the family. Talking about culture

refers to the symbols of a certain community, so the traditional culture of communication in a

Vietnamese family is typical values of Vietnamese families in the context of Vietnamese community

and society. On the basis of the wet rice agricultural economy, the Vietnamese people are intimately

attached to nature and the universe, living in a peaceful, flexible, emotional, discreet, delicate, all

forming principles and how to communicate and behave in Vietnam (Trần, 2001).

Communication follows hierarchy

Traditional communication culture in families is formed and maintained in the context of

traditional Vietnamese families, and becomes an important part of family culture. The family is not

only a specific social group, but also a biological - cultural entity, a social - cultural institution. Family

from the beginning is a cultural existence, a cultural entity in close relation with biological factors

and gender (Lê, 2015). Therefore, the communication culture in the family is shaped and standardized

from the common standards of the family culture. In the traditional Vietnamese family, there are three

values and standards that are appreciated, creating the family culture, including: "gia đạo", "gia

phong" and "gia lễ". "Gia đạo" is the moral standards that the family values, among those standards,

filial is the highest value (filial piety to parents, ancestors). "Gia lễ" are customs in a family that are

expressed through the way of eating, behaving, and walking that have been passed down through

generations become a tradition and descendants must follow as a ritual hierarchy. "Lễ", according to

Asian, not only means autonomy but also means human. In a word, then "all the treatment of the

Asian people are in one word Lễ" (Phạm, 2012). Many Vietnamese families in the past, thanks to

their ability to maintain cultural behaviors, have created an order and discipline for everyone to

follow. "Gia đạo", "gia phong" and "gia lễ" are the root of the family, keeping the people of Vietnam,

the family and Vietnamese society a strong vitality and purity with their roots. "Gia đạo", "gia phong"

and "gia lễ" are three important standards that govern and regulate family relationships and govern

the behavior of family members not only towards the survivors but also towards the ancestors have

passed away. All elements of family communication are referenced in the common standard of that

family culture. Accordingly, the speaker, the listener, the communication content, the way of

communication, the way of responding and the context of communication are all placed in the

common cultural framework of the family. This cultural framework forms the principle of highly

hierarchical communication and obey the hierarchy.

Principle of highly hierarchical communication guides the communicator in his or her role

and position with the communicator and the context of communication. In terms of hierarchy in

family communication, communicators must be aware of who they are in that communication

relationship to have an appropriate way of communicating (vocative, attitudes, gestures). In the

traditional communication of the Vietnamese family, the speaker usually targets the listener with two

attitudes: polite or impolite expressed in four types of vocative nuances: (1) formal; (2) neutralization;

(3) friendly, flippant; (4) buggery, contemptuous (Nguyễn, 1993). In a normal conversation, the

speaker who in a high position (great grandparent, grandparents, parents, uncles, aunts) talking to

their children or grandchildren can display one of three nuances of the address: (1) normal; (2)

neutralization; (3) friendly, flippant. However, if the speaker in low position (kid, grandchildren) who

talks to their great grandparent, grandparents, parents, aunts and uncles, they are only allowed to use

the expression (1) formal. The principles of family vocation are often strict and very respectful, both

according to the order of bloodline, and according to the age order, but the order of blood is still the


55

decisive factor. Therefore, in the groups of vocative nouns, kinship nouns are used more often to

ensure the exact position and hierarchy of the family members when communicating. If in English

only "I" and "you" refer to the speaker and the listener, in Vietnamese, there are 3 ways of addressing

people at lower position when talking to people at higher position, including: "con" (kid), "cháu"

(grandchildren) and "em" (younger sister/ younger brother), the people at higher position depending

on their position to responded. Specifically, speaker call "con" when talking to "bố" (father) and "mẹ"

(mother); call "cháu"’ when talking to "cụ" (great grandparent), "ông" (grandfather), "bà"

(grandmother), "cô" (father's sister), "bác" (father's brother, mother's brother); "chú" (uncle); "dì"

(mother's sister); "cậu" (mother's brother), "thím" (uncle's wife), "mợ" (wife of mother's brother),

"dượng" (aunt's husband); call "em" (younger brother/ younger sister) when talk to "anh" (older

brother) or "chị" (older sister). All vocative nouns that do not correspond exactly have their own

meanings with different psychosocial colors: grandparents call their grandchildren is "con", parents

call their children is "em" to show their intimacy affection between family members or an older

person vocative to the younger being "mày" (you), "tao" (I) to expresses plain, intimate or maybe

angry. Conversely, when a person in lower position vocative "tao" and call "mày" to a person in a

high position, it will be attributed to chaotic and filial behavior. In different communication situations,

a given word can reveal many different expressions, even opposites. For example, the vocation "ông"

represents the normal relationship between a grandfather to his grandchild (or any elderly man when

communicating with a young subject but does not have any blood relationship), but there are also

cases where younger people vocative "ông" to an elderly, when a young man is in a quarrel with an

older person, he says: "ông" (I) challenged "mày" (you) do that. In addition to the right vocative, there

still exists the phenomenon of "vocation for replacement", which means that the vocation of the

person who claims is not showing his position but in the position of others. For example, a kid calls

his parents is grandparents when that kid also has a child. The way of vocation "grandparents" in this

case mean that the parents call to replace their children. In Confucian culture, there is always the

thought that men despise women, so they often use words for men first, words for women put behind

in a phrase used by both sexes, such as "ông bà" (grandfather grandmother), "anh chị" (brother sister),

"chú dì" (uncle aunt). The choice of forms of vocation clearly shows the position and power in the

family as well as the attitude of the characters in communication. Therefore, the home network is a

sustainable structure in which vocation have important role for showing attitudes, feelings. All forms

of vocation in society are influenced by the choice of the form of vocation in the home network (Bùi,

2018).

The vocative communication mechanism is understood as a structured system of the vocative

communication elements operating under a certain organization, including: vocative communication

units (vocative words, structures and vocative pattern), speaker - the person called and the principles

of vocative communication (Nguyễn, 1993). In the Vietnamese family, when the communication

takes place, the speaker - the listener who wants to perform a proper vocative communication must

determine how he and the object communicates in the relationship, especially save pay attention to

factors of age, gender, position, and intimacy level. In terms of age, the older person must be called

with respect, the position of the person of lower position shows respect for the person of high position,

if the relationship is a close one, the vocation is also more intimate. This principle forms an implicit

rule, when naming children, it is certain to avoid the same name as the superiors in the family. In

terms of gender, Vietnamese language is very rich with the system of anonymous words to call in

communication such as: "nàng", "thiếp", "người", "ngài", "mình", "ta" to use instead the name of

husband - wife in the family ("nàng": the husband calls his wife, "thiếp": the wife calls herself;

"chàng", "ngài", "người": wife calls her husband; "ta": used for both husband and wife when talking

to the other; "mình": wife or husband calls the other). In addition to the above factors of age, gender,

status, participants must pay attention to specific communication situations in terms of space, time,

and purpose.


56

Paying attention to communication space demonstrates the characteristic that values

communication context. The traditional Vietnamese family communication space is usually the space

during a meal or after a meal when all family members enjoy tea and chat. Communication space is

sometimes extended in the workplace (in the garden, in the field, for example, people weeding,

transplanting rice, digging peanuts, etc. and talking together). Communication contexts can show a

state of close, intimate connection, but can also be formal, serious, and even heavy. Conversations

around the tray are often associated with problems or daily activities of the family, so the main theme

is temperate and intimate. One of the unique culinary cultural traits of Vietnamese people is the sense

of community shown right on the tray: food is share and everyone eats together, including a bowl of

sauce. That has a lot to do with the way Vietnamese people eat and communicate when they eat.

People of high position, the elderly take the food first and then the people of low position, children

must invite the adults before eating. Therefore, in the Vietnamese food culture, there is a saying "be

careful of possible faux pas", this regulates the behavior of family members when eating together.

Everyone has just eaten but must also listen and observe to ensure dignity and show respect for the

superior, the elderly. Children in the family are also taught how to eat slowly and especially when

chewing, they don't talk. The context of family communication is sometimes extended in family

meetings, which often have different emotional nuances depending on the content and purpose of the

meeting. If it is a family meeting about rejoicing (getting married, building a house, reaping crops),

the emotional state is usually comfortable and happy. However, if it is a meeting that involves dealing

with unusual incidents in the lineages, for example descendants in the offending family line (theft,

unmarried daughter pregnant) then the atmosphere is heavy. Most family meetings involve the

elderly, so when young people want to consult and exchange information, they must be allowed and

use honorifics with the people have higher position when speaking.

Communication context in traditional Vietnamese families is often associated with

communication time. Communication time is usually while the family is eating and working, but

perhaps the main time is still the evening when everyone is drinking tea and talking. Because this is

the time when most of the family's day-to-day tasks have been settled, everyone is in an

accommodating and relaxed mood while enjoying tea and chatting. Stories on the teapot or tray are

often related to family, how to organize life, assign tasks for tomorrow, ask questions, remind

children's education, but can also be stories about village communities. Later, when economic

conditions as well as technology developed, family members drank tea, watched television and

discussed together. There, although technology has begun to take part in family life, almost every

family member shares activities together with content on television: watching news, watching

movies, listening to music and entertainment together. Although there are intermediaries involved,

the communication of family members is still guaranteed.

Thus, all factors of age, gender, role, context, time or family communication purpose create

a multi-dimensional space, helping to realize communication and vocative behavior in

communication of Vietnamese family. Understand that multidimensional space in vocation and

family communication is to grasp the key of the traditional communication and help each family

member perform appropriate and effective communication behavior.

Communication emphasizes top-down pattern

Communication follows the principles of promoting hierarchies, so sharing and

communicating information is usually one-way from top to bottom. Listening, receiving and

responding to information in communications of low position people often must comply with

standards in eye contact, attitudes expressed through verbal and nonverbal language. Therefore, in

traditional Vietnamese family, parents attach great importance to teaching their kids "think today,

speak tomorrow", "courtesy costs nothing", "the cobbler should stick to his last", "words must be

weighed, not counted" it emphasizes that the speaker must be very careful before saying anything.


57

When people are angry, do not say anything, because "word is silver but silence is gold". Even people

at higher position like grandparents, parents must also pay attention to this to act as an example for

younger people. On the contrary, those at lower position and younger people have to be more cautious

when speaking so as not to make messy mistakes with those above, violating the family hierarchy.

Vietnamese people say "cha mẹ đặt đâu con ngồi đó", it’s mean kids must follow all parental,

arrangements cover all the implications of parents' influence on their kids in the family, including

life-long greatness such as (marriage) to daily routine (communication). That affirms parents' right

to make decisions over all their kid's problems. Accordingly, imposing communication has also

become common in many families, parents say what their kids must obey. Because, in traditional

Vietnamese society, kids obey their parents is one of the criteria to show a good, filial and polite son.

Gradually it shapes the habit of one-way communication, that is, kids, people at low position only

receive information from adults and obey, less critical and objectionable. Judging from the point of

view of the kids and people at low position is often seen as disobeying their parents - one thing to

avoid in the family. The limitation from this communication feature is that the formation of

generations is only obedient without their own opinion, so personal development is also inhibited.

In addition, the delicate, circular communication style that makes all family members, big

or small, when expressing their opinions, is often less likely to open up directly to issues like in the

West. Delicate and caring communication style is the product of a respectful lifestyle and a way of

thinking that values relationships. This method of communication contributes to maintaining

affection, harmony, joy, avoiding family conflicts and quarrels, but its disadvantage is its lack of

assertiveness and frankness. Vietnamese people love harmony, so they always try to maintain

solidarity and happiness in the family; each family member must be educated and trained to have

appropriate communication. The ability to communicate, namely the kid's ability to speak and

behave, is the appearances of their parents, parents pay much attention to this, so they often teach

their kids how to communicate in a proper manner. The teaching content is not only the way of

speaking, how to convey it, but also the tone of the communication.

Hierarchical communication is also reflected in the ritual in a very polite and rich way of

speaking, the people at lower position always have to use honorifics when talking to the people at

high position and the elderly. Right vocation shows the full educational environment that is received

from children to adults and shows how that individual is in dealing with human beings. It requires

the speaker and the listener to attach to different honorifics, and to state the subject and the predicate

in which. Depending on the position of each person in the communication relationship, honorifics are

also used with different degrees.

Through communication to teach communication

Admittedly, people begin to communicate from birth with early behaviors such as: eye

contact, physical contact, conversation between adult and child. This has been made clear through

the psychiatrist Bowlby's theory of attachment, who affirms that "attachment is a long-term

psychological relationship between people" and that attachment begins at a young age newborn baby

(Bowlby, 1969). The theory of attachment states that infants enjoy human company and that most

infants respond equally to any caregiver when the child before the age of 6 months (McLeod, 2017).

In the Vietnamese family, in addition to the usual ways of communication such as

conversation, body caressing, eye contact, the adults in the family have a special way of

communicating with the child, which is "lullaby". Lullaby is performed with the purpose of helping

the child to fall asleep easily, feel secure and warm when sleeping, but from this activity it creates a

unique way of communication, that is how adults show love for children, and also a way of educating

the child from birth. From there, forming a precious treasure of lullabies for which grandmother and

mother are the main transmitters to the child, sometimes the men also perform this work. Through

lullabies, adults comfort the child to go to sleep, but more importantly transmit the teachings, basic


58

values, good manners, speech, in human morality. From that way of communication, the child will

know filial piety with ancestral root, the merits of parents, the peaceful affection between brothers,

and the behavior of words and voices to be human. The process of socialization of a child starts from

those everyday actions, each child in the family is raised with a treasure of proverbs, singing

performed through lullabies about how to be human. From the way family functions, it can be stated

that the socialization function of the traditional Vietnamese family not only focuses on teaching

children, directing them towards scientific knowledge, but first of all, towards human morality. That

process continues every day, as the child grows up, the lullabies are replaced by moral and benevolent

stories, to teach the child how to live and behave humanly, then the discussions about daily life. Every

story, event has an educational implication in it. When a child is well educated there will be good

manners and communication, because personal honour is tied to the ability to communicate, good

words spoken leave marks, forming a reputation; bad words spread to many people's ears, creating

disreputable. In addition, the respect of family dignity makes parents in traditional Vietnamese

families aware of teaching their children to behave in an ethical manner, because in the community

"bad news has wings". Children must be cultivated so as not to affect the honour of their parents,

ancestors, because "the apple never falls far from the tree".

Thus, Vietnamese people attach special importance to communication and love to

communicate; although they like to communicate, Vietnamese people have the opposite, almost,

timid characteristic and be careful in communication. The coexistence of these two opposing

personalities (like to communicate and shy) stems from two basic characteristics of Vietnamese

villages: community and autonomy. Put this in the context of family communication, everyone in the

family communicates very openly, but outside the family, it is quite timid, meeting strangers is even

more quiet. Children, people lower position when communicating with adults must be cautious and

cautious. These two seemingly contradictory personalities do not contradict each other, they are two

sides of the same nature, a manifestation of the flexible behavior of the Vietnamese people.

Discussions

This research explores the basic characteristics of the traditional Vietnamese family pattern

and the characteristics of the communication culture dominated by this family pattern. In synthesis,

there are linked and analyzed relevant documents to discover those features. There are two main

issues to clarify in this study, which are also more extensive and complete than previous studies on

traditional Vietnamese family and family communication culture.

As in previous studies as Trần (2001), Trần (1996, 1997, 1998, 2016), Trần (2005), Huỳnh

(2012), Đào (2014), the family pattern is shaped by the specific economic conditions and cultural and

social contexts of the country. This is clearly reflected in the characteristics of Asian production

methods - with the core base of the wet rice agricultural economy. However, on that common

background, each Asian country also has its own ethnic characteristic and the Vietnamese family

depends on and is dominated by villages. Village units are the foundation of the monarchy of

Vietnam, not the family unit. Vietnamese village is the place where the community and autonomy is

most clearly shown and in that particular context, the family culture, including the communication

culture, has a clear mark. It should also be added that the community and autonomy in the village as

well as the expression in the family are not two opposing and mutually exclusive states, on the

contrary, these two characteristics are complementary to create high cohesion but still have

differences and encourage autonomy and independence.

In addition to the economic context, ideology is also an important factor affecting the

lifestyle and culture of the Vietnamese people and the Vietnamese family. Specifically, it is the

Buddhist and Confucian ideology that creates strict rules, expressing hierarchy (Confucianism) but

also very humane (Buddhism), thereby creating the model of family and obey the defence is in a

family order, but also very soft and harmonious (Đỗ, 1990). Therefore, Vietnamese family’s notion


59

is only influenced by Confucianism creates harshness for some family members is not really

satisfactory, because before Confucian introduction, Vietnam was an independent country, a culture

with its own basic characteristics.

Communication culture in traditional Vietnamese family through this study shows the

following: all elements of family communication are referenced in the common standards of family

culture, forming principles communicate highly and hierarchically, communication emphasizes the

principle of top-down stereotypes. It can be seen that the principle of communication upholding and

obeying the hierarchy requires that participants to always pay attention to the hierarchy of

communication relationships, but it seems very natural and is not basically a mode of communication

that limits the communication level or ability of family members. This is actually easy to understand

and explain, because what comes from the family and community culture, all members of that cultural

context practice cultural norms freely natural and voluntary. Therefore, Vietnamese people have a

way of transmitting the family culture, including a specific communication culture: through

communication to teach communication.

Research results also show that although communication emphasizes top-down stereotypes

according to the hierarchy is maintained in the social relations of the Vietnamese people (Nguyễn &

Cao, 2012), Vietnamese people also seek to soften it through opening and leading communication in

a subtle, circular manner to increase the communicator's encouragement to participate in

communication. According to the Confucian influence, the moral concept of "tam cương, ngũ

thường" has quite profoundly influenced three core relationships in society: king - people, father -

child, wife - husband. Setting in the family context shows the clear shaping the father - child, wife-

husband relationship through behavior and communication, in which the husband, the father has the

biggest role and position in the family, has strongest influence on the remaining members. But it is

also important to see that this father - child relationship has expanded further into a parent-child

relationship. Therefore, in general, parents have a profound influence on their children, even on the

communication aspect that creates the imposed communication from top to bottom. This

communication limits the power and the capacity to criticize from low - position people (children) to

high - position people (parents) in the family, it tends to the principle of listening and passive

reception of the low - position people (children). To soften this principle, Vietnamese people build a

habit of delicate and thoughtful communication, which is also a product of a dignified lifestyle and a

way of thinking that values relationships. This way of communication contributes to maintaining

affection, harmony, joy, and avoiding conflicts and quarrels in the family. Therefore, despite focusing

on the way of communicating that is highly hierarchical and imposed from above, Vietnamese people

still maintain a respectful, flexible communication style that has created a cultural behavior, creating

a background order, discipline for everyone to follow.

Conclusions

Traditional culture of communication in the Vietnamese family was formed, preserved and

developed for a long time, bearing the imprint of wet rice civilization as well as Confucian and

Buddhist ideology. The respectful but flexible way of communication has created a cultural behavior,

creating an order and discipline for everyone to follow. However, the limitation of this

communication style is the lack of assertiveness, inhibiting personal criticism; the overestimation of

the reputation and dignity of the family creates stricter stereotypes against some family members,

especially towards people at low position, women and children. In that context, every family member

must learn how to communicate through daily communication, whether verbal or non-verbal, self-

improvement to form a way of communication, behave in accordance with standards. Since then, the

family fully performs their socialization functions, becoming the cradle to nurture, store and transfer

traditional cultural values from generation to generation. It can be seen that, although the term

"traditional Vietnamese family" is used according to a time convention, the reality still shows that


60

the characteristics of the traditional Vietnamese family are still preserved in many modern

Vietnamese families through values including respect for affection, living in love (Lê, 2015, para.15).

However, in the context of modern society some basic conditions of traditional society have

been changed, leading to many other changes in communication, behavior and culture in the family.

Traditional wet rice agriculture was gradually replaced by other economic activities, the influence of

Confucian thought was increasingly narrowed down at the same time with the expansion of

Buddhism's influence. Besides that, the trend of opening up integration, international exchange in

culture was also focused. The profound influence of science and technology, particularly the

penetration and influence of the Internet, are creating significant disturbances in the traditional

communication culture of the Vietnamese family. In the context Vietnam ranks 6th in Asia, 4th out of

10th in Southeast Asia and 17th out of 20 countries with the most Internet users in the world (Trần,

Trần, Nguyễn, Nguyễn, & Trần, 2017), using the Internet too much affects the quality and

effectiveness of communication in the family. In fact, there is a paradox that the more connected

users on social media, the more lonely they feel (Turkle, 2017), that fact requires a comprehensive

and comprehensive study on the influence of the Internet on communication in the Vietnamese family

to help families to be more fully aware of this issue, thereby having solutions to use the Internet and

communicate effectively, in accordance with national cultural traditions.

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65

AGE VARIATIONS AND SEXUAL DIMORPHISM IN ADIPOSITY AND BODY

COMPOSITION AMONG TRIBAL ADOLESCENTS OF KHARAGPUR, WEST BENGAL,

INDIA

DOI: http://doi.org/10.26758/11.1.5

Gopal Chandra MANDAL (1), Saheli BISWAS (2), Pijush Kanti ROY (2), Kaushik BOSE (2)

(1) Bangabasi College, Kolkata, India;

(2) Vidyasagar University, Paschim Midnapore, West Bengal, India

Address correspondence to: Gopal Chandra Mandal, Department of Anthropology, Bangabasi

College, 19, Rajkumar Chakraborty Sarani, Kolkata-700009, India, Ph.: 91-9433773205; E-mail:

[email protected]

Abstract

Objectives. Although tribals constitute around 8.6% of the total population of India, detailed

information on their body composition is scanty. Thus, our objective was to evaluate age variations

and sexual dimorphism in adiposity and body composition among rural tribal adolescents of

Kharagpur, West Bengal, India.

Material and methods. This cross-sectional study was conducted among 788 tribal adolescent boys

and girls, aged 10-17 years of Kharagpur, West Midnapore, West Bengal, India. Height (kg), weight

(cm) and skinfolds were measured following standard method. The Body Mass Index (BMI) was

derived. Body composition measures including Percent Body Fat (PBF), Fat Mass (FM), Fat Free

Mass (FFM), Fat Mass Index (FMI) and Fat Free mass Index (FFMI) were computed using standard

equations.

Results. All the variables showed a significant age trend in both sexes. Age-combined significant sex

differences existed in mean BMI and all body composition measures. Girls had significantly higher

mean values of fat measures (PBF, FM and FMI) whereas boys had significantly higher mean values

of non-fat measures (FFM and FFMI). In both sexes, age had significant correlations with BMI and

the five body composition measures. Similarly, all body composition indicators were significantly

correlated with BMI in both sexes.

Conclusions. There were significant age and sex variations in body composition measures. Girls had

significantly more fat mass whereas boys had more lean body mass. All body composition measures

increased significantly with increasing age as well as BMI. Attainment of puberty could be a

mediating factor causing these age variations and sexual dimorphism.

Keywords: India, tribal adolescents, age variations, sexual dimorphism, body composition.

Introduction

The adiposity of an individual can be assessed by body composition. Eveleth and Tanner

(1990) commented that, the age, sex, genetic component, environmental conditions affect the

differential accumulation of body fat which is considered as a good indicator of the health and

nutritional status of a community. Skinfold thickness is an important measure of fatness (Roche,

Sievogel, Chumlea, & Webb, 1981). Body mass index (BMI) has been found to be associated with

body composition (Garrow & Webster, 1985) and nutritional status. It also has a high correlation with

body fatness (Rolland-Cachera, 1993). The influence of body fat distribution on health, first

suggested by Vague in 1956, is a topic of current interest. Several criteria are used for selecting

https://www.journalstudiesanthropology.ro/en/age-variations-and-sexual-dimorphism-in-adiposity-and-body-composition-among-tribal-adolescents-of-kharagpur-west-bengal-india/a163/


66

probable measures for nutritional studies. Skinfold thickness measures subcutaneous or “low-risk”

fat and is thus better for measuring body composition, while BMI is good for assessing the

relationship between internal fat and risk factors (Rolland-Cachera, 1993). Skinfold thickness has

been measured to estimate total body fat (TBF) and provide a fair assessment of the fat location.

Nearly all of the fat in the body lies beneath the skin, so thickness of subcutaneous fat reflects body

fat (Orphanidou, 1994). As the subcutaneous fat serves as a reservoir of energy during nutritional

deprivation, lower BF indicates a lower energy intake by children. The role of environment in the

development of adiposity is also evidenced in USA (Troiano, Flegal, Kuczmarski, Campbell, & John,

1995) and some developing countries (Martorell, Kettel Khan, Hughes, & Grummer-Strawn, 2000).

In very poor countries, such as those in Sub-Saharan Africa and South Asia, obesity among women

was greatly concentrated in an urban environment and among better educated women, whereas in

more developed regions, obesity levels were more equally distributed in the general population. The

distribution of BMI and subcutaneous fat in children of different ethnic origins - African or Indian

subcontinent descent living in Trinidad and Tobago, was studied by Gulliford, Mahabir, Rocke and

Chinn (2001). A study among young people of Romania by Rada (2017) pointed out that although

sedentary life was high among girls, boys showed higher rates of overweight and obesity and opined

that it may be due to the diet practices among girls.

According to Must and Anderson (2006), although BMI is frequently used to evaluate

obesity among children, it has its limitations like, there is no possibility to differentiate obesity due

to fat mass (FM) from that due to excess lean body mass. It is important to assess body composition

continuously and accurately during infancy which will help to evaluate the weight gained overtime.

Furthermore, it also provides useful information on nutritional requirements, the efficacy of diet and

medical interventions, and the influence of chronic diseases (Olhager & Forsum, 2003). The global

prevalence of overweight and obesity among children increased from 4.2 % in 1990 to 6.7 % in 2010

and is expected to reach 9.1 % by 2020 (de Onis, Blössner, & Borghi, 2010). The major patterns of

fat distribution develop in childhood and adolescence in both sexes. Males develop more trunk fat

than females, and this development is more clearly established after puberty (Bray & Bouchard,

1988). Children and adolescents with a high BMI also tend to have a high level of body fatness, but

because BMI is based only on weight and height, it can be an inaccurate indicator of body fatness,

particularly among those who have normal or relatively low levels of body fatness (Bray, DeLany,

Volaufova, Harsha, & Champagne, 2002). Many authors pointed out that relation of BMI to body

fatness differs based on race-ethnicity groups (Deurenberg, Deurenberg-Yap, Foo, Schmidt, & Wang,

2003; Freedman et al., 2008). Asians generally have more body fat and blacks have less body fat than

white Caucasians. Although, Ulijaszek and Kerr (1999) commented about the technical error of

measurements related with skinfold thicknesses, these are being widely used among children and

adolescents as they provide a more direct and accurate estimate of body fatness than BMI (Laurson,

Eisenmann, & Welk, 2011; Leitao, Rodrigues, Neves, & Carvalh, 2011; Going et al., 2011).

Furthermore, many authors are of opinion that, there is stronger association of body fatness with

skinfold thicknesses than with BMI (Bray et al., 2002; Sardinha, Going, Teixeira, & Lohman, 1999;

Steinberger et al., 2005; Freedman et al., 2007). In a study among children and adolescents aged 7 –

15 years from Vojvodina, North Serbia, it was reported that percent of skeletal muscle mass (% SMM)

increased with age in both sexes and was significantly influenced by gender, age and physical activity,

cumulatively and partially (Pavlica & Rakic, 2019). The role of physical activity in body composition

had also been investigated in another study (Nikolova, Mladenova, Boyadzhiev, & Paskaleva, 2019)

among 7-17 years aged children and adolescents from Plovdiv, Bulgaria. The authors had observed

that the increase in percentage body fat and values of the fat mass index and the decrease in frame

index were entirely or partially caused by reduced physical activity. Albu and Rada (2014) had

studied in detail the dynamics of anthropological markers among Romanian teenagers between 1978-

1999. They had found significant changes in anthropometry and body composition in this time span.


67

Adolescence is one of the four known sensitive periods in life for the development of obesity,

the other three being intrauterine life, infancy and ages 5-7 years (Monyeki, van Lenthe, & Steyn,

1999). It begins with pubescence, the earliest signs of emergence of secondary sexual characters and

continues up to the morphological and physiological maturation to the adult status (WHO, 1995).

Unique changes that occur in an individual during this period are accompanied by progressive

achievement of biological maturity (Tanner, 1962). This period is very crucial since these are the

formative years in the life of an individual when major physical, psychological and behavioural

changes take place (Patil, Wasnik, & Wadke, 2009).

There are several socially disadvantaged communities in India, among which tribal

populations are the most deprived ones. Although, tribals constitute around 8.6% of the total

population of India, detailed information on their body composition is scanty (Khadilkar & Khadilkar,

2019). In this context, we have tried to investigate age variations and sexual dimorphism of body

composition of the tribals of a particular area of Eastern India.

In this context, our objective was to evaluate age variations and sexual dimorphism in

adiposity and body composition among rural tribal adolescents of Kharagpur, West Bengal, India.


Area under study. The present cross-sectional study was conducted in Higher Secondary

Schools of 10 villages (Changual, Gangarampur, Benapur, Balarampur, Sankoa, Gopinathpur,

Chakmakrampur, Mawa, Amlatoria, Chakturia) of Kharagpur Community Development Block II,

West Midnapore, West Bengal, India which are situatedaround10 km from Midnapore town, the

district head quarter. A total of 25.6% of the total population of the Block is constituted by tribal

groups.

The participants. Measurements as well as other information were collected from 788 tribal

adolescents (370 boys; 418 girls), aged 10-17 years. The students who were present in class were

randomly selected. Various tribal communities like Santhal, Bhumij, Munda, Mahali, Sabar live in

these villages. The living amenities were more or less same for all the groups. Hence, we considered

them as a single homogenous population termed ‘tribal group’. Age of the participants was calculated

from the Date of Birth recorded in the school registration books. Adolescents of non-tribal

communities were excluded from this study. Table 1 represents the age and sex wise distribution of

the participants.

Table 1

Distribution of the participants by age and sex

Sex Age in years Total

10 11 12 13 14 15 16 17

Boys 55 42 54 52 43 39 45 40 370

Girls 40 48 64 58 50 57 52 49 418

Total 95 90 118 110 93 96 97 89 788

Anthropometric variables. Height (kg), weight (cm), triceps skinfold (TRSF, mm) and sub-

scapular skinfold (SSSF, mm) were measured following standard methods (Lohman, Roche, &

Martorell, 1988) by the second and third (SB and PKR) authors. Skinfold measurements were used

to measure BF (%) from which fat mass (FM, kg) and fat-free mass (FFM, kg) were calculated.

Triceps (TRSF, mm) and subscapular (SSSF, mm) skinfold thicknesses were measured to the nearest

0.1mm using Holtain skinfold caliper. The following measures were derived: BMI, Percent Body Fat


68

(PBF), Fat Mass (FM), Fat Free Mass (FFM), Fat Mass Index (FMI) and Fat Free Mass Index

(FFMI).The equations used are presented in Table 2.

Table 2

BMI and body composition variables

Variables Formulae Reference

BMI Weight (kg)/Height (m)² WHO, 1995

PBF (Boys) 1.21 (TRSF+SSSF) -0.008 (TRSF+SSSF)2 -1.7 Slaughter et al., 1988

PBF (Girls) 1.33 (TRSF+ SSSF) -0.013 (TRSF+SSSF)2 -2.5

FM (kg) Body Weight (kg) x[PBF/ 100]

Van Itallie, Yang,

Heymsfield, Funk, &

Boileau, 1990

FFM (kg) Weight (kg) – Fat Mass (kg)

FMI (kg / m2) FM (kg) /Height2 (m2)

FFMI (kg / m2) Fat Free Mass (kg)/ Height2 (m2)

The technical error of measurements (TEM) was calculated for height and weight and they

were found to be within reference values as given by Ulijaszek and Kerr (1999). Thus, TEM were

not incorporated in any analyses.

Statistical analyses. Students’t-test and ANOVA were performed to study sexual

dimorphism and age variations, respectively. Pearson’s correlation coefficient (r) analyses was

undertaken to study the association between the continuous variables. All statistical analyses were

performed using statistical package for social sciences (SPSS, version 16.0).

Ethical approval. Ethical approval was obtained from Department of Anthropology,

Vidyasagar University. Permission for conducting this study was also obtained from each school

authority. Moreover, informed verbal consent was obtained from each participant.

Results

In case of PBF, among boys the mean values didn’t show gradual increase with age.

However, there was the gradual increase among girls and these values were much higher at all ages

than in boys (Figure 1). Although the sex differences were significant in most of the cases (except at

few ages) for FM, FFM, FMI and FFMI, both sexes showed an increasing trend with age. In case of

FM the mean values were higher among girls in all age groups, whereas, FFM displayed a reverse

trend (Figure 2). When age combined overall means were taken into account, except height, FFM and

FFMI, all other variables showed higher means among girls. All the variables showed significant

sexual dimorphism in each of the age groups but it was different in BMI, where it was significant in

case of only 14 and 15 years of age.

Figure 1 shows that there was a gradual increase of PBF among girls and these values were

much higher at all ages.


69

Figure 1

Age specific sex variation in PBF

Figure 2 shows a reverse trend compared to the previous figures with boys having higher

values from age 13 onwards.

Figure 2

Age specific sex variation in FFM

Table 3 presents the age and sex-specific mean height, weight, BMI and the five body

composition measures. The mean values of all the variables significantly (p < 0.001) increased with

age. In case of height and weight, the mean values were lower among boys in earlier ages which were

reversed in the later ages. This was indicative of probably an earlier occurrence of adolescent growth

spurt among girls.


70

Table 3

Age and sex-specific mean height, weight, BMI and the five body composition measures

* = p < 0.05; ** = p < 0.01; *** = p < 0.001

Variables Sex Age in years Total F

10 11 12 13 14 15 16 17

Height

(cm)

Boys 131.0

(7.5)

135.6

(6.01)

140.5

(8.4)

147.7

(7.6)

152.9

(10.7)

152.9

(9.3)

160.3

(6.6)

160.4

(7.6)

146.8

(13.1)

87.9***

Girls 133.7

(8.3)

139.1

(6.6)

144.2

(7.2)

145.9

(6.5)

148.7

(5.7)

149.9

(4.6)

150.4

(5.3)

150.9

(5.2)

145.7

(8.2)

43.9***

t -1.7 -2.6* -2.6* 1.3 2.4* 2.2* 8.2*** 7.1*** 1.5

Weight

(kg)

Boys 24.4

(4.3)

27.8

(5.2)

31.1

(6.5)

36.0

(6.2)

40.0

(7.0)

39.4

(8.1)

47.4

(8.0)

47.2

(7.0)

36.1

(10.3)

78.5***

Girls 25.8

(5.3)

29.1

(5.7)

32.9

(6.0)

36.0

(6.0)

40.2

(6.5)

41.1

(4.1)

42.4

(6.2)

41.4

(5.1)

36.4

(7.9)

57.9***

t -1.40 -1.16 -1.56 -0.02 -0.2 -1.4 3.5** 4.5*** -0.5

BMI

Boys 14.1

(1.4)

15.0

(1.9)

15.6

(2.0)

16.4

(2.1)

17.1

(2.4)

16.8

(2.6)

18.4

(2.2)

18.3

(2.0)

16.3

(2.5)

24.4***

Girls 14.3

(1.9)

14.9

(2.2)

15.7

(1.9)

16.8

(2.1)

18.1

(2.4)

18.3

(1.9)

18.7

(2.2)

18.2

(2.0)

16.9

(2.6)

32.5***

t -0.54 0.17 -0.29 -1.0 -2.1* -3.4** -0.7 0.21 -3.3**

PBF

Boys 10.8

(2.6)

12.5

(4.6)

13.2

(4.5)

13.2

(4.3)

12.9

(3.3)

14.0

(4.0)

14.6

(4.1)

14.4

(3.9)

13.1

(4.1)

4.7***

Girls 13.7

(3.9)

14.9

(3.8)

17.4

(3.9)

18.7

(4.4)

21.6

(4.7)

21.9

(3.6)

22.6

(4.0)

22.5

(3.8)

19.3

(5.1)

37.6***

t 4.5

***

2.7** -5.0** -6.6

***

-10.3

***

-10.1

***

-9.7

***

-10.0

***

-18.5

***

FM

Boys 2.7

(1.0)

3.6

(2.3)

4.3

(2.5)

4.9

(2.4)

5.2

(1.9)

5.6

(2.6)

7.1

(3.03)

6.9

(2.9)

4.9

(2.7)

19.6***

Girls 3.7

(1.8)

4.5

(2.0)

5.8

(2.3)

6.9

(2.5)

8.9

(3.2)

9.1

(2.2)

9.7

(2.9)

9.4

(2.4)

7.3

(3.2)

45.0***

t -3.4** -1.93 -3.4

***

-4.3

***

-6.5

***

-7.2

***

-4.3

***

-4.5

***

-11.1

***

FFM

Boys 21.7

(3.5)

24.2

(3.7)

26.8

(4.6)

31.1

(4.8)

34.7

(5.6)

33.8

(6.4)

40.3

(5.8)

40.3

(5.1)

31.1

(8.2)

92.7***

Girls 22.1

(3.8)

24.6

(4.1)

27.1

(4.1)

29.1

(3.9)

31.3

(3.8)

32.0

(2.7)

32.6

(3.8)

32.0

(3.4)

29.1

(5.0)

51.2***

t -0.502 -0.57 -0.39 2.4* 3.5** 1.9 7.9*** 9.2 4.3***

FMI

Boys 1.5

(0.5)

1.9

(1.1)

2.1

(1.1)

2.2

(1.1)

2.2

(0.7)

2.4

(1.0)

2.7

(1.1)

2.7

(1.0)

2.2

(1.0)

7.5***

Girls 2.0

(0.9)

2.3

(0.9)

2.7

(0.9)

3.2

(1.1)

4.0

(1.4)

4.1

(1.0)

4.3

(1.2)

4.1

(1.0)

3.4

(1.3)

34.8***

t -3.3** -1.61 -3.3** -4.5

***

-7.6

***

-8.0

***

-6.7

***

-6.8

***

-13.6

***

FFMI

Boys 12.6

(1.0)

13.1

(1.2)

13.5

(1.2)

14.2

(1.3)

14.9

(1.9)

14.4

(2.0)

15.6

(1.5)

15.6

(1.3)

14.2

(1.8)

29.2***

Girls 12.3

(1.2)

12.7

(1.4)

13.0

(1.2)

13.6

(1.1)

14.1

(1.3)

14.3

(1.1)

14.4

(1.3)

14.1

(1.3)

13.6

(1.4)

20.0***

t 1.3 1.56 2.2* 2.5* 2.2* 0.43 4.4*** 5.6*** 5.0***

Sex specific correlations of age with BMI and the body composition measures are presented

in Table 4. All the variables showed highly significant (p < 0.01) positive correlations with age. All

the fat measures (PBF, FM and FMI) displayed stronger correlations among girls. However in case

of all the non-fat measures (FFM and FFMI) the trend was reverse, i.e. much higher correlations were

noticed among boys. The sexual dimorphism was most marked in case of PBF followed by FMI. A

noteworthy finding was that the BMI showed similar correlations in both sexes.


71

Table 4

Sex specific correlation of age with BMI and body composition measures

Variables r

Boys Girls

BMI 0.553** 0.561**

PBF 0.260** 0.600**

FM 0.515** 0.632**

FFM 0.787** 0.642**

FMI 0.340** 0.582**

FFMI 0.582** 0.464**

** = p < 0.01

Table 5 presents the sex specific correlations of BMI with the indicators of body

composition. In both sexes, all the measures showed significant positive correlations (p< 0.01) with

BMI. It was observed that all the fat measures (PBF, FM and FMI) displayed much stronger

associations with BMI in girls. The most noticeable sexual dimorphism was found in PBF.

Table 5

Sex specific correlation of BMI with the body composition measures

** = p < 0.01

Variables r

Boys Girls

PBF 0.646** 0.821**

FM 0.833** 0.901**

FFM 0.779** 0.839**

FMI 0.810** 0.923**

FFMI 0.939** 0.933**

Discussions

Adolescence is a decisive period of rapid physical growth attainment and development or

maturity with multiple physiological changes occurring between the childhood and adulthood. It

also includes body composition transforming with differential changes taking place between sexes

(WHO, 1995; Wells, 2007).

Mean height and BMI of the present adolescents were much higher than the Santhal

adolescent boys (134.8 cm) and (girls-142.8cm) respectively from Purulia, West Bengal (Das & Bose,

2011). However, mean weight among boys and girls were similar (Das & Bose, 2011). Mean height

(134.2 cm) and weight (29.9 kg) among adolescent boys of Kolam tribe of Telengana (Karri,

Ghritlahre, Das, & Bose, 2017) state were much lower than our participants. A study among rural

male adolescents from Naxalbari, Darjeeling District, West Bengal (Dey et al., 2011) found that the

height (154.4 cm) and weight (42.0 kg) among boys were much higher than the participants of the

present study. However, in comparison of the rural adolescent boys of West Bengal studied by Pal,

Pari, Sinha and Dhara (2017), the mean values of the present adolescent boys were slightly lower for

height and weight but these were slightly higher among the girls of the present study. Mean BMI

among the boys was slightly higher than adolescent boys (15.6 kg/m2) and slightly lower than found


72

among girl (17.4 kg/m2) Santhal adolescents from Purulia, West Bengal (Das & Bose, 2011).

Adolescent boys from Naxalbari, Darjeeling showed higher mean BMI (17.7 kg/m2) than boys of the

present study (Dey et al., 2011). Among the Rajbanshi adolescent girls from North Bengal, the three

anthropometric variables had similar (to our study) mean values (Roy, Barman, Mondal, & Sen,

2016).

The present study revealed that girls had higher mean PBF, FM and FMI than boys at all

ages. A reverse sex trend was observed in case of FFM and FFMI. This indicated that the level of

adiposity was significantly higher among girls. A similar trend has been reported in other studies

from India as well as other countries also (Dutta Chowdhury, Chakraborti, & Ghosh, 2007; Rakic &

Pavlica, 2014; Mandal & Bose, 2017; Mehdad et al., 2012; Rajkumari, Akoijam, Akoijam, &

Longjam, 2012; Freedman, Horlick, & Berenson, 2013; Nwizu, Njokanma, Okoromah, & David,

2014; Sharma & Mondal, 2018). Mean PBF among boys and girls of the present study were 2.8%

and 3.9% lower respectively, than those found among the adolescents from Imphal, Manipur, India

(Rajkumari et al., 2012). In the same study, it was observed that FM was 3.8 kg higher among both

the boys and girls than the participants of our study. A similar trend was also found among Moroccan

adolescents aged 11-17 years, where, PBF among boys was 15.9% higher and among girls it was

11.2% higher than our study (Mehdad et al., 2012). Similar results were observed in case of FM of

the participants of the same study and school children from Washington, USA (Freedman et al.,

2013). However, these were lower among Nigerian adolescents aged 10 – 18 years (Nwizu et al.,

2014) and among school going children and adolescents from Phanshidewa Block, Darjeeling

District, WB, India (Debnath, Mondal, & Sen, 2018). Our study provided preliminary evidence of a

significant spurt growth in PBF and FM. This indicated the approaching of peak velocities in height

and weight (Bell, 1993). It is noteworthy to mention here that the role of height is more important

than adiposity in predicting lean body mass (LBM or FFM) (Malina, Bouchard, & Beunen, 1988).

Mean FFM of the adolescents of the present study increased gradually with age in both sexes.

Sexual dimorphism became more pronounced at higher ages. The same trend had also been earlier

reported among Nigerian adolescents. They showed more or less 30.0% higher mean values among

boys and girls (Nwizu et al., 2014). However, another recent study found that there were no

significant sex differences among Santhal children (FFM: boys-22.2 kg; girls-21.2 kg) of Purulia,

West Bengal, and their mean values were lower than the present study (Dutta Chowdhury et al.,

2007).

The BMI was highly correlated with body composition parameters in both sexes and the

magnitude was greater among girls (except in FFMI). Similar results had been earlier reported from

Santhals of Purulia (Dutta Chowdhury et al., 2007), Moroccan adolescents (Mehdad et al., 2012),

adolescents from Imphal, Manipur (Rajkumari et al., 2012), rural adolescent girls from Kabri

Anglong, Assam (Sharma & Mondal, 2018) and Chakmas of Tripura (Saha & Sil, 2019). Maynard et

al. (2001) in their analysis of the data from the Fels Longitudinal Study had also showed a

significantly high correlation between BMI and body composition variables. Similar results had been

reported from black Jamaican children (Gaskin & Walker, 2003).

In the present study, the body composition measures that were significantly higher in girls

indicated that they tend to accumulate more fat than boys. In our study, we derived body composition

measures based on subscapular and triceps measurements. It has been earlier shown that girls possess

higher adiposity in their subscapula and triceps regions (Zimmermann, Gübeli, Puntener, & Molinari,

2004). The use of BMI to identify children with excess adiposity during the pubertal development

has an important limitation; it has been shown that BMI increases in adolescents from both sexes are

primarily determined by increases in FFM (or lean body mass, LBM) rather than in body fat

compartment (Yoo, Lee, Kim, & Sung, 2006). Pubertal ages are important for changing body

composition and it is more marked earlier among girls between pre and menarche individuals (Prado

Martinez, Marrodan Serrano, Acevedo Cantero, & Carmenate Moreno, 2017).


73

Besides demonstrating distinct age variations in both sexes, our study provided unequivocal

evidence that there existed significant sexual dimorphism in body composition measures. We also

found that, in girls, fat measures were more strongly associated with both age as well as BMI which

is a measure of generalized obesity. The inverse was observed in boys, i.e. non-fat (or lean) body

composition measures had a stronger relationship with age. Taken together, these results clearly

indicated that with increasing age, there significantly more fat deposition among girls. Moreover,

increase in BMI in girls is concomitant with increasing fat deposition. This implied that there was a

distinct dimorphism in the increase between fat and non-fat (or lean) components with increasing

BMI. These morphological changes could be mediated by the attainment of puberty. More detailed

longitudinal studies are needed to fully comprehend the mechanism involved this significant sexual

dimorphism in fat deposition. Unfortunately, the present investigation was cross sectional in nature

which is major limitation of our study.

Conclusions

There were significant age and sex variations in body composition measures. Girls had

significantly more fat mass whereas boys had more lean body mass. All body composition measures

increased significantly with increasing age as well as BMI. Attainment of puberty, which involves

hormonal changes, could be a mediating factor causing these age variations and sexual dimorphism.

Further longitudinal studies are required to understand the mechanisms linked with these changes.

The uniqueness of our study is that it deals with age variations and sexual dimorphism in body

composition among tribals (indigenous people). Hitherto, to the best of our knowledge, such

investigations are scanty from India.

Conflict of interest: None

Acknowledgements

All subjects who participated in the study are gratefully acknowledged. Special thanks are

due to the parents and the School authorities for their kind cooperation and help.

Funding

The authors received no financial support for the research, authorship, and/or publication of

this article.

Abbreviations used

SSSF – Sub scapular skinfold

TRSF – Triceps skinfold

BMI – Body mass index

FM -Fat Mass

FFM – Fat free mass (also known as Lean Body Mass, LBM)

FMI – Fat mass index

FFMI – Fat free mass index

PBF – Percent body fat


74

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78

HIGH RISK OF POSTPARTUM HAEMORRHAGE AT BOUAKÉ UNIVERSITY

HOSPITAL (NORTH-CENTRAL CÔTE D’IVOIRE)

DOI: http://doi.org/10.26758/11.1.6

Zahouo Pascale Ghislaine KOUAMÉ (1), Adou Serge Judicaël ANOUA (1), N’Doumy Noël ABE

(1)

(1) Alassane Ouattara University, Côte d’Ivoire

Address correspondence to: Adou Serge Judicaël Anoua, Department of Anthropology & Sociology,

Alassane Ouattara University, BP V18 Bouaké 01, Bouaké, Côte d’Ivoire, Ph. : +225 07070136; E-


Abstract

Objectives. Postpartum haemorrhage is one of several direct causes of maternal death in Côte

d’Ivoire. It is recurrent in the department of gynaecology and obstetrics at Bouaké University Hospital

(CHU de Bouaké), but little is known to date about the underlying risk factors. The present study

aims to describe the levels and trends displayed by the risk factors of postpartum haemorrhage before

determining the contributing social factors in the aforesaid department.

Material and methods. This study is retrospective in nature, concerning the period from 2014 to

2016. Data was obtained from delivery records and through individual interviews. The overall

approach adopted is an anthropological one.

Results. Postpartum haemorrhage is significant in light of its very high and increasing incidence

(22.31%) among multiparous mothers. Within the latter category, fatal complications are a critical

problem, with an annual average estimated at 35.98% and on the rise. The overall situation is alarming

in view of this progressive deterioration. The persistence of the reproductive morbidity is attributable

to various economic, social, cultural, and infrastructural factors.

Conclusions. Communicational strategies are proposed as a type of community intervention

conducive to social and behavioural change, with multiparous mothers as a priority target group,

followed by older mothers in the medium term and by adolescent mothers in the long term. This

should raise awareness about high-risk reproductive behaviours and practices as well as the

environmental, economic, social, cultural, and infrastructural factors correlated to postpartum

haemorrhage, with the ultimate goal of improving the quality and safety of reproductive practices.

Keywords: postpartum haemorrhage, reproductive behaviour, high risk, obstetric emergency,

maternal morbidity, Côte d’Ivoire.

Introduction

Postpartum haemorrhage is currently an especially concerning instance of maternal

reproductive morbidity. According to WHO (2014, p. 8), it affects about 2% of parturient women in

the world. Its impact on them is enormous. It seems to promote in these women a state of post-

traumatic stress such as a feeling of death and loss of control, a bad memory of childbirth, avoidance

of elements reminding them of childbirth, sleep disorders (Faure, 2011). In addition, other women

suffer from complications of transfusion, resuscitation, and infertility in case of hysterectomy

(Deneux-Tharaux, Bonnet, & Tort, 2014). Sometimes complications such as acute anuric renal failure

and inferior vena cava thrombus are highlighted (Deneau, Jean-Michel, Salah, Benyaghla, & Kalfon,

2017). Furthermore, it is responsible for almost a quarter of all maternal deaths, which makes it the

https://www.journalstudiesanthropology.ro/en/high-risk-of-postpartum-haemorrhage-at-bouak-university-hospital-north-central-c-te-d-ivoire/a164/



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leading cause of maternal deaths (WHO, 2014, p. 8). In the majority of low-income countries, its

prevalence is especially notable. This is the case of Côte d’Ivoire too, where postpartum haemorrhage

is the most frequently observed direct cause of maternal death. Its incidence has been estimated at

42% of women in the national representative sample in Côte d’Ivoire’s National Health Development

Plan for 2016-2020 (MSHP, p. 18).

The characteristics of this maternal morbidity are related to several aspects of public and

community health. There are in turn conditioned by the financial, geographic, social and material

constraints to which mothers are subject (Fenomanana, Riel, Rakotomena, Andrianjatovo, &

Andrianampanalinarivo, 2009). The overlap of these diverse factors adds to the complexity of the

issue of maternal morbidity, which the existing literature has approached from multiple perspectives.

From a sociodemographic point of view, it has been noted that postpartum haemorrhage correlates

with age (Alouini, Randriambololona, & Randriamboavonjy, 2015) and with multiparity (Mazouz,

Sabri, & Hamadouch, 2018, p. 30), whereas from a medical and healthcare point of view, relevant

factors include restricted access to centres for obstetric emergencies and obstetric complications

(Mukuna, Okenge, Sepou, & Modia, 2018). In the latter case, uterine atony and soft tissue tearing or

uterine rupture (Diakité, 2015) as well as intervals of oxytocin increase of less than 20 minutes during

spontaneous labour (Loscul et al., 2016) have been found to be the most common causes. Sometimes

these complications are aggravated by factors such as delays in care. This is often justified by

resistance generated by the organization and operation of obstetric emergency services (Faye Dieme

et al., 2017).

The health care policy of Côte d’Ivoire aims to reduce postpartum haemorrhage by

developing the skills of staff who provide emergency obstetric and neonatal care. The same is true

by improving the quality and range of care services in all regions of the country, so that mothers can

receive adequate and even optimal treatment. This issue is prominently addressed by the National

Health Development Plan for 2016-2020, in its fifth strategic component, pertaining to the health of

mothers, new-borns, children, adolescents, and the youth, which sets the objective of improving the

health of the aforementioned categories by 2020 and reducing mortality by 50% (MSHP, 2016, p.

53).

However, the implementation of these initiatives and response actions is undeniably limited.

In the specific case of the department of gynaecology and obstetrics at Bouaké University Hospital,

there are several shortcomings to be pointed out following an exploratory survey of the manager and

health workers in the department. These are notably the upsurge of cases of postpartum haemorrhage

and delays in providing care in case of an obstetric emergency. The social aspect remains crucial in

the search for solutions to these problems. Indeed, there are sociological factors with underlying

sociodemographic and epidemiological variables that are of importance for combating the morbidity

under discussion. In particular, high-risk reproductive behaviours are a risk factor for postpartum

haemorrhage, along with environmental, economic, social and cultural determinants.

It is thus within an anthropological perspective that is formulated the hypothesis that efforts

to prevent postpartum haemorrhage must include a dynamic process of long-term health education,

aimed at reducing high-risk behaviours and other risk factors. This is considered as a necessity since

a mother is the mainstay of the family, by virtue of her role in covering household expenses. Her

survival is thus essential because of her productive contributions. The present study aims to describe

the levels and trends displayed by the high risk factors for postpartum haemorrhage before

determining the social factors that contribute to in the department of gynaecology and obstetrics at

Bouaké University Hospital. Thus, for the purpose of the analysis, it appears necessary to situate the

incidence and trends of postpartum haemorrhage in adolescent, older, and multiparous mothers, to

present the incidence and trends of deaths related to this morbidity in this category of mothers, and

finally to expose the social factors associated with its dynamics. Before addressing these matters, a

presentation of the methodology is in order.


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Material and Methods

Scope of the Study

The research was carried out in Bouaké University Hospital, in North-Central Côte d’Ivoire.

This is the only specialised medical unit for obstetric complications in the region. It is a public,

national institution with a threefold vocation – medical care, education, and research in the field of

health – and it is equipped with a department for gynaecology and obstetrics according to its 2016

activity report. It is the unit for delivery and obstetric emergencies of this department that was selected

as the scope for this study.

Research Type and Population

The present study has a descriptive and interpretive (Thorne, 2008) approach and a

retrospective viewpoint. It was conducted from the perspective of social anthropology, applied to

informants from the department of gynaecology and obstetrics. The latter included an obstetrician-

gynaecologist, a midwife, five women who had been treated for an obstetric emergency, and five

relatives of these women. Thus, there was a total of twelve informants in the study, selected for their

fluency in French and the experiences with postpartum haemorrhage that they could relate; in other

words, they were chosen as a convenience sample. To do this, a basic survey of a list of people present

at the time of the survey was used as a sampling technique. They were then interviewed so that the

social factors that influence postpartum haemorrhage could be identified. Furthermore, the delivery

records for the period 2014-2016 were examined, with a view to determine the levels and trends

displayed by postpartum haemorrhage and consequent death in adolescent, older, and multiparous

mothers.

Ethics and Data Collection

For the approval of the research, the scientific board of the Department of Anthropology and

Sociology of Alassane Ouattara University in Côte d’Ivoire reviewed and ratified the procedures to

be used to get informed verbal consent from the participants of the study. The collected data were

subsequently anonymized and could no longer be linked to any individual informant.

The research took place between the 15th of August and the 15th of December of 2016 and

consisted of two stages. First, a quantitative analysis of the delivery records made available by the

department of gynaecology and obstetrics was carried out. The period under study spanned three

years, from 2014 to 2016 and the data was collected following a previously established grid. The

numerical data collected represented the variables of age, number of births, maternal death, and

postpartum haemorrhage, noted for each mother included in the records. The collection of the data

was carried out by three students, each one working on one of the three observation years, in a space

allocated to them by the director of the department of gynaecology and obstetrics. This first stage was

followed by a qualitative investigation performed with the aid of an interview guide focused on the

social factors relevant to haemorrhage in parturients, during or following childbirth. The interviews

were conducted individually with the aforementioned twelve informers, namely the obstetrician-

gynaecologist, the midwife, the five women who had experienced postpartum haemorrhage, and five

friends and relatives thereof, and were organised according to the availability of the respondents.


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Data Management and Analysis

The data drawn from the delivery records were digitally analysed with the use of the program

Epi Info 5.3. The grids were validated once the delivery records had been surveyed and the data

representing the variables of age, number of births, maternal death, and postpartum haemorrhage

were coded before being entered into the chosen software on a computer. The statistical analysis that

was then conducted served to identify the levels and trends of postpartum haemorrhage in adolescent,

older, and multiparous mothers, as well as the mortality rate associated with this morbidity in these

three categories of mothers. The relevance of the analysis methods rests upon the theory of

reproductive transition, which is a reduced model of demographic dividend, at the scale of a

healthcare network (Abé, 2013). This theory led to the establishment of a priority ranking of the

response actions proposed, reflecting the respective risk levels of the categories of mothers.

As for the data obtained by means of the interview guide, they were tallied manually and

subjected to a thematic content analysis (Paillé & Mucchielli, 2012). Within the information gleaned

in this way, the main properties and trends of the social factors contributing to postpartum

haemorrhage were pinpointed. These were then further analysed so that their significance could be

elucidated. To this end, the theory of personal constructs set forth by Carré and Fenouillet (2019) was

relied upon, for a more insightful interpretation of the personal and subjective experiences of

postpartum haemorrhage that were recorded. In the following, there will be presented the results of

the study and what they have revealed about the department of gynaecology and obstetrics at Boauké

University Hospital.

Results

The results can be broken down into three sets: 1) incidence and trends of postpartum

haemorrhage per category of mothers in the period 2014-2016; 2) incidence and trends of maternal

mortality due to postpartum haemorrhage per category of mothers in the period 2014-2016; and 3)

the social factors correlated to postpartum haemorrhage.

Postpartum Haemorrhage per Category of Mothers

Table 1

Incidence and trends of postpartum haemorrhage in mothers from 2014 to 2016

Postpartum haemorrhage in adolescent, older, and multiparous mothers

Bouaké PPH in

mothers

In

adolescent

mothers

(< 19 yo)

In older

mothers

(> 35 yo)

In

multiparous

mothers

(> 4 births)

Dominant

risk factor

Year n % n % n % n %

Multiparity

2014 105 13.20 09 8.57 17 16.19 23 21.90

2015 101 12.47 07 6.93 21 20.79 20 19.80

2016 107 9.69 11 10.20 25 23.36 27 25.23

Yearly

average

11.78 8.59 20.11 22.31

Trend Decreasing Increasing Increasing Increasing

Status Alarming


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In the department of gynaecology and obstetrics at Bouaké University Hospital, postpartum

haemorrhage displayed a high average incidence of 11.78% per year, albeit with an apparent decrease

between successive years.

Although it appeared to be relatively lower for adolescent mothers 8.59% and older mothers

20.11%, it exhibited to be more significant for its high 22.31% for multiparous mothers.

On the whole, postpartum haemorrhage predominantly affected multiparous mothers.

However, the overall state of affairs and its trends with a gradual rise over time observation period

2014-2016 are deplorable in the case of adolescent, older, and multiparous mothers alike.

In the following subsection, there will be presented the patterns of maternal mortality due to

postpartum haemorrhage in each category of mothers.

Maternal Mortality Due to Postpartum Haemorrhage per Category of Mothers

Table 2

Incidence and trends of maternal mortality due to postpartum haemorrhage in from 2014 to 2016

Mortality due to postpartum haemorrhage in adolescent, older, and multiparous

mothers

Bouaké Maternal

deaths due to

PPH

In adolescent

mothers

(< 19 yo)

In older

mothers

(> 35 yo)

In multiparous

mothers

(> 4 births)

Dominant

risk factor

Year n % n % n % n %

Multiparity

2014 10 27.78 0 0.00 3 30.00 4 40.00

2015 15 36.58 1 6.67 5 33.33 5 33.33

2016 24 39.34 2 7.69 9 34.61 9 34.61

Yearly

average

31.57 4.79 32.65 35.98

Trend Increasing Increasing Increasing Increasing

Status Alarming

There was a high risk of maternal deaths due to postpartum haemorrhage, with an average

yearly incidence of 31.57% and an increase over the three observation years in the department of

gynaecology and obstetrics at Bouaké University Hospital.

Adolescent mothers displayed per year a relatively low average rate of 4.79%, and older

mothers a high average frequency of 32.65%. The highest average yearly incidence of deaths due to

postpartum haemorrhage, 35.98%, was recorded in the case of multiparous mothers.

Thus, maternal mortality due to postpartum haemorrhage was especially significant in the

case of multiparous mothers, with the overall situation being alarming for all three categories of

mothers under consideration.

In the following subsection, there will be turned to the social factors that contribute to

postpartum haemorrhage.

Social factors that contribute to postpartum haemorrhage

The analysis of the data has shown that a parturient’s decision whether or not to seek

obstetric care could depend on her willingness to receive emergency care, since a parturient or her

family might not have the necessary financial resources to pay for the healthcare provided in case of

an emergency. This was evident in the dissatisfaction with the cost of transport by ambulance voiced


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by several women referred to the centre for obstetric emergencies because of postpartum

haemorrhage. This is one of the reasons that the women refrained from requesting obstetric services

or deferred their decision to do so. One of them lamented the high expenses as follows:

When my giving birth started to wear out the midwife, she asked for me be to driven to the

ER in an ambulance, but my husband didn’t know where to get the 20,000 francs [XOF] that they

wanted to charge me for the trip in the ambulance. With the help of relatives, we mustered the money,

but once I got to the ER, there was expensive medication to pay for. So it’s because of all of that that

some women would die when they lost a lot of blood because of a complication of childbirth

(Interview with a woman referred to the centre for obstetric emergencies in Bouaké).

Such issues also led women to postpone their decision to visit a health centre, which in turn

aggravates the risk of maternal death, as the obstetrician-gynaecologist from the department of

gynaecology and obstetrics at the Bouaké University Hospital who was interviewed explained in the

following words:

Putting off visits to the unit for obstetric emergencies was one of the principal reasons for

death due to blood loss in parturients. Their reluctance was due to their insufficient financial means

or their preference for a home birth, among other factors (Interview with an obstetrician-

gynaecologist in Bouaké).

Dismissing the warning signs of postpartum haemorrhage must also be recognised as a risk

factor for the women that were sent to the centre for obstetric emergencies. Indeed, some of the

pregnant women had experienced haemorrhage prior to delivery, which could be a sign of a problem

with the placenta which poses a risk of later postpartum haemorrhage. This could kill the mother or

the fetus, but the women who had been sent to the emergency centre did not perceive their symptoms

in this way. In their view, bleeding during or after childbirth was a consequence of the diet of the

parturient during her pregnancy, as one of the respondents affirmed:

If a woman bleeds after giving birth, it’s because she’s been eating food which custom

forbids. That’s what she must have been doing. So if she gets pregnant again, she should stop eating

everything that’s forbidden for a pregnant woman, otherwise she’ll bleed again (Interview with a

woman referred to the centre for obstetric emergencies in Bouaké).

Such lack of awareness is thus also a risk factor, considering that it had delayed the expectant

mothers’ decision to seek obstetric care and thus increased the chances of subsequent postpartum

haemorrhage.

Independently of such delays in seeking emergency care, the very access to such care could

be impeded by a lack of means of transport at the parturient’s disposition. Indeed, some parturients

might arrive in time at the maternity hospital closest to their place of residence, only to find that that

there was no ambulance available to drive them to the centre for obstetric emergencies. This would

aggravate the risk of obstetric complications such as postpartum haemorrhage. A relative of a woman

referred to the centre for obstetric emergencies recounted this kind of experience:

My niece was referred to the ER but she died as a result of profuse bleeding after giving

birth. First, when we got to the village hospital, she gave birth normally, but then they said that she

was bleeding and that she would have to be taken to the ER. There was no ambulance and we had

trouble finding a car quickly. The road was also in poor condition, so by the time we got to the ER,

she was already dead (Interview with the relative of a woman referred to the centre for obstetric

emergencies in Bouaké).


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This example proves that access to emergency obstetric care may be belated. Inadequate

organisation and management also stand out as a factor conducive to delays in providing medical care

to parturients. In particular, the dysfunctionality of the referral system exacerbates the risk of

postpartum haemorrhage by occasioning such delays. Furthermore, the healthcare staff declared that

their equipment and supplies and the range of services they could provide were often meagre. The

midwife interviewed illustrated this deficiency as follows:

In the pharmacy, the lack of essential medication like magnesium sulphate, the scarcity of

fresh frozen plasma, and the untimely shortage of blood were greatly to be deplored (Interview with

a midwife at the centre for obstetric emergencies in Bouaké).

It is thus apparent that among the factors which discourage seeking obstetric care, limited

access and supplies are notable obstacles.

Discussions

Two main facts merit a detailed examination, namely the high risk of postpartum

haemorrhage at the department of gynaecology and obstetrics at Bouaké University Hospital and the

social factors that contribute to this reproductive morbidity.

The risk of postpartum haemorrhage is the most severe in case of multiparity, since this

morbidity was especially prevalent in mothers who had given birth to more than four children. In

Faure’s study (2011) of postpartum haemorrhage in France, it is mentioned that anomalies in uterine

contractility caused by multiparity occur in 59% of cases of postpartum haemorrhage (p. 13).

Additionally, in Diallo’s study (2012) of postpartum haemorrhage in Mali, it is noted that grand

multiparity heightens the risk of improper uterine contraction and retraction, which can then give rise

to postpartum haemorrhage (p. 30). Taking these data into account, one sees why multiparity was an

important determinant of postpartum haemorrhage as a reproductive morbidity in the department of

gynaecology and obstetrics at Bouaké University Hospital.

In this medical unit, postpartum haemorrhage exhibited the highest rate (22.31%) in

multiparous mothers, with a tendency to increase over time, observed in the period 2014-2016. The

incidence and trends of this reproductive morbidity in multiparous mothers were thus quite

catastrophic. Similar observations have been made by Randriambelomanana et al. (2011), in a study

of 26 women having undergone an obstetric hysterectomy, in which grand multiparas were most at

risk of needing this procedure, which followed postpartum bleeding in 19% of the total cases. Belaidi,

Benchachou, and Bennabi (2015), in turn, report a rate of postpartum haemorrhage of 56.71% in

multiparous mothers in their study of the frequency of the risk factors for this complication in Algeria

(p. 55). On the other hand, Descargues, Pitette, Gravier, Roman, and Lemoine (2001) indicate that

primiparity is also a factor that significantly increases the risk of postpartum haemorrhage. Similarly,

Nikiema (2011) notes in his study that 36% of postpartum haemorrhage cases were primiparas, more

numerous than the multipara making up 6.8% (p. 80).

It is thus apparent that this reproductive morbidity affects all mothers regardless of their

parity. However, considering that all pregnancies entail a risk of death, repeated procreation increases

this risk. That is why multiparous mothers have stood out as a risk category, including through their

mortality rate in case of postpartum haemorrhage in the department of gynaecology and obstetrics at

Boauké University Hospital, especially since the incidence of mortality due to postpartum

haemorrhage among multiparous mothers was found to be clearly increasing in the observation period

2014-2016, with a high annual average of 35.98%. Consequently, the situation was particularly

alarming. Multiparous mothers were most at risk of death due to postpartum haemorrhage.

Multiparity as a risk factor of maternal death is reported by Mahbouli et al. (2003), with 40%

of the cases being attributable to immediate or delayed postpartum haemorrhage. Similarly, for


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Roman et al. (2004), grand multiparity was an obstetric and neonatal excess risk, presumably in part

because it increased the likelihood of maternal death due to postpartum haemorrhage, and

Fenomanana et al. (2009) claim in a study aimed at the identification of risk factors for maternal death

that multiparity significantly correlated with the reproductive morbidity under discussion. Finally,

Mbeva, Karemere, Prudence, Nyavanda, and Mundama (2018), in their study aimed at determining

the causes and circumstances of maternal deaths in hospital conditions, find that bleeding was the

leading cause of death, accounting for 63.4% of cases, out which 40% fell in the category of

multiparous mothers.

Though it has been recognised that multiparity is a significant risk factor for the occurrence

of postpartum haemorrhage and consequent death, the fact remains that multiple social factors

contribute to this reproductive morbidity. The relevant social factors can be categorised as three types

of delays: a delay in deciding to seek obstetric care, a delay in transport to the emergency department,

and a delay in the provision of care to parturients.

As far as the delay in deciding to seek obstetric care is concerned, it is first of all due to the

difficulty of covering the expenses associated with the transfer to the emergency department, as

reported by the women interviewed who had been admitted to the department of gynaecology and

obstetrics at Bouaké University Hospital. In particular, patients need to pay the cost of the fuel for

the trip and of the services provided by the driver of the ambulance, if one is at all available. In default

of an ambulance, they would be compelled to engage the services of a private driver, often beyond

their means. Concrete figures are provided by Thiam (2014), who reveals that the cost of the transfer

to an obstetric department due to bleeding ranges between 25,000 and 30,000 XOF for patients driven

directly from a rural health post, reaching up to 50,000 for those using public transport. He explains

that these prices prevent low-income patients from Senegal from accessing emergency obstetric care.

The situation is similar in Mali: Cissé (2014) reports that referrals to the department of gynaecology

and obstetrics of the health centre in Markala due to bleeding in the third trimester involved direct

transport of the parturients at a high cost, more than some of the families could afford; hence, the

eventual admission to the emergency department of many parturients would be delayed for hours (pp. 7-

8).

Besides the difficulty of covering the expenses associated with a transfer to an obstetric

department, ignorance of the warning signs of postpartum haemorrhage also contributes to the delay

in a parturient’s decision to seek emergency obstetric care. Furthermore, the interviews conducted

for the present study clarified that the persistence of traditional social attitudes discourages recourse

to such care. Such unfavourable social circumstances have been pinpointed as a risk factor for

postpartum haemorrhage by Subtil, Sommé, Ardiet, and Depret-Mosser (2004). The period of

pregnancy itself is often a target of prejudice and other cultural constraints which hinder access to

emergency obstetric care (Sepou et al., 2011, p. 7). In the context of the department of gynaecology

and obstetrics at Bouaké University Hospital too, insufficient financial means compounded by

unawareness of the warning signs of postpartum haemorrhage contribute to delaying the decision to

seek obstetric care which might result in a referral due to postpartum haemorrhage.

As for the delay in reaching the emergency department, the respondents interviewed at the

department of gynaecology and obstetrics at Bouaké University Hospital agreed that accessing

emergency care was indeed difficult. They cited the lack of means of transport as the main problem.

In this regard, Sepou et al. (2011) have underscored that even when there are ambulances available

in certain medical units in the Central African Republic, they often fail to provide transport to the

referred patients, because the attending expenses need to be covered by the relatives of the latter, who

are essentially destitute (p. 7). In his thesis regarding Mali, Cissé (2014) additionally points out the

scarcity of modern means of transport for patients referred due to an obstetric emergency, as well as

the defectiveness of the vehicles used and the poor condition of the roads between the community

health centres and the maternity hospitals, both of which impede the transport of patients which

present bleeding in the third trimester (p. 7). Moreover, Fofana (2018) notes that the numerous


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patients transported by taxi, mostly due to immediate postpartum haemorrhage, without an

accompanying medical professional, arrived from medical units which do not have ambulances at

their disposition (p. 75). In light of these facts, it is indisputable that in case of postpartum

haemorrhage, the precarious transport conditions are a factor that prolongs the delay in reaching the

emergency centre of the department of gynaecology and obstetrics at Bouaké University Hospital

too.

Lastly, as regards the delay in the provision of care to parturients, the participants

interviewed at the department of gynaecology and obstetrics at Bouaké University Hospital attributed

it to inadequate management, as well as insufficient equipment and medications in the emergency

centre. Kéïta (2008) also points out insufficient supplies in the department of gynaecology and

obstetrics of the referral health centre of Commune V of the District of Bamako: a shortage of

emergency products and blood which is a serious obstacle to the efficient treatment of patients which

present bleeding in the third trimester of their pregnancy (p. 50). Similarly, Adjoby et al. (2014)

identify belated blood transfusion as a factor contributing to mortality in patients admitted for an

obstetric emergency. Morau, Ducloy, Le Roux, and Weber (2018), in turn, draws attention to

organisational faults in the treatment of postpartum haemorrhage in France. The suboptimal aspects

of the emergency obstetric care that he identifies include delays in making a diagnosis, treating

internal bleeding, and starting resuscitation procedures, as well as insufficient prenatal orientation of

the patients towards appropriate medical centres and improper coordination among the medical staff.

Based on the same French data, Tessier, Leroux, and Guseva-Canu (2017) indicate that the provision

of emergency obstetric care is more dysfunctional in the case of patients in a state of socioeconomic

precarity, which increases the risk of maternal death due to morbidities such as postpartum

haemorrhage. All these studies present situations analogous to the correlation between inadequate

management and the delay in the provision of care to patients experiencing postpartum haemorrhage

at the department of gynaecology and obstetrics at Bouaké University Hospital.

Conclusions

Postpartum haemorrhage is a morbidity that predominantly affects multiparas rather than

older or adolescent mothers. In the triennium studied at Bouaké University Hospital, the yearly

average of postpartum haemorrhage was 22.31%, with a rise between successive years, while the

average yearly rate of consequent maternal deaths was 35.98%, with the same tendency to increase.

In this case study, the trend of this morbidity and of the associated mortality was alarming especially

among multiparous mothers, because of the clearly growing rates. These bleak figures at the

department of gynaecology and obstetrics at Bouaké University Hospital are partly due to social

factors such as insufficient financial resources, ignorance of the warning signs of postpartum

haemorrhage, precarious transport conditions, and inadequate management. The enumerated factors

contribute to delays in the decision to seek out obstetric care, in transport to the centre for obstetric

emergencies, and in the provision of care at the aforementioned department to parturients presenting

postpartum haemorrhage, which in turn exacerbate this reproductive morbidity. These results raise

the question of what measures can be taken and how they could be implemented in order to accelerate

the reduction of the incidence of postpartum haemorrhage and the mitigation of its high risk factors?

A concrete solution to the problem could be the planning of communicational strategies that could

induce social and behavioural change, as a form of community intervention. The response action must

furthermore respect an order of priority. The category of mothers to be targeted as a first priority

would be multiparas, due to the especially high incidence of postpartum haemorrhage and consequent

death that they exhibit. The second category would be older mothers, to be targeted in the medium

term, as they also present a high rate of postpartum haemorrhage and consequent death. Finally, the

third category of mothers, to be targeted in the long term, are adolescent mothers, in view of their

intermediate rate of postpartum haemorrhage and consequent death. The population in question needs


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to be led to intelligently re-examine their high-risk reproductive behaviours and practices, as well as

the environmental, economic, social, and cultural factors that contribute to postpartum haemorrhage.

It is only in light of real, identified problems that appropriate action can be envisaged and carried

through with the ultimate goal of increasing the quality and safety of reproductive practices.

Furthermore, it would be interesting to carry out a survey on the sociological logics underlying the

differences in morbidity in these different social categories. It would make it possible to highlight the

explanatory model of postpartum haemorrhage in adolescent, older, and multiparous mothers, and

their incidence of understanding of this morbidity. However, it should be noted at the outset that an

interpretative approach may be used in this study. In this case, this orientation presents itself as an

opportunity to shed relevant light on the risk factors for the occurrence of postpartum haemorrhage

outside of the demographic, economic and logistical deficit variables. This perspective is defined as

an openness to conflicts of representation or targeted contradictions between lived cultural practices

and public health norms in relation to the postpartum haemorrhage. This approach would make it

possible to act on these points of impact in order to achieve the desired change to reduce the risk

factors for this morbidity.

Acknowledgements

Authors wish to express their gratitude to the women referred to the centre for obstetric

emergencies due to postpartum haemorrhage as well as their relatives for their participation in the

present study and the many hours they set aside to this end. They would also like to thank the director

of the department of gynaecology and obstetrics at Bouaké University Hospital as well as the

obstetrician-gynaecologist and the midwife who were interviewed, for their availability and their

cooperation during the period of data collection.

Conflicts of Interest

The authors have no conflict of interest to declare.

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DIMENSIONS OF CRIME INVOLVING WOMEN IN DRUG TRAFFICKING -

LITERATURE REVIEW FROM DEPENDENT BEHAVIOR TO RELAPSE

DOI: http://doi.org/10.26758/11.1.7

Miana DINA (1), Jose Manuel Rodriguez GOMEZ (2), Cornelia RADA (3)




Bucharest, Romania;

(2) Guardia Civil de Madrid, Ministerio Del Interior, Espania, e-mail: [email protected];

(3)"Francisc I. Rainer" Anthropology Institute of the Romanian Academy, e-mail:

[email protected]

Address correspondence to: Miana Dina, National Administration of Penitentiaries, Directorate of

Social Reintegration, Maria Ghiculeasa, No.47, 2th Distinct, Bucharest, 023761, Romania. Ph.:+40-

021- 27583; Fax: +40-021-242.05.05; E-mail: [email protected]

Abstract

Objectives. The aim of this study was to review the most important factors influencing women's

involvement in drug trafficking.

Material and methods. A systematic search of literature was carried out using Web of Science,

Academic Search Complete, ProQuest Central, PsychInfo. The inclusion criteria were met by fifty-

two studies. In order to facilitate the understanding of the behaviour of women who commit this

crime, factor analysis was grouped into social-cultural, personal and psychological factors.

Results. The main social and cultural factors considered were the adopted political system, the racial

element, the cultural-regional peculiarities, the geographical positioning, the socio-economic status

and the sociofamilial environment. The personal factors identified were age, occupation, lifestyle,

system of norms and values, and psychological ones referred to indicators of psychological disorders,

addictive behavior, the ability to control reactions and the perceived level of self-efficacy.

Conclusions. The factors with the highest share of drug trafficking among women were group

membership, economic and social status, educational level of parents and friends, prison history and

drug use. If in the rural area the main factor that determines women to get involved in drug trafficking

is the lack of a job and a low level of education, in the urban area, the influence of the group is

significant. Regarding the reasons behind the involvement of women in such criminal acts or in the

manifestation of addictive behaviors, these are often compensatory mechanisms, adopted in the

absence of effective coping strategies.

Keywords: women, drugs, trafficking, addiction, relapse.

Introduction

Although the global increase in female drug trafficking has highlighted the need to identify

determinants, a limited number of researches have been carried out on this issue over time (Faupel,

2010; Ritchie, 2017). Also, in scientific debates and studies, the link between drug use and trafficking

in women was one of the less observed and debated topics (Faupel, 1987).

Since specialists in the field have observed that, despite the experience of incarceration, a

large proportion of women continue to use drugs and carry out trafficking even after being released

https://www.journalstudiesanthropology.ro/en/dimensions-of-crime-involving-women-in-drug-trafficking-literature-review-from-dependent-behavior-to-relapse/a165/


93

from prison, the importance of the psychological dimensions that can influence this type of behavior

have been pointed out (Kensy, Stengal, Nougier, & Birgin, 2012). According to Bergman (2018) it

is the presence of an addictive behavior, namely the use of illegal substances with an onset prior to

the involvement in drug trafficking, not only facilitated the commission of the criminal act but also

the state of relapse.

In terms of global consumption, in Europe it is estimated that more than 92 million people

aged 15 to 64 years (which represents more than 25% of the Union's population) have tried illegal

drugs at some point in their lives. In Germany, approximately 3.7 million of the population reported

frequent cannabis use (Atzendorf, Rauschert, Seitz, Lochhühler, & Kraus, 2019), and in Italy, "in

2009-2016, there was an increase in the number of people using drugs, 20% confirming the use of

more than one drug, 18% for cannabis and cocaine, 6% for benzodiazepines and 3.5% for methadone"

(Carfora, Campobasso, Cassandro, Petrella, & Borriello, 2018).

In southern Europe, drug use is constantly increasing, in Portugal, about 35% of the

population reported drug use, ethanol being the most commonly identified psychoactive substance,

i.e. in 55% of cases, between January 1990 and December 2007 (Costa et al., 2012). At the same time

in Spain, between 2003 and 2016, 10% of the population reported cannabis use, and in Bulgaria 3.5%

of cases supported this fact (Montanari, Guarita, Mounteney, Zipfel, & Simon, 2017).

In northern Europe, according to researchers Buvik, Bye and Gripenberg (2019), Nordic

countries differentiate themselves from others by a much lower rate of consumption. In Sweden,

drug use varies by age and region. Cannabis use was more common in southern Sweden than in the

northern region. At the same time, high alcohol consumption and illegal drug use appear to be more

widespread in those parts of Sweden that are closer to the European continent (Bränström &

Andrésson, 2008).

In Romania, as reported by the study conducted in 2019 by the National Anti-Drug Agency

(ANA) "compared to the European average, lifetime use (at least once in a lifetime) is lower for all

categories of illicit drugs analysed. The most widely used illicit drug among adolescents continues to

be cannabis/hashish, followed by new psychoactive substances (NPS)". The study shows that "there

is a better perception of the risks of experimental use of new psychoactive substances, amphetamines

and ecstasy, with an increasing proportion of those who attribute high risks to such consumption. The

greatest risks are for amphetamine use and cannabis use" (ANA, 2019).

In the USA, after 2012, heroine and cocaine use was frequently associated with a

considerable mortality rate (Walker, Pratt, Schoenborn, & Druss, 2017) and in Australia "after the

year 2000, the prevalence of drugs (other than alcohol) was present in 26.7% of cases, and

psychotropic drugs in 23.5%, namely cannabis (13.5%), opioids (4.9%), stimulants (4.1%),

benzodiazepines (4.1%) and other psychotropic drugs (2.7%)" (Drummer et al., 2003).

Even in states where the political system is characterised by a high level of control over the

population, the phenomenon of drug use and trafficking has seen a considerable increase. In Russia,

according to the study conducted by Kartashev and his collaborators (2016) between 2011 and 2015,

drug use and trafficking has increased considerably, with 23.8% of drug trafficking committed by

organised groups, and in Jordan, between 2008 and 2014, 36.5% of cases confirmed psychotropic

drug use, with users aged between 19 to 29 (Al-Abdallat et al., 2016).

Given that more than 70% of illegal drug use is used at retail level, in those states that have

become strategic regions for the international drug market (Belgium, Spain, the Netherlands), women

can hold important roles (Bergman, 2018).

The idea has emerged that women involved in the drug world belong to the category of

"specialist criminals". They are qualified in at least one or two offences, which they rely on to produce

their own income. Sometimes committing a single offence cannot provide the desired financial

support, and therefore the achievement of at least two offences increases this possibility. Such

specialisation involves learning important skills that facilitate not only the commission of the crime

but also ways of detecting and avoiding arrest (James, Gosho, & Wohl, 1979).


94

In view of the above circumstances, it is useful to carry out a systematic search of the

literature in order to identify the factors that motivate women to engage in drug trafficking, both

locally and internationally.


Purpose and Objectives

The purpose of this study was to explore existing research on the topic of determinants in

drug trafficking in women. Thus, the objective of this study was to highlight the main social-cultural,

personal, but also psychological factors encountered in the commission of this criminal act.

The analysis of the specialized studies and their results focused on the following research

questions:

1. What social-cultural factors are involved in drug trafficking in women?

2. What personal factors are found in the choice to commit this crime?

3. What are the psychological factors that cause women to commit drug trafficking?

Search strategy

A systematic search of the literature was carried out and the following databases were used:

THOMSON ISI - Web of Science, EBSCO – Academic Search Complete, ProQuest Central,

PsychInfo, but also numerous manual searches via Google Academic Search Engine. Among the main

journals identified are The Journal of Ethnicity in Substance Abuse, Drugs & Society, International

Feminist Journal of Politics, Journal of Criminal Justice Education, Journal of Crime and Justice.

The search covered the period from 1979 to August 2020.

Two types of variable categories were used, namely, demographic variables that included

the gender – female and age category – at least 14 years, as well as psychological, aspects of

vulnerability, respectively.

As far as the psychological picture is concerned, the main vulnerable dimensions that

facilitate both involvement in such crimes and the perpetuation of such behaviour have been analysed.

The target was to identify the main determinant factors, to understand what motivated the appearance

of women in the drug market, but also to outline a complex picture of women drug dealers.

Selection of studies

The first author independently selected the studies with iligible potential according to the

search criteria. In the first phase, the selection was based on title and summary, and in the second

phase on the full-text article. All studies identified during the first selection phase were re-evaluated

in the second selection phase. The inclusion criteria consisted in the age category – participants to be

at least 14 years old, gender – to be female and to refer to psychological characteristics whose form

of expression may have significant consequences in terms of the manifestation of behavior according

to the socio-cultural norms.

The following keywords were used: trafficking, drugs, women, addiction and relapse. For

each keyword a certain number of studies were explored, namely women = seven studies, drugs = 21

(twenty-one) studies, trafficking = seven studies, dependence = six studies, relapse = 11 (eleven)

studies. The selection process of the studies is summarised in Figure 1.

http://search.ebscohost.com/


95

Figure 1

The selection process of the studies included in the article

Data extraction

Data extraction and evaluation of the quality of studies were carried out by the first author

and independently verified by the third author. Disagreements were resolved by consensus. Data on

the target group, the presence of information to support the information, as well as recruitment

methods were highlighted (the main condition was expressed voluntary agreement).

The methodological quality of the studies included was assessed according to the following

criteria: sample size, adequacy of randomization and management of missing data.

The quality of one study was assessed as high when all three criteria were met, an average

when only two criteria were met and low when only one was met. 10 (ten) low-level studies, 21

(twenty-one) of average quality and 21 (twenty-one) high-quality studies (Figure 2) were evaluated.


96

Figure 2

The evaluation process of the studies included in the article

Tables 1, 2, 3, 4 and 5, located after the Study limitations section, show the adjacent studies

and conclusions for each keyword used in this article. Information regarding author(s), year of

publication, place of study, type and size of the sample were retained.

Results

The following social-cultural factors responsible for women's involvement in drug

trafficking were identified in 24 studies: the political system adopted (criminal justice); racial

discrimination; geographical positioning, cultural-regional peculiarities (promotion of nightlife);

socio-economic status (poverty); socio-familial environment (reference group, identity incongruity,

number of children, absence of roles and responsibilities, educational level of the family) (Figure 3).


97

Figure 3

Social-cultural factors involved in the case of women who have committed drug trafficking

The political

system

adopted

Geographic

positioning

Racial

discriminatio

n

Socio-family

enviroment

Socio-

economic

status

Regional

cultural

features

The personal factors of women who committed drug trafficking were analyzed in 10 studies.

These are: lifestyle (carceral history, risk behaviours, prostitution, drinking and driving); personal

values (disregard for the rights of others, lack of morality); age (adolescence); occupation (joining

criminal groups, organised crime, human trafficking and money laundering) (Figure 4).


98

Figure 4

Personal factors involved in the case of women who have committed drug trafficking

Personalfactors

Prostitution

Occupation

Personel values

Lifestyle

Prison history

Age

The following psychological factors of women involved in drug trafficking in women were

identified in 18 studies: indicators of psychological disorders (depressive mood, suicidal ideation,

anxiety, emotional lability, emotional and behavioral imbalance); perceived level of self-efficacy

(self-esteem, confidence in one's own problem-solving skills); ability to control one's own reactions

(disguise, self-control); addictive behaviour (drug use, adrenaline and ecstasy) (Figure 5).


99

Figure 5

Psychological factors involved in women who have committed drug trafficking

The indicators of psychological

disorders

The emotional

labiliy

The ideation and suicidal

intention

Despresive mood

The anxiety

The perceived level of self-efficacy

The self-esteem

The confidence in one s own

problem-solving skills

Dependent behaviour

The ability to control one s own

reactionDrug use

The adrenalinThe self -control

Dissimulation

Psychological factors

Discussions

Social-cultural factors

Although the war on drugs in the US was declared as early as 1971 by President Richard

Nixon, attention to crime in women returned after a period of pause, i.e. after the 1980s, when the

literature began to look again with interest on the involvement of women in drug trafficking.

According to Fondevila, Massa and Meneses-Reyes (2020) researchers in the 21st century, there has

been a higher incarceration rate in the United States than in any other country, but with immediate

effects on the minority population. As per to the three authors, between 1986 and 1995, the arrest of

adult women for drug abuse violations increased by "91.1% compared to 53.8% for men, and from

2010 to 2014, women's arrests increased by 9%, while for men they decreased by 7.5%".

Despite the fact that this fight against drugs concerned the distribution and use of drugs, the

particular effects for women occurred in the form of their criminalisation and selective incarceration.


100

According to Johnson and Young (2002) this increased selectivity is found mainly in African women.

Following a qualitative study of five incarcerated African women, former drug users and drug

traffickers, the analysis revealed that they were in financial difficulties and did not receive support in

this regard. As a result of this situation, women were stigmatized in several ways, including sexual

abuse, drug use, and drug trafficking. At the same time, conforming to Schemenauer (2012) and

Moloney, Hunt and Joe-Laidler (2015) most often female couriers are described as victims of a racial

subculture, Madonnas that carries out drug trafficking in order to benefit from some male protection.

As can be seen, an important role in criminal justice policies is gender bias, social class and

discriminatory race-based elements (Nicewarner, 2019). Considered to be partially effective, several

authors consider that in many cases of drug use and trafficking, the restorative justice policies can be

more appropriate ways, as they include simultaneous interventions for both the offender and the

victim (Dandnord & Griffiths, 2006; Dignan, 2005; Van Ness, Morris & Maxwell, 2001; Braithwaite,

2002). In fact, in agreement with Oancea and Micle (2015) law enforcement is "a process of social

influence", and for an effective rehabilitation program, careful focus is needed, both on dealing with

antisocial attitudes and on cognitive development, designed to help them solve problems.

Another phenomenon that has led to the emergence of women in the USA on the drug market

and in criminal activity is the absence of the probation system in regions at risk of criminal acts

(Robbins, Martin, & Surratt, 2009). The mere incarceration of a person from a disadvantaged area

and the lack of focus on programs to provide support in obtaining financial resources has to some

extent led to a continuity of women's involvement in drug trafficking (Olson, Stalans, & Escobar,

2016).

In Europe, the phenomenon of drug trafficking has focused more on state interests, "from

the individual policies of the liberal Netherlands to Sweden's repressive policies" (Chatwin, 2003).

In consonance with Chatwin (2016) across Europe, there are no common indicators of success that

allow drug policies to be judged, the cultural peculiarities having their say depending on each region.

If in Italy drug trafficking is primarily influenced by the existence of specific routes, social and

geographical proximity being key factors that explain the configuration of heroin supply (Giommoni,

Aziani, & Berlusconi, 2017), in the UK, drug trafficking is facilitated by the particularity of leisure

spaces, such as cafes, dance clubs, those spaces that offer pleasure for the consumer society, and can

represent an opportunity in the conduct of drug-related crimes (Measham, 2004). Also, in Romania

as reported by Baciu's qualitative study (2018) attended by 30 students from the Faculty of Medicine

in Bucharest, aged 20-21 years, it seems that the students considered that the places where illegal

drugs could be used are the most withdrawn, unlit, as safe from other people as possible, at parties,

in clubs or in parks and parking lots, at night.

Nor should the strategic role given by the geographical positioning of these states be omitted.

For example, Romania fulfils the role of "transit country", facilitating the involvement of women in

drug trafficking. The emergence of new routes for heroin trafficking to intermediate destinations such

as Georgia requires a growing diversification of criminal groups in order to achieve their objective.

Concealing criminal infrastructure with commercial activities that avoid possible risks, ensures a

major role for women in this regard (Nucu, 2018).

According to the Direction of Investigation of Organized Crime and Terrorism Crimes

[DIICOT], Romania has become a "target country" of risk drugs, especially in the case of cannabis,

and in recent times the number of cases of illicit cannabis plantsh has also increased. Even in this

situation, women can play a key role. Given that the prevalence of women in the countryside is higher

than men, but also that obtaining financial income is more difficult for women than for men, in this

context of physical work, involvement in such activities is perceived by them as a solution. If in rural

areas the lack of jobs causes women to commit drug trafficking, in major cities they are influenced

rather by the group of friends and the ways of promoting nightlife (Ţical, 2019).

Another factor is the influence of the reference group and the entourage. The results of a

study of 500 participants in Saudi Arabia showed that the predictor with the highest share in substance


101

use and trafficking is the influence of the membership group (Beaver et al., 2016). Similarly, in Italy,

the results of a study of 33,185 adolescents between the ages of 15 and 19 highlighted the influence

of the membership group in terms of drug use and trafficking, as well as the high educational level

or, on the contrary, of parents and friends (Denoth, Siciliano, Iozzo, Fortunato, & Molinaro, 2011).

As per to Stanciu and Cotruş (2014) it seems that young people whose parents have a lower social

status and have no resources, or who have parents of high status, are more inclined to drug

consumption, due to lack of supervision and with a considerable financial support, create this

opportunity for the world of drugs.

At the same time, in Romania the results of a quantitative study, carried out in the period

2017-2018 on a sample of 459 students and students showed that the example offered by friends

influenced the behavior of adolescents and young people more than that offered by the family, most

of them using drugs under the influence of friends or at their urging, to "be of their own", "to be cool",

"to see what it is like to smoke cannabis" (Baciu, 2019).

The influence of one’s background can determine the degree of involvement in such

activities. The existence of models in the family, the lack of responsibilities or of children, influence

the commission of crime by adopting behaviors against social norms (Fowler, Dinitto, & Webb,

2005). A qualitative study from New Zealand highlights that women who do not have children and

use drugs tend to commit more serious crimes, i.e. to carry out drug trafficking in more dangerous

conditions or in greater quantities. This non-existence of a possible affective bond, which could have

been given by motherhood, increases the probability of manifesting risky behaviors (Hutton, 2005).

Personal factors

US specialists said that the lifestyle and implicit social norms by which a person is guided

are key elements in the commission of such a crime (Flynn & Hoffer, 2019; Bergseth, Jens, Bergeron-

Vigesaa, & McDonald, 2011; Dodge & Pogrebin, 2001). Thus, involvement in criminal activities and

criminal history can be significant factors in shaping this lifestyle for women who consume and carry

out drug trafficking (Bui & Morash, 2010). In their study of the needs of incarcerated women,

consisting of 402 women who committed crimes, Holtfreter and Morash (2003) highlighted the

implications of custodial sentences, notably the lack of community programs and services that can

provide specialized assistance for the purpose of lowering the relapse rate and for adopting a different

lifestyle.

At the same time, the presence of risk behaviours is part of this lifestyle, Jørgenrud et al.

(2018) stating in a study of 5031 male and female participants, from Norway, between April 2016

and April 2017, that speeding and drink driving use are found in drug traffickers. Alantes, Fraile and

Page (2002) also argue that the occurrence of such risky behaviour is often found in women who are

involved in drug crime.

Similarly, Calafat et al. (2009) in his study of 1363 participants in nine European cities

concluded that in their case, the most common risk behaviour linked to drug trafficking turns out to

be prostitution.

Other authors (Hughes, Chalmers, & Klimoski, 2018) suggested through a systematic

analysis carried out in Australia, in two distinct periods, namely 2005-2006 and 2014-2015, that drug

trafficking is most likely linked to money laundering, fraud, corruption and human trafficking.

Therefore, the main occupation of people who commit drug trafficking is organised crime.

Bellis and his colleagues (2008) through a study of 1,314 participants aged 16 to 35 from

nine European cities point out that drug trafficking occurs more in teenage girls, but who are also

involved in other criminal activities. It also seems that in large cities where the concept of freedom is

lived at intense levels, drug use and trafficking is closely related to the states of excitation or ecstasy

in sexual intercourse. As a result, girls under the age of 16 who were engaged in cocaine use and

trafficking were five times more likely to have had more sexual partners in the past 12 months.


102

Psychological factors

Psychological disorders, i.e. personality disorders or anxiety disorders are often found in

women involved in such criminal activities. In line with several authors (Wexler, Cuadrado, &

Stevens, 1998; Stevens, Andrade, & Ruiz, 2009) there appears to be a direct relationship between the

addictive behavior, the seriousness of the crime committed and the presence of several signs of

psychological disorders. At the same time, Brownstein, Baxi, Goldstein and Ryan (1992) using data

from 414 homicide cases in New York, highlighted the association of depression with constant drug

use or overdose against a background of emotional instability.

Although depressive symptoms were correlated with people who were trafficking drugs for

the purpose of obtaining money for personal use, Iwamoto, Liu and McCoy (2011) in their study of

163 Asian women, they did not identify correlations between drug trafficking and coping strategies.

In fact, the manifestation of dependent behaviours often constitutes compensatory mechanisms in the

absence of effective coping strategies. In-depth interviews of several incarcerated women allowed an

understanding of the evolution from victim to survivor and then to the offender. Women who have

been subjected to different forms of abuse are subject to these compensatory mechanisms, such as

drug use and trafficking (Gilfus, 1993).

Emotional liability, emotional and behavioral imbalance are also psychological

characteristics found in women with a history of drug use and trafficking, Murphy, Stevens, McGrath,

Wexler and Reardon (1998), concluding these aspects in their study of 98 women enrolled in a

residential drug treatment center in Tucson, Arizona.

This spectrum also includes low self-esteem, how the person perceives himself as image and

self-confidence, feelings of shame and submissive behavior. As per to studies by Haselschwerdt,

Maddox and Hlavaty (2020) on 23 women in California, as well as studies by Radosh (2008), these

are psychological dimensions found in women convicted of illicit drug use and trafficking. According

to Micle and his colleagues (2013) it is self-esteem that sustains the person in those difficult situations

in life, and a person with negative self-esteem will tend towards states of unhappiness and anxiety.

Another register lists the conclusions of Marsh's qualitative study (2016) on a sample of 16

women from Ecuador who participated in international drug trafficking, which highlighted the

existence of a high level of self-control, concealment as well as good problem-solving skills. The

same aspects were discovered in studies conducted by Dotherte, Jacinto, Sales, & Murphy (2009) on

a sample of 80 drug dealers in California, but also by Ludwick, Murphy and Sales (2015) on a sample

of 160 drug dealers in the San Francisco Bay Area.

Grace (2017) concludes that in the UK, another factor involved in drug trafficking is drug

use itself. Women use drugs not only for pleasure, but also to cope with difficult life circumstances,

such as domestic abuse, and addictive behaviour thus becoming a compensatory measure in the

absence of effective coping strategies.

And in Spain, drug use is very common among women incarcerated for drug trafficking.

Sánchez, Fearn and Vaughn (2018) said in a research that examined the prevalence and correlations

of drug use in the penitentiary, on a random sample in four regions of Spain, that the previous history

of drug use was significantly associated with substance use in prison, with trafficking women more

prone to addictive behaviour.

In view of the international report on the drug situation in Europe and the rate of use as well

as the market, by "age group 15-34 years, the prevalence of drug use ranges from 0.4% in Turkey to

22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for

cocaine, and from 0.1% or less in Romania, Italy and Portugal at 2.5% in Estonia for amphetamine".

According to the researchers, drug trafficking is closely linked to drug use, so dependent women are

more inclined to practice drug trafficking (Mounteney et al., 2016).

Also, in Romania, drug trafficking is closely linked to drug use, with dependent women

more likely to commit this crime (Stanciu & Cotruş, 2014).


103

The Australian Institute of Forensics draws attention to important differences in drug use

patterns in women compared to men. Thus, the risk factors for drug use differ significantly, depending

on both the experienced history and the perception of the phenomena in each person's life. If in the

case of women a leading role is represented by a history of traumatic potential, namely sexual and

physical abuse, as well as early exposure to dependent behaviour in the family environment, in the

case of men, the perception of the surrounding world, influenced by the entourage and the need to

affirm masculinity, is an essential element. Understanding this connection between the underlying

variables of drug use can help develop interventions and crime reduction strategies for female

offenders (Taylor, 2015).

In view of the above, in order for addicts to be perceived as people who have a serious

problem, and not as a "chaff" of society, with no chance of recovery, it is important not only to

increase the level of education but also to inform society about drug use (Baciu, 2017).

Conclusions

This study aims to identify the main factors underlying women's involvement in drug

trafficking, as well as to highlight their psychological characteristics, with the aim of shaping ways

to stop this phenomenon.

Regarding the first question of this study - What social-cultural factors are involved in drug

trafficking in women? it can be observed that the social-cultural factors that have an impact on

women's involvement in drug trafficking are the political system adopted, discrimination on the basis

of race, the cultural peculiarities of each region, geographical positioning, socio-economic status, but

also the socio-family environment.

Society's focus on criminal and less on restorative policies has facilitated the imprisonment

of women who have committed drug trafficking but could not control the criminal repression.

Although this type of policy ensures that potential sources of crime are reduced, full control is not

possible, nor can we speak of eradicating the criminal phenomenon.

If in the United States of America discrimination based on race (black population) facilitated

this measure, in the case of Europe the cultural peculiarities and the perception of the concept of

freedom led women to a large extent to commit this type of crime.

In northern Europe, where the educational level is higher, drug trafficking is much lower,

and in the southern part of Europe the incidence of drug trafficking in women is much higher. At the

same time, if in the rural area the main factor that causes women to get involved in drug trafficking

is the lack of employment and a low educational level, in the urban area, the influence of the

membership group is significant.

It is obvious that, not only the educational level of the person concerned, influences this

behaviour, but also of the family, in this case of the parents. Thus, whether it is a high level, which

causes parents to be more concerned with professional activity, at the expense of spending time with

their own child and careful monitoring him, or it is a low level, which reduces the chances of

providing an appropriate family model for the development of prosocial values.

At the same time, the absence of roles and statuses, the absence of children or

responsibilities, emphasizes this perception of freedom taken to the extreme, the idea of living the

moment, regardless of the consequences, becoming a priority in this type of situation. Freedom, led

to the extreme by disregarding moral principles, leads women to follow different models in the

membership group and to engage in such illegal acts.

As well, the influence of large cities and nightlife facilitates both trafficking and drug use.

The existence of a space that can represent an opportunity for drug use leads to the emergence of drug

trafficking. In Romania, the influence of the sociofamilial environment, the lack of studies or the

existence of jobs in the vicinity of the home, leads women to get involved in this type of criminal

acts, allowing them to obtain financial income.


104

Regarding the second question of the study – What personal factors are found in the choice

to commit this crime? the studies analysed have shown that age, occupation, lifestyle and therefore

personal values are the main personal factors found in women involved in drug trafficking. Lifestyle

characterized by the manifestation of risk behaviours such as drunk driving, prostitution, the

commission of criminal acts in a repeated manner and therefore the existence of the criminal history,

support this involvement of women in drug trafficking.

Since lifestyle is the strategic option adopted by a person, the activities to which he or she

will decide to turn will be those that will guide decisions, behaviours and living conditions. In this

context, the appropriation of a system of anti-social values, such as disregard for the rights of others

and lack of morality, is nothing more than a tribute to the beliefs and representations he or she has

formed about the world and life, and by virtue of which he or she chooses, behaves and acts. The

decision to be part of criminal groups, especially those that commit human trafficking and money

laundering, is part of this lifestyle, based on occupations against the legal system, but which constitute

financial sources of living.

In the case of young women, especially in the case of teenage girls, the group of friends, and

the entourage are elements that influence this value system. The need to be accepted, to be like others

or to be the center of attention, causes them to enter a vicious circle, in which drug trafficking

correlates with drug use. Therefore, the younger women are, the greater their likelihood of drug

trafficking.

The third question – What are the psychological factors that cause women to commit drug

trafficking? refers to indicators of psychological disorders, perceived level of self-efficacy, ability to

control their own reactions, but also to addictive behavior. The presence of signs of psychological

disorders such as depressive mood, suicidal ideation, anxiety, emotional lability, emotional and

behavioural imbalance can often be psychological factors that facilitate women's involvement in drug

trafficking.

Negative self-assessment of one's own chances of success, failure to accept weaknesses and

flaws, and severe self-criticism are the basis of a lack of balance. At the same time, feelings of guilt,

fear or negative beliefs about oneself contribute to a generalized state of anxiety and dependent

personality structure.

High levels of stress and a state of emotional vulnerability can lead to depressive states,

negative emotional states, as well as involvement in different risk behaviors. These include drug

abuse. A woman addicted to drugs may be at high risk in terms of involvement in drug trafficking, as

there is a certainty that she will be able to benefit from the physical element that ensures pleasure and

determines the momentary well-being, namely the drug.

The absence of coping strategies, poor concealment capacity and low level of self-control

lead these women, in certain situations, to adopt drug trafficking as a compensatory mechanism.

Although this psychological vulnerability is very common in women who traffic drugs, the category

of women demonstrating outstanding skills in the coordination of these crimes should not be omitted.

On the one hand, women who commit drug trafficking, can belong to the category of those

who do not trust themselves, are easily influenced, have a poor ability to adapt to new situations and

are hesitant in their behaviour, and on the other hand there is the category of those who lack empathy,

guide their behaviour according to their financial objective, tend to overestimate their capabilities,

disregard moral values and have good problem-solving skills.


105

General conclusions

In order to be able to stop this phenomenon, it is necessary first of all to apply measures to

raise awareness at the level of society, the consequences and risks that drugs have. Media prevention

campaigns, but especially those aimed at schools from disadvantaged backgrounds, can facilitate this

awareness of risks. At the same time, creating a closer link between school and family, by supporting

parenting sessions by school specialists, guiding parents in adopting parenting style and advising in

difficult situations, can be a method that reduces the involvement of adolescents in this drug world.

The following measures may be included in this group: increasing the employment

opportunities of people with low levels of education, developing the social support system for women

who do not receive family help or who are victims of domestic violence, and the existence of national

programs for free psychological counselling.

It aligns with the elements that may contribute to the decrease in the relapse rate and the

programmes carried out in prisons with women convicted of trafficking and illicit consumption of

dogs and the identification of networks to ensure the different needs of prisoners. At the same time,

another factor aimed at the reintegration of women into the community may be the analysis and

intervention on social networks, which supported their criminal activity in the past.

In Romania, the causes of the growth of the female population convicted of drug trafficking

also include the insufficient development of social services, which is why measures of a criminal

nature are applied, rather than social measures towards women who break the law. The absence of

organisations to support women in difficulty and to act towards helping them adapt to society is also

a sensitive matter for drug-related crimes.

As well, alternating criminal and restorative justice policies can positively influence this

approach. The development of centres for drug users, depending on existing cases, can contribute to

a decrease in the recidivism rate by including them in a specialised programme.

Study limitations

This article has several limitations. Because 25% of the studies had access to the abstract

only, as full access required buying them for a fee, this can influence the results in a negative way.

Secondly, the low number of researches on this subject has reduced the chances of highlighting

several aspects leading to an understanding of this phenomenon.

In the future, a possible metaanalysis that analyzes studies in a differentiated manner, i.e.

qualitative studies separate from quantitative ones, can bring significant information and a much

higher level of knowledge.


106

Table 1

Analyzed studies and adjacent conclusions for the keyword - women

Authors, year of publication Place of study Study population N

James, Gosho, & Wohl, (1979). University of Washington,

Seattle, Washington.

Drug-addicted women

and prostitutes.

268

Findings: For all women addicted to heroin, drug resale and prostitution were the usual means of support.

Bränström & Andrésson, (2008). Sweden. Women with criminal

records.

14.400

Findings: The particular effects of drug policy.

Gilfus, (1993). University of Wisconsin,

Madison.

Incarcerated women. 20

Findings: Victimization of women - a factor influencing criminal activity.

Murphy, Stevens, McGrath, Wexler,

& Reardon, (1998).

Tucson, Arizona. Abused women. 98

Findings: The victim profile of women involved in crime.

Stevens, Andrade, & Ruiz, (2009). Tucson, Arizona. Women drug users. 200

Findings:Specific psychological factors involved in drug trafficking.

Haselschwerdt, Maddox, & Hlavaty,

(2020).

California. Abused women. 23

Findings: The role of vulnerability elements.

Dodge & Pogrebin, (2001). University of Colorado,

Denver.


Findings: Collateral effects of women's incarceration.


107

Table 2

Analyzed studies and adjacent conclusions for the keyword – drugs


Alantes, Fraile, & Page, (2002). University of Valencia,

Spain.

Women involved in

crime.

50

Findings: Risk behavior in drug trafficking.

Radosh, (2008). Department of Womens

Studies, Western.

Women involved in drug

trafficking.

40

Findings: The racial element in drug trafficking.

Moloney, Hunt, & Joe-Laidler, (2015). San Francisco, California. Women involved in drug

trafficking.

253

Findings: Perception of advantages and disadvantages in drug trafficking.

Hughes, Chalmers, & Klimoski,

(2018).

National Drug and Alcohol

Research Center, Australia.

Women drug users. 1000

Fondevila, Massa, & Meneses-Reyes,

(2020).

Mexico city, Mexico. Women drug users. 1000

Findings: Involvement of women in drug trafficking-related crimes.

Hutton, (2005). Victoria University of

Wellington, New Zealand.

Women drug users. 3

Findings: Drugs and risk behaviors in drug trafficking.

Flynn & Hoffer, (2019). Case Western Reserve

University, Cleveland,

Ohio.

Women drug users. 52

Findings: Social implications of drug trafficking in women

Chatwin, (2003). England and Europen

Union.


use and trafficking.

-

Findings: The impact of political systems on drug trafficking.

Chatwin, (2016). Swedan and Netherlands.



-

Findings: Impact of cultural peculiarities on drug trafficking.

Bellis et al. (2008). European countries. Women drug traffickers. 1314

Findings: The connection betweeen adrenaline and drug trafficking.

Measham, (2004). Lancaster University, UK.



-


108


Findings: The impact of nightclubs in the phenomenon of drug trafficking.

Nucu, (2018). Romania. Women involved in drug


-

Findings: Effects of geographical positioning in drug trafficking.

Ţical, (2019). Romania. Women involved in drug


-

Findings: Economic motivation in drug trafficking.

Giommoni, Aziani, & Berlusconi,

(2017).

Italy. Women involved in drug


50

Findings: The connection between social proximity and drug trafficking.

Mounteney, (2016). European countries. Women drug users. 15.000

Findings: The connection between dependent behavior and drug-trafficking.

Beaver et al. (2016). Saudi Arabia. Women drug users. 500

Findings: The role of the entourage in drug use and trafficking

Denoth, Siciliano, Iozzo, Fortunato,

& Molinaro, (2011).

Italy. Teenage drug users. 33.

185

Findings: The role of the entourage in drug use and trafficking.

Stanciu & Cotruş,

(2014).

Romania.

Teenage drug users. -

Findings: The role of social factors in drug use and trafficking.

Baciu, (2018). Romania. Students. 30

Findings: Favorite places for drug use.

Baciu, (2019). Romania. Students. 459

Findings: The influence of the membership group on drug use.

Baciu, (2017). Romania. Drug users. -

Findings: Informing the company about drug use


109

Table 3

Analyzed studies and adjacent conclusions for the keyword – traffic


Johnson & Young, (2002). United States of America. Abused women. 5

Findings: The psychological implications of the victim.

Schemenauer, (2012). Columbia. Women drug traffickers. 100

Findings: Confidence in one's own ability to conceal

Whitney, (2016). Ecuador. Women drug traffickers. 16

Findings: The psychological implications of the victim.

Jørgenrud et al. (2018). Norway. Women with a history of

addiction.

5031

Findings: Risk behaviors in drug trafficking.

Ludwick, Murphy, & Sales, (2015). San Francisco. Women drug traffickers. 160

Findings:Perception of the advantages and disadvantages of drug trafficking by women.

Calafat et al. (2009). European countries. Women with a history of

addiction.

1363

Findings: Risk behaviors in drug trafficking.

Dotherte, Jacinto, Sales, & Murphy,

(2009).

California. Women with a history of

addiction.

80

Findings:The implications of addictive behavior.

Table 4

Analyzed studies and adicent conclusions for the keyword – addiction


Grace, (2017). England. Women who committed

drug trafficking.

89

Findings: Addiction - survival strategy.

Robbins, Martin, & Surratt, (2009). U.S.A. Women drug users. 50

Findings: Intervention - measure to prevent relapse

Bui & Morash, (2010). U.S.A. Incarcerated women. 20


110


Findings: Involvement of the probation service in the return process.

Sánchez, Fearn, & Vaughn, (2018). Spain. Women with a history of

addiction.

100

Findings: The use of substances in prison can be a barrier to the rehabilitation objectives of these women.

Wexler, Cuadrado, & Stevens,

(1998).

South Florida. Women with a history of

addiction.

83

Findings: The presence of psychological disorders in addictive behavior.

Brownstein, Baxi, Goldstein, & Ryan,

(1992).

New York. Women in communities

dealing with drug

trafficking.

414

Findings: Increased risk of suicide.

Table 5

Analyzed studies and adjacent conclusions for the keyword – relapse


Fowler, Dinitto, & Webb, (2005). U.S.A. Women drug users. 51

Findings: Individual intervention in addicted behavior.

Olson, Stalans, & Escobar, (2016). Loyola University,

Chicago.


Findings: Risk factors for relapse.

Bergseth, Jens, Bergeron-Vigesaa,

& McDonald, (2011).

Chicago. Incarcerated women. -

Holtfreter & Morash, (2003). U.S.A. Incarcerated women. 402

Findings: Means to stop recidivism in drug use and trafficking.

Dandnord & Griffiths, (2006). New York. Convicted people. -

Dignan, (2004). Glasgow. Convicted people. -

Szabo, (2010). Romania. Convicted people. -

Braithwaite, (2002). England. Convicted people. -

Findings: The importance of the political system at the level of society.

Oancea & Micle, (2015). Romania. Convicted people. -

Findings: The importance of dealing with antisocial attitudes.


111


Taylor, (2015). Philadelphia, U.S.A. Incarcerated women. 40

Findings: Influence of the support environment by gender.

Micle, Oancea, Saucan, &

Dragomirescu, (2013).

Romania. Convicted persons. 100

Findings: Inability of subjects to select important information.

Acknowledgements

This study is part of the doctoral research project entitled "Dimensions of personality,

emotions and cognitions in people deprived of freedom", carried out at the School of Advanced

Studies of the Romanian Academy, "Constantin Rădulescu-Motru" Institute of Philosophy and


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117

THE IMPORTANCE OF WELL-BEING AND SATISFACTION WITH LIFE IN READING-

COMPREHENSION AND MATHEMATICAL ABILITIES IN DEAF AND HEARING

INDIVIDUALS

DOI: http://doi.org/10.26758/11.1.8

Yahir GONZALEZ (1), Diego-Oswaldo CAMACHO-VEGA (2)

(1) (2) Faculty of Medicine and Psychology, Universidad Autónoma de Baja California, USA

(2) E-mail: [email protected]

Address correspondence to: Diego Camacho, Universidad Autónoma de Baja California. Facultad de

Medicina y Psicología. Calzada Universidad 14418, Parque Internacional Industrial Tijuana, 22390

Tijuana, B.C. Ph.: 664 682 1233; E-mail: [email protected]

Abstract

Objectives. The primary objective of this study is to evaluate if there are significant differences in

reading-comprehension and mathematics between deaf and hearing individuals, identify if the level

of Psychological Well-Being and Subjective Well-Being is related to higher mastery in reading-

comprehension and mathematics, and finally, determine if self-perceived disadvantages in reading

and mathematics by deaf individuals are related with their mastery in reading and mathematics tasks.

Material and methods. A mixed-method was conducted including correlational and topological

analysis of speech. The sample was constituted by 58 volunteers: five deaf individuals (age M =28.4)

and 53 hearings (age M =18.75). Participants responded to the Satisfaction with Life Scale and the

Ryff´s Scales of Psychological Well-Being after solving the Adults Reading Evaluation and the

Buenos Aires Mathematics test.

Results. Higher scores were found for the hearing group in reading and mathematics. No correlations

were found between Satisfaction with Life and reading and mathematics neither between

Psychological Well-Being and reading and mathematics for both groups. The qualitative analysis

indicated that deaf individuals perceived no differences in their reading-comprehension and

mathematics skills regarding hearings, but they scored significantly lower than hearings.

Conclusions. This study corroborated results from previous research about the differences in reading-

comprehension and mathematical abilities between deaf and hearing individuals. This study identifies

that differences between deaf and hearings might be more related to other factors such as the lack of

awareness of difficulties in reading-comprehension and mathematics, while satisfaction with life and

psychological well-being appears to be related to employment difficulties.

Keywords: Deaf, reading-comprehension, mathematics, psychological well-being, subjective well-

being.

Introduction

According to the Organisation for Economic Co-operation and Development (OECD)

cognitive abilities refer to "a set of thinking strategies that enable the use of language, numbers,

reasoning and acquired knowledge, comprising verbal, non-verbal and high-order thinking skills"

(OECD, 2019, p. 86). The OECD (2013) through the Programme for the International Assessment of

Adult Competencies (PIAAC) identifies the cognitive abilities that are essential for adult life:

Literacy, Numeracy, and Problem Solving in Technology-rich Environments (OECD, 2013) which

are relevant in numerous social and working contexts and are necessary for participation and full

https://www.journalstudiesanthropology.ro/en/the-importance-of-well-being-and-satisfaction-with-life-in-reading-comprehension-and-mathematical-abilities-in-deaf-and-hearing-individuals/a166/


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integration in the labor market, education, and the social and civic development (Prada & Rucci,

2016). This study focuses on the cognitive skills of reading-comprehension and mathematical

abilities. Reading-comprehension is the capacity to understand, evaluate and apply written texts to

develop personal skills, achieve goals and participate in society while mathematical ability is defined

as the capacity to access, interpret and apply data and mathematical concepts in answer to overcome

the diverse situations in daily life (OECD, 2013). Particularly, this research considers the

manipulation of elements, logical-deductive reasoning, symbolic representation, and analytic

reasoning as mathematics abilities (Cortada & Macbeth, 2007).

Previous studies have analyzed both reading-comprehension and mathematical abilities

based only on hearing individuals. Therefore, there is a need of assessing these abilities in vulnerable

groups such as deaf individuals who are considered by the World Health Organisation (WHO, 2020)

as people with profound hearing loss which implies very poor or null access to sound.

Studies that consider deaf-individuals are relevant because it has been found that deaf people

perform low in reading tasks, being a clear minority who achieve a reading skill equivalent to the

expected at the end of elementary education (Moreno-Pérez, Saldaña, & Rodríguez-Ortiz, 2015).

These differences can be explained in part by the differences in phonological processes between deaf

and hearing individuals (Herrera, 2005; Kyle & Cain, 2015; Moreno-Pérez et al., 2015; Wauters, Van

Bon, & Tellings, 2006). Additionally, deaf individuals who did not acquire sign language (SL) show

structural differences compared with those who acquired previously the SL. The main differences

consist in spoken language acquisition difficulties, as well as the limited linguistic experience

including low access to lexical, syntax, semantics, speech as elements of language, and weak reading

instruction processes implied in the level of reading and writing, which implies better achievement

for deaf readers with the dominion of SL in reading and writing tasks. (Figueroa & Rosa Lissi, 2005).

Similarly, previous research suggests that deaf individuals show lower performance than

hearing in mathematics assignments (Andin, Rönnberg, & Rudner, 2014; Bull, Blato-Valle, &

Fabich, 2006; Kelly, Lang, & Pagliaro, 2003; Masataka, 2006; Pagliaro & Ansell, 2012). It is

considered that hearing loss and environments with little language stimulation influence low scores

because they deprive deaf people of learning opportunities, a situation that reduces their exposition

to early numerical concepts which consequently leads to a lack of the necessary elements for further

mathematical learning, contributing to the difficulty that deaf individuals experience with

arithmetical estimations when values should be accessed from symbols (Bull et al., 2011). That

becomes more relevant considering the importance of mastering whole numbers and basic

mathematical operation before starting fractional numbers (Mousley & Kelly, 2017). Otherwise,

Marschark, Morrison, Lukomski, Borgna and Convertino (2013) point out that deaf signers have

some advantage in the visual-spatial working memory, a condition that translates into a better

development in visual mathematical problems but only in schematization and organization, not in

mathematical processing itself compared to non-signer equals and hearing peers.

In addition to the lack of educational opportunities, some evidence about the association

between cognitive and life satisfaction has suggested a close correlation (Enkvist, Ekström, &

Elmståhl, 2013). In the same way, prior evidence suggested a significant correlation between

psychological well-being and cognitive skills (Llewellyn, Lang, Langa, & Huppert, 2008) but

research about these topics is not yet clear in deaf groups.

Deaf people are known to be at much greater risk of developing psychological problems

(Gascon-Ramos, 2007) but the relationship between psychological issues and educational problems

in this population is still unclear. Psychological Well-being has become relevant due to its

relationship with facts as employments or happiness, the ease or difficulty to find employment,

academic performance, and social participation, being more notorious in female and student

population (Moreta-Herrera, López-Calle, Gordón-Villalba, Ortíz-Ochoa, & Gaibor-González, 2018;

Wiklunda, Nikolaevb, Shirc, Food, & Bradleye, 2019). There are two broad lines of study for Well-

being in Psychology: a) psychological well-being, based on the concept of eudaimonia which is


119

linked to the ideal of happiness, (Padrós & Medina, 2015) b) subjective well-being, based on the

concept of hedonism, related to satisfaction and avoidance of suffering (Moreta, Gaibor, & Barrera,

2017; Zubieta & Delfino, 2010), both included inside the framework of the Positive Mental Health.

In this study the concept of Psychological Well-Being (PWB) refers to what makes us feel

alive and authentic, helping us to grow as individuals. Therefore, it includes social and individual

indicators including the evaluation that people make about their circumstances and function in

society, the way they face their conditions in life, the reach of success, and personal development.

Subjective Well-Being (SWB) focalizes the perception that people have of their current

condition (Cárdenas et al., 2012; Moreta et al., 2017; Padrós & Medina, 2015) and asks how and why

people can perceive their life positively (Moreta et al., 2017). Subjective well-being is compound by

cognitive and emotional elements (positive or negative emotions). Its cognitive element is the

satisfaction with life defined as a global opinion that the individual has about his life comparing his

overall success versus his expectations (Cabañero et al., 2004; Cárdenas et al., 2012).

Based on the beforehand explanation, the present study aims to evaluate if there are

significant differences in reading-comprehension and mathematical abilities between deaf and

hearing individuals, identify if the level of Psychological Well-Being and Subjective Well-Being is

related to higher mastery in reading-comprehension and mathematics, and finally, determine if a self-

perceived disadvantage in reading and mathematics by deaf individuals is related with their mastery

in reading and mathematics tasks.


A mixed method was applied with a correlational focus for quantitative aspects of the study

and a transversal topological analysis of speech for qualitative aspects (the qualitative approach was

only considered for the deaf group). Due to the lack of instruments to measure cognitive skills,

psychological well-being, and satisfaction with life, this study searches to obtain objective and

subjective/self-report measures of cognitive abilities of reading comprehension and mathematical

ability.

Sample

The study was conducted on a sample of 58 volunteers from a Mexican population that

accepted to participate in the study after signing the informed consent. Then, two groups were formed.

The first group corresponded to five deaf individuals (DG) (3 females and 2 males) (DG mean age

M= 28.4), all bilateral, profound, prelingual deaf who reached university education and practiced

Sign Language (specifically the Mexican Sign Language or MSL). This group was selected with the

collaboration of an SL translator. None of the participants had an auxiliary implant and all of them

spoke SL. The second group was formed by 53 hearing participants (HG mean age = 19) where 67%

were females.

Instruments

All participants completed the Adults Reading Evaluation test (ELA) (Matute, Chamorro,

González, Ventura, & Parra, 2015), the Buenos Aires Mathematics Test (TMBA) developed by

Cortada and Macbeth (2007), the Satisfaction with Life Scale (SWLS) developed by Diener,

Emmons, Larsen and Griffin (1985), and the Ryff´s Scales of Psychological Well-Being (SPWB)

(Díaz et al., 2006). An MS PowerPoint presentation with video-recordings supported by the

explanation of a Sign Language interpreter was delivered for the deaf group (DG) during the whole

evaluation. Only the reading passage from ELA was not translated to SL. Following the

recommendations of Kyle and Cain (2015) who suggest that deaf individuals have difficulties


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understanding abstract or poorly concrete contents, all the scales were reduced to 3 choices (Yes = 1,

I don´t know = 2, no = 3) for the DG.

The ELA is an instrument that assesses reading precision, speed, and comprehension. For

this study, we focused on the comprehension dimension of the instrument using the reading passage

provided by the instrument. To test mathematics ability, a 10-items adaptation of the TMBA was

administrated. This questionnaire evaluates the manipulation of elements; logical-deductive

reasoning; symbolic representation; and analytic reasoning. TMBA was reduced from 50 to 10 items

choosing the items with higher correlation indicated by Cortada and Macbeth´s study (2007) (items

2, 13, 18, 22, 25, 28, 34, 38, 39, 49 from the original 50-item questionnaire). Each one related to one

of the dimensions assessed in the test, namely: simple arithmetic calculations (item 4); operation with

decimals (items 1, 5, and 6); proportions, percentages, and rule of three (items 3 and 10); algebraic

solving (items 8 and 7); and geometry problems (items 2 and 9).

The SWLS is a 5-item scale to evaluate the global judgment about self-perceived satisfaction

with life.

Finally, the SPWB is a 29-items scale to measure six factors of Psychological Well-Being:

1) Self-acceptance, 2) Autonomy, 3) Positive Relationships, 4) Environmental Mastery, 5) Purpose

in Life and 6) Personal Growth.

Procedure

Both groups completed the full evaluation in the faculty computer laboratory. For the

assessment of DG the SL interpreter helped to locate the participants giving them the instructions

orally. Complementary, an MS PowerPoint presentation was shown on the same screen. For the HG

sample, the formulary was given with no modifications. Cronbach-alpha values for each scale are

shown in Table 1.

Quantitative analysis

A descriptive analysis of all the natural scores of each sub-test in the formulary was done,

then an exploratory analysis of the data distribution was calculated for each group. After that,

significant differences between both groups were examined in each sub-test of the formulary using

the Mann-Whitney U test for independent non-parametrical samples, and finally, the correlation

coefficients were obtained with Pearson´s r in the DG because of the normal distribution of data

showed from the Shapiro-Wilk test, while the Spearman's rank correlation coefficient rs was applied

in the HG due to the non-normal distribution of data in this group.

Qualitative analysis

Deaf participants were interviewed with a semi-structured interview supported by the LS.

Then, a topological analysis of speech was conducted. This process was audio-recorded and

subsequently, the information was analyzed using the ATLAS.ti 8 software.

Results

Quantitative results

To determine significant differences between groups, the Mann-Whitney´s U was calculated

for the whole set of tests (Table 1).


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Table 1

Differences between groups and reliability by scale

Scales Groups M SD U(56) p Cronbach-

alpha

SWLS DG 12.20 2.59 122.50 .780

.65

HG 12.26 2.94 .77

ELA DG 1.60 1.14 14.500 <.001 .62

HG 5.89 2.09 .50

TMBA DG 2.20 1.48 21.000 <.001 .33

HG 5.21 1.69 .35

SPWB DG 76.20 5.07 4.00 <.001 .61

HG 62.66 6.81 .74 Notes.

SWLS = Satisfaction with Life Scale

ELA = Reading Evaluation for AdultsEvaluación de Lectura para Adultos

TMBA = Test de Matemáticas Buenos Aires

SPWB = Ryff’s Psychological Well-Being Scales

As is shown in Table 1, the results indicated significant differences (p <.01) between the DG

and HG for ELA U(56) = 122, and TMBA U(56) = 21. For further analysis of our data, we compare

all items of the TMBA between DG and HG. We found significant differences for items 9 (geometry

problems scale), and item 10 (proportions, percentages, and rule scale). Meanwhile, significantly

higher values were found for the DG in the SPWB scale U(56) = 4, p <.01.

To achieve the second objective of this research which tried to determine if reading-

comprehension and mathematical abilities are correlated with Psychological Well-Being, the

Spearman´s Rank-Order Correlation was calculated for HG while the Pearson´s Product-Moment

Correlation test was conducted for DG due to the distribution of the dataset.

For DG, no significant correlation (p .05) was found between SWLS and reading-

comprehension as well as no significant correlation was found between SWLS and mathematical-

abilities. Similar results were found for HG (Table 2).

Table 2

Correlations between ELA, TMBA, and SWLS, SPWB

SWLS SPWB

Coeficient p Coeficient p

ELA DG .81 .09 .33 .60

HG -.20 .14 -.00 .99

TMBA DG .27 .66 .41 .50

HG -.06 .66 .05 .72 Note. rs Spearman was calculated for HG, whereas r Pearson for DG.


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Qualitative results

To determine if self-perceived disadvantages in deaf individuals are related to results in

reading-comprehension and mathematics tasks for deaf individuals, the qualitative analysis indicated

that deaf individuals self-perceive their cognitive skills as high (Table 3 shows the inductive

codification based on the theoretical framework, the analytic categories defined as high and low and

examples of unit analysis). Individuals from the DG do not self-perceive differences in reading and

mathematics skills regarding hearings. They expressed that their SPWB and their SWLS is affected

by inequalities in job opportunities more than disadvantages in the analyzed cognitive skills. Besides,

learning for life, family, friends, and healthy social relations were considered important factors related

to their PWB and SWLS. While participants referred to positive high levels regarding the six factors

evaluated by the SPWB. Finally, deaf individuals experience a lack of social inclusion which has

resulted in difficulties to get hired and complications to obtain autonomy in their life.

Table 3

Matrix of codification and examples

Inductive

codification Analytic categories Analysis unit (examples)

RCA

Declared

Reading

comprehension

ability

High: Between 70-100 points on

a 0-100 scale. "80" - A

Low: Between 0-50 points on a

0-100 scale. "40 - 45" - C

MA Declared

mathematical

ability

High: Between 70-100 points on

a 0-100 scale. "90" - B

Low: Between 0-50 points on a

0-100 scale. "50" - A

PWB Psychological

well-being

Range between 70-100 points on

a 0-100 scale. "80-90" – A

The participant relates certain

elements with his/her own PWB

"Having a job, family well-being,

social relationships, that would make

my life better" - A. The participant declares their

interest in autonomy in their life

or give example related to

autonomy in their life.

"I´m looking to be autonomous" - A.

SWB Subjective

Well- Being

The participant relates certain

elements with his/her own SWB

"When you have a good job and go

ahead that is satisfaction" - B.

Participants relate the role of

their job in their SWB

"Obviously when you have a good job,

and the salary is good your satisfaction

with life" - B.

IEA Influence of the

environment on

self-esteem

Understand sentences where is

evident the feeling of inferiority

related to self-esteem, self-

image, etc.

"Hearing people always will be higher

than us in advantage with deaf people"

– B.


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Inductive

codification Analytic categories Analysis unit (examples)

Participants give examples

about how they have shown

resilience.

"Is about awake and go ahead in life,

there are deaf people who do not accept

it and deaf people who accept it. It is

about your attitude" – C.

LPWB

Learning as an

important

element in

his/her

psychological

well-being

Participants relate the learning

of how an important factor for

PWB.

"Based on many mistakes and lessons

learned, I have practiced and developed

my quality of life" – B.

PREM

Problems

related to the

environment

where he is part

of a minority.

Participants refer to a lack of

inclusion explaining the

situation of their own life.

"I do not declare I´m deaf until the

recruiter calls me to know my perfect

CV, during the interview they know

about my reality. I do not declare I´m

deaf because they will say no" – B. Participants refer to specific

problems when they started their

professional life.

"I have my degree, but I will search

everywhere because they tell me no

because I´m a deaf woman" – A.

Discussions

According to the obtained results, there is evidence to state that the hearing group performed

significantly better than deaf individuals on reading-comprehension and mathematical tasks in line

with results from Kyle and Cain (2015), Wauters et al. (2006), Herrera (2005), Moreno et al. (2015),

and Figueroa and Rosa Lissi (2005). Considering that reading and mathematics are one of the most

important problems in education for the Mexican population (i.e. Mexico was ranked below the

average in the PISA evaluation in both, reading and mathematics) (OECD, 2018), the fact of low

mastery in these abilities in hearing population implies that the problem for deaf individuals might

be a very important issue to consider in future research and educational policies.

The reason for the differences in performance between hearing and deaf individuals is

currently unclear but the researchers agree with the hypothesis that the early development of language

has a profound impact (Faletty, 2016; Fontané-Ventura, 2005; Myklebust, 1971). Sign language

could settle the basis of oral language acquisition (ex. Spanish, English, etc.) (Herrera, 2005). Andin

et al. (2014) and Bull et al. (2006) found that oral-phonologic knowledge influences multiplication

tasks, underlining the importance of early development of language, being broadly evident in deaf

individuals. Nevertheless, we did not consider when sign language was acquired by deaf individuals,

we cannot assume this suggestion until we develop more research considering this factor.

Particularly, comparing all items of the TMBA, our analysis suggests differences between

DG and HG in the proportions, percentages, and rule scale, as well as in the geometry problems scale.

Consequently, future work should therefore include measurements to prove whether these factors are

indeed significantly different.

It is important to note that the problem in reading and mathematics is hard in the entire

hearing population in our country but unfortunately no data is available about deaf individuals. The

fact of lower mastery in reading and mathematics could express different issues. For example,

Hernández-Ontiveros and Camacho-Vega (2020) suggested that our educational system does not

attempt to integrate deaf students. It avoids hearing loss students to develop oral skills in addition to

a lack of development of the sign language since early childhood (Okada et al. 2015). Based on this


124

asseveration, the analysis of reading and math solving problems between deaf and hearing individuals

implies some difficulties mainly based on the context of the education received by deaf individuals.

Another important factor to understand disadvantages in reading and mathematics in deaf individuals

is the role of teachers in the educational processes. First, according to Kelly et al. (2003), teachers

must have certificates. In higher education is common in our country that teachers demonstrate

experience in their field before giving courses, but these experiences should indicate certification in

pedagogical strategies for reading and mathematics, even more, when teaching deaf individuals.

Kelly et al. (2003) also suggested that teachers should focus more on tasks which require analytical

strategies and cognitively challenging problem rather than on task involving surface cues, language

comprehension, and exercise drills for deaf students.

Moreover, results from the qualitative analysis indicated that deaf individuals do not

perceive their reading and mathematics skills as low, but they obtained significantly lower scores in

both tasks regarding hearings. This is a highlight proposed by our research because it might imply

that deaf individuals may not be aware of cognitive differences compared to hearings. Thus, this lack

of awareness about their difficulty in addition to the lack of opportunities in education might be an

important approach for future research. It is necessary to create social and political awareness about

the inclusion of deaf individuals in similar educational and adequate support such as sign language

in their early years to create similar opportunities between deaf and hearings and create adequate

strategies for better cognitive development.

Even deaf individuals referred not to have difficulties in the cognitive skills analyzed, they

indicated another important disadvantage regarding hearings. Deaf individuals referred that

employment is an important factor for their psychological well-being and satisfaction with life,

ranked as the most important element followed by family-friends’ relationships. They indicated that

these disadvantages are more related to the fact of being deaf individuals rather than their abilities or

experience for the job solicited. Further research is needed to understand the role of hiring difficulties

in deaf individuals because it was not the objective of this study. Besides, our results suggested

significant differences in SPWB between DH and HG but a deep analysis is needed to understand

more about these differences.

Additionally, deaf individuals face several problems in their learning process that hearing

people do not experience. This study focused on deaf individuals who reached an undergraduate level

obtained at a university or technical degree and results evince that there is a lack of institutional

consideration about deaf’s difficulties to understand sentences with complex grammar structure,

including abstract or not concrete sentences (Kyle & Cain, 2015).

Finally, this study had some limitations. First. The voluntary integration of the deaf community could

respond to a lack of social integration. This research indicates there is still a lot of work to do before

inviting deaf people to participate in research studies about their condition. For this reason, our

sample should be increased to obtain more reliable results.

Conclusions

In conclusion, this study supports research about the differences between reading-

comprehension and mathematics in hearing and deaf individuals. It appears that certainly, deaf

individuals develop lower than hearing individuals in reading and mathematics tasks. This study

considered samples from deaf and hearing individuals with higher education studies to avoid bias

based on educational level. Therefore, the paired-samples considering grade can reduce the bias of

knowledge and abilities in both groups. Thus, the differences were significantly lower for deaf

individuals and results suggest that educational level is not a factor that explains per se the differences

between groups.

Second, no evidence of correlation based on the statistical analysis was found between

cognitive abilities and psychological well-being or between cognitive abilities and satisfaction with


125

life, but the qualitative analysis indicated an important finding: deaf individuals do not perceive

difficulties in reading and mathematics which is not congruent with the results obtained in the tasks,

suggesting a lack of awareness about their abilities.

If well, reading and mathematics abilities appear to be of no significances for deaf

individuals in their psychological well-being and satisfaction with life, the most important factor

related to their SPWB and SWLS appears to be the lack of job opportunities.

Finally, this study fills the need to propose instruments to measure the well-being and

subjective well-being in deaf individuals showing that the SPWB and the SWLS are highly correlated

questionnaires and its application fits in both samples for furthermore studies, in addition to the

evaluation of reading and mathematics abilities using the ELA and the TMBA test respectively.

Acknowledgments

We would like to thank the Universidad Autónoma de Baja California for all the facilities

provided and to Sara Rivera for her valuable help translating to MLS all the necessary content for the

deaf-individual participants and supporting them during all the study. Additionally, we would like to

thank Maria Guadalupe Delgadillo for helping us to develop the qualitative analysis of this research.

Abbreviations

DG Deaf Group

HG Hearing Group

SWLS Satisfaction with Life Scale

ELA Reading Evaluation for Adults

TMBA Test de Matemáticas Buenos Aires

SPWB. Ryff’s Psychological Well-Being Scales

PWB Psychological Well-Being

RCA Declared Reading comprehension ability

MA Declared mathematical ability

PWB Psychological well-being

SWB Subjective Well- Being

IEA Influence of the environment on self-esteem

LPWB Learning as an important element in his/her psychological well-being

PREM Problems related to the environment where he is part of a minority.

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BODY IMAGE AVOIDANCE QUESTIONNAIRE AND ASSOCIATED FACTORS: A

STUDY OF A GROUP OF MOROCCAN ADOLESCENTS

DOI: http://doi.org/10.26758/11.1.9

Raja ZAKARIA (1), Hakima AMOR (1), Abdellatif BAALI (1), Noureddine ELKHOUDRI (2)

(1) Laboratory of Human Ecology, Faculty of Sciences Semlalia, "Cadi Ayyad" University, Marrakesh,

Morocco; E-mail: [email protected]; [email protected]

(2) Higher Institute of Health Sciences, "Hassan I" University, Settat, Morocco; E-mail:

[email protected]

Address correspondence to: Raja Zakaria, Laboratory of Human Ecology, Department of Biology,

Faculty of Sciences Semlalia, Avenue Prince Moulay Abdellah, BP 2390, Marrakesh, Morocco. Ph:

0212 614-545787; E-mail: [email protected]

Abstract

Objectives. The aim of this study is to assess physical appearance behavior avoidance among a group

of Moroccan adolescents and to identify the associated factors.

Material and methods. The data were gathered from a cross-sectional study conducted on 487

adolescents (223 boys and 264 girls), with the average age of 14.6 years. Gender, age, body mass

index (BMI), and satisfaction of their body weight and height were considered in this study. Body

satisfaction was evaluated by two questions: "Are you satisfied with your body weight?" and "are

you satisfied with your body height?". The Body Image Avoidance Questionnaire (BIAQ) test was

used to assess the adopted behaviors.

Results. The average score on the BIAQ test was 24.4. According to the different factors of the BIAQ

test, the factors "clothing", "grooming and weighing", and "eating restraint", were more noticed

among adolescents. The results showed that behavioral avoidance was associated with gender, age,

BMI, and body dissatisfaction. It was females, the youngest group of adolescents, overweight, and

those dissatisfied with their body weight or height who had the highest scores. This reflects the fact

that adolescents resort to physical appearance behavior avoidance or control including practices such

as dressing, grooming, and weighing.

Conclusions. It is recommended by health professionals to enhance awareness among adolescents

about the risks of adopting such behaviors on their physical and mental health, to correct the narrow

and unrealistic standards of physical appearance, and to encourage healthy behaviors.

Keywords: body image, behavior avoidance, adolescents, Marrakesh, Morocco.

Introduction

Body image is defined as one’s attitude towards one’s body, particularly its size, shape, and

aesthetics (Cash, 1990). Adolescence is a critical period for body image development because of the

various social, cultural, physical, and psychological changes occurring in this period (Campagna &

Souza, 2006). These transformations also involve major upheavals in body image (Blyth, Simmons,

& Zakin, 1985). Body image disturbance is conceptualized as a multidimensional construct with

perceptual, attitudinal, and behavioral components (Banfield & McCabe, 2002). The perceptual

component is defined as the relative inaccuracy of individuals’ judgment regarding the shape of their

whole body or various body parts (Slade, 1994). The attitudinal component involves dissatisfaction

with body shape or size (Gardner, 2001). The behavioral component comprises body avoidance,

https://www.journalstudiesanthropology.ro/en/body-image-avoidance-questionnaire-and-associated-factors-a-study-of-a-group-of-moroccan-adolescents/a167/



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including tendencies to avoid situations that elicit worry about physical appearance (Rosen, Srebnik,

Saltzberg, & Wendt, 1991), and body checking, the behavioral manifestation aimed at gaining

information on body shape, size, or weight (Shafran, Fairburn, Robinson, & Lask, 2004). According

to Stapleton, McIntyre and Bannatyne (2014), body image disturbance "serves as an important risk

factor in the development of eating disturbances and other unhealthy behaviors". Among these,

avoidance behaviors that typically refer to a range of behaviors intended to avoid information

regarding one’s shape, weight, or size. Examples of these behaviors include not weighing oneself,

avoiding looking in mirrors wearing loose-fitted clothing, and avoidance situations in which revealing

clothing may be required, such as the gym or the beach (Walker, Anderson, & Hildebrandt, 2009).

These behaviors may play a significant role in the development of disturbed eating behaviors and in

the maintenance of body image disturbance (Fairburn, Cooper, & Shafran, 2003).

Maïano, Morin, Monthuy-Blanc, and Garbarino (2009) remarked that, unlike the perceptual

and attitudinal components of Body Image Disturbances, the behavior one benefited from very few

assessment instruments to measure either body avoidance (e.g., Body Image Avoidance

Questionnaire, Physical Appearance Behavior Avoidance Test) or body checking or both (e.g., Body

Checking and Avoidance Questionnaire). Among these, the BIAQ is "the most widely used", as

revealed by the literature review.

Overweight has gained increasing attention in developing countries as an issue that needs to

be addressed (Musaiger et al., 2016). Adolescence is a sensitive period marked by important physical

and social changes that can lead to a negative body image. Therefore, changes related to the body or

body parts increases vulnerability to the use of unhealthy body change strategies, such as avoidance

behaviors.

Thus, this study seeks to evaluate the avoidance behaviors and their association with gender,

age, BMI, and satisfaction of their body weight and height among a group of Moroccan adolescents.


Participants

This cross-sectional survey was carried out in several secondary schools in Marrakesh,

Morocco. The survey took place between 2014 and 2016. Marrakesh is situated in the center of

Morocco, and its population rises to 928 850 inhabitants. During the studied period (2014-2016) there

were 56 secondary schools located with a total secondary school student population of 78306. A

random cluster sampling technique was used in this study. The sampling frame comprised a list of all

56 secondary schools in educational districts in Marrakesh. Six out of the 56 schools were selected

via random sampling. The sample population included students from the six selected schools. Three

classes were randomly picked up from each of the selected schools. The students were randomly

chosen from those classes. Those who refused to participate were excluded from the study. The total

obtained sample was 487 male and female adolescents aged 10 to 18 years, with 223 boys (45.8%)

and 264 girls (54.2%).

According to the World Health Organization (WHO, 2017) classification, the sample was

divided into two groups: early adolescents (between 10-14 years old) and middle to late adolescents

(between 15-19 years old).

Measures

Weight status. Height and weight measurements were undertaken twice in private areas.

Weight was measured in light clothes and no shoes to the nearest 0.1 kg by a portable digital Seca.

Height was measured while subjects were in the standing position, not wearing shoes, hat, hair bows,

combs, and with the normal position of shoulder to the nearest 0.1 cm by a portable/wall-mounted


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stadiometer with movable headpiece. An average of two values for each measurement was

documented. Body mass index (BMI) was calculated by the following formula: weight (kg)/height

(m2) and standard deviation scores (BMI z-scores) were gathered using the age and sex according to

the WHO standards reference (De Onis et al., 2007). Adolescents were also categorized according to

their BMI z-score in three groups: Overweight (BMI obesity included; z-score is ≥+1), normal weight

(BMI z-Score between– 2 and +1), and underweight adolescents (BMI z-sore is ≤ -2).

Avoidance and physical control behaviors. The behavioral trends, which frequently

accompany body image disturbances of adolescents, were assessed by BIAQ test (Body Image

Avoidance Questionnaire) (Rosen et al., 1991); the scale consisted of 19 items. The test could be

subdivided into 4 factors allowing to evaluate the adopted behaviours. The questionnaire has 19 items

across four behavioral themes: clothing (disguising or covering up the body through clothing choices;

items 1-4, 13, 15-18), social activities (avoidance of social situations that involve eating or focusing

on appearance; items 8-11), eating restraint (dietary restriction; items 5-7), and grooming/weighing

(checking behaviors such as scrutinizing oneself in the mirror and weighing…; items 12, 14, 19).

Each item on this factor is scored on a 6-point scale ranging from 0 (never) to 5 (always) (Table 1).

The findings suggest that the higher is the individual score, the more likely the individual resort to

physical appearance behavior avoidance.

The BIAQ test has demonstrated good psychometric properties among patients with eating

disorders as well as healthy adults or adolescents (Lydecker, Cotter, & Mazzeo, 2014; Maïano et al.,

2009; Rosen et al., 1991; Senín-Calderón, Santos-Morocho, & Rodríguez-Testal, 2020; Stapleton et

al., 2014).

In the present study, the translation-back translation procedure was used. Two translations

of the questionnaire from English to Arabic were conducted by two independent, bilingual, and

qualified translators. One bilingual expert translated the questionnaire into Arabic. The second expert,

who was kept unfamiliar with the original questionnaire, translated this Arabic version back into

English. Then a final version was prepared with the help of the research team’s native Arabic

speakers, who examined the translation quality, ensured its validity and measured reliability in the

Moroccan context. The final Arabic version was piloted, with very few comments returned that were

corrected.

Body satisfaction. Body satisfaction was evaluated by two questions: "are you satisfied with

your body weight?" and "are you satisfied with your body height?".

Procedure

The study was approved by the Moroccan Ministry of Education and the State Department

of Education of the city of Marrakesh. None of the participants were forced to participate in this

study, they were reassured that any dissent on their part would not affect them in any way, and the

purpose of the study was explained to them as well. A written consent form was obtained from the

participating adolescents and their parents. The data was collected by the researcher who interviewed

adolescents individually at their school in one session. The interview lasted 30 minutes on average.

Then anthropometric measurements were taken. The information was collected anonymously and

confidentially.

Analysis

The statistical treatment of data was carried out by WHO AnthroPlus 2007 program (WHO,

2009) which determines BMI z-scores and Statistical Package for the Social Sciences Program (SPSS

for Windows, version 18) was also used for all statistical analysis. Qualitative variables were

described by their size and percentage. Quantitative variables were described by their mean and

standard deviation. Intergroup comparisons were made by Mann-Whitney and Kruskall-Wallis test


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for quantitative variables and by Chi-square tests for qualitative variables.

Results

Age, weight status, and body satisfaction

The age of adolescents ranged from 10 to 18 years while the average age was 14.6 years

(SD=2.8). Adolescents aged 10 to 14 years were relatively more represented than their counterparts

in the 15-18 years age group, 53.6 % and 46.4%, respectively. On average, males were older than

females (14.9 ± 2.8 vs 14.4 ± 2.8); there were no significant differences among different age groups

(U Mann-Whitney=1.9; p=0.07). Of adolescents, 78.9% had normal weight, 8.6% underweight, and

12.5% overweight (8.4% pre -obese and 4.1% obese). While considering adolescents' perception of

their body weight and height, the majority of them were satisfied, 78.4% and 84.6% respectively.

Avoidance and physical control behaviors

Overall, the total BIAQ score for the adolescents in this sample varied from 4 to 54 with an

average of 24.4 (SD = 9.7; median = 23). The alpha value of Cronbach is equal to 0.723. Table 1

presents the results of the evaluation of the different items of the BIAQ scale. The highest scores were

those scoring 3 (often), 4 (usually), and 5 (always). This reflects the adolescents' resort to body

avoidance behaviors. The dimensions "clothing", "grooming and weighing" and "eating restraint",

especially the restriction of the amount of food consumed, were more noticed among adolescents.

Table 1

Assessing adolescents using the BIAQ test: Percentage of adolescents adopting the following

behaviours

Factors and Items 0 1 2 3 4 5

Factor 1: Clothing

- I wear baggy clothes 43.1 18.3 24.6 5.1 4.7 4.1

- I wear clothes that I do not like 66.1 12.3 15.4 2.1 2.5 1.6

- I wear darker colour clothing 10.7 13.3 36.6 15.0 12.3 12.1

- I wear a special set of clothing, e.g, my "fat

clothes" 83.2 8.4 5.7 1.4 0.6 0.6

- I am inactive 48.9 14.6 29.0 5.3 1.2 1.0

- I avoid physical intimacy 50.3 5.1 10.9 5.1 6.2 22.4

- I wear clothes that will divert attention from

my weight 56.7 6.0 14.2 4.9 6.0 12.3

- I avoid going clothes shopping 92.0 2.9 3.3 0.6 0.8 0.4

- I don't wear "revealing" clothes (eg, bathing

suits, tank tops, or shorts...) 61.0 3.3 8.2 3.3 4.3 19.9

Factor 2: Eating restraint

- I restrict the amount of food I eat 56.1 6.4 15.4 5.5 7.2 9.4

- I only eat fruits, vegetables, and other low

calorie foods 70.6 7.4 7.2 4.5 4.7 5.5

- I fast for a day or longer 88.5 2.7 4.1 1.6 0.8 2.3

Factor 3: Social activity

- I do not go out socially if I will be "checked

out" 60.2 5.7 9.9 3.7 2.5 18.1


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Factors and Items 0 1 2 3 4 5

- I do not go out socially if the people I am with

will discuss weight 56.7 4.5 8.6 3.7 3.7 22.8

- I do not go out socially if the people I am with

are thinner than me 84.8 2.7 5.7 1.2 1.0 4.5

- I do not go out socially if this involves eating 90.8 2.5 4.1 0.8 0.6 1.2

Factor 4: Grooming and weighing

- I weight myself 18.7 27.9 35.5 5.1 6.6 6.2

- I look at myself in the mirror 1.6 3.3 11.5 8.8 13.8 61.0

- I get dressed up or made up 29.6 10.9 23.0 8.6 10.1 17.9

0: Never; 1: Rarely; 2: Sometimes; 3: Often; 4: Usually; 5: Always

An examination of the relationship between the BIAQ score and the used variables is

presented in Table 2. The results of the comparison of the avoidance behaviors among adolescents

by gender, age, BMI categories, and body satisfaction with weight or height, showed that behavioral

avoidance was associated with all the used variables: the average of BIAQ score was higher for the

females than males (p<0.05). Young adolescents had a significantly higher BIAQ scores as compared

to their younger counterparts (p<0.001). According to the weight categories, overweight adolescents

reached the highest BIAQ scores (32.0) as compared to adolescents with normal weight (23.4) or

underweight (22.4) (p<0.001). The dissatisfied adolescents with their body weight or height had a

high average BIAQ score (28.9) and (27.6), respectively. BIAQ was found to be strongly associated

with body weight satisfaction (p<0.001). In fact, the youngest, female adolescents, overweight and

those dissatisfied with their body weight or height showed these behaviors or strategies (way of

dressing, of eating, of behaving in public).

Table 2

Mean scores of the BIAQ test according to gender, age, BMI categories, and body satisfaction

Variables Modalities n Mean ± SD Testsa, b

Gender Boys 223 23.3 ± 9.7

2.5 a ; p<0.05 Girls 264 25.3 ± 9.6

Age 10-14 years 261 26.1 ± 9.5

4.8 a ; p<0.001 15-18 years 226 22.5 ± 9.5

BMI categories

Underweight 42 22.4 ± 8.8

36.1 b ; p<0.001 Normal weight 384 23.4 ± 9.1

Overweight 61 32.0 ± 10.4

Body weight

satisfaction

Satisfied 382 23.2 ± 9.1 5.0 a ; p<0.001

Dissatisfied 105 28.9 ± 10.2

Body height

satisfaction

Satisfied 412 23.8 ± 9.4 2.8 a ; p<0.01

Dissatisfied 75 27.6 ± 10.6 aMann-Whitney test; bKruskal Wallis test

Discussions

Body image dissatisfaction was a particular phenomenon of Western societies, recent studies

have shown an increasing level of body image dissatisfaction in non-Western Arabic countries,

including Morocco. Body image dissatisfaction is prevalent among adolescents in Arabic countries

with socio-cultural conditions relatively similar to that of their Moroccan counterparts. In United


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Arab Emirates, Schulte and Thomas (2013) found that 73% of adolescents indicated body

dissatisfaction (78% of females, 58% of males). In Lebanon, 39% of adolescents underestimated or

overestimated their body weight (Assaad et al., 2018). In Egypt, about 25.6% of males and 40% of

females had some level of body image concern among undergraduate students (El Ansari, Dibba,

Labeeb, & Stock, 2014). In Morocco, body dissatisfaction was prevalent in 61.0% of the adolescents,

of whom 38.2% wanted to gain weight while 22.8% wanted to lose it (Zakaria, Amor, & Baali, 2021).

Furthermore, as the world becomes increasingly globalized, Western beauty practices have

spread rapidly in many countries. Morocco is no exception. It is a country which has undergone deep

transformations, an unprecedented process of modernization and a series of socio-economic and

socio-cultural changes (High Commission for Planning (HCP), 2018). These changes included a

transformation in dressing styles from long loose dresses to Western modern styles. The combination

of these factors of acculturation would change body image ideals of Moroccan adolescents and

contribute to adopt some negative attitudes.

For knowledge, this is the first nationwide study of its kind to be carried out in Morocco and

the Arab region that investigates body image avoidance and associated factors in adolescent males

and females.

The average score of the BIAQ test in this study was 24.4 (SD = 9.7). This was higher than

the score found among Spanish adolescents (23.6 ± 11.0) (Senín-Calderón et al., 2020). It is worth

noting that "clothing", "grooming and weighing", and "eating restraint" factors reached the highest

score, particularly food restriction.

Adolescents were more concerned about the most visible part of the body and the face (often

looking at the mirror, putting on makeup). They also weigh themselves frequently as a means of

controlling their body weight. In the context of weight control, self-monitoring of weight in

adolescents was a strategy that can be used to monitor body weight variation. This concern about

body weight could have negative consequences on body image (Dionne & Yeudall, 2005; Friend,

Bauer, Madden, & Neumark-Sztainer, 2012), which will push the individual to adopt means of loss

or gain weight if one’s current weight exceeds or falls behind the one desired (Neumark-Sztainer, van

den Berg, Hannan, & Story, 2006). In addition, the frequency of weighing may worsen body image

according to Ogden and Whyman (1997), the self-frequent weighing was associated with worse body

image among women with normal weight. The adolescents in this study used grooming behaviors

more than weighing to control and change their physical appearances and physical aesthetics by

frequently looking in the mirror and using cosmetics to increase physical attractiveness.

Subsequently, as international studies have shown, these subjects become more concerned about their

body image (Cash, Dawson, Davis, & Bowen, 1989). As for the clothing factor, women who declared

themselves dissatisfied / perceived themselves as failing to meet the ideal standards usually wear

clothes that allow them to control their appearance and hide their size and shape (Rudd & Lennon,

2000), also the men interested and concerned about their body used clothing to manipulate their

appearance (Frith & Gleeson, 2004). In the present study, adolescents avoid the use of tight clothing;

because they probably choose to dress in the Islamic style (do not reveal body contours/silhouette).

This fact was also revealed in various studies in Arab countries, Muslim oriented, having the same

socio-cultural conditions (e.g. El Ansari et al., 2014). In addition, body satisfaction with their body

weight and height could also have a direct impact on eating behaviors to achieve the perceived ideal

body and to have a sense of control and even lead the individual to practice chronic diets (Calderon,

Yu, & Jambbazian, 2004; Stice, Presnell, & Spangler, 2002).

Young adolescents in pubertal development are more likely to adopt these behaviors because

rapid changes in physical appearance happening during this period (Patton & Viner, 2007) could lead

to enhanced preoccupation with physical appearance, especially among girls (Grogan & Richards,

2002). This dissatisfaction of girls may be due to the fact that puberty leads to a departure from the

thin-ideal of Western feminine beauty by an excessive accumulation of fat in certain parts of their

body (Steinberg & Morris, 2001; Waylen & Wolke, 2004).


135

Another formative factor that contributes to body dissatisfaction is the social comparison

(Leahey, Crowther, & Mickelson, 2007). Social comparison theory claims that people have an innate

drive to evaluate themselves, often in comparison to others; it emphasizes the importance of social

comparisons in self-evaluation and social behavior (Festinger, 1954; Wood, 1989). This process is

also true about body image. Meta-analyses have revealed that when women compare themselves with

thinner females, their body dissatisfaction increases (Bailey & Ricciardelli, 2010). Being overweight

is also one of the factors that may cause adolescent dissatisfaction (Latiff, Muhamad, & Rahman,

2018); overweight adolescents in this study used more these behavioral avoidance strategies.

Conclusions

In the present study, adolescents reported body avoidance behaviors, especially those related

to grooming, weighing, and clothing. The results support the association of these manifestations with

the adolescents' gender, age, weight status, and perception of their weight and height. It is worth

noting that the phenomenon affects mostly females, the youngest and overweight adolescents.

Adolescents tend to adopt avoidance behavior to cope with body dissatisfaction. It is recommended

by health experts to enhance awareness among adolescents about the risks of doing so on their

physical and mental health, to correct the narrow and unrealistic standards of physical appearance,

and to encourage healthy behaviors.

Acknowledgments

The authors would like to thank all students and their parents for their participation in this

study. Special thanks go to the Ministry of National Education authority of Marrakesh and school

staff.

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ANXIETY, DEPRESSION, STRESS, EMOTIONALITY AND AGGRESSIVITY - FACTORS

THAT MAY INFLUENCE IRRATIONAL ALCOHOL CONSUMPTION AND RISKY

SEXUAL BEHAVIOR

DOI: http://doi.org/10.26758/11.1.10

Mihaela LUNGU(1), Elena Lucreția NEACȘU (2), Cornelia RADA (3)




Bucharest, Romania;

(2) PhD. Student, "Educational Sciences" Doctoral School of The State Pedagogical University "I.

Creangă" from Chișinău, Republic of Moldova; E-mail: [email protected]

(3) "Francisc I. Rainer" Anthropology Institute of the Romanian Academy, Bucharest, Romania; E-


Address correspondence to: Mihaela Lungu, Str. Gheorghe Asachi, No. 1, Bl. B7, Sc. A, Ap.12,

Pitești, 110318, Argeș, Romania. Ph: +40 751072206; E-mail: [email protected]

Abstract

Objectives. This literature review aimed to reveal the relationship between psychological factors

such as anxiety, depression, stress, emotionality and aggression on the one hand, and irrational

alcohol consumption and risky sexual activity on the other hand, in students (19-25 years) and

adjacent age groups.

Material and methods. The study was conducted by analyzing the literature published between 2010

and 2020. The search was conducted in Romanian and English, in 9 international publications, by the

following key phrases and terms, separately or in combination: anxiety, depression, stress,

emotionality, aggressiveness, alcohol consumption, drinking motives, binge drinking, sexual

behavior, risky sex.

Results. Applying repeated exclusion criteria, 31 articles remained in the analysis. Among these, risk

behaviors were rarely analyzed in connection with psychological factors. Most studies that investigate

risky behaviors regarding alcohol consumption and sexual activity, address them according to gender,

educational level, age groups. Women were more prone to anxiety and depression, but also to show

more psychological aggression compared to men who showed more physical aggression, even in

sexual activity. Researches included aggression as a behavioral trait, and emotionality has been used

as a variable in studies to validate standardized tools. Irrational alcohol consumption has been

significantly associated with risky sexual activity and various forms of aggression.

Conclusions. The risk of manifesting and developing depressive and anxiety symptoms is higher in

victims of aggression, in people with risky sexual activity, and in consumers of irrational alcohol. In

students and young people, stress has high values, contributing to the tendency towards risky

behaviors. It is necessary to promote successful coping strategies and mechanisms, both in individual

and group level, as well as the development of prevention strategies and therapeutic procedures to

improve the listed risk behaviors.

Keywords: anxiety, depression, aggression, alcohol consumption, sexual activity.

https://www.journalstudiesanthropology.ro/en/anxiety-depression-stress-emotionality-and-aggressivity-factors-that-may-influence-irrational-alcohol-consumption-and-risky-sexual-behavior/a168/





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Introduction

The mental balance of people is a condition of normal life as important as physical or somatic

health.

The number of people suffering from anxiety, depression, and stress is constantly increasing

worldwide, and young people, teenagers or even children do not seem to have a higher protection

factor than adults or the elderly. Research shows that students are a social category highly exposed

to high levels of stress, anxiety, and depression (Bryan, Baker, & Tou, 2017; Tutino, Shaughnessy,

& Ouimet, 2018; McDougall, Langille, Steenbeek, Asbridge, & Andreou, 2019), and this can lead to

aggressive behaviors towards the intimate partner (Davis et al. 2012; Agardh, Tumwine, Asamoah,

& Cantor-Graae, 2012b) or in other situations.

Regarding of risky sexual behavior, there is less research and their strategies differ a lot. The

prevalence and transmission of HIV/AIDS and syphilis are still to the attention of the authorities and

have been monitored at the level of limited research (Monu et al., 2020), but also of institutions with

long-term decision-making and action, such an example being the European Center for Disease

Prevention and Control (2019). The results showed that there are parts of the population that are very

poorly informed about risky sexual behavior.

The association between risky behaviors and psychological factors occurs most often in

scientific studies with medical themes, associated with diseases (Guruprasad, Ramakrishnan, & Shah,

2015), dysfunctions such as infertility (Yang et al., 2017; Lalinec-Michaud & Engelsmann, 1984),

unhealthy diet (Ahmed, Al-Radhwan, Al-Azmi, & Al-Beajan, 2014), or special social contexts (Foli,

South, Lim, & Hebdon, 2012; Hebdon, Foli, South, & Lim, 2012).

Alcohol is one of the most consumed and dangerous psychoactive substances. In the United

States, Stahre, Roeber, Kanny, Brewer and Zhang said in 2010 that one in ten deaths at the age of 20-

64 was due to excessive alcohol use. In 2019, new information emerged, showing that although for

teenagers and some young people it was forbidden to buy alcohol, 24% of 8th graders had already

tried alcohol, as well as 77% of students and 85% of young people (19-28 years) (Schulenberg et al.,

2019).

The 2019 World Health Organization report stated that Romania does not have a written

national policy on alcohol consumption (World Health Organization, 2019) and no monitoring system

on this behavior, although it is ranked 7th among European countries and ranked 9th in the world with

12.6 l annual per capita alcohol consumption (World Health Organization, 2018). Worldwide, the

same source reports that there are three million deaths due to alcohol consumption each year, and

40% of alcohol consumers experienced at least one heavy drinking event per month.

Rada and Ispas (2016), following a study conducted on 1539 young people in Romania, aged

between 18 and 30, in 2013 and 2014, argued that heavy episodic/occasional drinking - binge drinking

- is a phenomenon that has attracted the attention of researchers in recent years on both adolescence

and early youth. The same idea was taken over by Aluja, Lucas, Blanch, and Blanco (2019) in a study

conducted on 668 young people in the same age range.

Starting from all this and partially knowing the effects that psychological imbalances can

produce personally or in community, the present study aims to broaden the field of knowledge by

connecting the results of several scientific studies and to identify areas that require further study.


Depression and anxiety are among the most common imbalances in the mental system and

often prove to be the cause of risky behaviors for people both individually and in the community.

Either stress reaches at post-traumatic or acute clinical levels, or is manifested in the form of transient

symptoms, it accompanies the life and activity of most people affecting their quality. The present

analysis is the scientific base for the study of psychological factors involved in risky behaviors among


141

students in Romania. It reveals the state of information accessed in 2020 on the psychological factors

such as anxiety, depression, stress, emotionality, and aggressivity in relation to alcohol consumption

and sexual activity, especially behaviors considered risky. The research directions of the analysis

carried out aimed at: identifying relationships between anxiety, depression, stress, aggressivity, and

emotionality in students (19-25 years) and adjacent age groups; exploring the influence of

psychological factors associated with risky behaviors regarding alcohol consumption and sexual

activity; identifying the need for further research on the influence of anxiety, depression, stress,

aggressivity, and emotionality on risky behaviors.

The analysis of the literature was done starting from two directions simultaneously. The first

direction of literature analysis followed psychological factors, aiming in particular the relationships

between anxiety, depression, stress, aggressivity, and emotionality. The second direction of analysis

focused on risky behaviors, tracking alcohol consumption, sexual activity, and harmful physical

activity.

A larger volume of publications on this topic was studied, but only materials from verified

sources that provided consistent information on the topic were selected for inclusion in the analysis.

The primary purpose of the present analysis was to explore the existing volume of information on the

influence of personality factors on risky behaviors, and into the background aimed to identify less

researched areas, but with the potential to provide relevant information for education, public health

policies and psychotherapy.

The next plan of research questions was based on the analysis of specialized studies and their

results:

How psychological factors such as anxiety, depression, stress, aggressivity, and emotionality

and risky behaviors are defined and characterized? What are the relationships between anxiety,

depression, stress, aggressivity, and emotionality explored in students?

What are the influences between the psychological factors mentioned and alcohol

consumption and/or harmful sexual activity? Are there also influences of risky behaviors on

psychological factors, among students and young people?

What aspects of the relationship between the psychological factors and the risky behaviors

mentioned are less researched and could bring valuable information for decision-makers and

psychotherapists?

The present research is an analysis of the literature on the relationship between psychological

factors such as anxiety, depression, stress, aggressivity, and emotionality, on the one hand, and

potentially harmful behaviors related to alcohol consumption and sexual activity, on the other hand.

The study was conducted through the systematic analysis of the scientific literature,

published between 2010-2020, including correlation between personality factors and risky behaviors.

The process consisted of stages of search, selection, and systematic analysis of scientific articles in

relation to the set of indicators and criteria detailed below.

The indicators that formed the basis of the analysis of the research results presented in the

selected articles were as follows: a) The presence of some personality factors measured in students

and the relations between them; b) The existence of correlations between personality factors and risky

behaviors; c) The existence of significant correlations between harmful forms of alcohol consumption

and sexual activity.

The search for study publications was done in English and Romanian, the search process

was done in the following databases: Sage Journals, APA, BioMed Central, US National Library of

Medicine, Journal of Studies on Alcohol and Drugs, ELSEVIER, SpringerLink and ScienceDirect,

after the following key phrases and terms, taken separately or in combination: anxiety, depression,

stress, emotionality, aggressivity/aggressiveness, alcohol consumption, drinking motives, binge

drinking, sexual behavior, risky sex.

The searches were performed between November 2019 and October 2020.


142

From the results of the online search, 551 titles and abstracts were reviewed, of which were

retained for the analysis of the full publication those that simultaneously met the following criteria:

the article was published in the period 2010-2020; presented quantitative or qualitative research

results relevant to the purpose of this research (study topic included: anxiety, depression, stress,

emotionality, aggressivity, risky sexual behavior, risky alcohol consumption, or a combination

thereof), at least one variable measured such behavior; the studies were published in journals or other

scientifically verified publications. Figure 1 illustrates the way the concepts in the study were

analysed and the relationships between them.

Figure 1.

Levels of analysis of the literature according to the relationships between the factors studied

Applying the selection criteria in a first stage, 93 public articles were retained for the analysis

of the text. In the next stage, 29 studies were eliminated and which, although they corresponded to

the search for keywords and conceptual constructs, were either strictly medical (not psychological),

or revealed rather demographic information (translation of the concept of gender, by the word sex).

In the third stage, a number of 33 articles were eliminated, the results of which did not provide

information relevant to the objectives of the present study. Thus, 31 scientific research articles

remained in the final stage, in order to be deepened. A summary of the main elements of analysis for

each article is included in Tables 2, 3, 4, and 5. Of the 31 remaining articles in the analysis, 3 dealt

with risky behaviors (on alcohol consumption and sexual activity), 11 reported results for the

prevalence and implications of psychological factors, and 17 studied both psychological factors and

risky behaviors.


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Results

The table below shows the distribution of research topics in the total number of articles

included in the analysis.

Table 1

Distribution by topics of interest of the studied articles Psychological factors

Anxiety Depression Stress Emotionality Aggressivity

No association with risky

behaviors

9 11 4 3 2

Risky behavior Alcohol

consumption

3 4 0 0 3

Sexual

activity

6 11 3 1 5

Total 18 26 7 4 10

In the research studied, risky behaviors were rarely analyzed in connection with psychic

components of personality/psychological factors. However, there is scientific concern in this regard.

Ngo et al. published in 2018 the results of a survey of 735 young people, according to which 27.2%

of respondents had exercised physical violence in couple, and 16.5% sexual violence in couple. The

results did not show gender differences in the presence of anxiety, nor were they conclusive whether

it precedes behavioral violence or vice versa. Shwartz, O’Rourke, and Daoud (2020), however, in a

study of 1,055 women in Israel, aged 18-48, on the relationship between postpartum depression and

intimate partner violence, found that unplanned pregnancy increases the risk of violence of the

intimate partner as well as that of postpartum depression. Significant associations have been found

between different risky behaviors such as irrational alcohol consumption and potentially harmful

sexual activity (Davis et al., 2012; Choudhry, Agardh, Stafström, & Östergren, 2014), but less in

relation to psychological components.

In a multimodal, predominantly qualitative study, Lloyd, af Klinteberg, and DeMarinis,

(2017) claimed that in Sweden, after 2004, young people were the largest group of psychiatric

patients. In Australia, 20% -25% of young people between the ages of 12 and 25 were estimated to

suffer from mental health problems as published in 2019 by Masters, Zimmer-Gembeck, and Farrell,

in a study conducted on 391 Australian students. Similar estimates have been made for Western

Europe and the United States. Predominant symptoms of anxiety and depression were found more in

adolescent girls than in boys, more in women than in men (Masters et al. 2019; Lloyd et al., 2017; ul

Haq, Irum Sajjad Dar, Aslam, & Mahmood, 2018). Lloyd et al. (2017) conducted a study on 53

women between the ages of 21 and 25 who were in treatment or waiting within a psychotherapy

clinic, and found that participants with high scores on depression had a negative concept about

themselves and the lack or inability to use existential resources (concept about self and world,

religion, ontological security, etc.).

ul Haq et al. published in 2018 the results of a study conducted in 2017 on 361 students at

Punjab University in Lahore, India. Exploring the levels of anxiety, depression and stress related to

various demographic factors, they found that male participants were more anxious, depressed and

stressed compared to female, students who reported parents with medium and high educational

instruction had fewer symptoms and stated that there were higher levels of anxiety where the

participant’s father was educated below the high school level.

Defined as anticipation of danger and characterized by muscle tension, alertness, necessary

to prepare for an expected danger, as well as through avoidance - cautious behavior (American


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Psychiatric Association, 2016, p.189), anxiety is one of the most common conditions. Unlike fear,

long-term anticipations of anxiety refer to negative events, which are usually (not exclusively)

psychological in nature (Lovibond & Lovibond, 1995). For the present research, articles containing

any of the following categories were searched and analyzed: social anxiety disorder/social phobia,

agoraphobia, generalized anxiety disorder, nonspecific anxiety disorder, combinations thereof,

symptoms or manifestations whether evaluated clinically or only in research purpose.

"Depression seems to be a state characterized mainly by a low level of self-esteem and

initiative, associated with the perception of a low probability of achieving significant personal goals

for the individual" (Lovibond & Lovibond, 1995, p. 31). In the present study were included all forms

of depression according to the American Psychiatric Association (2016, p. 155-188), but also specific

symptoms or manifestations.

Mutalik, Moni, Choudhari, and Bhogale, in a study published in 2016, in which they

explored depression, anxiety and stress in students in Bagalkot, India, found high levels in all three

measured parameters. In Canada, it has been estimated that 8% of people over the age of 18 will

experience depression at some point in their lives. Also, 60% of respondents to a study of University

of Alberta students reported depressive symptoms (McDougall et al. 2019). The same study

mentioned above, published in 2018 by ul Haq and his collaborators, showed that the symptoms of

depression and stress have higher values in students living with family than those living alone or with

friends and that those coming from illiterate mothers have higher levels of anxiety also.

According to the longitudinal study published in 2019 (Carney et al., 2019) and conducted

on 662 soldiers over 18 years of age in the United States, infected with HIV, found that those with

clinically diagnosed depression reported the lowest condom use in sexual intercourse with new

partners compared to those with mild depressive symptoms. Depression seems to be an important

factor in choosing risky behaviors in students as well. It may influence the decision to drop out of

university, as mentioned by McDougall et al. in 2019, in a study conducted on 6,639 Canadian female

students under the age of 30. "Young adults are more vulnerable to depression and stress being in a

period of transition of identity formation" (ul Haq et al., 2018, p. 1). Other researchers have concluded

that depression is the most common mental disorder in students.

From a wider range of disorders, the general term of stress "can be conceived as a persistent

state of hyperactivation that reflects the difficulty of coping with the difficult demands of life"

(Lovibond & Lovibond, 1995, p. 32). Psychological disorder increasingly present in postmodern

society, stress, in its various forms, accompanies the individual at all stages of age. For the present

study, attention was paid to all forms of stress included in studies on young people (18-25 years),

teenagers or adults.

Post-traumatic stress disorder and depression have been associated with intimate partner

violence in men in South Africa as well as in developed countries, as Breet, Seedat, and Kagee

mentioned in an article published in 2019. The article is the result of a cross-sectional study conducted

on 221 HIV/AIDS survivors. Psychological imbalances and poor mental health can be risk factors

for aggressivity. Irritability and anger, as symptoms associated with post-traumatic stress disorder,

may increase the likelihood of committing intimate partner violence (Breet et al., 2019). The same

study revealed that men who reported more severe symptoms of post-traumatic stress reported 3 times

more sexual coercion (committed), while women who reported more severe symptoms of post-

traumatic stress disorder were 3 times more likely to commit psychological aggression.

Ahmed et al., in a study published in 2014, conducted on 407 students at the University of

Kuwait, over the age of 18, found that stressed female students had a significantly higher tendency

than boys to choose unhealthy food.

As an infinitum continuum, the psychological factor emotionality designates the dynamics

of the person’s affective spectrum, polarizing from "emotional stability, or, at the opposite pole, a

person’s neuroticism" (Fahrenberg, Hampel, & Selg, 2001, p. 45).


145

The increased risk of psychological pathology has been associated with emotional disorders

(Masters et al., 2019). Emotionality has also been described as "the ease with which emotions are

aroused", defining negative emotionality as the experience of the generally negative environment of

individuals interacting with other people (Wolff & Baglivio, 2017, p.5). Analyzing a database of

27,720 juvenile delinquents who completed the sanctioning service in Florida, Wolff and Baglivio

found that hostile childhood experiences are activated in the form of negative emotionality.

Moreover, they said about children with a predominantly negative perception of others and the

environment and those whose (negative) emotions are easier to activate, that they were more likely

to engage in antisocial and therefore risky behaviors.

Aggressivity refers to that personality factor characterized either by self-control or by "a

high level of spontaneous aggressivity, (...) a general state of hostility towards others and towards the

events they face" (Fahrenberg et al., 2001, p. 32).

Although exposure to violence, as a control, may not differ by gender, a 2005 study of 1,220

students in Uganda (Agardh et al., 2012.b) found that symptoms of mental imbalance could be

expressed differently. This was relevant in a broader conceptual context, with women experiencing

more sexual violence and men experiencing more physical aggressivity. Brett et al. in 2019 showed

that when analyzing the tendency to act aggressively, men are more prone to physical aggressivity

while women are more prone to psychological aggressivity. In Romania, following a study of 869

respondents between 18 and 75 years old, Rada (2014) found that psychological abuse of men against

women was the most common type of reported violence, and 35% of respondents had witnessed

parental violence during childhood.

A study carried out in Romania between 2014-2015 among 836 young people aged 19-23

years living in a romantic relationship revealed that men perceived significantly higher levels of

aggressiveness in couple than women. The most surprising result showed that "men were three times

more exposed to forced sexual intercourse than women" (Faludi, 2018).

In teenagers, experiencing and committing violence in a cogeneration context (with

colleagues and/or couple) amplifies the risk of internalizing symptoms, as found by Garthe, Sullivan,

and Behrhorst (2018), in a study conducted on 1,087 teenagers in disadvantaged areas of the United

States of America, achieved through the education system.

Only one of the reviewed and studied studies concerns aggressivity as a personality factor

(Fahrenberg et al., 2001), the vast majority considering aggressivity as a type of behavior

(aggressivity, violence; physical or mental). Lloyd et al. (2017) found that participants with high

scores on depression also recorded high scores on inhibiting aggressivity.

For most states, the mental health of citizens has become one of the priority directions of

public health policies. Even in some African countries, the national strategic health plan contains

aspects of mental health, as shown by Agardh, Cantor-Graae and Ostergren (2012a).

The present study considered the following potentially harmful behaviors: irrational alcohol

consumption, risky sexual activity and sedentary lifestyle, later extended to the dimensions of

physical activity.

Alcohol consumption is one of the factors with a great influence on the social group and

society in general. Kilwein and Looby in 2018 reported reasons for socializing for alcohol

consumption, following a study of 108 students, aged 18 to 24, in the central-western United States.

The research was supported a year later by Looby, Bravo, Kilwein, Zimmerman and Pearson in 2019,

who found similar conclusions, conducting a research on 2,039 students from 10 universities in the

United States, with an average age of 19.79 years. The influence of colleagues/ cogeneration rather

than parents was also reported by Rada and Ispas (2016).

Understanding the risks associated with sexual activity requires both a psycho-social and a

psycho-medical approach. The definition of sexual health according to the World Health

Organization: "A state of physical, emotional, mental and social well-being in relation to sexuality;


146

it is not merely the absence of disease, dysfunction or infirmity" (Glasier, Gülmezoglu, Schmid,

Moreno, & Van Look, 2006, p. 1596).

In order to determine the sexual quality of a person’s life, it is necessary to consider the

subjective interpretation of personal experiences and satisfaction. Tutino et al., in a study of 306

students (boys), published in 2018, concluded that sexual arousal could be the most sensitive

dimension of sexual functionality in the presence of mental health deficiencies. Another finding of

the study was that mental health difficulties may have a greater impact on men’s sexual function and

quality of life compared to frequency. "Sexual victimization and depression are common in university

campuses, especially for women" (McDougall et al., 2019, p. 1).

Risky alcohol consumption is viewed both in terms of the potential harm to human

individuals and the destruction of goods that may result from it. Its measurement is made both

quantitatively based on an international standard related to culture - Standard Unit of alcohol and as

a frequency. Exceeding 4 standard units for women and 5 standard units for men on a single occasion

is considered dangerous.

The standard unit (US) of alcohol consumption is also controversial, especially in relation

to the country/culture in which the research is carried out: in France - contains 10 g of pure alcohol,

as explained by Costa et al. (2020) in a study conducted between 2016-2018, in France, on 179

subjects over 18 years of age. In Romania, Ministry of Health, National Institute of Public Health,

National Center for Health Assessment and Promotion and Sibiu Regional Center for Public Health

(Ministerul Sănătății, Institutul Național de Sănătate Publică, Centrul Național de Evaluare și

Promovare a Stării de Sănătate și Centrul Regional de Sănătate Publică, Sibiu, 2019) established the

standard unit of alcohol consumption at 12 g of pure alcohol. Both episodes of excessive drinking

and sexual risks are behaviors with specific traits, related to culture (Petrova et al., 2019).

Carney et al. found in a study published in 2019 on 662 active HIV-infected soldiers in the

United States that consumption of alcohol is a high-risk factor for respondents with recent onset of

depressive symptoms. They concluded that there is a linear relationship between daily alcohol

consumption and the increased risk of engaging in harmful sexual behaviors.

Like other researchers, Choudhry et al., in 2014, concluded, based on a cross-sectional study

conducted on 1,954 students in Uganda, that a possible explanation for the association of alcohol

consumption with sexual activity and having multiple sexual partners would be that individuals who

believe that alcohol will make them less agitated, more sexually uninhibited, and those who are more

at ease in a potentially sexual situation are more likely to drink before a possible sexual interaction

in certain social contexts (in a bar, at a meeting, or party).

In some circumstances, the risks associated with sexual activity can be multiple and are

studied according to national priorities or contexts. Maina, Orindi, Osindo, and Ziraba (2020), in a

study conducted in 2017, on 606 girls aged 10-14 in Kenya, included in the definition of sexual

activity, as non-penetrative sexual activities: kissing, holding hands, touching or caressing and

spending time together.

Like sexual activity, risky sex is defined in several forms: sexual intercourse with two or

more partners in the last 12 months (Choudhry et al., 2014) or even in the last 3 months (Carney et

al., 2019); inconsistent condom use with new partners (Carney et al., 2019, Choudhry et al. 2019,

Agardh et al. 2012a); sexual assault and/or coercion (Davis et al. 2012; Choudhary, Smith, &

Bossarte, 2012); commercial and intergenerational sex (Choudhry et al., 2014).

Analyzing the gender difference, Breet et al. (2019) found that boys had a tendency almost

2 times higher (42.9%) than girls (23.8%) to commit sexual coercion. At the same time, Tutino et al.

(2018) found that mental health difficulties can have a greater impact on men’s sexual functionality

and quality of sex life.

McDougall and colleagues (2019) associating risky sex with psychological characteristics

found that 6.8% of study participants, female students under 30, were victims of unconsented sex


147

during university courses. Moreover, they were 2.1 times more likely to be at risk of depression than

those who had not experienced sexual victimization.

Discussions

Looking to identify relationships between anxiety, depression, stress, aggressivity, and

emotionality in students (19-25 years old), the following questions were used: How are the

psychological factors such as anxiety, depression, stress, aggressivity and emotionality and risky

behaviors defined and characterized? What are the relationships between anxiety, depression, stress,

aggressivity, and emotionality explored in students?

It was found that the definition of personality factors was mostly common and was based in

particular on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American

Psychiatric Association, 2016). Most of the studies found addressed either separately or

comparatively anxiety, depression, and stress (Mutalik et al., 2016; ul Haq et al. 2018; Tutino et al.,

2018; Bryan et al., 2017; Agardh et al. 2012a) and there are many studies that address these issues in

relation to intimate partner violence (Yavuzer, Albayrak, & Kılıçarslan, 2019; Ngo et al., 2018;

Agardh et al., 2012b).

The exploration of the influence of psychological factors associated with risky behaviors on

alcohol consumption and sexual activity was conducted by looking for answers to the questions: What

are the researched influences between the mentioned personality factors and alcohol, sexual activity

and harmful physical activity? Are there also influences of risky behaviors on psychological factors?

The answer to the second question was negative: none of the studies included in the analysis

investigated how the behavior influences the psychological factors.

The most common factor is the aggressivity factor as being investigated in relation to risky

behaviors regarding alcohol consumption and sexual activity (Ngo et al. 2018; Davis et al. 2012;

Agardh et al., 2012a, 2012b; Breet et al., 2019), but very often in research on psychological factors

such as depression and anxiety there are also variables on potentially harmful sexual activity (Kalina

et al., 2011; Tutino et al., 2018; Breet et al., 2019; Rada, 2020) and sometimes irrational alcohol

consumption (Choudhry et al., 2014; Carney et al., 2019; Agardh et al., 2012a; McDugall et al., 2018).

In order to identify the need for further research on the influence of anxiety, depression,

stress, aggressivity and emotionality on risky behaviors, it was studied what aspects of the

relationship between psychological factors and the risky behaviors mentioned are less researched and

could bring valuable information for decision-makers and psychotherapists. It was found that

although there is interest in these associations, the age stages have not yet been studied separately,

and in terms of students there are still questions whose answer may influence age-specific educational

and therapeutic strategies (Figure 2).

In tables 2, 3, 4, 5 after the Acknowledgments section the analysis of the studies discussed

in this article can be consulted by categories as follows: studies that had students as subjects, studies

that investigated both psychological factors and risky behaviors, studies that investigated

psychological factors unrelated to risky behaviors and studies that investigated only risky behaviors

in students.


148

Figure 2.

Analysis of the need to deepen and conduct studies on the correlation between risky behaviors and

psychological factors

- anxiety was associated with threatning and inhibition of aggression in

women, and with effective physical violence (sexual coercion) in men

- high anxiety scores were associated with high number of partners (in men)

and inconsistent condom use

• Requires further research

- substance abuse - including alcohol - was associated with an increased risk

of depression


• Not enough studies

- was associated with anger in men with depression

- was associated in women with the threatning, and in men with actual

physical violence, sexual coercion

- (HIV) Respondents with severe depression and those with a recent onset

were more likely to engage in risky sexual behaviors than those with mild

depression

- low levels of pleasure during intercourse and lack of sexual activity was

associated with depression

- high scores on depression were associated with large numbers of sexual

partners

- depression mediates in: the relationship between body image and sexual

well-being; between self-objectification and sexual functionality

• Further research can improve the quality of life


- men who reported more severe symptoms of post-traumatic stress,

reported 3 times more acts of sexual coercion (committed)



- emotional regulation difficulties leaded to poor sexual health in terms of

functionality and satisfaction


- high alcohol consumption is associated with greater aggression, physical

and sexual violence in couples, and with condoms non-usage

- rapes (by incapacity) were positively associated with alcohol consumption

by the aggressor, 51.5% penetrative sexual assaults involved alcohol

consumption


- a percentage of 42.9% men and 23.8% women (out of 210 HIV/ AIDS

survivors, in South Africa) committed sexual coercion


An

xie

tyD

epres

sion

Str

ess

Ag

gres

sivit

y

Em

oti

on

ali

ty


149

Conclusions

There are few studies that simultaneously investigate psychological factors and risk

behaviors in students, most researching their prevalence. Anxiety and depression are very common

and prevalent conditions in students. It was observed that the effects of mental imbalances are

consistent and due to them mental health is one of the priorities of health policies. At the same time,

although stress is one of the most common and widespread challenges of the 21st century, it does not

benefit from in-depth studies on the psychological and behavioral repercussions.

Female subjects seem to tend to experience more anxiety and depression, but also to show

more psychological aggressivity compared to male subjects who showed more physical aggressivity,

even in sexual activity.

Emotionality as a psychological factor was mostly examined in studies aimed at validating

psychodiagnostic tools and less to survey the population or correlate it with other personality or

behavioral factors.

Aggressivity has been included in studies most often as a behavioral component (expressive)

and not as a psychological factor.

According to the analyzed studies, the mental health difficulties generated sexual

dysfunctions (especially in men) and predisposed to risky behaviors for health. Irrational alcohol

consumption has been significantly associated with risky sexual activity and various forms of

aggression.

Irrational alcohol consumption and risky sexual activity have been mostly investigated as

distinct elements or in terms of physical effects on people. They have rarely been associated with

personality factors.

Following the research direction coming from risky behaviors to imbalances of

psychological factors, it was found that the risk of manifestation and development of symptoms and

disorders such as anxiety and depression is higher in victims of aggressivity, people with risky sexual

activity and those who consume alcohol irrationally.

The main limitation of the study is that it included insufficient databases in the analysis.

In the subsequent analyzes would be useful to identify articles, studies addressing successful

coping strategies and mechanisms at an individual and group level, the development of prevention

strategies applicable to teenagers and young people and therapeutic procedures to improve the listed

risky behaviors.

Table 2

Analysis of studies that had students as subjects

References Sample Methodology

Psychological

factors

1. Bryan et al.,

(2017).

537 US volunteer

students, (18-60)

average 21.75 years,

74.7% women,

managed online

(extra course

credits).

Cross-sectional study

Brief Symptom Inventory-18 (BSI-18),

The Daily Drinking Questionnaire, The

Rutgers Alcohol Problem Index (RAPI),

The Authenticity Inventory-3 (AI-3), The

Three-Item Loneliness Scale (TILS)

anxiety,

depression

Conclusions and

findings Loneliness correlates positively with poor mental health, anxiety and depression.

2. McDougall et

al., (2019).

6939 students under

30, Maritime

Canada

Online cross-sectional study, 20-25

minutes, 44 multiple-choice items, +

Center for Epidemiologic Studies depression


150


Psychological

factors

Depression

(CES-D12),

Conclusions and

findings A percentage of 36.7% of students are at risk of depression

3. Ngo et al.,

(2018).

735 young people

(18-25 years old,

average 21.5) 270F

and 465M

Ahimsa Project, Revised Conflict Tactics

Scales (CTS-2), Alcohol Use Disorders

Identification Test–Consumption (AUDIT-

C), Five Factor Mindfulness

Questionnaire–Short Form, Brief

Symptom

Inventory

anxiety,

aggressivity

Conclusions and

findings

No gender differences in anxiety. It is unclear whether anxiety precedes aggressivity

(mental behavior) or vice versa

4. Pelletier,

Lytle, and

Laska, (2016).

441 students under

35 (Body Mass

Index of 20-

35kg/m2),

community colleges

Minnesota, USA


Shorr height boards (Irwin Shorr, Olney,

MD) and Tanita scales (Tanita TBF-300A

Body Composition Analyzer, Arlington

Heights, Cohen Perceived Stress Scale, stress

Conclusions and

findings

High levels of stress have been associated with a high prevalence of overweight and

obesity.

5. Agardh et al.,

(2012a).

980 students (80%

of the total

university), Uganda


self-administered questionnaire (132

items) + Hopkins Symptoms Checklist-25

and Symptom Checklist-90

anxiety,

depression, anger

Conclusions and

findings

High scores in anxiety are associated with high number of partners (M) and inconsistent

use of condom (M). High scores in depression (15% M, 16% F) associated with a large

number of sexual partners (F, M), Sexual activity can be related to anger, a strong

element in men with depression.

6. Agardh et al.,

(2012b).

1220 students,

University of

Mbarara, Uganda

(under 23 years and

over), average 23

years, 64.6% M,

35.4% F


self-administered questionnaire (132

items), English language, + Hopkins

Symptom

Checklist (HSCL-25) and Symptom

Checklist-90 (SCL-90) anxiety/depression

Conclusions and

findings

Poor mental health is (anxiety and depression) associated in women with threats, and in

men with effective physical violence. Women have higher scores in depression, but the

relationship between depression and violence is similar (F, M). Sexual coercion has been

significantly associated with poor mental health (F, M)

7. Cazan, and

Truța, (2015).

341 (260F, 81 M)

Romanian students,

(average age 20.65)

Validation study (cross-sectional)

The Adolescent Resilience Scale, The

Student-life Stress Inventory (SSI); The

Satisfaction with Life Scale,

stress,

emotionality

Conclusions and

findings

Stressors worked as mediators between resilience, reaction to stress and life satisfaction.

Emotional regulation has a mediating effect on reactions to stress.

8. Mutalik et al.,

(2016).

118 students (42%

M) in the first year,

18-25 years

(average 21)


Depression, Anxiety and Stress Scale

(DASS 21), General Health Questionnaire

28 (GHQ 28)

anxiety,

depression, stress


151


Psychological

factors

Conclusions and

findings High levels of depression, anxiety and stress were identified.

9. ul Haq et al.,

(2018).

361 students,

Punjab University,

Lahore, Pakistan


self-administered questionnaire:

demographic data + DASS-21

anxiety,

depression, stress

Conclusions and

findings

Male participants had higher levels of anxiety, depression and stress compared to female

participants. Students with educated parents had fewer symptoms. High levels of

anxiety, depression and stress were found where the mother was illiterate. The level of

anxiety is higher where the father is educated below the level of high school graduation.

Symptoms of depression and stress have higher values in students living with family

than those living alone or with friends (anxiety does not differ).

10. Yavuzer et

al., (2019).

904 students

(average 25 years)

volunteers

different

specializations

Anatolia (Turkey)

65.7% F, 34.3% M


Self-Theory Scale, KAR-YA Aggression

Scale (KAR-YA AS), Beck Depression

Inventory, UCLA Loneliness Scale

(UCLA)

depression,

aggression

Conclusions and

findings

Loneliness leads to the development (exacerbation) of depression. Depression is a

positive predictor of aggressivity in young adults.

Table 3

Analysis of studies that researched both psychological factors and risky behaviors


Psychologic

al factors

Behaviors

approached

through the

risk

dimension

1. Davis et al.,

(2012).

225 young men, 21-

35 years old, single,

volunteers,

Cross-sectional, quantitative study

Eligibility conditions, laboratory,

male operator, consent, computer

application: drinking calendar and

history questionnaire, Modified

Sexual Experiences Survey

(MSES), aggressivity

alcohol

consumption,

sexual

activity

Findings

(psychological

factors)

Very consistent association between alcohol consumption and lack of condoms in sexual

assault. Men who have high expectations about the effect of alcohol on risky sex and

aggressivity are most likely to commit sexual assault without a condom under the influence

of alcohol.

Findings

(behaviors)

Alcohol consumption considerably reduces condom use. Incapacitated rapes are positively

associated with alcohol consumption by the aggressor. 51.5% of penetrating sexual assaults

involved alcohol consumption and lack of condoms. Very consistent association between

alcohol consumption and lack of condoms in sexual assault.

2. Garthe et

al., (2018).

1087 young people

(51% M), 7th grade,

ethnic and racial

diversity,

disadvantaged

communities, USA

Secondary data analysis + cross-

sectional study (computer-assisted

interview + teachers’ reports on

anxiety and depression in

adolescents. The Problem

Behavior Frequency Scale,

anxiety,

depression,

aggressivity

sexual

activity


152


Psychologic

al factors

Behaviors

approached

through the

risk

dimension

adapted Safe Dates aggression

scale, Behavioral Assessment

System for Children (BASC)

Findings

(psychological

factors)

Teenagers in the category violence against their peers and couples had higher levels of

anxiety than those in the class minor violence. The coincidence of violent relationships (eg:

colleagues aggressivity and victimization, violence against colleagues and peers),

substantially increase the risk of depressive symptoms in young adolescents.

Findings

(behaviors) Not relevant.

3.McDougall,

et al., (2019).

6939 female students

under 30, Maritime

Canada

Online cross-sectional study, 20-

25 minutes, 44 multiple-choice

items, + Center for Epidemiologic

Studies Depression (CES-D12),

reminders and incentives,

informed consent depression

alcohol

consumption,

sexual

activity

Findings

(psychological

factors) A percentage of 36.7% of the participating female students reveled a risk of depression.

Findings

(behaviors)

Risk behaviors and substance abuse have been associated with an increased risk of

depression. A percentage of 6.8% were victims of non-consensual sex during university

courses. The risk of depression was found to be 2.1 times higher than in non-victims.

4. Ngo et al.,

(2018).

735 young people

(18-25 years, average

21.5) 270F and

465M


Ahimsa Project, Revised Conflict

Tactics Scales (CTS-2), Alcohol

Use Disorders Identification Test

– Consumption (AUDIT-C), Five

Factor Mindfulness Questionnaire

- Short Form, Brief Symptom

Inventory

anxiety,

aggressivity

alcohol

consumption

Findings

(psychological

factors)

No gender differences in anxiety. 27.2% committed physical violence in a couple, 16.5%

committed sexual violence in a couple.

Findings

(behaviors)

A percentage of 58.6% of the particiapnts reported alcohol consumption. High alcohol

consumption is associated with higer aggressivity of physical violence as of sexual violence

in couple, also.

5. Shwartz et

al., (2020).

1055 women Arab

(248) and Jewish

(807) Israel, 18-48

years (6 weeks - 6

months from birth)


female interviewers, trained,

Arabic / Hebrew, private rooms,

Edinburgh Postnatal Depression

Scale

(EPDS), + specific questions

depression,

stress

sexual

activity

Findings

(psychological

factors)

A percentage of 10.3% of participants showed postpartum depression (20.7% Arabs, 7%

Jews), 36% exercised violence against their intimate partner. Increased chronic stress

produces an indirect effect on postpartum depression.

Findings

(behaviors)

Unplanned pregnancy increases the risk of intimate partner violence and postpartum

depression.


153


Psychologic

al factors

Behaviors

approached

through the

risk

dimension

6. Tutino et

al., (2018).

306 men, students

Ottawa, Canada, 17-

47 years old (average

19.97) who reported

sexual activity alone

or with a partner in

the last 4 weeks

Cross-sectional online study,

online, consent, questionnaire

packet, ASI-3 Difficulties in

Emotion Regulation Scale

(DERS;) Depression Anxiety

Stress

Scales (DASS), Male Sexual

Function Index (MSFI), Sexual

Quality of Life Scale – Male

Version (SQoL-M) and Sexual

Experiences Questionnaire (SEQ),

offset by course credits,

anxiety,

stress,

emotionality

sexual

activity

Findings

(psychological

factors)

Greater sensitivity to anxiety leads to more difficulties in emotional regulation). Emotional

regulation moderates the relationship between sensitivity to anxiety and anxiety symptoms.

High mental stress (suffering) leads to poor sexual results. Men with high sensitivity to

anxiety and maladaptive emotional regulation skills: are more likely to develop symptoms

of anxiety and depression, more likely to experience sexual difficulties with functionality

and satisfaction.

Findings

(behaviors)

The same factors that make you mentally vulnerable (sensitivity to anxiety, difficulties in

emotional regulation) lead to difficulties in sexual health. Psychological risk factors were

associated with greater difficulties in sexual arousal, orgasm (F, M) and desire (M). Mental

health difficulties can have a greater impact on men’s sexual function and quality of sex

compared to frequency.

7. Vencill,

Tebbe, and

Garos, (2015).

426 heterosexual

women, over 18

years old

cross-sectional study

General Internalization subscale of

the Sociocultural Attitudes

Toward Appearance Scale

(SATAQ-3), Surveillance

subscale of the Objectified Body

Consciousness Scale (OBCS;),

Depression subscale of the

Depression Anxiety Stress Scale-

21 (DASS-21), Zung Self-Rating

Depression Scale (SRDS;), Center

for Epidemiological Studies-

Depression Scale–Revised

(CESD-R), The Body Exposure

during Sexual Activities

Questionnaire (BESAQ), Sexual

Quality of Life Questionnaire-

Female (SQoL-F)

anxiety,

depression

sedentary

lifestyle/

physical

activity

Findings

(psychological

factors)

Image anxiety is a mediator in the relationship between body surveillance and sexual well-

being. Depression is a mediator in: the relationship between body surveillance and sexual

well-being, between self-objectification and sexual functionality.

Findings

(behaviors)

Image anxiety during sexual activity is negatively associated with sexual physical

functionality. Participants more involved in body monitoring had a higher tendency to

experience depression and image anxiety specific to sexual activity.


154


Psychologic

al factors

Behaviors

approached

through the

risk

dimension

8. Agardh et

al., (2012a).

980 students (80% of

the total university),

Uganda


self-administered questionnaire

(132 items) + Hopkins Symptoms

Checklist-25 and Symptom

Checklist-90

anxiety,

depression,

anger

alcohol

consumption,

sexual

activity

Findings

(psychological

factors)

High anxiety scores associated with large number of partners (M) and inconsistent

condom use (M). High scores in depression (15% M, 16% F) were associated with a large

number of sexual partners (F, M). Sexual activity has been linked to anger, a strong

element in men with depression.

Findings

(behaviors)

Strong effect of the high frequency of episodes of excessive drinking, as a measure of

mental health control in terms of sexual activity and the large number of partners. High

scores in anxiety associated with large number of partners (M) and inconsistent use of

condom.

9. Agardh et

al., (2012b).

1220 students,

University of

Mbarara, Uganda

(under 23 years and

over), average 23

years, 64.6% M,

35.4% F


self-administered questionnaire

(132 items), English language +

Hopkins Symptom

Checklist (HSCL-25) and

Symptom Checklist-90 (SCL-90)

anxiety,

depression,

aggression

sexual

activity

Findings

(psychological

factors)

Poor mental health (anxiety and depression) has been associated with women with threats,

and in men with actual physical violence. Women have higher scores in depression, but the

relationship between depression and violence is similar (F, M). Sexual coercion was

significantly associated with poor mental health (F, M).

Findings

(behaviors)

A percentage of 31.1% of respondents experienced sexual coercion (regardless of gender),

a significant association between experiencing sexual coercion and exposure to violence.

10. Breet et al.,

(2019).

210, South Africa,

peri-urban,

HIV/AIDS survivors


self-report questionnaire, Conflict

Tactics Scale – Revised (CTS2),

Beck Depression Inventory –

Second Edition (BDI-II), PTSD

Symptom Scale – Self-Report

(PSS-SR), English / Afrikaans /

isiX-hosa language, rewarded

with voucher to the supermarket,

depression,

stress,

aggression

sexual

activity

Findings

(psychological

factors)

A percentage of 48% manifested moderate-severe depression (M, F). Women who reported

symptoms of moderate-severe depression tended to report 4 times more physical

aggressivity (committed). Men who reported more severe symptoms of post-traumatic

stress reported 3 times more sexual coercion (committed). Women who reported more

severe PTSD symptoms were more than 3 times more likely to commit psychological

aggressivity. 44.4% M and 39.3% F committed physical aggressivity, 52.4% M and 46.4%

F committed psychological aggressivity

Findings

(behaviors) A percentage of 42.9% male and 23.8% female committed sexual coercion.


155


Psychologic

al factors

Behaviors

approached

through the

risk

dimension

11. Carney et

al., (2019).

662 active soldiers

(over 18 years old)

infected with HIV,

USA

Longitudinal study informed

consent, self-reported multiple

measurements Center for

Epidemiological Studies

Depression (CES-D 2006-2010) +

Sexual risk behavior surveys

(RBS 2015) depression

alcohol

consumption,

sexual

activity

Findings

(psychological

factors)

A percentage of 57% of the participants reported mild symptoms of depression, 26% recent

onset, 17% severe depression (90% undiagnosed). Participants with clinically diagnosed

depression (10%) reported fewer condom use with new sexual partners than undiagnosed

ones. Those with newly onset depression and severe depression use fewer condoms with

new sexual partners (and more than 2 in the last 3 months) than those with reduced

depressive tendencies.

Findings

(behaviors)

A linear relationship was found between daily alcohol consumption and increased risk of

engaging in harmful sexual behaviors. Respondents with severe depression and those with

recent onset were more likely to engage in risky sexual behaviors than those with mild

depression.

12. Choudhary

et al., (2012).

61187 adults USA,

(over 18 years old),

48.75% M, 51.25%

F,


Behavioral Risk Factor

Surveillance System (BRFSS)

questionnaire

anxiety,

depression

sexual

activity

Findings

(psychological

factors)

A percentage of 5% were victims of sexual assault, of which: 8.37% manifested anxiety

disorder, 18.82% diagnosed depression, 28.28% diagnosed depression and anxiety.

Findings

(behaviors)

A percentage of 5.3% stated that they were victims of sexual abuse (88.84% F). Anxiety

and depression had significantly higher values in victims of sexual assault.

13. Kalina et

al., 92011).

3725 (limited to

2318) students, 13-

16 years (51% F),

schools – towns in

Slovakia

Cross-sectional, quantitative

study, questionnaires addressed in

2 consecutive hours (90 minutes).

Self-esteem (Rosenberg);

Psychological well-being (GHQ-

12)

anxiety,

depression

alcohol

consumption,

sexual

activity

Findings

(psychological

factors)

Older boys who reported having more frequent sex had higher levels of positive self-esteem,

higher levels of psychological well-being (for those who reported low numbers: higher

scores were reported in depression/anxiety, social functioning problems)

Findings

(behaviors)

A percentage of 48.2% (108) reported sexual activity after drinking alcohol, 37.5% without

a condom at the last report, sometimes followed by unwanted pregnancy. Of total

respondents, 33.9% (224) had first sexual intercourse, after at least one month of

relationship, 19.6% had> 4 partners; Reported effects: sexually transmitted diseases,

unwanted pregnancy.

14. Maina et

al., (2020).

606 girls, 10-14

years old, Nairobi,

Kenya

Longitudinal study (secondary

stage)

face-to-face interview with

trained operators, women,

parental consent depression

sexual

activity

Findings

(psychological

factors)

A percentage of 60% of girls have reported at least one symptom of depression in the last

12 months. Girls with depressive symptoms were more likely to have sexuality in the pattern

“experienced”.


156


Psychologic

al factors

Behaviors

approached

through the

risk

dimension

Findings

(behaviors)

A percentage of 13% out of the participants reported naive or experienced sexual

experience.

15. Rada,

(2020).

601 geriatric patients

in a institute, 55-93

years old (average

67.32)


informed consent, The Geriatric

Depression Scale long form

(GDS), ++ depression

sexual

activity

Findings

(psychological

factors) Association between those who report sedentary lifestyle and depression were found.

Findings

(behaviors) Not relevant.

Table 4

Analysis of studies that researched psychological factors unrelated to risky behaviors


Psychological

factors

1. Bryan et al.,

(2017).

537 US volunteer

students, (18-60),

average 21.75 years,

74.7% women,

managed online (extra

course credits).


Brief Symptom Inventory-18 (BSI-

18;

Derogatis, 2000), The Daily Drinking

Questionnaire, The Rutgers Alcohol

Problem Index (RAPI), The

Authenticity Inventory-3 (AI-3), The

Three-Item Loneliness Scale (TILS) anxiety, depression

Findings

(psychological

factors) Loneliness positively correlates with poor mental health, anxiety and depression.

2. Dobson,

Ahnberg

Hopkins, Fata,

Scherrer, and

Allan, (2010).

High-risk adolescents

(high score on severe

depression but no major

depressive disorder or

current or past manic

episode), Calgary,

Alberta, and Canada.

25- “Coping with

stress”, 21- “Let’s talk”


Center for Epidemiological

Studies–Depression Scale (CES-D),

Computerized Diagnostic Interview for

Children and Adolescents for DSM-IV,

Mood and Anxiety Symptom Questionnaire

(MASQ), Rosenberg Self-Esteem Scale

(RSES)

anxiety,

depression

Findings

(psychological

factors)

The CBT protocol as well as the “Let’s talk” protocol reduce the severity of depressive

and anxiety symptoms in high-risk adolescents and increase self-esteem.

3. Bonsaksen

and Lerdal,

(2012).

18 (12M, 6F)

hospitalized psychiatric

patients (average 7-8

months of treatment),

Oslo, Norway, average

age 43.7 years.


The Global Assessment of Functioning Scale

(GAF), International Physical Activity

Questionnaire (IPAQ), The World Health

Organization Quality of Life – BREF

anxiety,

depression


157


Psychological

factors

(WHOQOL-BREF), The Hospital Anxiety

and Depression Scale (HADS)

Findings

(psychological

factors)

Patients with different diagnoses of schizophrenia reported higher levels of depression

and anxiety.

General levels of physical activity were low and did not seem to relate to quality of life.

Patients with different diagnoses of schizophrenia were more physically active and

reported a lower quality of life.

4. Lloyd et al.,

(2017).

53 F, 21-25 years

(average 22.7),

outpatient

psychotherapy clinic,

Sweden

Multi-modal study, predominantly

qualitative, semi-structured interview.

Quantitative: Karolinska Scales of

Personality (KSP), Multidimensional

Measurement of Religiousness/Spirituality

for Use in Health Research, Structural

Analysis of Social Behaviour-Self-Concept

(SASB),

anxiety,

depression,

aggressivity

Findings

(psychological

factors)

High anxiety. Tendency to depression. Participants with high scores in depression had

a negative conception of themselves and a lack or inability to use existential resources.

Inhibition of aggressivity.

5. Wolff and

Baglivio,

(2017).

27720, (21% of

juvenile delinquents

who completed

Community sanction

service), Florida

Data analysis,

centralized community sanction service

database, Full Community Positive

Achievement Change Tool (C-PACT)

anxiety,

depression,

emotionality

Findings

(psychological

factors)

(Anxiety and depression were included in the negative emotionality). About 50% of the

observed effects of adverse childhood experiences are indirectly activated by negative

emotionality. Children with a more negative perception of others and the environment

and those whose (negative) emotions are easier to activate are more likely to engage in

antisocial behaviors.

6. Cazan and

Truța, (2015).

341 (260F, 81 M)

Romanian students,

different faculties

(average age 20.65)

The Adolescent Resilience Scale, The

Student-life Stress Inventory (SSI); The

Satisfaction with Life Scale

stress,

emotionality

Findings

(psychological

factors)

Stressors acted as mediators between resilience, reaction to stress, and life satisfaction.

Emotional regulation has a mediating effect on stress reactions.

7. Masters et

al., (2019).

391 students (56% F),

Australia, grades 6-8

(monitored up to 9-11)

Longitudinal, quantitative study

parental consent, questionnaire applied 4

times, kept 3 (for each year) last year was

completed online. The Social Anxiety Scale

for Adolescents (SAS-A), The Short Mood

and Feelings Questionnaire (SMFQ), The

Difficulty in Emotion Regulation Scale

(DERS),

anxiety,

depression,

emotionality

Findings

(psychological

factors)

Early emotional disorders associated with symptoms of anxiety and subsequent

depression, instead associated with emotional disorders. There is a process of emotional

problems in adolescents, in the transition from early to middle adolescence. Lack of

emotional clarity, non-acceptance of emotional responses, difficulties in controlling

impulses, limited access to emotional regulation strategies, and difficulties in engaging

in goal-oriented behaviors


158


Psychological

factors

8. Mutalik, et al.

(2016), May

118 students (42% M)

in the first year, 18-25

years (average 21)

Informed consent, Depression, Anxiety and

Stress Scale (DASS 21), General Health

Questionnaire 28 (GHQ 28),

anxiety,

depression,

stress

Findings

(psychological

factors)

The level of anxiety was found to be higher than that of depression, followed by stress

(DASS 21). Female respondents had higher levels of emotional distress than male

respondents (GHQ 28).

9. Soleimani et

al., (2017).

October-

November 2015

399 teenagers (14-19

years old), Qazvin, Iran

Cross-sectional, descriptive study, Revised

Child Anxiety and Depression Scale

(RCADS), Iranian Adolescents Risk-taking

Scale (IARS),

anxiety,

depression

Findings

(psychological

factors)

Anxiety and depression significantly predict the occurrence of risky behaviors, along

with: having smoking friends, suicidal ideation, and strong suicidal ideation.

10. ul Haq et al.,

(2018).

361 students, Punjab

University, Lahore,

Pakistan


self-administered questionnaire:

demographic data + DASS-21

anxiety,

depression,

stress

Findings

(psychological

factors)

Male participants had higher levels of anxiety, depression and stress compared to female

participants. Students with educated parents had fewer symptoms. Symptoms of

depression and stress have higher values in students living with family than those living

alone or with friends (anxiety is no different). The illiterate mother correlates with high

levels of anxiety, depression, stress. The level of depression is higher where the father

is illiterate. The level of anxiety is higher where the father is educated below the level

of high school graduation.

11. Yavuzer et

al., (2019).

904 students (average

25 years) volunteers,

different specializations

Anatolia (Turkey)

65.7% F, 34.3% M

Transverse sturgeon

Self-Theory Scale, KAR-YA Aggression

Scale (KAR-YA AS), Beck Depression

Inventory, UCLA Loneliness Scale (UCLA)

depression,

aggression

Findings

(psychological

factors)

Loneliness leads to the development (exacerbation) of depression. Depression is a

positive predictor of aggressivity in young adults. Loneliness and depression were found

to be positive predictors for aggressivity in young adults, while self-conception was

found to be a negative predictor.

12. Yuan and

Hesketh,

(2019). July-

September 2018 2987 women, China

Partly Conflict Tactics Scale-2 (CTS-2),

partly Composite Abuse Scale, The Center

for Epidemiologic Studies Depression

Scales (CES-D) (paper and electronic) depression

Findings

(psychological

factors)

Prevalence of depression: 65.8% experienced psychological violence, 69.5% physical

violence, 75.8% sexual violence.

13. Pelletier et

al., (2016).

2011 - 2012

441 students under 35

(index of 20- 35kg/m2),

community colleges

Minnesota, USA


Shorr height boards (Irwin Shorr, Olney,

MD) and Tanita scales (Tanita TBF-300A

Body Composition Analyzer, Arlington

Heights, Cohen Perceived Stress Scale stress

Findings

(psychological

factors)

High levels of stress have been associated with a high prevalence of overweight and

obesity.


159

Table 5

Analysis of studies that researched only risky behaviors in students

References Sample Methodology Behaviors

approached

through the risk

dimension

1.

Choudhry

et al.,

(2014).

2010

1954 students, under 22,

over 22, University of

Mbarara, Uganda


self-administered questionnaire, 132

items, English language

alcohol

consumption,

sexual activity

Findings

(behaviors)

Alcohol consumption has been associated with 2 or more sexual partners in the last year (M, F).

Significant associations between: alcohol consumption in general, alcohol consumption in

relation to sexual activity and alcohol consumption at the last sexual intercourse with having

multiple sexual partners. Inconsistency in condom use with new sexual partners was significant

for men who consumed alcohol in connection with sexual activity. For women who drank

alcohol frequently in connection with sexual activity, the risk of inconsistency in condom use

was 2 times higher.

2. Kilwein

and Looby,

(2018).

108 students, 18-24 years

old (average 19.9),

Midwestern US, 90 female

(83.3%)


Daily Drinking Questionaire (DDQ);

Drinking Motives Questionnaire -

Revised (DMQ-R); Cognitice Appraisal

of Risky Events Revised (CARE-R) -

Risky sexual Activity Scale

alcohol

consumption,

sexual activity

Findings

(behaviors)

Risky sexual behavior more often when consuming alcohol. Reported risky sexual activities:

unprotected sex, sexual coercion, sex with unknown partners. The trend towards risky sexual

behavior increases by 10.4% with each unit of social reasons. Individuals with strong reasons

for strengthening/intensifying (validation) were prone to risky sex (regardless of alcohol level).

3. Looby et

al., (2019).

2039 (out of 7307)

students, 18-24 years old

(average 19.79, at 10

universities in 10 US

states, 1485 female

(72.83%)


online questionnaire; informed consent,

credit for participation in scientific

research, M-DMQ-R, Protective

Behavioral Strategies Scale-20 (PBSS-

20); DDQ; CARE-R-FOI;

alcohol

consumption,

sexual activity

Findings

(behaviors)

Alcohol consumption mediates the association between social reasons and risky sexual behavior,

between reasons for reinforcement and risky sexual behavior. Risky sexual activities:

unprotected sex, sexually transmitted diseases, multiple sexual partners, risky sexual partners,

sexual coercion. Reduction of serious harm (negative effects) mediates the association between

social reasons and risky sexual behavior; Reduction of serious harm mediates the association

between reasons for reinforcement and risky sexual behavior;

Acknowledgements

This study is part of the doctoral research project entitled "Psychological factors involved in

risk behaviors in Romanian students", PhD. Student LUNGU Mihaela, coordinated by PhD. Cornelia

Rada, at the School of Advanced Studies of the Romanian Academy, "Constantin Rădulescu-Motru"

Institute of Philosophy and Psychology, Department of Psychology, Romanian Academy, Bucharest,

Romania.


160

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ASSESSMENT OF THE QUALITY OF LIFE OF A GROUP OF SUBJECTS AGED 65 AND

OVER (MOROCCO)

Abdellatif BAALI (1), Hakima AMOR (1), Raja ZAKARIA (1), Noureddine EL KHOUDRI (2),

Nadia FATHI (3), Nadia EL KADMIRI (3)

DOI: http://doi.org/10.26758/11.1.11

(1) Laboratory of Human Ecology, Faculty of Sciences Semlalia, "Cadi Ayyad" University,

Marrakesh, Morocco; E-mails: [email protected]; [email protected];

[email protected]

(2) Higher Institute of Health Sciences, "Hassan I" University, Settat, Morocco; E-mail:

[email protected]

(3) Molecular engineering, valuation and environment team, Multidisciplinary Faculty, "Ibn Zohr"

University, Taroudant, Morocco; E-mails: [email protected]; [email protected]

Address correspondence to: Abdellatif Baali, Laboratory of Human Ecology, Faculty of Sciences

Semlalia, Cadi Ayyad University, Bd. My Abdallah, BP 2390, Marrakesh, Morocco. Ph.:

212661613396; E-mail: [email protected]

Abstract

Objective. The aim of this study was to assess the health related quality of life of elderly Moroccans

living at home as well as determining the factors that influence it.

Material and methods. The data was gathered through a questionnaire survey conducted between

2017 and 2018. Age, gender, level of education, socio-professional activity, morbidity and perception

of old age were chosen as variables, and the LEIPAD scale was used to evaluate the respondent’s

quality of life, French version.

Results. This study included 520 subjects aged 65 and above (277 men and 243 women). The average

age was 71.2 years, and 60.8% of them were illiterate, 22.3% employed, 25.0% retired, and 52.7%

have never worked. In addition, 57.9% of participants had at least one chronic illness and 42.9% had

a pessimistic attitude toward old age. Overall, the surveyed subjects’ quality of life was adequate and

satisfactory. The main ratings for the areas involving "taking care of oneself" and "depression-

anxiety" were the lowest (23.7 and 28.6). On the other hand, the "sexual functioning" area was the

most affected (score=73.7), thus impacting the participants’ quality of life. Furthermore, socio-

demographic characteristics proved to have a negative impact on the participants’ quality of life. The

highest average test scores were reported by women, the oldest subjects (>-75 years), subjects with

low levels of education, without professions and retirees, suffering from chronic diseases and those

who negatively perceived the old age, which showed a relatively impaired quality of life.

Conclusions. The majority of the surveyed people had a good quality of life. Nevertheless, providing

adequate treatment for the most disadvantaged elderly people could improve their quality of life and

help them reach the old age in good health.

Keywords: quality of life, elderly, test LEIPAD, Morocco.

https://www.journalstudiesanthropology.ro/en/assessment-of-the-quality-of-life-of-a-group-of-subjects-aged-65-and-over-morocco/a169/



166

Introduction

Globally, the number of people aged 65 and over will reach 1.5 billion by 2050, up from 703

million in 2019. The proportion of people in this age group has increased from 6% in 1990 to 9% in

2019 and will increase further to 16% in 2050, making one in every six people 65 years or older

(United Nations, 2019). Due to the impact of the techno-cultural environment and the significant

widespread medicalization, the majority of individuals were able to reach adulthood and,

subsequently, the old age. Nevertheless, aging is associated with the deterioration of elderly health,

sensory condition, nutritional state, and changes in their perception of life (progressive or brutal

isolation, lack of social contacts, confinement at home, etc.), ranging from material, physical or

financial incapacity (fragility, risk of dependence at the end of life...) to psychophysiological

problems (anxiety, depression, etc.). However, as people grow older, all of these factors may have a

negative effect on their quality of life. As a result, as the population ages, new issues emerge, such as

the rising prevalence of chronic diseases and physical disorders, which particularly affect the elders

(Monod-Zorzi, Seematter-Bagnoud, Büla, Pellegrini, & Jaccard, 2007; Lalive d'Epinay, Guilley,

Guillet, & Spini, 2008).

Quality of life is defined as an "individuals' perception of their position in life in the context

of the culture and value systems in which they live, and in relation to their goals, expectations,

standards and concerns" (World Health Organization (WHO), 1999). It is a very broad concept

influenced in a complex way by the participant's physical health, psychological state, level of

independence, active participation, social image, social support system, social relationships as well

as his or her relationship to the essential elements of his or her environment. Furthermore, the quality

of life would depend on the gender of the individual, his or her age, living conditions, family,

entourage, socio-economic level and state of health (chronic illnesses, health behaviors, etc.)

(Compagnone, Van, & Bouisson, 2007; Rada, 2020). Standardized and validated questionnaires

would allow a precise and a reliable assessment of the quality of life linked to the health of the elderly

individuals. The LEIPAD test (acronym resulting from the universities involved in creating it: Padua

and Brescia - Italy, Leiden - the Netherlands, and Helsinki - Finland) is one of the instruments that

can be used to identify seven dimensions of the individual's state of health: the physical function,

level of independence, anxiety and depression, cognitive functioning, social life, sexual life and life

satisfaction.

In addition, Morocco’s population, like the rest of the world, is rapidly aging: people aged

60 and over accounted for 8% in 2004, 10.5% in 2018, and 11.5% in 2020. In addition, by 2030, the

ratio will reach 15.4%, and almost a quarter of Moroccans (23.2%) will belong to this age group.

Furthermore, life expectancy at birth is expected to increase from 76.1 years in 2017 (71 years in

2004) to 80.4 years in 2050 (Haut-Commissariat au Plan (HCP) 2006; 2017) [High Commission for

Planning. In the face of these positive trends, improving the quality of life of the elderly is an

increasingly important challenge for the Moroccan country as well as for the responsible political and

health services, especially from this age group when the social security system is still fragile and

remote. In addition, in most cases, part or all of the care of the elderly is still mainly the responsibility

of the family, especially the children. Thus, the objective of this study was to evaluate the quality of

life of a group of individuals aged over 65 years old and living at home in Morocco using a specific

and validated self-administered scale, in order to detect the dimensions of the LEIPAD test that

affected the quality of life of these subjects and finally, to grasp the associated socio-demographic

factors.


The data for this study came from a survey conducted at the Marrakesh City Health Center

from 2017 to 2018, and the subjects were 520 elderly people over 65 years old. The subjects under


167

investigation were randomly selected during their visits to these health centers for consultation,

medical treatment or accompanying their family members. The data was obtained through direct

interviews and questionnaires on the subject. This information was collected anonymously,

respecting the confidentiality; the interviews were conducted only with the subjects who had

approved it in advance. The selected variables were: gender, age, education level, social professional

activities, health status (chronic diseases) and perceptions of old age, and were evaluated by the

following questions: "For you, what is like getting old?" to which there were two types of answer

(Yes/No). The quality of life of these subjects was assessed by the LEIPAD test (De Leo et al., 1998),

French version (Jalenques et al., 2013). This is a multi-dimensional instrument composed of 31 items,

each of them containing 2 to 6 items: physical function (understand the physical condition of the

elderly), self-care (the ability to carry out daily activities by oneself), depression-anxiety (right

anxiety assessment and perception of depression), cognitive function (attention, confusion, memory

problems), social function (individual integration and satisfaction in society), sexual function (interest

and sexual ability/activities) and life satisfaction (satisfaction with the standard of living and the

financial situation). The score for each item is divided into a 4-point Likert scale, ranging from 0

(better quality of life) to 3 (very poor quality of life) (Table 1). Therefore, high scores reflect changes

in the personal quality of life. A single total score is obtained by adding the scores of different items,

and the total score of each of the seven categories is converted linearly on a scale from 0 to 100.

The data was collected and statistically processed through SPSS PC 18. Qualitative variables

were expressed in quantity and percentage, while the quantitative variables were expressed in means

and standard deviation. The comparison between groups was performed by a Chi-square test for

qualitative variables, and the non-parametric test, Mann-Whitney and Kruskal-Wallis test for

quantitative variables. The significance threshold was set to 5%.

Results

Socio-demographic profile of the studied group

The results are shown in Table 1. The sample studied included 520 elderly people aged 65

and over living at home, including 277 men (53.3%) and 243 women (46.7%). The average age was

71.2 years (=6.5; range: 65-96 years), of which 65-74 years old accounted for the highest proportion,

75.8%, while older people or those over 4 years old (>=80 years old) represented only 6.3%. At the

time of the survey, more than half of the participants (58.5%) lived with their partners, while 6.5%

were single, 6.7% were divorced and 28.3% were widowed. In terms of education level, 60.8% of the

people in this sample were illiterate, 17.9% were in elementary schools, 14.2% were in middle

schools, and 7.1% were in higher education. As far as the social professional activities were

concerned during the survey, only 22.3% of the participants reported that they were still working at

the time of the survey, 25.0% had retired, and 52.7% had never worked or had no occupation. Among

retirees, only 19.0% received pensions. In addition, 57.9% of participants reported having at least one

chronic disease. Among them, 33.7% were suffering from one disease, 13.3% were suffering from 2

diseases, 9.0% were suffering from 3 diseases, and 1.9% suffering from 4 diseases. Diabetes and

hypertension were the two most common chronic diseases, at 26.3% and 24.4%, respectively,

followed by rheumatic diseases (12.9%), cardiovascular diseases (8.1%) and respiratory diseases

(4.2%). The prevalence of other reported diseases was relatively low (frequency between 0.2% and

2.5%). After medical diagnosis, these diseases were identified in 97.7% of cases. The proportion of

individuals enjoying medical insurance was 56.3%, of which 28.6% of the Medical Assistance Plan

(RAMed) in Morocco covering individuals socially disadvantaged. Finally, among the 326

participants who answered to the questionnaire on feelings of old age, 57.1% of them had positive

feelings about old age.


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Table 1

Socio-demographic profile of the study group

Variables Modalities Frequency %

Gender Men 277 53.3

Women 243 46.7

Age groups (in years)

65 – 74 394 75.8

75–84 93 17.9

>=85 33 6.3

Level of study No 316 60.8

Primary 93 17.9

Secondary and

more 111 21.3

Socio-professional activity Without profession 274 52.7

Active 116 22.3

Retired 130 25.0

Chronic diseases

Yes 301 57.9

No 219 42.1

Old age perception

Positive 186 57.1

Negative 140 42.9

Quality of life

The average LEIPAD test score of the elderly participants in the study was 33.7 (= 17.1).

Cronbach’s alpha value was 0.94. In order of importance, the average scores on each dimension of

the test were as follows: sexual function (73.7±27.1), physical (43.9±25.3), social (37.6±20.9), life

satisfaction (36.7±22.1), and cognitive function (33.1±24.1), depression and anxiety (28.6±24.8) and

finally self-care (23.7±25.1). The propositions of the scores of the responses to different test items

are given in Table 2. For the sexual function that had the greatest impact on the quality of life of the

study subjects, the ratio of individuals who were not interested in sex and completely abstain from

sexual relations range between 46.7% and 46.5%. In terms of function, the perception of the subject’s

health status seemed to affect the score of this dimension. Among the participants, 52.1% considered

their physical condition not good (17.1 is extremely poor), and other items were related to sleep

problems, feeling tired, etc., more than half of the participants were in a positive state. As for other

categories, regardless of the category, the percentage of individuals in good condition was very high.

In fact, participants usually had a positive view of their social life. They were satisfied with their

social relationships with their families and within the communities, their financial situation, current

living conditions, very optimistic for their future, mnemonic, attentive, neither anxious, nor depressed

and feeling that they had no difficulty in carrying out their daily tasks independently (climbing stairs,

eating, getting dressed, bathing).

Quality of life and profile of the studied group

Table 3 shows the results of the study on the relationship between the average score of the

LEIPAD exam and its components, as well as the socio-demographic characteristics of the

participants. The quality of life of the participants was statistically calculated, sorted by importance,


169

incidence, age, gender, literacy and awareness of old age. The participants suffering from chronic

diseases were the oldest ones, while also having a low level of education and a negative perception

of old age, thus having the highest average scores, i.e. their quality of life was relatively impaired.

For other variables, there was no correlation between the "Social Functioning" scale and the

satisfaction with life between men and women, as well as social professional activities, feelings of

old age and the "Depression and Anxiety" scale. Finally, the scales of "social function" and "sexual

function" seemed to had no connection with feelings of old age.

Table 2

Scores (in %) of the subjects' responses to the different items of the LEIPAD test

Scales and items Scores

0 1 2 3

Physical functioning

1–How would you rate your overall physical health? 8.9 38.9 36.5 15.8

6–Do you have sleep problems? 29.8 39.0 23.1 8.0 7–Do you feel tired‚ without energy? 16.3 41.4 28.9 13.4 9–Are you able to accomplish your usual tasks either at home‚ at work‚ or elsewhere? 31.5 26.4 25.9 16.3 12–How much do your physical health problems (if any) stand in the way of doing the

things you want to do? 32.9 35.8 17.1 14.2

Self-care

2–Are you able to get up and down the stairs without help? 46.9 33.7 12.5 6.8 3–Are you able to dress all by yourself? 69.2 19.7 7.5 3.6 4–Are you able to eat by yourself? 81.5 12.5 4.1 1.9 5–Are you able to bathe or take a shower by yourself? 56.3 22.1 16.8 4.8 10–Can you shop all by yourself? 46.1 23.6 10.6 19.7 11–Can you travel by public transportation? 45.4 21.7 13.7 19.2 Cognitive functioning

8–Do you have difficulties concentrating? 33.4 39.4 20.9 6.3 13–How often‚ would you say‚ does it happen that you are not able to think clearly or that

you are confused? 29.8 35.6 25.7 8.9

14–How much do your problems with thinking (if any) stand in the way of doing the things

you want to do? 38.7 38.2 15.8 7.4

15–How good is your memory? 19.7 50.0 19.5 10.8 16–How much do your memory problems (if any) stand in the way of doing the things you

want to do? 56.5 28.1 11.1 4.3

Depression and anxiety

17–Taking everything in consideration‚ how anxious do you feel? 26.5 41.8 21.1 10.6 18–How much do your feelings of anxiety (if any) stand in the way of doing the things you

want to do? 42.5 34.8 17.6 5.1

19–Taking everything in consideration‚ how depressed (blue) do you feel at present? 47.8 34.8 14.2 3.3 20–How much do your depressed feelings (if any) stand in the way of doing the things you

want to do? 54.6 31.0 11.1 3.3

Social functioning

21–How satisfied are you with your social ties or relationships? 40.4 48.3 9.8 1.5 22–Do you feel emotionally satisfied in your relationships with other people? 13.9 42.8 26.4 17.0 23–Is there someone to talk to about personal affairs when you want to? 39.2 25.2 21.2 14.4 Sexual functioning

24–Are you interested in sex? 5.8 15.6 31.2 47.4 25–How often do you have sexual contact? 3.3 16.3 31.5 49.0 Life satisfaction

26–How satisfied are you with your ability to manage your hobbies or recreational

activities? 21.4 41.3 25.2 12.2

27–How satisfied are you with your financial situation? 22.4 40.8 27.4 9.4 28–Do you feel you cannot afford the standard of living you would like? 39.7 34.6 18.0 7.7


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Scales and items Scores

0 1 2 3

29–How satisfied are you with your life at present when compared to the past? 22.6 33.9 28.3 15.2 30–Taking everything in consideration‚ how would you expect things will go in the future? 19.9 57.5 18.0 4.6 31–How much do your expectations of the future stand in the way of doing or initiating the

things you want to do (want)? 54.8 31.7 10.6 2.9

Table 3

Average scores of the LEIPAD test and each of its scales and socio-demographic profile of the

studied group

Variables Modalities LEIPAD PF SC DA CF SF XF LV

Gender Men 29.8±15.5 39.5±24.4 18.3±22.3 24.8±22.6 28.6±22.3 36.8±20.3 62.4±27.0 34.9±21.1 Women 38.1±17.8 48.9±25.6 29.9±26.8 33.1±26.4 38.2±25.0 38.6±21.5 86.6±20.8 38.7±23.0 U test 5.4*** 4.2*** 5.4*** 3.5*** 4.4*** 1.0 ns 10.5*** 1.7 ns

Age

groups (in years)

65 – 74 30.3±15.3 38.4±22.1 18.1±21.1 27.1±24.1 30.0±21.7 35.5±21.0 69.2±27.4 34.6±21.7 75–84 43.5±18.2 60.5±27.7 39.2±28.0 34.1±26.5 42.0±29.2 44.8±20.0 86.4±22.1 43.0±22.9 >=85 45.9±18.2 63.8±24.9 46.8±30.3 32.3±25.7 45.1±25.9 42.8±16.9 90.9±16.7 44.3±19.6

H test 52.8*** 67.5*** 67.2*** 6.6* 19.2*** 15.9*** 49.9*** 15.4***

Level of

study

No 36.8±17.9 47.6±26.4 27.6±26.4 30.3±25.3 36.6±25.2 39.3±20.6 80.6±23.9 39.9±22.5 Primary 32.7±15.7 41.7±24.9 19.1±24.4 30.6±26.7 28.5±22.0 43.8±20.4 65.9±28.0 39.5±19.8 Secondary

and more 25.7±12.5 35.3±19.8 16.6±19.4 22.2±20.1 27.1±20.6 27.6±18.8 60.4±28.5 25.2±18.6

H test 30.2*** 17.2*** 20.5*** 8.0* 14.7*** 37.3*** 53.8*** 38.0***

Socio-

professional

activity

Without

profession 37.0±17.7 47.0±26.2 27.3±26.8 30.9±26.5 35.7±25.0 40.3±21.3 84.2±22.0 40.2±22.0

Active 31.5±17.8 41.4±25.3 18.6±23.8 28.5±24.2 32.5±24.2 36.0±21.6 61.4±28.5 37.2±23.2 Retirees 28.7±13.4 39.7±22.7 20.7±21.3 24.1±20.6 28.1±21.1 33.5±18.7 62.4±26.8 28.8±19.1 H test 19.6*** 7.7* 12.5** 4.0 ns 7.7* 10.6** 91.4*** 24.6***

Chronic

diseases

Yes 40.5±16.8 56.0±23.6 33.1±26.8 36.4±24.7 40.8±24.1 40.3±19.1 77.9±26.1 41.0±22.4 No 24.3±12.4 27.4±17.0 10.9±15.3 18.0±20.5 22.5±19.6 33.9±22.7 67.9±27.5 30.7±20.1

U test 10.9*** 13.0*** 10.5*** 9.0*** 8.6*** 3.3*** 4.4*** 5.1*** Old age

perception

Positive 34.0±16.6 45.1±25.4 23.6±24.9 31.3±25.2 33.9±22.7 39.8±20.8 72.0±28.3 34.6±21.2 Negative 41.0±19.2 53.2±27.4 32.1±28.8 36.0±27.5 44.0±25.2 41.5±20.6 75.2±27.6 44.9±24.5 U test 3.4*** 2.7*** 2.6** 1.5 ns 3.5*** 0.8 ns 1.1 ns 3.9***

PF=Physical functioning, SC=Self-care, DA=Depression and anxiety, CF=Cognitive functioning,

SF=Social functioning, SxF=Sexual functioning, LF=Life satisfaction. U and H test=Mann-Withney

and Kruskal-Wallis test, respectively;

*=p<0.05; **=p< 0.01; ***= p<0.001.


171

Discussions

The study included 520 Moroccans 65 years and older, including 277 men and 243 women.

The average age was 72.2 years, and there were very few subjects (6.3%) aged 80 years and over,

while the number of subjects in the 65-74 age group is 75.8%. This fact can be attributed to the

difference in mortality and the decrease in life expectancy with age; nationwide, the life expectancy

at birth in 2018 was 76.1 years (HCP, 2017). Most of the study subjects lived with their families

(92.3%), and more than half (58.5%) lived with their husbands and wives. Family life enables social

connections and solidarity and mutual assistance between family members, thereby helping to

improve the quality of life of the elderly. Compared with the national level of 2012, the literacy rate

of the surveyed samples (37.7%) was very high, i.e. 28% (Observatoire National du Développemet

Humain (ONDH), 2015) National Observatory for Human Development. This significant

improvement is the result of the progress made by the Moroccan country to improve the educational

level of all generations, and it is also the result of the large number of respondents in the sample

belonging to the 50s generation (65-69 years old) when the population gradually began to go to school

during the independence period. As for social professional activities, only 22% of the participants

were active at the time of the survey, which was relatively low compared to the 2012 study conducted

by Baali et al. (2012) in the city of Marrakesh. However, this study included participants of 60 years

and older. On the other hand, 25% of the participants retired and more than half (52.7%) had no social

activities. In fact, a large number of the surveyed elderly people have a low percentage of participation

in social and professional activities, which guarantees their retirement pensions. This is due to the

high percentage of women who have never participated in social and professional activities, 87.7%,

as opposed to men, who account for only 22%. Therefore, the proportion of people receiving pensions

was only 19.0%, a rate that was relatively low in 2017, among people aged 60 and over, i.e. (24.5%)

(Autorité de Contrôle des Assurances et de la Prévoyance Sociale (ACAPS), 2017) [Insurance and

Social Welfare Control Authority.

In addition, like all elderly people, the percentage of individuals with chronic diseases was

very high, and 57.9% of the surveyed participants reported having at least one chronic disease.

Diabetes and hypertension both accounted for 50.7% of the recorded chronic diseases; these diseases

were the most common diseases observed in a group of Moroccan participants, accounting for 34.1%

(the average age of the group was 64.3±21.6 years) (Elkafssaoui et al., 2017). The proportion of

individuals with chronic diseases recorded in our sample has increased along with the age; for the

three surveyed age groups, 50.2%, 61.3% and 77.6% of people had at least one chronic disease. This

result is consistent with research showing that aging increases the risk of chronic diseases (Monod-

Zorzi et al., 2007; Lalive d'Epinay et al., 2008). This will require treatment of affected individuals

because the treatment of these diseases is time-consuming and expensive. In addition, medical

insurance covers only a small part of the population, accounting for 60% (Agence Nationale de

l’Assurance Maladie (ANAM), 2016) [National Agency for Health Insurance. This rate has

increased since 2005 (25%), thanks to the generalization of the medical assistant scheme (RAMED)

since 2012. The surveyed sample with medical coverage rate (56.3%) was relatively close to the

national level, but the RAMED system sample accounts for more than half (27.7%). Finally, 42.9%

of the participants expressed negative opinions about old age; compared with 37.5% in 2012, this

proportion is relatively high (Baali et al., 2012). This feeling does not seem to be related to age or

incidence, but to the gender and education level of the participants. In fact, there were the women and

those with a low level of education who had a negative perception of ageism. Perception of aging is

considered one of the indicators of health and vulnerability: the more negative people’s perceptions

of aging, the easier it is for them to reach a worrying state of vulnerability (Bruin, Picavet, Nossikov,

& WHO Regional Office for Europe, 1996).

The quality of life of the participants seemed to be generally satisfying; the average LEIPAD

score was very low, at 33.7 (LEIPAD scores range from 0 to 93). In fact, 25% of participants scored


172

greater than 43 (75th percentile), and only 10% of participants scored greater than 59 (90th

percentile). The results showed that participants enjoyed greater autonomy, and very few of them had

difficulties in completing daily tasks independently without the help of anyone else (climbing stairs,

eating, dressing, bathing, etc.). Similarly, they were in a good mental health (very low average score

for the "depression and anxiety" dimension was very low). However, diagnosing the elderly with

depression and anxiety is still difficult (Thomas & Hazif-Thomas, 2008). In addition, their cognitive

function (mental ability, knowledge acquisition and memory) was satisfactory: the average score of

this dimension was low, and the score was higher than 70% of the cognitive function (mental ability,

knowledge acquisition and memory). The average score of this dimension was low, and more than

70% of the participants were in a positive state. This feature can be attributed to the predominance of

the 65-74 age group in this sample (75.8%). Moreover, they were doing quite well were more likely

to reach the age of 75.

As for the two variables "life satisfaction" and "social functioning", they reflected the extent

to which the surveyed people were satisfied with the standard norms of their life in the community

and their current financial situation as well as their perception of the future, which shows that the

respect which is granted to the elderly by the community, as well as the solidarity and the socio-

culturally governed family ties are still strong and solid for them. These attitudes and behaviors will

only have a positive impact on the individual's living conditions (providing daily needs, satisfactory

living conditions, shopping and travel expenses, access to medical care, etc.) and will reduce their

psychological deterioration. Nevertheless, the quality of life of the participants was affected by

certain changes caused by the "sexual function" variable, while the changes caused by the "body

function" variable were smaller. The average scores of these two variables were 73.3 and 43.9,

respectively. As for physical function, it seemed that the self-perception regarding the health had had

the greatest influence on the score of this variable. 47.8% of the participants thought they were in

poor physical condition (including 9% in extremely poor physical condition). The actual health status

of the participants made an important contribution to this self-assessment. In fact, 76.4% of

participants with a chronic disease believed that their health was very poor (including 28.6% of people

who were in poor physical condition), while only 18.8% of the participants (including 1, 4% who

were unwell) considered themselves to be unaffected (2 to 3ddl=177.8; p<0.001). Regarding other

items in the scale (sleep problems, feelings of fatigue, completing daily tasks, health-related

obstacles), most participants (over 55%) had the lowest score (0 or 1), indicating a better quality of

life. As for the "sexual functioning" scale, it is well known that problems related to sexual activity

are frequently encountered by the elderly (Jalenques, Auclair, Rondepierre, Gerbaud, &

Tourtauchaux, 2015; Kharrat, Mersni, Guebsi, Ben Salah, & Dziri, 2017). Many variables are

believed to have an influence on the sexual life of elderly participants, such as: reproductive aging,

hormone deficiency, related pathologies and their treatments (diabetes, hypertension), menopause,

psychosocial factors, sexual desire disorders (Graziottin & Leiblum, 2005; Grafeille, 2016).

In addition, the socio-cultural background may also be the reason for this result, because

sexuality is still considered a taboo topic, especially among people of this age group, and even among

unmarried elderly participants. However, the widowhood experienced by participants who lost their

spouse had a significant impact on this ratio. Widows had an average score of 96.5, and married

participants had an average score of 62.2 (average scores for divorced and single persons were 72.4

and 79.4). The latest work of Jalenques et al. (2015) and Kharrat et al. (2017), carried out on French

and Tunisian participants aged 65 and above (Figure 1), also revealed the negative impact of the scale

on the quality of life of the respondents. Finally, the average scores of the various scales obtained in

the study are higher than those of the French counterparts (except for LS); difference which could be

attributed to the obvious difference in the living conditions and caring conditions for the elderly

participants studied compared to their French peers. There are obvious differences in living conditions

and nursing conditions. On the other hand, the score registered for this research was much lower than

that of the Tunisian group. The difference between the two groups of elderly participants with


173

relatively similar socioeconomic levels was due to the fact that the average age of Tunisians (74.3

years) was higher than the average age of Moroccans (71.2 years), and the sample of Tunisians only

included participants who have been interviewed during their hospitalization.

Figure 1

Average scores of the dimensions of the LEIPAD scale of the studied group, compared to those of

their Tunisian and French counterparts

Furthermore, there is a clear relationship between the quality of life and its span and the

socio-demographic characteristics of the studied sample (Table 3). These results indicate that

women’s quality of life seemed to be more impaired than men’s, which could be attributed primarily

to sexual functioning. The average scores for women and men were 86.6 and 62.4, respectively. This

difference between men and women was especially likely to increase the frequency of women’s

widowhood; 48.6% compared to only 10.5% among men, as well as the response rate with "never"

to items related to sexual desire (item 24) and sexual activity (item 25) (Table 2), which were similar

to the widowhood rate of 47.4% and 49.0%. Moreover, it must be noted that the length of the marital

status is the result of women’s life expectancy at birth, which is relatively higher than that of men

(77.8 years vs. 74.5 years) (HCP, 2018). In addition to that, the age gap between spouses at the time

of marriage and the possibility of men remarrying after the death of their spouse is high. For the scales

of "social functioning" and "life satisfaction", there was no gender association, which shows the value

of this age group without any difference between men and women and the fact that the culture and

customs of the Moroccan society towards these people reinforce social ties which consequently leads


174

to supporting them as well as their integration into the society, as people who are wise, and

experienced, in addition to that as people who have effectively fulfilled their roles in society.

Moreover, the results showed that the quality of life of participants and all their scales

deteriorated with age. In fact, regardless of the dependent variable, the average score would

significantly increase with age. This is still the biggest differentiator of aging and has a great impact

on its quality. Similarly, the level of education, which is one of the most important factors that

determine personal living conditions and health status (better access to information related to health

education, nutrition and life hygiene), also seemed to affect the quality of life of elderly participants’

scale. The positive impact of intellectual activities on the quality of life of the elderly has been fully

demonstrated; compared with peers with a higher education level, illiterate or less educated people

suffer more damage (Martin, 2010). Consequently, education has a great influence on the cognitive

performance of older participants. This effect seems to be reflected in the lower allocation of

dedicated resources required to perform certain tasks (Guerrero-Sastoque, Bouazzaoui, Burger, &

Taconnat, 2017). However, the level of education was assumed to be closely related to the average

age of people with secondary education and above. The average age was 69.2 years (=4.4), while the

average ages of elementary school and illiterate counterparts were 70.2 years (6.3) and 72.2 years

(7.0), which showed a statistically significant difference (Kruskal-Wallis H=7.2; p<0.01). Morbidity

also greatly affected the participants’ health-related quality of life and various aspects. The physical

deterioration (high frequency of chronic pathologies) that older people are expected to face increases

with age (Monod-Zorzi et al., 2007; Lalive d'Epinay et al., 2008). Chronically ill participants were

statistically older than their unaffected counterparts (72.3±7.0 years vs. 69.7±5.4 years; Mann-

Whitney’s u-test=4.2; p<0.001). Professional activity is an essential element in an individual’s life

because it is obvious that any activity with a decent and stable salary would certainly have a positive

effect on the individual's living conditions while enabling him or her to meet their daily needs, and

to ensure a sufficient and a balanced nutrition, satisfactory living conditions, a better access to health

care and a satisfactory social life in general. Any activity in general whether it is professional or non-

professional, is associated with both physical and mental health. Socio-professional activities are

statistically related to the participants’ socioeconomic level, as well as to the participants’ quality of

life and all test scales, i.e. the Depression-Anxiety Scale (Kivits, Erpelding, & Guillemin, 2013).

Nowadays, living to old age and not being able to work exposes individuals without pensions

to severe economic insecurity this can only be addressed through special solidarity (mostly family

solidarity). There is no doubt that the family environment will have positive impact on the lifestyle,

the health state and the quality of life of the elderly, and the cohabitation will also contribute to intra-

and inter-generational family solidarity, with children providing care and kindness to their parents at

all stages of their lives and especially in old age. Therefore, the family is the most important social

institution that can meet the needs of the elderly. In fact, family members, especially children, will

provide elderly parents with all the financial means to meet their daily needs, especially for those

who cannot benefit from any type of social or medical insurance, which is the case for the majority

of elderly Moroccans. In addition, children will provide parents with psychological, emotional and

physical support, especially in vulnerable and/or dependent situations (HCP, 2006; Baali et al., 2012;

Baali et al., 2017). Similar to the education level and morbidity, age is also a confounding factor that

may affect the impact of social and professional activities on the quality of life of the studied samples.

Therefore, the subjects who declared they had never had a socio-professional activity and the retirees

were older than the participants who are still practicing a professional activity was of 71.7 years

(=7.2), 7.9 years (=6.3) and 69.3 years respectively (=4.1) (Kruskal-Wallis H test=8.9; p<0.01).

However, this only affected the scales of "physical function", "care", "cognitive function" and "life

satisfaction". Studies have shown that negative perceptions of aging have many effects on physical

health (Levy, 2000). In addition, older participants tend to have a negative perception about the future

and tend to be unsatisfied about their life (Netuveli, Wiggins, Hildon, Montgomery, & Blane, 2006).

However, in our case, age had nothing to do with the perception of age: participants who perceived


175

old age negatively were on average at the same age as their counterparts who had a positive view,

which was demonstrated in the result 70.9 (=6.3), and 71.8 (=6.8) years old (Mann-Withney u-

test=1.01; p=0.29). Similarly, there were no associations between this variable, morbidity and the

level of education.

Conclusions

The overall quality of life of Moroccan people over 65 and living at home was satisfactory.

However, the results showed that variables such as "sexual function", "physical function" and the

selected socio-demographic characteristics (gender, age, education level, occupational activity,

morbidity and perception of age) have a negative effect on the quality of life of the participants. Based

on the Moroccan socio-economic and cultural background, implementing programs for this age

group, focusing on preventing the consequences and effects of chronic diseases, preventing

vulnerability and dependence, good social integration and physical and intellectual maintenance

activities, as well as the professionalization of certain occupations, the improvement of the medical

and financial care, and the assistance to the most disadvantaged families are very necessary to ensure

that the elderly could enjoy a good "quality of life" in the years to come.

Conflict of interest: None

Acknowledgments

The authors sincerely thank all those who were deliberately involved in the investigation

and, consequently, the realization of this work. Also special thanks go to the Health Authority of

Marrakesh.

Funding

The authors received no financial support for the research, authorship, and/or publication of

this article.


176

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PERIOD 2012-2020

Specialists involved in the review of articles and abstracts published in the journals

Anthropological Researches and Studies (ARS) (ISSN 2360-3445; ISSN-L 2360-3445) and Studii și

Cercetări de Antropologie (SCA) (ISSN 2344-2824; ISSN-L 0039-3886) in the period 2012-2020.

1. Adina BACIU, "Francisc I. Rainer" Anthropology Institute of the Romanian Academy,

Bucharest, Romania.

2. Adriana ALBU, "Grigore T. Popa" University of Medicine and Pharmacy, Faculty of Medicine,

Department of Preventive Medicine and Interdisciplinarity, Iasi, Romania.

3. Albena NAKOVA, Institute of Philosophy and Sociology, Bulgarian Academy of Sciences,

Sofia, Bulgaria.

4. Alexandra COMŞA, Center of Thracology of the "Vasile Pârvan" Institute of Archaeology,

Romanian Academy, Bucharest, Romania.

5. Alexandra Elena NEAGU, "Francisc I. Rainer" Anthropology Institute of the Romanian

Academy, Bucharest, Romania.

6. Anca Adriana CUȘMIR, European Institute for Gender Equality, Vilnius, Lituania.

7. Andrei Dorian SOFICARU "Francisc I. Rainer" Anthropology Institute of the Romanian


8. Andrey KOZLOV, Lomonosov Moskow State University, Anuchin Research Institute and

Museum of Anthropology, Russia.

9. Angela SIMALCSIK, "Olga Necrasov" Center of Anthropological Research, Romanian

Academy, Iași Branch.

10. Anne RYEN, University of Agder, Faculty of Social Sciences, Department of Sociology and

Social Work, Kristiansand, Norway.

11. Aparna KHANNA, University of Delhi, Department of Development Communication and

Extension, New Delhi, India.

12. Archna KUMAR, University of Delhi, Department of Development Communication &

Extension at Lady Irwin College, New Delhi, India.

13. Atanas BALTADJIEV, Medical University of Plovdiv, Faculty of Medicine, Department of

Anatomy, Histology and Embryology, Bulgaria.

14. Aura PREDA, "Acad. Andrei Rădulescu" Legal Research Institute, Romanian Academy,

Bucharest, România.

15. Aurelian Petrus PLOPEANU, Alexandru Ioan Cuza University of Iasi, Department of

Interdisciplinary Research-Humanities and Social Sciences, Iasi, Romania.

16. Beatrice ABĂLAȘEI, Alexandru Ioan Cuza University of Iasi, Faculty of Physical Education

and Sport, Iasi, Romania.

17. Bianca FOX, University of Wolverhampton, Faculty of Arts, Department of Film, Media and

Broadcasting, Wolverhampton, United Kingdom.

18. Brighita VLAICU, "Victor Babes" University of Medicine and Pharmacy Timisoara, The

Faculty of Medicine, Department XIV: Microbiology, Timisoara, Romania.

19. Carmen STRUNGARU, University of Bucharest, Department of Anatomy, Animal Physiology

and Biopsysics, Bucharest, Romania.

20. Christiana KOUTA, Cyprus University of Technology, Faculty of Health Sciences,

Department of Nursing, Limassol, Cyprus.

21. Clara POPA, Rowan University, Department of Communication Studies, Glassboro, New

Jersey, USA.

22. Constanţa Nicoleta URZEALĂ, National University of Physical Education and Sports from

Bucharest, Faculty of Physical Education and Sports, Sports and Motor Performance

Department, Bucharest, Romania.


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23. Corina BISTRICEANU PANTELIMON, "Spiru Haret" University, Faculty of Psychology and

Education Sciences, Department of Psychology and Social Sciences, Bucharest, Romania.

24. Cornelia RADA, "Francisc I. Rainer" Anthropology Institute of the Romanian Academy,

Bucharest, Romania.

25. Corneliu BILBA, Alexandru Ioan Cuza University of Iasi, Faculty of Psylosophy and Social-

Political Sciences, Department of Political Studies, International Relations and European

Studies, Iasi, Romania.

26. Cristi PANTELIMON, The Institute of Sociology of the Romanian Academy, Bucharest,

Romania.

27. Cristian ȚIERANU, "Elias" Emergency University Hospital, Gastroenterology Department,

Bucharest, Romania.

28. Cristiana GLAVCE, "Francisc I. Rainer" Anthropology Institute of the Romanian Academy,

Bucharest, Romania.

29. Cristina FALUDI, "Babes-Bolyai University", Faculty of Sociology and Social Work, Cluj-

Napoca, Romania.

30. Diana BAKALOVA, Institute for Population Studies at Bulgarian Academy of Sciences, Sofia,

Bulgaria.

31. Diana ȘERBAN, National Anti-Drug Agency, Bucharest, Romania.

32. Diego Oswaldo CAMACHO VEGA, Universidad Autónoma de Baja California, Faculty of

Medicine and Psychology, Mexico.

33. Dobrinka PEICHEVA, South-West University "Neofit Rilski", Blagoevgrad, Faculty of

Philosophy, Department of Sociology, Blagoevgrad, Bulgaria.

34. Dorota, HALL Institute of Philosophy and Sociology of the Polish Academy of Sciences,

Warsaw, Poland.

35. Duska N. MATEVSKA, University "EURO-BALKAN", Faculty of Pedagogy, Skopje,

Macedonia.

36. Ecaterina BALICA, The Institute of Sociology of the Romanian Academy, Bucharest,

Romania.

37. Elena-Ana PAUNCU, "Victor Babes" University of Medicine and Pharmacy Timisoara, Faculty

of Medicine, Department of Internal Medicine, Timisoara, Romania.

38. Elena CIOBANU, Nicolae Testemitanu State University of Medicine and Pharmacy of the

Republic of Moldova, Department of General Hygiene, Chisinau, Republic of Moldova.

39. Elena GODINA, Moscow State University "M. Lomonosov", Institute of Anthropology with

Museum, Moscow, Russia.

40. Eleonora FARINA, University of Milano-Bicocca, "Riccardo Massa" Department of Human

Sciences for Education, Italy.

41. Elisabetta SAGONE, University of Catania, Department of Educational Sciences, Catania, Italy.

42. Ergyul TAIR, Institute for Population Studies at Bulgarian Academy of Sciences, Sofia,

Bulgaria.

43. Francesco Maria CARISSIMO, Sapienza University, Sant'Andrea Hospital, Rome, Italy.

44. Françoise ROVILLE-SAUSSE, National Museum of Natural History, Paris, France.

45. Frederic DUTHEIL, University of Auvergne, University Hospital of Clermont-Ferrand (CHU),

Clermont-Ferrand, France.

46. Gabriel STOICIU, "Francisc I. Rainer" Anthropology Institute of the Romanian Academy,

Bucharest, Romania.

47. Galina KASPEROVICH, Centre of Research into Belarusian Culture, Language and Literature,

National Academy of Sciences of Belarus, Minsk, Belarus.

48. Gheorghita GEANA, "Francisc I. Rainer" Anthropology Institute of the Romanian Academy,

Bucharest, Romania.


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49. Gordana NIKIĆ, Singidunum University, Faculty of Media and Communications, Belgrade,

Serbia.

50. Grigore FRIPTULEAC, Nicolae Testemitanu State University of Medicine and Pharmacy of the

Republic of Moldova, The Hygiene Department, Chisinau, Republic of Moldova.

51. Gudrun VELDRE, University of Tartu, Department of Cardiology, Tartu, Estonia.

52. Hana HAŠKOVÁ, Institute of Sociology of the Czech Academy of Sciences, Department of

Gender & Sociology, Prague, Czech Republic.

53. Hisao SEKINE, Tsukuba University, College of International Studies, Tsukuba, Japan.

54. Jasminka HADŽIHALILOVIĆ, University of Tuzla, Faculty of Sciences, Tuzla, Bosnia and

Herzegovina.

55. Julia DONCHEVA, "Angel Kanchev" University of Ruse, Department of Pedagogy,

Psychology and History, Ruse, Bulgaria.

56. Luminita BEJENARU, Alexandru Ioan Cuza University of Iasi, Faculty of Biology, Iasi,

Romania.

57. Maria MARCZEWSKA-RYTKO, Maria Curie-Skłodowska University, Faculty of Political

Science, Department of Political Movements and Ethnic Research, Lublin, Poland.

58. Maria Nives SALA, University of Torino, Department of Psychology, Italy.

59. Marian PETCU, University of Bucharest, The Faculty of Journalism and Communication

Studies, Department of Cultural Anthropology and Communication, Bucharest, Romania.

60. Mark WIDDOWSON, Salford University, School of Health and Society, Salford, United

Kingdom.

61. Maya RANGANATHAN, Macquarie University, Department of Media, Music,

Communication and Cultural Studies, Sydney, Australia.

62. Mihaela-Camelia POPA, "Constantin. Rădulescu-Motru" Institute of Philosophy and


63. Mihaela Suzana TURCU, "Francisc I. Rainer" Anthropology Institute of the Romanian


64. Mihai BURLACU, Transilvania University of Brasov,

Faculty of Sociology and Communication, Department of Social and Communication Sciences,

Brasov, Romania.

65. Mihail PÎRLOG, University of Medicine and Pharmacy Craiova, Faculty of Medicine, 5th

Department Medical Specialties III, Craiova, Romania.

66. Monica TARCEA, University of Medicine and Pharmacy Targu-Mures, Faculty of Medicine,

Department of Functional and Complementary Sciences M2, Romania.

67. Muhammad SUBHAN, King Abdulaziz University, Faculty of Maritime Studies, Department

of Ports and Maritime Transportation, Jeddah, Saudi Arabia.

68. Nailya SPITSYNA, N.N. Miklukho-Maclay Institute of ethnology and anthropology of the

Russian Academy of Sciences, Moscow, Russia.

69. Nicolae NEAGU, "George Emil Palade" University of Medicine, Pharmacy, Science and

Technolgy of Targu Mures, Faculty of Medicine, Department of Functional and Additional

Sciences M2, Targu Mures, Romania.

70. Nicoleta MILICI, "Francisc I. Rainer" Anthropology Institute of the Romanian Academy,

Bucharest, Romania.

71. Nila KAPOR-STANULOVIC, University of Novi Sad, Faculty of Technical Sciences, Novi

Sad, Serbia.

72. Olga KURBATOVA, Vavilov Institute of General Genetics, Russian Academy of Sciences,

Moscow, Russia.

73. Olumuyiwa KAYODE, Bingham University Karu, Faculty of Social Sciences, Department of

Sociology, New Karu, Nigeria.

74. Paul NCHOJI NKWI, Catholic University of Cameroon, Bamenda, Cameroon.

https://mq.academia.edu/


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75. Rafal, SMOCZYNSKI, Institute of Philosophy and Sociology of the Polish Academy of

Sciences, Warsaw, Poland.

76. Ramona MARINACHE, University of Bucharest, The Faculty of Letters, Department of

Cultural Studies, Romania.

77. Robert M. GORDON, Institute for Advanced Psychological Training, Pennsylvannia, USA.

78. Rozeta DRAGHICI, National Institute of Gerontology and Geriatrics "Ana Aslan", Bucharest,

Romania.

79. Santa PARRELLO, University of Naples Federico II, The Department of Humanistic Studies,

Researcher in developmental psychology and educational psychology, Italy.

80. Sára FELSZEGHI, University of Miskolc, Health Care and Methodology Centre, Hungary.

81. Sedin HABIBOVIĆ, University of Zenica, Zenica, Bosnia and Herzegovina.

82. Silvia BRANEA, University of Bucharest, The Faculty of Journalism and Communication

Studies, Department of Cultural Anthropology and Communication, Bucharest, Romania.

83. Silviya MLADENOVA, Plovdiv University "P.Hilendarski", Branch Smolyan, Smolyan,

Bulgaria.

84. Simona PROSEN, University of Ljubljana, Faculty of Education, Ljubljana, Slovenia.

85. Stefan SIVKOV, Medical University, Department of Anatomy, Histology and Embryology,

Plovdiv, Bulgaria.

86. Stevo PAŠALIĆ, University of East Sarajevo, Faculty of Pedagogy, Lukavica, Bosnia and

Herzegovina.

87. Stojko VIDOVIĆ, University of Banja Luka, Faculty of Medicine, Department for Biology with

Human Genetics, Banja Luka, Bosnia and Herzegovina.

88. Taiwo Motolani Williams, Babcock University Ilishan Remo, School of Education and

Humanities, Department of Education, Ogun State Nigeria.

89. Tamara EFENDIC-SPAHIC, University of Tuzla, Faculty of Philosophy, Tulza, Bosnia and

Herzegovina.

90. Tatiana Shopova, South-West University "Neofit Rilski", Faculty of Arts, Department of

Cultural Studies, Blagoevgrad, Bulgaria.

91. Tatjana PAVLICA, University of Novi Sad, Department of Human Biology and Ecology, Novi

Sad, Serbia.

92. Tudor B. MARINESCU, "Carol Davila" University of Medicine and Pharmacy, Anatomy

Department, Bucharest, Romania.

93. Valentina MARINESCU, University of Bucharest, Faculty of Sociology and Social Work,

Department of Sociology, Romania.

94. Valentina MILENKOVA, South-West University "Neofit Rilski", Faculty of Philosophy,

Department of Socilogy, Blagoevgrad, Bulgaria.

95. Valeria LAZA, Iuliu Hatieganu University of Medicine and Pharmacy, Division of Community

Medicine, Cluj-Napoca, Romania.

96. Vasile CREȚU, University of Bucharest, The Faculty of Orthodox Theology "Justinian the

Patriarch", Bucharest, Romania.

97. Veska SHOSHEVA, Thracian University – Stara Zagora, Medical School, Department of

Social Care Services, Stara Zagora, Bulgaria.

98. Zoran MATEVSKI D., Cyril and Methodius University, Faculty of Philosophy, Skopje,

Macedonia.

Thank you for the excellent work you have done

over these years !

No.11, 2021 - Anthropological Researches and Studies

Documents

Transcript of No.11, 2021 - Anthropological Researches and Studies