Gender Differences in Risk Behaviours: Does Sexual Maturation Matter?

iMedPub Journals
2015
International Archives of Medicine
http://journals.imed.pub
Section: Global Health & Health Policy

ISSN: 1755-7682
Vol. 8 No. 76
doi: 10.3823/1675
Gender Differences in Risk Behaviours: Does

Sexual Maturation Matter?
Original
Abstract
Background: Menarche is a milestone of entering puberty, representing an indicator of sexual maturity and revealing normal physical,
biological, psychological, and emotional development. This study aimed to compare pre-menarche girls, same age post-menarche girls,
and boys according to risk behaviours.
Methods: Participants (n=2608) completed a comprehensive survey

regarding headache, irritability, feeling nervous, tobacco use, drinking
beer, physical fighting, diet, and perception of health.
Results: The prevalence of having headaches (p<0.001), being irritable or having a bad temper (p<0.001), feeling nervous (p<0.001),
being on a diet (p<0.001) was significantly higher among post-menarche girls than boys and pre-menarche girls. Post-menarche girls
had a poorer perception of health (p<0.001). After adjusted data for
socioeconomic status and BMI, frequency of having headaches, bad
temper and feeling nervous was higher for post-menarche girls.
Conclusions: Specific school-based intervention is required so that
Adilson Marques1,2,3,
Ctia Branquinho1,2,
Margarida Gaspar de
Matos1,2
1 Projeto Aventura Social, Universidade de
Lisboa, Lisboa, Portugal.
2ISAMB Instituto de Sade Ambiental,
Faculdade de Medicina, Universidade de
Lisboa, Lisboa, Portugal.
3Centro Interdisciplinar de Estudo da
Performance Humana, Faculdade
de Motricidade Humana, Universidade de
Lisboa, Cruz Quebrada, Portugal
Contact information:
Adilson Marques.
Tel: (351) 214149100
Address: Faculda de Motricida de
Humana, Estrada da Costa, 1499-002
Cruz Quebrada, Portugal.
amarques@fmh.ulisboa.pt
the perception of well-being and social participation can be maintained during after menarche.
Keywords
adolescence, gender differences, health behaviours, attitudes
Introduction
Adolescence is a stage of life characterized by rapid growth and development. In girls, menarche is considered the milestone of entering
puberty, representing an indicator of sexual maturity and revealing
normal physical, biological, psychological, and emotional development
Under License of Creative Commons Attribution 3.0 License
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ISSN: 1755-7682
[1-3]. Although there is variability in the menarche

age, European and North-American studies pointed
out a menarche age of between twelve and thirteen years [4-6]. In boys, it is difficult to determine
at what age this stage begins, because there is no
event that culminates this life phase. Spermarch,
although rarely used in research to study the onset of puberty, is the limit between childhood and
adolescence in boys [7].
Menstruation has an important role in emotional regulation and is associated with many physical
symptoms during the menstrual cycle in girls [8]. Its
beginning is related to a host of factors: physical,
socioeconomic, environmental, ethnicity, body mass
index (BMI), geography, and eating habits [3, 9].
When analysing subjective health complaints (e.g.
headaches, abdominal and muscle pain, sadness,
irritability, nervousness, sleeping difficulty, and dizziness) between girls and boys, it appears that girls
report a higher level of symptoms [10, 11]. Girls also
present a lower health perception, in terms of selfimage and incidence of physical and mental symptoms, when compared to boys [8]
In the study of risk behaviours associated with
adolescence, it appears that in the post-pubertal
period, girls have a higher consumption of alcohol than boys, are more likely to use inhalants and
stimulants, and tend to start smoking before the
opposite sex; while boys present a higher level of
risk behaviours in other areas such as violent behaviours, engaging in fights, and accidents [12, 13].
Early menarche constitutes a factor that enhances
the predisposition to alcohol abuse and also the beginning of sexual activity at a premature age (before
aged 15) [14], and in addiction to a higher rate of
alcohol consumption, as well as an increased use
of cigarettes and marijuana [15, 16]. In boys, early
puberty is associated with engaging in fights, and
aggressive responses in emotional situations during
early adolescence [17].
Since adolescence is a period of physical and
psychological maturation, but also associated with
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different levels of risk behaviours in girls and boys,

the aim of the present study was to use data from
a large population study in order to compare three
groups: pre-menarche girls, same age post-menarche girls, and boys. The study of gendered risky
behaviours, and its association with pubertal status
in girls, is essential in order to better adjust health
preventive and promotional interventions to different stages of development of young people, while
taking into consideration gendered differences.
Methods
Participants
This study is based on data from the Health Behaviour in School-Aged Children (HBSC) Portuguese
survey [18]. The HBSC is a school-based survey of
adolescents health behaviours, carried out every 4
years. HBSC Portugal is one of 43 countries and
regions across Europe and North America that integrate the HBSC Network. Data is collected using an
international standardized methodological protocol
[19], to gain new vision into young peoples health
and well-being, to understand the social and psychological determinants of health, and to incorporate policies to improve young peoples lives. For the
present study the sample consisted of 2608 children
aged 10-13 years, attending grades 6 and 8, from
the HBSC 2010 waves. Children aged 10-13 were
selected because there was an intention to have
three groups: boys, pre-menarche girls and postmenarche girls.
Measures
Gender, age, socioeconomic status, menarche age,
weight, and height.
Socio-demographic variables were: gender, age,
and socioeconomic status (SES). Gender and age
were self-reported. The Graffar scale, emphasizing
parents occupation, was used to identify the SES.

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To determine age at menarche, girls were asked if

they had had their first menstruation (status quo
method). Weight and height were self-reported.
BMI was then calculated based on mass (kilograms)
divided by height (square metres). Adolescents BMI
class and BMI z-score were determined based on
International Obesity Taskforce criteria [20], with
overweight and obesity defined as an adult BMI
equivalent 25 and obesity 30. Overweight and
obese were defined simply as overweight/obese.
Headache, irritability or bad temper, and feeling
nervous
The frequency of headaches, being irritable, and
feeling nervous was listed as a single multipart question: In the last 6 months, how often have you?
For each question children were required to specify
the frequency on a five point scale: (1) rarely or never, (2) about every month, (3) about every week, (4)
more than once a week, (5) about every day.
Tobacco use
Tobacco use status was defined on the basis of the
question, How often do you smoke tobacco at
present. Possible responses included: (1) do not
smoke, (2) less than once a week, (3) once a week,
(4) every day.
Drinking beer
The frequency of drinking beer was assessed by
asking, How often do you drink beer?. The following multiple-choice answers were included: (1)
never, (2) rarely, (3) every month, (4) every week,
(5) every day.
Physical fighting
Children were asked how many times during the
last 12 months they had been involved in a physical
fight. Responses were given in a 5-point scale (1)
none, (2) one time, (3) two times, (4) three times,
(5) four times or more.
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Diet
Children were asked if they were currently trying
to lose weight or if they needed to lose weight.
Answers were included (1) no, I am pleased with
my weight, (2) no, but I should have to lose weight,
(3) no, I need to put on some weight, (4) yes. To
simplify, the responses were dichotomized as yes
or no.
Perception of health
Perception of health was assessed through the
question, How would you rate your health? Answers were given, through selection, on a 4-point
scale: (1) poor, (2) fair, (3) good, (4) excellent.
Procedure
The survey was based on a self-administered standardized questionnaire administrated by teachers,
or members of the research group, in the classroom in public schools randomly selected from
Portuguese administrative regions. After completion, the children were asked to put the questionnaire in an envelope, seal it, and hand it to the
teacher or to a member of the research group.
The study was anonymous, making it impossible to
conduct an individual non-response analysis. Research was approved by the Ethical Committee of
Porto Medical School, and was in accordance with
the rules of the National Data Protection System.
All school administrators gave their consent; legal
guardians gave written informed consent. This study followed all scientific and ethics recommendations for research on humans. The study was also
authorized by the Ministry of Education. Children
participated on an anonymous and voluntary basis.
A detailed chapter regarding methods is available
[18].
Data analysis
Descriptive statistics were calculated (means, standard deviation and percentages) for the sample
according to gender and girls menarche status.
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Chi-square and Kruskal-Wallis were used to assess

differences among boys, girls pre-menarche, and
girls post-menarche in relation to headache, irritability temper, feeling nervous, tobacco use, drinking beer, physical fighting, being on a diet, and
perception of health. To identify which group was
different from others, multiple comparisons of rank
cases were performed through the LSD Fisher test.
Because most risk behaviours variables were ordinal, they were treated as continuous variables. Thus,
they were tested for normality. Because these variables did not have normally distributed residuals they
were therefore log-transformed for analysis. For the
comparison between boys, girls pre-menarche, and
girls post-menarche (according risk behaviours) ANCOVA was used; age, BMI and SES were used as
covariates. Statistical analyses were performed using
IBM SPSS Statistics 22.0. The level of significance
was set at 0.05.
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Table 1. Characteristics of the participants.

N
Boys
1284
49.2
Pre-menarche girls
583
22.4
Post-menarche girls
741
28,4
10-11 years
1113
42.6
12-13 years
1495
57.4
Low
276
10.6
Middle/low
1047
40.1
Middle
397
15.2
Middle/high
237
9.1
High
282
14.6
Normal weight
1884
75.9
Overweight/obese
597
24.1
Gender
Age
SES
BMI
Abbreviation: SES, socioeconomic status
Results
a poorer perception of health (2KW(2)=51.623,

p<0.001) than boys and pre-menarche girls. Premenarche girls had a lower rate of tobacco use
(2KW(2)=27.259, p<0.001) and beer consumption
(2KW(2)=68.031, p<0.001). On the other hand,
the prevalence of physical fighting was significantly
higher among boys than girls (2KW(2)=307.570,
p<0.001).
Participants characteristics are presented in table 1.

The prevalence of having headaches (2KW(2)
=69.582, p<0.001), being irritable or having a bad
temper (2KW(2)=43.803, p<0.001), feeling nervous (2KW(2)=59.571, p<0.001), being on a diet
(2(2)=22.456, p<0.001) was significantly higher
among post-menarche girls than boys and pre-menarche girls. Conversely, post-menarche girls had
Table 2. C
omparison among boys, pre-menarche girls and post-menarche girls, according headache, risk
behaviours, and perception of health.
Boys
Pre-menarche girls
Post-menarche girls
N=1284
%
N=583
%
N=741
%
Rarely or never
78.3
75.9
61.4
About every month
9.3
9.5
14.7
About every week
3.8
3.3
7.9
More than once a week
5.0
9.3
11.8
About every day
3.5
2.1
4.2
Headachea
<0.0011
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doi: 10.3823/1675
Irritability or bad tempera

Rarely or never
63.6
70.1
52.5
About every month
18.6
14.0
22.6
About every week
6.8
6.0
8.7
7.2
6.9
11.7
About every day
3.8
2.9
4.4
Rarely or never
59.9
60.4
43.9
About every month
19.0
18.5
22.5
About every week
8.2
6.1
12.4
8.2
9.2
14.3
About every day
4.7
5.9
6.9
Do not
95.5
98.6
92.4
Less than once a week
2.6
0.5
4.8
Once a week
0.7
0.7
1.8
Every week
1.1
0.2
1.0
Never
76.9
92.6
78.4
Rarely
19.4
7.3
19.0
Every month
2.7
0.0
2.2
Every week
0.9
0.2
0.4
Every day
0.1
0.0
0.0
None
53.7
87.7
82.4
1 time
20.3
8.8
9.0
2 times
9.2
1.4
4.6
3 times
5.4
0.9
1.8
4 or more times
11.5
1.2
2.2
No
92.6
93.2
87.0
Yes
7.4
6.8
13.0
Poor
0.5
0.2
0.3
Fair
8.7
9.7
14.4
Good
48.7
49.0
58.0
Excellent
42.2
41.1
<0.0011
Feeling nervousa
Tobacco
<0.0011
usea
<0.0012
Drinking beera
<0.0012
Physical fighting
<0.0013
Dieta
<0.0011
Perception of healtha
<0.0011
27.2
b
Tested by Chi-square
Tested by Kruskall-Wallis
Girls are significantly different from boys and girls pre-menarche.
2 Girls pre-menarche are significantly different from boys and girls.
3 Boys are significantly different from girls pre-menarche and girls post-menarche
1

ISSN: 1755-7682
The comparison analysis among boys, pre-menarche girls and post-menarche girls adjusted for
age, BMI and SES is presented in table 3. The frequency of having headaches in the last 6 months
was higher for post-menarche girls, followed by
pre-menarche girls and then boys. The results were
significantly different among each others group
(F(2)=27.985, p<0.001). Although the frequency of physical fighting was much higher among
boys than among both groups of girls, all groups
were also significantly different from one another
(F(2)=148.227, p<0.001). Regarding irritability or bad
temper (F(2)=12.600, p<0.001) and feeling nervous
(F(2)=18.982, p<0.001), post-menarche girls reported to have these feelings more often than boys and
pre-menarche girls. Conversely, post-menarche girls
had a significantly lower perception of health than
boys and pre-menarche girls (F(2)=21.479, p<0.001).
Regarding beer drinking, boys and post-menarche
girls have similar results, which were significantly higher than pre-menarche girls (F(2)=10.214, p<0.001).
Although tobacco uses were significantly different
among boys, pre-menarche girls and post-menar-
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che girls in the previous analyses, when results were

adjusted for covariates (age, BMI and SES), the differences were no longer significant.
Discussion
The results highlight that the prevalence of physical
and psychological symptoms was significantly higher among post-menarche girls than boys and premenarche girls. Post-menarche girls also had a poorer perception of health than boys and pre-menarche girls, confirming gender differences presented
in other studies [10, 11]. The prevalence of physical
fighting was significantly higher among boys than in
girls, also confirming results from other studies [12].
The comparison analysis among boys, pre-menarche girls and post-menarche girls adjusted for
age, BMI and SES confirmed that the frequency of
having a headache in the last 6 months, reporting
irritability, reporting bad temper or feeling nervous
was higher in post-menarche girls; while post-menarche girls had a significantly lower perception
of health than boys and pre-menarche girls. Diffe-
Table 3. C
omparison analysis among boys, pre-menarche girls and post-menarche girls adjusted for age,
BMI and SES.
Risk behaviours and perception
of health
Boys
Pre-menarche girls
Post-menarche
Girls
Headache
0.220.46
0.270.50
0.420.57
<0.0011
Irritability or bad temper
0.340.51
0.310.50
0.480.56
<0.0012
Feeling nervous
0.400.54
0.430.56
0.600.59
<0.0012
Tobacco use
0.040.18
0.020.12
0.070.24
0.080
Drinking beer
0.170.33
0.060.19
0.170.32
<0.0013
Physical fighting
0.500.59
0.100.30
0.170.40
<0.0011
Perception of health
1.190.21
1.170.21
1.120.22
<0.0012
Abbreviation: BMI, body mass index; SES, socioeconomic status.

Risk behaviours and perception of health were treaty as continuous variables. Because these variables did not have normally
distributed residuals they were therefore log-transformed for analysis.
Tested by ANCOVA. Age, BMI and SES were used as covariates.
1
Boys, pre-menarche girls, and post-menarche girls were different from each other.
2 Post-menarche
3 Pre-menarche
girls are significantly different from boys and pre-menarche girls.
girls are significantly different from boys and post-menarche girls.


ISSN: 1755-7682
rences in health and risky behaviour between boys

and girls during adolescence have been repeatedly
pointed out [21-23]; this study confirms previous
results. The new highlight is that the present analysis strongly supports the assumption that gendered differences increase after girls reach puberty,
and that post menarche girls seem to be at an
increased risk of bad health, both psychological
and physical, compared to both boys and to nonmenarche girls.
Some methodological limitations should also be
mentioned. First, there was no information about
the actual menarche dates of the girls. However,
status quo method is considered to be reliable for
obtaining menarche dates. Second, the cross-sectional design does not allow conclusions of causal
relationships between menarche and physical activity and sedentary behaviours.
This finding calls for: 1) specific measures regarding health preventive and promotional interventions in schools, in the family, and in the community, and 2) trying to find a better approach for
post-menarche girls to avoid a bad health perception which interferes with, and impairs, their sense of well-being and social participation. Measures
can include: a) specific medical assistance to lower
sickness perception and, in general, bad feelings
related to menstruation days, and b) information
about hormonal functioning and potential humour
changes during menstruation days. Specific schoolbased educational intervention is required so that
the perception of well-being and social participation
can be maintained during menarche days, thereby
decreasing its power as a risk factor regarding post
menarche girls. Furthermore, early adolescence
is a period where gender differences can be approached so that boys and girls can improve their
means of coping with their emotional responses,
increase their problem solving skills and increase
their ability to search for adult help when necessary.
Acquiring these skills will enable them to develop
across adolescence [18, 24, 25] and to enhance their
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behavioural repertoire, as well as their perception of

well-being, while preventing risk behaviours and a
poor perception of health.
Acknowledgement
The HBSC study in Portugal was funded by public
funds: Ministry of Health and Ministry of Education
and Science. The authors thank the children for their
participation in the study, and the teachers for their
assistance in helping collecting data. We also thank
Professor Bruce Jones for revising the document.
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