Variations in Natal Knowledge Among High School Students David L. Decker, PhD Donald F. Caetano, PhD Problem In the continuing concern of educators t o establish programs of health education, certain problems manifest themselves that interfere with the programs designed to disseminate information. One of these problems is the different effects the educational program has upon different types of people, as well as the different needs of different people. To a large extent these differences will determine the eventual success or failure of health education programs. In constructing high quality educational programs it isessential t o be aware of, and then take into account, the different needs of the various types of peoples the programs are designed t o serve. Studies have documented differences in sexual and socioeconomic levels of health knowledge.’ - 4 However, there is little known about the levels of health knowledge among the different racial and ethnic groups in American society, and how these differences are related t o sexual differences. This study was conducted to determine the differences in the level of natal knowledge in a high school sample in which there are large numbers of diverse racial and ethnic members. Methodology An itemized questionnaire was constructed to measure how much high school students know about the prevention of birth defects. If it could be established that certain racial and ethnic groups know less than others about birth defects, then this information could be used t o increase their level of knowledge, and subsequently improve levels of prenatal care and lower rates of birth defects and mortalities. The natal knowledge questionnaire contained 32 questions about environmental and hereditary factors associated with birth defects. All questions were in a commonsense vocabulary recognizable by a high school population, since the intent 286
THE JOURNAL OF SCHOOL HEALTH
of the questionnaire was t o test basic knowledge, not the students’ grasp of technical terminology. The questionnaire was pretested and refined before being administered in the social science classes of five high schools in the San Bernardino, California school district. Some of the questions used in the survey were: Children born t o women over thirty-five years of age tend t o have more birth defects. v e s L
O
d o not know A woman should avoid all exercise while pregnant. ves L
O
40 not know A great many birth defects are inherited, so there isn’t much one can d o t o prevent them. v e s L
O
d o not know Doctors can now detect many birth defects while the child is still in the mother’s womb. v e s L
O
20 not know Non-prescription drugs (for example : vitamins, aspirins, and hay fever pills) can safely be used by an expectant mother. v e s L
O
d o not know Heroin addicted mothers can give birth to addicted children. v e s L
O
d o not know If used in moderation, a woman can continue t o use drugs (for example: sleeping pills, diet pills, tranquilizers, water retention pills, and birth control pills) prescribed prior to her pregnancy.
v L
e
s O
d o not know If a person o r his parents have a hereditary defect, there isn’t any way t o predict whether his children will also have it.
MAY 1977
v 4
e
s 0
20 not know Genetic counseling is a form of group therapy for parents of deformed children. ves d
0
o not know A woman should have a periodic x-ray to check o n the d
course o f her pregnancy. v e s L
O
20 not know
The sample was composed of 1128 students, of which 43% were female and 57% were male. Average age of the students completing the questionnaire was 16. The racial and ethnic composition of the sample was 66.2%white, 18.5%black, and 14.5% Mexican-American. The other 6.7% of the sample was eliminated from the following analysis because it is a diverse group, and is too small a group to yield reliable information. The religious composition was 31.8%Protestant, 33.7%Catholic, 2.6%Jewish, 31.7%reporting no religion, and .1% other. The chi square statistic was used in the analysis of the data t o test for significant differences. Results The results of the study indicated that there are statistically significant differences between racial and sexual groups in the level of natal knowledge. Whites had the largest proportion of high scores (ie, 57% or more questionnaire items correct) with 35.676, followed by blacks with 31.1%, and Mexican-Americans, 24.4%. The pattern of natal knowledge among the racial and ethnic groups remained the same when the respondents were divided between the males and the females in each group. The differences in the responses between the males and the females were also statistically significant. In every case the females scored higher than the males. However, white females and black females had almost identical proportions in the highest scoring group (39.8% and 38.7’36, respectively), with MexicanAmerican females scoring 29.8%. Among the males, the white males had the largest proportion in the highest scoring group, 29.5%, followed by black males, 22.476, and MexicanAmerican males, 19.0%. It is interesting to note that the highest scoring males (whites) were lower in proportion with the most correct answers than the lowest scoring female group. Although there are patterns of natal knowledge between the racial and ethnic groups, the differences in the natal knowledge of males and females is more outstanding. MAY 1977
The differences in the natal knowledge levels of the different racial and ethnic groups may be attributed t o differences in social class. Although the questionnaire administered t o the students did not have a reliable measure of family income, the students did give information on the levels of education of their mothers, an item that correlates highly with measures of social class. It was found that the level of a mother’s education does have impact upon differences in natal knowledge for Mexican-Americans. For example, only 18.7% of Mexican-Americans whose mothers had less than nine years of education scored in the highest group, whereas 34.1% of those whose mothers had 13 o r more years of education scored in the highest group. However, a mother’s education did not have the same influences for whites and blacks, as there was not a statistically significant correlation between a mother’s education and level of natal knowledge.
Discussion The data indicate that in this sample of high school students there are significant differences in the level of natal knowledge of different racial and ethnic groups. In general the pattern is for whites to score the highest, followed by blacks and Mexican-Americans, in that order. There are certain departures from this pattern, such as black and white females score equally well, and in all racial and ethnic groups the females score significantly higher than the males. The natal knowledge scores of Mexican-Americans are positively correlated with the amount of their mother’s education, although this correlationdoes not hold for whites and blacks. In this sample the group with the consistently lowest scores are the Mexican-Americans, both males and females. In identifying a target group for the dissemination of natal knowledge, this group would seem t o provide the most urgent need. Although there may be sociocultural factors that combine to inhibit the dissemination of accurate natal information, there may also be a specific problem of language. Most natal information, both in educational institutions and in the mass media forms, have been in English, which may be a less efficient approach than a bilingual approach. The other important finding of this study is that males are significantly less knowledgeable than are females, and this finding is true for all racial and ethnic groups. A continued effort t o educate males about their role in natal health is indicated. For this effort t o be successful it may be necessary to reorient the male’s concept of his sex role. HeretoTHE JOURNAL OF SCHOOL HEALTH
287
fore the male sex role has emphasized the detachment of the male from primary responsibility for matters of conception, birth, and childbearing. The importance of the male must be emphasized in natal matters, including birth defects, and their intimate relationship t o the consequences of their sex role behavior.
REFERENCES 1 . Karsdorf GZ: Hygenic attitudes of secondary school pupils. 2 Gesamte Hyg 12:122-128, 1966. 2. Wilson RA, Kane RL: Health knowledge among residents of a rural Kentucky county. J K y Med Assoc 6 7 : 113-174, 1969. 3. Marshall CL, Haffanein KM, Haffanein RF, e t al: At-
titudes toward health among children of different races and socio-ecorlomic status. Pediatrics 4 6 :422-426, 197 0. 4. Gibbs CE, Martin HW, Guitierrez M: Patterns of reproductive health care among the poor of San Antonio, Texas. A m JPublic Health 67:37-40, 1974. A copy of t h e natal knowledge questionnzire may be obtained by writing to the authors, Department of Sociology, California State College, San Bernardino, CA 92407
David L. Decker, PhD, is Associate Professor, Department o f Sociology, California State College, San Bernardino, CA 92407 (corresponding author). Donald F. Caetano, PhD, is Assistant Professor, Department o f Sociology, California State College, San Bernardino, CA 92407.
An Important Message From the National Institutes of Health QUESTION? Were you o r your daughter born after 1940? Did your mother take a drug during pregnancy t o avoid miscarriage? Since 1940, mothers of perhaps a million girls have been treated with synthetic hormones for complications of pregnancy. Is it likely t h at a physician may have prescribed DIETHYLSTILBESTROL (di-ethylatil-bes-trol) or a drug of that type, for your mother before you were born? (Diethylstilbestrol is sometimes called just STILBESTROL or DES). WHAT to DO? If so, you should now be examined by a physician. He o r she will check for slight, non-harmful abnormalities of the female reproductive organs and for any indication of c a n c e r a very unlikely development. Daughters who might have been exposed before birth to diethylstilbestrol (DES) o r other DES-type drugs should be examined if they: ( 1 ) have begun t o menstruate, o r ( 2 ) have abnormal signs such as bleeding o r discharge from the vagina before their periods have begun. If possible, exposure t o DES-type drugs before birth should be verified from medical records. These may be available from the physician who cared for your mother during pregnancy or from the hospital where you were born. But whether o r not you are certain about exposure, play it safe and see a physician now. WHAT KIND of EXAMINATION? The examination is painless, fast and is d one in a physician’s office. It is the same pelvic examination with a Pap test t h at every woman over 18 should have regularly. In addition, for DES-exposed daughters, it should include a brief staining of t h e vagina with an iodine solution t o enable the physician t o observe any abnormal tissues that may be present. A magnifying instrument called a colposcope occasionally may be used as well. WHY SHOULD YOU HAVE SUCH an kXAMINATION? In 1971, physicians discovered an association between DES-type drugs given during pregnancy and certain unusual tissue formations in t h e vagina o r cervix of daughters. The tissue abnormalities have not been found to develop into cancer, and d o not interfere with intercourse, contraception, or pregnancy. However, some cases of a rare type of cancer have occurred in DES-exposed daughters. No findings of any kind have been reported with respect t o cancer in boys o r men whose mothers received a DES-type drug. WHY COMPLY WITH YOUR PHYSICIAN’S ADVICE REGARDING FOLLOWUP? Even though a vast majority of such women will be found not t o have cancer, close followup is important t o insure early detection if cancer should develop. Treatment of DES-related cancers has been highly effective when cancers have been detected a t a n early, localized stage. FOR FURTHER INFORMATION: Write to t h e National Cancer Institute, Office of Cancer Communications, NIH, Bethesda, MD 20014.
288
THE JOURNAL OF SCHOOL HEALTH
MAY 1977
THE JOURNAL OF SCHOOL HEALTH
of the questionnaire was t o test basic knowledge, not the students’ grasp of technical terminology. The questionnaire was pretested and refined before being administered in the social science classes of five high schools in the San Bernardino, California school district. Some of the questions used in the survey were: Children born t o women over thirty-five years of age tend t o have more birth defects. v e s L
O
d o not know A woman should avoid all exercise while pregnant. ves L
O
40 not know A great many birth defects are inherited, so there isn’t much one can d o t o prevent them. v e s L
O
d o not know Doctors can now detect many birth defects while the child is still in the mother’s womb. v e s L
O
20 not know Non-prescription drugs (for example : vitamins, aspirins, and hay fever pills) can safely be used by an expectant mother. v e s L
O
d o not know Heroin addicted mothers can give birth to addicted children. v e s L
O
d o not know If used in moderation, a woman can continue t o use drugs (for example: sleeping pills, diet pills, tranquilizers, water retention pills, and birth control pills) prescribed prior to her pregnancy.
v L
e
s O
d o not know If a person o r his parents have a hereditary defect, there isn’t any way t o predict whether his children will also have it.
MAY 1977
v 4
e
s 0
20 not know Genetic counseling is a form of group therapy for parents of deformed children. ves d
0
o not know A woman should have a periodic x-ray to check o n the d
course o f her pregnancy. v e s L
O
20 not know
The sample was composed of 1128 students, of which 43% were female and 57% were male. Average age of the students completing the questionnaire was 16. The racial and ethnic composition of the sample was 66.2%white, 18.5%black, and 14.5% Mexican-American. The other 6.7% of the sample was eliminated from the following analysis because it is a diverse group, and is too small a group to yield reliable information. The religious composition was 31.8%Protestant, 33.7%Catholic, 2.6%Jewish, 31.7%reporting no religion, and .1% other. The chi square statistic was used in the analysis of the data t o test for significant differences. Results The results of the study indicated that there are statistically significant differences between racial and sexual groups in the level of natal knowledge. Whites had the largest proportion of high scores (ie, 57% or more questionnaire items correct) with 35.676, followed by blacks with 31.1%, and Mexican-Americans, 24.4%. The pattern of natal knowledge among the racial and ethnic groups remained the same when the respondents were divided between the males and the females in each group. The differences in the responses between the males and the females were also statistically significant. In every case the females scored higher than the males. However, white females and black females had almost identical proportions in the highest scoring group (39.8% and 38.7’36, respectively), with MexicanAmerican females scoring 29.8%. Among the males, the white males had the largest proportion in the highest scoring group, 29.5%, followed by black males, 22.476, and MexicanAmerican males, 19.0%. It is interesting to note that the highest scoring males (whites) were lower in proportion with the most correct answers than the lowest scoring female group. Although there are patterns of natal knowledge between the racial and ethnic groups, the differences in the natal knowledge of males and females is more outstanding. MAY 1977
The differences in the natal knowledge levels of the different racial and ethnic groups may be attributed t o differences in social class. Although the questionnaire administered t o the students did not have a reliable measure of family income, the students did give information on the levels of education of their mothers, an item that correlates highly with measures of social class. It was found that the level of a mother’s education does have impact upon differences in natal knowledge for Mexican-Americans. For example, only 18.7% of Mexican-Americans whose mothers had less than nine years of education scored in the highest group, whereas 34.1% of those whose mothers had 13 o r more years of education scored in the highest group. However, a mother’s education did not have the same influences for whites and blacks, as there was not a statistically significant correlation between a mother’s education and level of natal knowledge.
Discussion The data indicate that in this sample of high school students there are significant differences in the level of natal knowledge of different racial and ethnic groups. In general the pattern is for whites to score the highest, followed by blacks and Mexican-Americans, in that order. There are certain departures from this pattern, such as black and white females score equally well, and in all racial and ethnic groups the females score significantly higher than the males. The natal knowledge scores of Mexican-Americans are positively correlated with the amount of their mother’s education, although this correlationdoes not hold for whites and blacks. In this sample the group with the consistently lowest scores are the Mexican-Americans, both males and females. In identifying a target group for the dissemination of natal knowledge, this group would seem t o provide the most urgent need. Although there may be sociocultural factors that combine to inhibit the dissemination of accurate natal information, there may also be a specific problem of language. Most natal information, both in educational institutions and in the mass media forms, have been in English, which may be a less efficient approach than a bilingual approach. The other important finding of this study is that males are significantly less knowledgeable than are females, and this finding is true for all racial and ethnic groups. A continued effort t o educate males about their role in natal health is indicated. For this effort t o be successful it may be necessary to reorient the male’s concept of his sex role. HeretoTHE JOURNAL OF SCHOOL HEALTH
287
fore the male sex role has emphasized the detachment of the male from primary responsibility for matters of conception, birth, and childbearing. The importance of the male must be emphasized in natal matters, including birth defects, and their intimate relationship t o the consequences of their sex role behavior.
REFERENCES 1 . Karsdorf GZ: Hygenic attitudes of secondary school pupils. 2 Gesamte Hyg 12:122-128, 1966. 2. Wilson RA, Kane RL: Health knowledge among residents of a rural Kentucky county. J K y Med Assoc 6 7 : 113-174, 1969. 3. Marshall CL, Haffanein KM, Haffanein RF, e t al: At-
titudes toward health among children of different races and socio-ecorlomic status. Pediatrics 4 6 :422-426, 197 0. 4. Gibbs CE, Martin HW, Guitierrez M: Patterns of reproductive health care among the poor of San Antonio, Texas. A m JPublic Health 67:37-40, 1974. A copy of t h e natal knowledge questionnzire may be obtained by writing to the authors, Department of Sociology, California State College, San Bernardino, CA 92407
David L. Decker, PhD, is Associate Professor, Department o f Sociology, California State College, San Bernardino, CA 92407 (corresponding author). Donald F. Caetano, PhD, is Assistant Professor, Department o f Sociology, California State College, San Bernardino, CA 92407.
An Important Message From the National Institutes of Health QUESTION? Were you o r your daughter born after 1940? Did your mother take a drug during pregnancy t o avoid miscarriage? Since 1940, mothers of perhaps a million girls have been treated with synthetic hormones for complications of pregnancy. Is it likely t h at a physician may have prescribed DIETHYLSTILBESTROL (di-ethylatil-bes-trol) or a drug of that type, for your mother before you were born? (Diethylstilbestrol is sometimes called just STILBESTROL or DES). WHAT to DO? If so, you should now be examined by a physician. He o r she will check for slight, non-harmful abnormalities of the female reproductive organs and for any indication of c a n c e r a very unlikely development. Daughters who might have been exposed before birth to diethylstilbestrol (DES) o r other DES-type drugs should be examined if they: ( 1 ) have begun t o menstruate, o r ( 2 ) have abnormal signs such as bleeding o r discharge from the vagina before their periods have begun. If possible, exposure t o DES-type drugs before birth should be verified from medical records. These may be available from the physician who cared for your mother during pregnancy or from the hospital where you were born. But whether o r not you are certain about exposure, play it safe and see a physician now. WHAT KIND of EXAMINATION? The examination is painless, fast and is d one in a physician’s office. It is the same pelvic examination with a Pap test t h at every woman over 18 should have regularly. In addition, for DES-exposed daughters, it should include a brief staining of t h e vagina with an iodine solution t o enable the physician t o observe any abnormal tissues that may be present. A magnifying instrument called a colposcope occasionally may be used as well. WHY SHOULD YOU HAVE SUCH an kXAMINATION? In 1971, physicians discovered an association between DES-type drugs given during pregnancy and certain unusual tissue formations in t h e vagina o r cervix of daughters. The tissue abnormalities have not been found to develop into cancer, and d o not interfere with intercourse, contraception, or pregnancy. However, some cases of a rare type of cancer have occurred in DES-exposed daughters. No findings of any kind have been reported with respect t o cancer in boys o r men whose mothers received a DES-type drug. WHY COMPLY WITH YOUR PHYSICIAN’S ADVICE REGARDING FOLLOWUP? Even though a vast majority of such women will be found not t o have cancer, close followup is important t o insure early detection if cancer should develop. Treatment of DES-related cancers has been highly effective when cancers have been detected a t a n early, localized stage. FOR FURTHER INFORMATION: Write to t h e National Cancer Institute, Office of Cancer Communications, NIH, Bethesda, MD 20014.
288
THE JOURNAL OF SCHOOL HEALTH
MAY 1977
