Copyright eContent Management Pty Ltd. Contemporary Nurse (2010) 34(2): 190198.

Self-esteem and optimism in rural youth: Gender differences

KATHRYN R PUSKAR
Professor, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA

LISA MARIE BERNARDO

Associate Professor, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA

DIANXU REN
Assistant Professor, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA

TAMMY M HALEY
Assistant Professor, University of Pittsburgh, Bradford Campus, Bradford, PA, USA

KIRSTI HETAGER TARK

Project Director, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA

JOANN SWITALA
Research Specialist, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA

LINDA SIEMON
Staff Nurse, Emergency Department, Somerset Hospital, Somerset, PA, USA

ABSTRACT
Aim: To identify and describe gender-related differences in the self-esteem and optimism levels of rural adolescents. Background: Self-esteem and optimism have been broadly examined and are associated with health-practices, social interaction, attachment, resiliency, and personal identity. Information describing the relationship of self-esteem and optimism as it relates to gender is limited. Methods: Using a cross-sectional survey design, students (N = 193) from three high-schools in rural Pennsylvania, USA completed the Rosenberg Self-Esteem Scale and the Optimism Scale-Life Orientation TestRevised as part of a National Institute of Health, National Institute of Nursing Research funded study. Results: Both instruments mean scores were in the range of average for this population, with females scoring lower than males in both self-esteem (p < 0.0001) and optimism (p < 0.0001). The results of this study have nursing implications for evidenced based interventions that target self-esteem and optimism. Attention to self-esteem and optimism in female youth is recommended.
Keywords: adolescents; nursing; optimism; rural; self-esteem

INTRODUCTION
elf-esteem is dened as a favorable or unfavorable attitude toward the self (Rosenberg, 1965) and is a feeling of pride in yourself (Websters Online Dictionary, 2008). Self-esteem
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is an essential component of an ego-identity which is the cornerstone of successful adolescent psychosocial development and self-care (Cantrell & Lupinacci, 2004). High self-esteem had been shown to be associated with better mental health

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outcomes, better coping ability, and a lower incidence of depression in both adolescents and adults (Birndorf, Ryan, Auinger, & Aten, 2005). Optimism can be dened as an inclination to anticipate the best possible outcome (Carver, Scheier, & Segerstrom, 2010). Optimists are dened as people who tend to make the most of their life by having a positive attitude in regard to their future and accepting problems by adapting in various ways, such as active positive problem solving, redening the situation in a positive manner, and using constructive emotional strategies like the use of humor. Dispositional optimism is a personality characteristic that is relatively stable and is dened when the persons overall expectations are of good outcomes in life (Carver et al., 2010; Scheier & Carver, 1992; Scheier, Carver, & Bridges, 1994). Although optimism is felt to be relatively stable, evidence supports that an optimistic orientation can be enhanced or manipulated with appropriate intervention (Fosnaugh, Geers, & Wellman, 2009). The purpose of this descriptive cross-sectional study was to identify relationships between selfesteem and optimism in rural youth. The research questions were: (1) Are there gender differences in self-esteem reported by rural adolescents and (2) Are there gender differences in optimism reported by rural adolescents? This study offers nurses information about rural youths self-esteem and optimism. Gender ndings are of interest due to the past history of inequalities between the genders.

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BACKGROUND
Self-esteem and optimism are broadly studied concepts throughout the literature, in both national and international arenas. They have been studied from many aspects including: family communication, development, parental attachment, resilience, identity style, bullying, self-harm, and criminal behaviors. Gender differences have not been consistently addressed.

Self-esteem
The link between self-esteem and externalizing problems, such as aggression, antisocial behavior

and delinquency was explored by Donnellan, Trzesniewski, Robins, Moftt, and Caspi (2005). Rosenbergs 10-item Self-Esteem scale was used in two consecutive studies conducted by the Donnellan et al. (2005). In the combined reporting of these studies conducted with a sample of children (N = 292) from two schools in Northern California, USA and two consecutive birth cohort samples from New Zealand who were 11 years of age (N = 812) and 13 years of age (N = 736), a relationship was found between low self-esteem and externalizing problems. No gender issues were noted. One example of their ndings was that 11-year-olds with low self-esteem tended to increase in aggression by age 13 (Donnellan et al., 2005, p. 333). In a longitudinal examination of self-esteem and bullying behavior among fth and sixth grade children (N = 307) in the northeast United States, Pollastri, Cardemil, and ODonnell (2009), reported that boys overall had higher self-esteem than girls regardless of the level of bullying behavior. They further identied that the lowest levels of self-esteem were reported by children who were both bully/victim, followed by those who were pure victims and those that were pure bullies. The highest levels of self-esteem were noted in the children who were not involved in bullying at any level. While the overall levels of self-esteem remained comparatively low for females over the course of the study, those who were reported to be pure bullies were found to have statistically signicant increases in self-esteem over time. These changes were not noted in the male participants. In a separate cross sectional analysis of Australian secondary school students (N = 1,284), between 40% and 50% of students reported being bullied while at school (Delfabbro et al., 2006). When compared to students who were never bullied, those often bullied by either peers or by teachers were found to have signicantly lower levels of self esteem. Trzesniewski et al. (2006) further studied self-esteem and found that weak self-esteem has detrimental consequences. Adolescents with low self-esteem have poorer mental health, physical health, worse

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Optimism
Puskar, Sereika, Lamb, Tusaie-Mumford, and McGuinness (1999) studied optimism and its relationship to depression, coping, anger and life events in 624 rural adolescents in western Pennsylvania, USA. The Optimism Scale-Life Orientation Test-Revised (LOT-R) measure was used and revealed that females had slightly lower mean scores than males, no signicant difference between genders was noted. Huan, Yeo, Ang, and Chong (2006) studied optimism and gender on adolescents perception of academic stress using the Life Orientation Test (LOT) measure. They found that a signicant negative relationship between optimism and academic stress, noting that gender was not a signicant predictor of academic stress. The concept of optimism was claried by Tusaie and Patterson (2006) from a study of 132 rural adolescents attending public school who were between 14 and 18 years of age. Participants completed the LOT-R and the Optimistic Bias Scale (OBS). In general, adolescents did not believe they were vulnerable to bad experiences. Females were found to believe that they were more likely to experience too much stress as compared to males. Results suggested that the inclusion of strategies to maximize optimistic thinking in situations holds the potential to inuence the level of resilience in adolescents. To examine the relationship of optimism to social support and positive health practices Mahon, Yarcheski, Yarcheski, and Hanks (2007) utilized regression analysis to evaluate a sample of 128 adolescents, 1214 years of age. Optimism was found to be a weak mediator for the relationship between social support and positive health practices.

economic prospects, and higher levels of criminal behavior during adulthood when compared to adolescents with high self-esteem. Low self-esteem during adolescence was shown to predict negative real-world consequences during adulthood. Laible, Carlo, and Roesch (2004) noted the relation between parent attachment and self-esteem was signicantly stronger for males than for females. The direct and indirect effects of parent and peer attachment on self-esteem in late adolescence was examined. For females, self-esteem may be more strongly affected by indirect inuences such as social behaviors. For males, self-esteem may be more directly linked to parental attachment. Parental attachment had the most direct effects on self-esteem. Self-esteem changes were studied in a random sample of teenagers (N = 16,489) from the National Education Longitudinal Study (Birndorf et al., 2005). High versus low self-esteem was measured by seven items from Rosenbergs self-esteem scale. Factors common to both male and female adolescents included positive family communication, baseline self-esteem, and feelings of safety. Adolescents reporting high self-esteem in grade eight were three times more likely to report high self-esteem in grade twelve. Male youth reported higher self-esteem than female youth at all grade levels. Further gender issues have been noted in the following literature. Robins and Trzesniewski (2005) noted on average self-esteem is relatively high in childhood. Self-esteem drops during adolescence (particularly for girls) then rises gradually throughout adulthood and declines sharply in old age. Evidence further supports that the self-esteem of female youth is regulated differently than the self-esteem of male youth (Raevuori et al., 2007). Sung, Puskar, and Sereika (2006) evaluated rural adolescents self-esteem using the Rosenberg SelfEsteem Scale. Descriptive results indicated that there were gender differences with signicantly higher self-esteem noted in male youth. Overall, these results were suggested to have implications for nurses and underscored the importance of assessing and bolstering self-esteem in adolescents, particularly female adolescents.
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Self-esteem and optimism

Yarcheski, Mahon, and Yarcheski (2004) measured self-esteem, optimism, hopefulness and coping skills and found they are positively correlated with positive health practices in adolescents. In another correlation study, Puskar, Ren, Bernardo, Haley, and Stark (2008) found self-esteem and optimism negatively correlated with anger. Higher self-esteem and optimism scores were correlated to higher anger

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control scores and lower anger scores in the remaining subscales of Spielbergers (1999) State-trait Anger Expression Inventory (STAXI-2). Therefore, lower self-esteem and optimism scores were correlated to higher anger scores, higher suppression of anger (self-esteem 0.438, optimism 0.329, p < 0.01), and lower anger control scores. All of these ndings were noted to have potential clinical implications for practitioners who are working with adolescents in either the clinical or community setting. In a 21-year longitudinal study by Heinonen, Raikkonen, and Keltikangas-Jarvinen (2005), selfesteem was found to predict dispositional optimism in a sample of youth in Finland. At 12 years of age, no signicant differences were noted between genders in the level of self-esteem. By age 18, females reported a higher level of self-esteem than males. No gender variations were noted with associations between the changes in self-esteem and optimismpessimism. Regression analyses of self-esteem found a signicantly higher level of pessimism by 33 years of age in those participants that had any type of change in their self-esteem between 1218 years of ages, versus those who had consistently high selfesteem over this developmental period. They suggested further studies are needed to evaluate their nding of a bi-directional relationship between selfesteem and optimismpessimism. The researchers expressed concerned that negative changes in selfesteem during the adolescent period could have severe consequences on optimism. In an examination of psychosocial variables and their relationship to adolescent identity style, Phillips and Pittman (2007) used the Rosenberg scale to measure self-esteem and a single item to measure optimism. No signicant interaction was noted among gender and identity styles with self-esteem and optimism. However, those participants with an avoidant identity style were found be less optimistic and have lower levels of self-esteem as evidenced by signicantly lower mean scores than those with normative or informational identity styles. The prevalence of self-harm among adolescents and the factors associated with self-harm were explored in a study of N = 2008 young people in

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west and central Scotland (OConnor, Rasmussen, Miles, & Hawton, 2009). Self harm was three times more likely to be reported by girls than boys (OR = 3.37. 95% CI 2.54.54, p < 0.001). Those who reported self-harm regardless of gender were noted to have lower levels of self-esteem and lower levels of optimism. Similar ndings were reported in a study of Irish youth. McMahon et al. (2010) found that lower self-esteem was an important factor associated with deliberate self-harm among adolescents (N = 3881). The study further identied that reported self-harm occurred three times more often in girls than boys. In summary, low self-esteem is correlated with externalizing problems (Donnellan et al., 2005); poor mental and physical health, higher levels of criminal behavior during adulthood and other realworld consequences (Trzesniewski et al., 2006); avoidant identity style (Phillips & Pittman, 2007); increased anger scores, anger suppression and decreased anger control (Puskar et al., 2008); and an increased prevalence of self-harm (McMahon et al., 2010; OConnor et al., 2009). Parental attachment was found to have the most direct effect on self-esteem in late adolescence (Laible et al., 2004) and optimistic thinking was found to inuence the level of resilience in adolescents (Tusaie & Patterson, 2006). The literature illustrates mixed ndings on self-esteem and optimism in relation to gender. Some researchers have identied that self-esteem and optimism are higher in adolescent males (Birndorf et al., 2005; Puskar et al., 1999; Sung et al., 2006), while others reported no difference dependent on the level of development when initially assessed (Heinonen et al., 2005). In both genders, common factors such as family communication and safety were noted to signicantly impact self-esteem (Birndorf et al., 2005).

METHOD
This descriptive cross-sectional study used a survey design to measure self-esteem and optimism in adolescents from three rural western Pennsylvania high schools, USA. These data were collected at baseline as part of a longitudinal randomized

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the remainder enrolled in vocational, business, or remedial programs. They were largely Caucasian (86.5%, n = 167) and female (53.4%, n = 103). Approximately one third of the sample (28.5%, n = 55) were reported to be currently employed an average of 14.1-h per week.

controlled study to assess the effectiveness of a targeted intervention designed for rural youth. The school sites were located in areas dened as rural by the Pennsylvania Department of Rural Health, USA (Pennsylvania Ofce of Rural Health, 2005).

Procedure and participants

Consent was received from the school administrators and the Universitys Institutional Review Board to conduct this study. The research team presented information at each school site. The students reported to the auditorium where the research team introduced themselves and described the project. Informed consent was obtained. Questions were addressed and consent forms were distributed. Directions included encouraging parents to call the principal investigator for further questions as needed before signing the consent forms. A packet of the data collection instruments was available at the school for parents to review. The consent forms were signed and returned by parents, with students providing assent prior to study participation. Only those students with consents completely signed and initialed by both student and parents/guardians were in the study. The survey instruments, included measures of self-esteem and optimism, and were administered in a group setting during school time. The students were paid $10 for completing the measures. Anonymity of the individual ndings was preserved.

Measures
Rosenbergs Self-Esteem Scale was developed to measure adolescents global feelings of self-worth or self-acceptance (Rosenberg, 1965). It includes ten items that are scored using a four-point response ranging from strongly disagree to strongly agree. Rosenberg (1965) tested 5,024 students to check the reliability of the self-esteem scale. Internal consistency with Cronbachs alpha was found to be 0.77. Coefcients of reproducibility were 0.91; testretest reliability was 0.85. Scale ranges from 030 and average range is 1525 (Rosenberg, 1965). Optimism was measured by the Life Orientation Test Revised (LOT-R). The LOT-R was designed by Scheier et al. (1994) to measure optimism by assessing the generalized outcome expectancies of individuals. The scale consists of 10 items. Each item is scaled on a 5-point Likert scale with responses ranging from strongly agree (4 points) to strongly disagree (0 points) with reverse scoring (on items 3, 7 and 9). The range is 024 possible points with no normative values. Greater optimism is represented by higher scores. The Cronbachs alpha was 0.78, level of internal consistency acceptable. Data were analyzed using descriptive and inferential statistical tests. The level of signicance was set at p < 0.05.

Sample and setting

Male and female students (N = 193) from three Western Pennsylvania, USA rural-area public high schools who were in the ninth tenth or eleventh grade participated in the study. Only those students with the ability to read and write in English fullled the inclusion criteria. The sample has been previously described in other publications (Puskar et al., 2006, 2008). Participants who completed the self-report measures at baseline were 1418-years old (mean = 15.57) and were enrolled in high-school. The majority of the participants were registered for academic programs (88.6%, n = 171) with
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RESULTS
Analysis of the summative total score for the Rosenbergs Self-Esteem Scale revealed that the mean score for male respondents (n = 90, M = 21.988, SD = 4.916) was higher than the mean score of female respondents (n = 103, M = 19.13, SD = 4.795). This nding was noted to be statistically signicant (t = 4.08, p < 0.0001). Table 1 outlines the results of Rosenbergs SelfEsteem Scale for this sample by gender.

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TABLE 1: GENDER DIFFERENCES FOR ROSENBERG SELF-ESTEEM SCALE (RSES) AND LIFE ORIENTATION TEST SCORES (LOT-R)
Male Mean RSES LOT-R 21.988 14.9 Standard deviation 4.916 3.48 Mean 19.132 12.637 Female Standard deviation 4.795 4.242 p value

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p < 0.0001 p < 0.0001

On the Optimism Scale Life Orientation Test (LOT-R) males again scored signicantly higher (n = 90, M = 14.9, SD = 3.48) than females (n = 103, M = 12.64, SD = 4.24) (t = 4.01, p < 0.0001) (Table 1). There was also noted to be a moderate positive correlation between optimism and self-esteem in this sample of rural adolescents (r = 0.637, p < 0.000 2-tailed).

DISCUSSION
The results of this study are felt to provide further evidence for the presence of gender differences in the level of self-esteem and optimism among rural adolescents. While the mean scores for self-esteem and optimism were noted to be within the average range for adolescents, there was a troubling trend for signicantly lower scores in rural female adolescents when compared to rural male adolescents. These ndings are noted to be consistent with previous research reporting signicantly higher levels of self-esteem in male youth (Sung et al., 2006) and lower levels of self esteem in female youth at all grade levels when compared to their male counterparts (Birndorf et al., 2005). In the current study, rural female adolescents were also noted to have signicantly lower mean scores for optimism as compared to their male counterparts. Tusaie and Patterson (2006) found the same pattern of response with the male participants reporting slightly lower trait optimism (M = 14.2 SD = 4.4) and the female participants reporting slightly higher levels of optimism (M = 13.3, SD = 3.1) than those noted in the current examination of rural adolescents. The current study identied that participants scores were on average neutral (M = 13.69, SD = 4.05) on

the LOT-R Optimism Scale. Puskar et al. (1999) found comparable on average neutral scores on the LOT-R in their study in rural youth (n = 624, M = 13.16, SD = 4.16). Similarly, Tusaie and Pattersons (2006) study of 132 adolescents found a mean score for trait optimism of M = 13.6, SD = 3.7 when using the LOT-R measure. Given these ndings, rural female adolescents may be especially vulnerable to potential negative outcomes and negative health behaviors associated with lower levels of self-esteem and optimism when compared to rural males. The recognition of these differences provides additional support for the creation of gender specic interventions targeting the enhancement of self-esteem and optimism for rural youth.

IMPLICATIONS FOR PRACTICE

Globally, those residing in rural areas struggle with issues of access, availability, and appropriateness of health services (Dolea, 2009; McGorry et al., 2007). With 11% of residents in Australia and 18% of residents in the United States residing in areas identied as rural (United Nations Statistics Division, 2009), nurses practicing in rural settings are well positioned to help provide early assessment and intervention to those at risk for low self-esteem and reduced optimism. Recent government funded initiatives in Australia such as MindMatters and headspace have placed an increased focus on an organized, evidence based approach to improving the mental health and well being of children and adolescents (Hodges, OBrien, & McGorry, 2007; Rowling, 2007). Because self-esteem, optimism, hopefulness and coping skills are positively correlated with

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2006; Pollastri et al., 2009). Community nurses working in collaboration with school counselors can provide education and interventions to increase self-esteem and reduce these negative behaviors. Nurses are well positioned to raise community awareness of the high prevalence of bullying behavior, empower parents to become involved if they suspect their child is being bullied, and help promote supportive peer relationships among adolescents keeping in mind that young girls are potentially more highly affected by these behaviors due to their lower levels of reported self-esteem. Evidence supports that females who suffer from low levels of self-esteem and optimism are at increased risk of negative health behaviors such as self-injury (McMahon et al., 2010; OConnor et al., 2009) and recurrent episodes of binge eating and extreme weight control behaviors (Hay, 2007). Nurses may need to pay special attention to these issues in rural females given the identied lower levels of self-esteem reported. Increased attention by nurses to screening and early intervention, as well as the creation of evidence based, gender specic interventions in this population may be warranted.

positive health practices in adolescents (Cantrell & Lupinacci, 2004; Yarcheski et al., 2004), it is appropriate for nurses to assess and improve these factors as part of health promotion interventions. It has been noted that interventions promoting optimism are needed in schools, communities, and institutions in order to stimulate the development of optimism and other psychological strengths in young people (Gillham & Reivich, 2004). In addition to the design and implementation of interventions to build self-esteem and optimism, nurses in daily professional practice can conduct screening of self-esteem and optimism in children and adolescents to identify those who may be at risk, with referral to a mental health nurse or other mental health professional if needed. Parental involvement should not be overlooked by nurses when designing interventions to promote positive health practices through the augmentation of self-esteem and optimism. It has been found that positive communication, with a child up to middle school may result in higher self-esteem by the time the child is in the 12th grade (Birndorf et al., 2005). Parents need to be cognizant of the environment they create for their children whether it is positive or negative. The analyses of family problems and the resolutions achieved are important to the family network. With the recognized gender differences in self-esteem and optimism noted by this study and evidence that the association of self-esteem and parental involvement may differ by gender (Laible et al., 2004) the creation of gender specic interventions should be considered. Apart from parental involvement, parenting styles warrant exploration by nurses aiming to increase self-esteem. Assessment of authoritarian parenting styles could lead to interventions that teach promotion of self-esteem. A sample of adolescents (N = 1,456, 1316 years of age) in Spain that had indulgent parents showed the highest self-esteem scores in contrast to adolescents from authoritarian parents who were found to have lower levels of self-esteem (Martinez & Garcia, 2007). The relationship of bullying and lower selfesteem has been well described (Delfabbro et al.,
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Limitations
Limitations of the study include the use of a sample who were predominately Caucasian and enrolled in academic programs. The participants were limited to three rural high schools in western Pennsylvania, USA. Future research may be done on a greater number of schools over a larger geographic area with more racial and academic diversity.

CONCLUSIONS
This study provides further evidence of the presence of gender differences in childhood and adolescence with regard to self-esteem and optimism. Consistent with published reports, rural females were noted to have lower levels of both selfesteem and optimism when compared to rural dwelling male youth. The screening of children and adolescents for low self-esteem and decreased levels of optimism may be indicated to help curb potentially negative outcomes associated with low levels of these characteristics.

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Community mental health nurses as well as those nurses in the inpatient, outpatient and school setting are well suited to play a central role in the creation and implementation of such services. As outlined by the aims of the headspace initiative, early detection and early involvement with the use of evidence-based interventions to stem mental disorders in children and adolescents is imperative (Hodges et al., 2007; McGorry et al., 2007). Young females appear to be especially vulnerable to the negative outcomes of low levels of self-esteem and optimism which may include poor school performance, decreased levels of mental and physical health, and increased potential for self-harm. The creation of evidenced based nursing interventions that target female youth with the goal of increasing self-esteem and optimism may be benecial in helping to limit or reduce these negative outcomes.

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Received 01 July 2008 Accepted 23 March 2010

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