성인지적 관점에서의 청소년 건강실태와 정책과제

A Gender Perspective on Adolescent Health and Policy Issues

1. 서론 □ 우리나라 청소년은 경제협력개발기구(OECD) 회원국과 비교하여 상대적으로 많은 시간을 학교와 학원에서 보내고 있고, 여가와 수면 시간조차 학업에 할애해야 하는 치열한 입시경쟁 환경에서 살아가고 있음. 이로 인해 청소년들은 체력 저하, 수면 부족, 영양 불균형, 비만, 우울 및 자살 등 신체적 정신적 사회적으로 복합적인 건강문제를 호소하고 있음. □ 청소년기의 부정적인 건강행태 및 신체적 정신적 건강상태는 성인기의 건강문제로 이행될 수 있기 때문에 예방측면에서 청소년을 대상으로 하는 건강증진 정책은 어느 인구집단 보다 중요함. □ 우리는 청소년기가 2차 성징을 비롯한 신체적 성장을 통해 남녀가 서로 다른 생물학적 성(sex)이라는 것만 인지하고 있지, 가정과 학교 및 사회구조 내에서 남녀가 서로 다른 사회적 성(gender)임을 경험하고 인지하는 시기라는 것을 간과하곤 함. ○ 생물학적으로 서로 다른 남녀 청소년의 삶의 구조와 성역할 경험이 어떻게 다르고, 이를 통해 건강행태와 건강의 질이 어떻게 결정되는지 이해하기 위해서는 성인지적 관점(gender perspective)이 필요함. ○ 성인지적 관점은 남녀 청소년을 대상으로 하는 건강증진 정책의 효과성과 효율성을 높이는데 있어 중요한 요소임.

As unhealthy behaviors and mental health occurring during adolescence, such as cigarette smoking, alcohol drinking, obesity, depression and suicide thoughts, have not only hovered at high levels but increased steadily during the last decade, their health quality has also become an important policy issue in Korea. Nonetheless, since teens experience rapid gains in growth and weight in combination with the development of secondary sexual characteristics during adolescence, national adolescent health policies seem to be more focused on a biological perspective, not on a gender perspective. The latter view, however, is much more important for health equality than the former view because of economic and social differences between men and women. In particular, health policies can impact on men and women's healthy lives in one way or another, so adolescent health policies from a gender perspective should be developed and performed. To find out a gender approach to adolescent health improvement and health equality between boys and girls, this study was to 1) examine the recent changes of health behaviors and health conditions (e.g., cigarette smoking, alcohol drinking, drug intake, physical activity, sleep satisfaction, skipping breakfast, unhealthy weight control behaviors, sexual behaviors, stress, depressed mood, and suicidal thoughts) of both genders during the period 2006-2011, 2) test the gender difference in mediating effect of body weight perception (BWP) between body mass index (BMI) and suicidal thoughts, even adjustment for confounding factors and 3) parse out whether a gender perspective on the operation types of school physical and health education performed by teachers is associated with physical strength, health condition, interest in physical and sport activity, and sexual consciousness, attitude and knowledge between boys and girls. Some of the key findings in the study are as follows: First, except for some health indexes, such as cigarette smoking, sexual relationship and obesity showing no change, but stress perception and body weight distortion showing an increasing trend over six years, most of health indexes seem to be positively improved in both genders. However, the gender inequality in all health indexes has still been existed. Particularly, girls are more likely than boys to report unhealthy weight control behaviors, body weight distortion and suicidal thoughts, which are usually affected by sociocultural environment. Second, this study found that BMI is related to BWP, BMI is related to suicidal thoughts, and BWP is related to suicidal thoughts, respectively. After adjustment for individual characteristics (e.g., gender, age, school type, school record, family structure, family socioeconomic status, and parents' educational attainment) and covariates (e.g., cigarette smoking, alcohol drinking, physical activity, drug intake, unhealthy weight control behaviors, and depressed mood), BWP plays a mediator for the association between BMI and suicidal thoughts. This phenomenon is also existed in both genders, but the mediating effect on the two relationship is different. For Boys, the significant relationship between overweight- obese and suicidal thoughts is disappeared, but the significant relationship between underweight and suicidal thoughts still remains when BWP is added, which indicates that BWP partially mediates the relationship between BMI and suicidal thoughts. For girls, in contrast, even the significant relationship between underweight and suicidal thoughts is disappeared when BWP is included, indicating that BWP perfectly mediates the association between BMI and suicidal thoughts. Third, physical education teachers who works at coeducational schools mostly operate their classes with a gender perspective, such as adopting to different learning level, evaluation standard, and active type between boys and girls with consideration to their different bodily powers, physical size, and inter