351
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Came H, Matheson A, Kidd J. Smashing the patriarchy to address gender health inequities: Past, present and future perspectives from Aotearoa (New Zealand). Glob Public Health 2021; 17:1540-1550. [PMID: 34097588 DOI: 10.1080/17441692.2021.1937272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The second wave feminist dream of smashing the patriarchy remains a task yet to be completed on a complex to do list. Women, particularly able-bodied cis-gendered white women however do enjoy the privilege of living longer than men. But our longer lives take place within patriarchal-capitalist systems where many women's social and cultural rights continue to be compromised. How do we ensure that all women can exercise our right to health and wellbeing? In this paper, the authors examine, critique, review and re-vision the dynamics of power and patriarchy over three distinct time periods - 1999, 2019 and 2039. We look to the past to track progress; we look to the present to see what we have achieved and look to the future for what might be. This conceptual paper is informed by the authors' expert knowledge, a review of the literature and the novel use of speculative ethnography. The authors conclude that patriarchy remains not only a negative determinant of women's health that needs to be smashed, but is also a threat to all people and to planetary health.
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Affiliation(s)
- Heather Came
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Anna Matheson
- School of Health, Victoria University, Melbourne, Australia
| | - Jacquie Kidd
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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352
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Cornell M, Majola M, Johnson LF, Dubula-Majola V. HIV services in sub-Saharan Africa: the greatest gap is men. Lancet 2021; 397:2130-2132. [PMID: 34087108 DOI: 10.1016/s0140-6736(21)01163-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023]
Affiliation(s)
- Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7700, South Africa.
| | - Mandla Majola
- Movement for Change and Social Justice, Gugulethu, Cape Town, South Africa
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7700, South Africa
| | - Vuyiseka Dubula-Majola
- Africa Centre for HIV/AIDS Management, Stellenbosch University, Stellenbosch, South Africa
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353
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Why Gender Equality Is Good for Men's Health and Why This Matters Now. Am J Prev Med 2021; 60:873-876. [PMID: 33653648 DOI: 10.1016/j.amepre.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/02/2020] [Accepted: 01/03/2021] [Indexed: 11/23/2022]
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354
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Perera C, Bakrania S, Ipince A, Nesbitt‐Ahmed Z, Obasola O, Richardson D. PROTOCOL: Impact of social protection on gender equality in low- and middle-income countries: A systematic review of reviews. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1161. [PMID: 37051182 PMCID: PMC8356277 DOI: 10.1002/cl2.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This is the protocol for a Campbell review. The review aims to systematically collect, appraise, map and synthesise the evidence from systematic reviews on the differential gender impacts of social protection programmes in Low- and Middle-Income Countries (LMICs). Therefore, it will answer the following questions: (1) What is known from systematic reviews on the gender-differentiated impacts of social protection programmes in LMICs? (2) What is known from systematic reviews about the factors that determine these gender-differentiated impacts? (3) What is known from existing systematic reviews about design and implementation features of social protection programmes and their association with gender outcomes?
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355
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Esteban-Gonzalo S, González-Pascual JL, Gil-Del Sol M, Esteban-Gonzalo L. Exploring new tendencies of gender and health in university students. Arch Womens Ment Health 2021; 24:445-454. [PMID: 33184725 DOI: 10.1007/s00737-020-01087-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
In light of the impact of gender roles on health, the aims of the present study are (1) to assess the associations between femininity/masculinity and gender typologies, and health indicators (mental health, wellbeing, and self-perceived health) and (2) to identify patterns of gender roles and health indicators, thus exploring new tendencies in gender and health in Spanish university students in the framework of the androgyny model. The sample was made up of 795 university students from Madrid and Toledo. Data collection was completed during 2019. Measures of self-rated health, mental health (GHQ12), and wellbeing (MHC-SF) were considered as health indicators, while the Bem Sex Roles Inventory (BSRI) was used to measure gender roles. Multilevel analysis was employed to value associations between masculinity and femininity and gender typologies with self-rated health, mental health, and wellbeing. Furthermore, cluster analysis was used to explore general tendencies in gender roles and health, while also considering biological sex composition. The best predictor of mental health was found to be masculinity, rather than femininity. Cluster analysis showed a dominance of androgyny and undifferentiated typologies with proportionally similar biological sex composition. Results confirmed the androgyny model, highlighting the role of androgyny and masculinity as protective factors of mental health. Cluster analysis suggested less gender-typed individuals and more flexible ways of adapting to gender roles in university students. Health systems, governments, and public institutions must take these results into account when designing health prevention and intervention policies. Social agents, educators, and the media must also collaborate in the achievement of equalitarian gender roles, which could result in a minimization of gender-related health differences.
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Affiliation(s)
- Sara Esteban-Gonzalo
- Faculty of Biomedicine, Psychology Department, Universidad Europea de Madrid, Madrid, Spain.
| | | | - Mónica Gil-Del Sol
- Faculty of Biomedicine, Nursing Department, Universidad Europea de Madrid, Madrid, Spain
| | - Laura Esteban-Gonzalo
- Faculty of Biomedicine, Nursing Department, Universidad Europea de Madrid, Madrid, Spain.,Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Madrid, Spain
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356
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Garrison-Desany HM, Wilson E, Munos M, Sawadogo-Lewis T, Maïga A, Ako O, Mkuwa S, Hobbs AJ, Morgan R. The role of gender power relations on women's health outcomes: evidence from a maternal health coverage survey in Simiyu region, Tanzania. BMC Public Health 2021; 21:909. [PMID: 33980197 PMCID: PMC8117490 DOI: 10.1186/s12889-021-10972-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Gender is a crucial consideration of human rights that impacts many priority maternal health outcomes. However, gender is often only reported in relation to sex-disaggregated data in health coverage surveys. Few coverage surveys to date have integrated a more expansive set of gender-related questions and indicators, especially in low- to middle-income countries that have high levels of reported gender inequality. Using various gender-sensitive indicators, we investigated the role of gender power relations within households on women's health outcomes in Simiyu region, Tanzania. METHODS We assessed 34 questions around gender dynamics reported by men and women against 18 women's health outcomes. We created directed acyclic graphs (DAGs) to theorize the relationship between indicators, outcomes, and sociodemographic covariates. We grouped gender variables into four categories using an established gender framework: (1) women's decision-making, (2) household labor-sharing, (3) women's resource access, and (4) norms/beliefs. Gender indicators that were most proximate to the health outcomes in the DAG were tested using multivariate logistic regression, adjusting for sociodemographic factors. RESULTS The overall percent agreement of gender-related indicators within couples was 68.6%. The lowest couple concordance was a woman's autonomy to decide to see family/friends without permission from her husband/partner (40.1%). A number of relationships between gender-related indicators and health outcomes emerged: questions from the decision-making domain were found to play a large role in women's health outcomes, and condoms and contraceptive outcomes had the most robust relationship with gender indicators. Women who reported being able to make their own health decisions were 1.57 times (95% CI: 1.12, 2.20) more likely to use condoms. Women who reported that they decide how many children they had also reported high contraception use (OR: 1.79, 95% CI: 1.34, 2.39). Seeking care at the health facility was also associated with women's autonomy for making major household purchases (OR: 1.35, 95% CI: 1.13, 1.62). CONCLUSIONS The association between decision-making and other gender domains with women's health outcomes highlights the need for heightened attention to gender dimensions of intervention coverage in maternal health. Future studies should integrate and analyze gender-sensitive questions within coverage surveys.
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Affiliation(s)
- Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA.
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Melinda Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Talata Sawadogo-Lewis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Onome Ako
- Amref Health Africa Canada, 489 College Street, Toronto, ON, M6G 1A5, Canada
| | - Serafina Mkuwa
- Amref Health African Tanzania, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
| | - Amy J Hobbs
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
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357
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Liu D, Wu Y, Jiang F, Wang M, Liu Y, Tang YL. Gender Differences in Job Satisfaction and Work-Life Balance Among Chinese Physicians in Tertiary Public Hospitals. Front Public Health 2021; 9:635260. [PMID: 34041214 PMCID: PMC8141628 DOI: 10.3389/fpubh.2021.635260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/15/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Gender has been associated with job-related experience, including job satisfaction and work-life balance. This study aimed to identify gender differences in job satisfaction and work-life balance among Chinese physicians in a large, nationally representative sample. Methods: A national cross-sectional survey was conducted between March 18 and 31, 2019, using an anonymous online questionnaire. The questionnaire included the short-form MSQ (Chinese version) and a work-life balance item. The demographic and job-related factors were also collected. Findings: In total, 22,128 physicians (9,378 males and 12,750 females) from 144 tertiary public hospitals completed the survey. The overall MSQ score (job satisfaction) was 70.31 ± 12.67, and it was 69.89 ± 13.24 in males, and 70.63 ± 12.22 in females, respectively (p < 0.001). Only 931 (4.21%) physicians were very satisfied with WLB (421 males, 510 females), and 2,534 (11.45%) were rated as satisfied. Age, education, monthly income, working hours, specialty, and professional titles were significantly associated with job satisfaction; while number of children, specialty, professional titles, monthly income, age, working hours were significantly associated with WLB. No significant gender differences were observed in job satisfaction or WLB after controlling confounding factors (both p > 0.05). Interpretation: While many demographic and work-related factors are significantly associated with job satisfaction and WLB, we found no significant gender differences, which is different from many other studies. To improve Chinese physicians' job satisfaction and work-life balance, interventions should be focused on certain specialties and on other modifiable factors, such as income, working hours.
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Affiliation(s)
- Dan Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yinuo Wu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng Jiang
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Mingxiao Wang
- Department of Cardiology, Emergency General Hospital, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.,Atlanta VA Medical Center, Decatur, Georgia, GA, United States
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358
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Jain A, Rodgers J, Li Z, Kim R, Subramanian SV. Multilevel analysis of geographic variation among correlates of child undernutrition in India. MATERNAL AND CHILD NUTRITION 2021; 17:e13197. [PMID: 33960621 PMCID: PMC8189194 DOI: 10.1111/mcn.13197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
Prior research has identified a number of risk factors ranging from inadequate household sanitation to maternal characteristics as important determinants of child malnutrition and health in India. What is less known is the extent to which these individual‐level risk factors are geographically distributed. Assessing the geographic distribution, especially at multiple levels, matters as it can inform where, and at what level, interventions should be targeted. The three levels of significance in the Indian context are villages, districts, and states. Thus, the purpose of this paper was to (a) examine what proportion of the variation in 21 risk factors is attributable to villages, districts, and states in India and (b) elucidate the specific states where these risk factors are clustered within India. Using the fourth National Family Health Survey dataset, from 2015 to 2016, we found that the proportion of variation attributable to villages ranged from 14% to 63%, 10% to 29% for districts and 17% to 62% for states. Furthermore, we found that Bihar, Jharkhand, Madhya Pradesh, and Uttar Pradesh were in the highest risk quintile for more than 10 of the risk factors included in our study. This is an indication of geographic clustering of risk factors. The risk factors that are clustered in states such as Bihar, Jharkhand, Madhya Pradesh and Uttar Pradesh underscore the need for policies and interventions that address a broader set of child malnutrition determinants beyond those that are nutrition specific.
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Affiliation(s)
- Anoop Jain
- Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin Rodgers
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
| | - Zhihui Li
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Rockli Kim
- Division of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
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359
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Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiol Psychiatr Sci 2021; 30:e36. [PMID: 33955350 PMCID: PMC8157816 DOI: 10.1017/s2045796021000275] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Anxiety disorders are widespread across the world. A systematic understanding of the disease burden, temporal trend and risk factors of anxiety disorders provides the essential foundation for targeted public policies on mental health at the national, regional, and global levels. METHODS The estimation of anxiety disorders in the Global Burden of Disease Study 2019 using systematic review was conducted to describe incidence, prevalence and disability-adjusted life years (DALYs) in 204 countries and regions from 1990 to 2019. We calculated the estimated annual percentage change (EAPC) to quantify the temporal trends in anxiety disorders burden by sex, region and age over the past 30 years and analysed the impact of epidemiological and demographic changes on anxiety disorders. RESULTS Globally, 45.82 [95% uncertainty interval (UI): 37.14, 55.62] million incident cases of anxiety disorders, 301.39 million (95% UI: 252.63, 356.00) prevalent cases and 28.68 (95% UI: 19.86, 39.32) million DALYs were estimated in 2019. Although the overall age-standardised burden rate of anxiety disorders remained stable over the past three decades, the latest absolute number of anxiety disorders increased by 50% from 1990. We observed huge disparities in both age-standardised burden rate and changing trend of anxiety disorders in sex, country and age. In 2019, 7.07% of the global DALYs due to anxiety disorders were attributable to bullying victimisation, mainly among the population aged 5-39 years, and the proportion increased in almost all countries and territories compared with 1990. CONCLUSION Anxiety disorder is still the most common mental illness in the world and has a striking impact on the global burden of disease. Controlling potential risk factors, such as bullying, establishing effective mental health knowledge dissemination and diversifying intervention strategies adapted to specific characteristics will reduce the burden of anxiety disorders.
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360
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Gashaw T, Hagos B, Sisay M. Expected Impacts of COVID-19: Considering Resource-Limited Countries and Vulnerable Population. Front Public Health 2021; 9:614789. [PMID: 34026704 PMCID: PMC8131657 DOI: 10.3389/fpubh.2021.614789] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/06/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease in 2019 emerged in Wuhan, Hubei Province, China, in December 2019. After a month, it was declared a global threat to public health. The effects of the pandemic could be socio-economic, undermining the health system and risking livelihoods. Vulnerability to this infection has been associated with underlying comorbidities such as hypertension, diabetes, coronary heart disease, chronic respiratory diseases, cancer, and compromised immune systems. Co-morbidity has been common to the elderly, the disabled, and the homeless. In addition, more severe coronavirus disease outcomes have been reported in older males than females. Nonetheless, multiple variables are related to the concept of cultural gender that should be taken into account as women in more affected sectors are economically disadvantageous and over-represented. Similarly, although children are not the face of this pandemic, calamity has a profound effect on their welfare, especially for those living in poor and inconvenient situations. Moreover, the economic influence could be profound and universal when viewed through a migration lens as it is exacerbating xenophobic and discriminatory treatment. Protection measures to mitigate the outbreak of a pandemic, such as social distancing, may reduce social support for certain categories relied on for their day-to-day activities. The mental health of people would definitely be affected by the additional psychosocial burden of the pandemic, particularly in vulnerable groups. Integrated approaches are therefore mandatory to assist these groups and contain the pandemic.
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Affiliation(s)
- Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bisrat Hagos
- Department of Social Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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361
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Chzhen Y, Prencipe L, Eetaama F, Luchemba P, Lukongo TM, Palermo T. Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents. J Adolesc Health 2021; 68:899-905. [PMID: 32843241 DOI: 10.1016/j.jadohealth.2020.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Inequitable attitudes toward men's and women's roles, rights, and responsibilities are associated with poor health-related outcomes, particularly for girls and women. Yet, we know relatively little about what interventions work to improve gender-equitable attitudes among adolescents in low-income countries. This study examines the impact of a government-implemented "cash plus" intervention on gender-equitable attitudes among adolescents in Tanzania. The intervention includes discussions and activities related to gender norms, embedded in broader life skills, livelihoods, and health training. METHODS The study utilizes a cluster randomized design, using data from 1,933 males and females aged 14-19 years at baseline who took part in the baseline (2017), midline (2018), and endline (2019) surveys. Gender attitudes were measured using 24 items from the Gender-Equitable Men (GEM) Scale. We estimate intent-to-treat impacts on the GEM scale and four subscales (violence, sexual relationships, reproductive health, and domestic chores). RESULTS The "cash plus" intervention had a significant impact on the overall GEM scale at midline. The intervention increased gender-equitable attitudes on the domestic chores subscale at both midline and endline. The intervention improved gender-equitable attitudes among males on the overall GEM scale and three subscales at midline and on two subscales at endline, but it had no impacts among females. CONCLUSIONS Gender transformative social protection is currently being advocated as a way to address the gendered nature of poverty and its consequences. Initiatives such as the one studied here, which address the multifaceted drivers of gender inequities, could be a promising way forward.
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Affiliation(s)
| | - Leah Prencipe
- Department of Public Health, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Frank Eetaama
- Children and AIDS Section, UNICEF Tanzania, Dar es Salaam, Tanzania
| | - Paul Luchemba
- Tanzania Social Action Fund, United Republic of Tanzania, Dodoma, Tanzania
| | | | - Tia Palermo
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, New York
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362
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Labib K, Evans N. Gender, diversity, and the responsible assessment of researchers. PLoS Biol 2021; 19:e3001036. [PMID: 33905411 PMCID: PMC8078804 DOI: 10.1371/journal.pbio.3001036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/24/2021] [Indexed: 02/01/2023] Open
Abstract
In response to the Hong Kong Principles for assessing researchers, this Formal Comment argues that it is time to take gender and diversity considerations seriously in the pursuit of fostering research integrity; this requires acknowledging and reshaping the influence of research assessment criteria on researcher representation.
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Affiliation(s)
- Krishma Labib
- Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Department of Law, Ethics and Humanities, Amsterdam Public Health Institute, Amsterdam, the Netherlands
- * E-mail:
| | - Natalie Evans
- Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Department of Law, Ethics and Humanities, Amsterdam Public Health Institute, Amsterdam, the Netherlands
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363
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Milner A, Kavanagh A, Scovelle AJ, O'Neil A, Kalb G, Hewitt B, King TL. Gender Equality and Health in High-Income Countries: A Systematic Review of Within-Country Indicators of Gender Equality in Relation to Health Outcomes. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:113-123. [PMID: 33937909 PMCID: PMC8082013 DOI: 10.1089/whr.2020.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 11/12/2022]
Abstract
Background: Gender equality is recognized as an important political, social, and economic goal in many countries around the world. At a country level, there is evidence that gender equality may have an important influence on health. Historically gender equality has mainly been measured to allow for between-country, rather than within-country comparisons; and the association between gender equality and health outcomes within countries has been under-researched. This article thus aimed to systematically review within-country indicators of gender equality in public health studies and assess the extent to which these are related to health outcomes. Materials and Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach with two independent reviewers. Results: Data from the eight included studies revealed that there was heterogeneity in the way gender equality has been measured as a multidimensional construct. Associations between gender equality and a number of different health outcomes were apparent, including mortality, mental health, morbidity, alcohol consumption, and intimate partner violence, with gender equality mostly associated with better health outcomes. Conclusions: Further investigation into the effects of gender equality on health outcomes, including a clear conceptualization of terms, is critical for the development of policies and programs regarding gender equality.
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Affiliation(s)
- Allison Milner
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anne Kavanagh
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anna J. Scovelle
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Adrienne O'Neil
- Deakin University, IMPACT–The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Guyonne Kalb
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
| | - Belinda Hewitt
- School of Social and Political Sciences, University of Melbourne, Melbourne, Australia
| | - Tania L. King
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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364
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van der Ham M, Bolijn R, de Vries A, Campos Ponce M, van Valkengoed IGM. Gender inequality and the double burden of disease in low-income and middle-income countries: an ecological study. BMJ Open 2021; 11:e047388. [PMID: 33895719 PMCID: PMC8074552 DOI: 10.1136/bmjopen-2020-047388] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Many low-income and middle-income countries (LMIC) suffer from a double burden of infectious diseases (ID) and non-communicable diseases (NCD). Previous research suggests that a high rate of gender inequality is associated with a higher ID and NCD burden in LMIC, but it is unknown whether gender inequality is also associated with a double burden of disease. In this ecological study, we explored the association between gender inequality and the double burden of disease in LMIC. METHODS For 108 LMIC, we retrieved the Gender Inequality Index (GII, scale 0-1) and calculated the double burden of disease, based on disability-adjusted life-years for a selection of relevant ID and NCD, using WHO data. We performed logistic regression analysis to study the association between gender inequality and the double burden of disease for the total population, and stratified for men and women. We adjusted for income, political stability, type of labour, urbanisation, government health expenditure, health infrastructure and unemployment. Additionally, we conducted linear regression models for the ID and NCD separately. RESULTS The GII ranged from 0.13 to 0.83. A total of 37 LMIC had a double burden of disease. Overall, the adjusted OR for double burden of disease was 1.05 per 0.01 increase of GII (95% CI 0.99 to 1.10, p=0.10). For women, there was a borderline significant positive association between gender inequality and double burden of disease (OR 1.05, 95% CI 1.00 to 1.11, p=0.06), while there was no association in men (OR 0.99, 95% CI 0.95 to 1.04, p=0.75). CONCLUSION We found patterns directing towards a positive association between gender inequality and double burden of disease, overall and in women. This finding suggests the need for more attention for structural factors underlying gender inequality to potentially reduce the double burden of disease.
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Affiliation(s)
- Mirte van der Ham
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Renee Bolijn
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Alcira de Vries
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maiza Campos Ponce
- Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1091, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Lebenbaum M, Stukel TA, Saunders NR, Lu H, Urquia M, Kurdyak P, Guttmann A. Association of source country gender inequality with experiencing assault and poor mental health among young female immigrants to Ontario, Canada. BMC Public Health 2021; 21:739. [PMID: 33863298 PMCID: PMC8052772 DOI: 10.1186/s12889-021-10720-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background Gender inequality varies across countries and is associated with poor outcomes including violence against women and depression. Little is known about the relationship of source county gender inequality and poor health outcomes in female immigrants. Methods We used administrative databases to conduct a cohort study of 299,228 female immigrants ages 6–29 years becoming permanent residence in Ontario, Canada between 2003 and 2017 and followed up to March 31, 2020 for severe presentations of suffering assault, and selected mental health disorders (mood or anxiety, self-harm) as measured by hospital visits or death. Poisson regression examined the influence of source-country Gender Inequality Index (GII) quartile (Q) accounting for individual and country level characteristics. Results Immigrants from countries with the highest gender inequality (GII Q4) accounted for 40% of the sample, of whom 83% were from South Asia (SA) or Sub-Saharan Africa (SSA). The overall rate of assault was 10.9/10,000 person years (PY) while the rate of the poor mental health outcome was 77.5/10,000 PY. Both GII Q2 (Incident Rate Ratio (IRR): 1.48, 95% Confidence Interval (CI): 1.08, 2.01) and GII Q4 (IRR: 1.58, 95%CI: 1.08, 2.31) were significantly associated with experiencing assault but not with poor mental health. For females from countries with the highest gender inequality, there were significant regional differences in rates of assault, with SSA migrants experiencing high rates compared with those from SA. Relative to economic immigrants, refugees were at increased risk of sustaining assaults (IRR: 2.96, 95%CI: 2.32, 3.76) and poor mental health (IRR: 1.73, 95%CI: 1.50, 2.01). Higher educational attainment (bachelor’s degree or higher) at immigration was protective (assaults IRR: 0.64, 95%CI: 0.51, 0.80; poor mental health IRR: 0.69, 95% CI: 0.60, 0.80). Conclusion Source country gender inequality is not consistently associated with post-migration violence against women or severe depression, anxiety and self-harm in Ontario, Canada. Community-based research and intervention to address the documented socio-demographic disparities in outcomes of female immigrants is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10720-0.
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Affiliation(s)
- Michael Lebenbaum
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Therese A Stukel
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Natasha Ruth Saunders
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.,Division of Paediatric Medicine, the Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,Department of Pediatrics, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON, M5G 1X8, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, 686 Bay St, ON, M5G 0A4, Toronto, Canada
| | - Hong Lu
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Marcelo Urquia
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada.,Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, 424 Brodie Centre, Winnipeg, Manitoba, Canada.,Rady Faculty of Health Sciences, University of Manitoba, 424 Brodie Centre, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.,Center for Addiction and Mental Health, 33 Russell St, Toronto, ON, M5S 3M1, Canada
| | - Astrid Guttmann
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada. .,Division of Paediatric Medicine, the Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. .,Department of Pediatrics, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON, M5G 1X8, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, 686 Bay St, ON, M5G 0A4, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada.
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366
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Sartori LRM, Henzel LT, de Queiroz ABL, Ramos EC, de Oliveira LJC, Chisini LA, Correa MB. Gender inequalities in the dental science: An analysis of high impact publications. J Dent Educ 2021; 85:1379-1387. [PMID: 33855714 DOI: 10.1002/jdd.12603] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the participation of women in publications of dental journals with a high impact factor. METHODS Articles published in 2016, 2011, and 2006 in 10 dental journals chosen for their highest impact factors in each dental fields were included in this research. Articles-related variables collected included the country of origin of each author, the type of study, and gender of the researchers. Gender was examined through PubMed, Scopus, ResearchGate, and respective affiliated institutions. Furthermore, a website designed to discover the gender of names was used when the previous alternatives were not conclusive. Forward stepwise Poisson regression models were used for data analysis. RESULTS A total of 3365 studies were included in the first authorship analysis and 3398 in analysis related to last authorship. The prevalence of women as first authors was 37.2% (confidence interval (CI) 95% 34.5-37.5) and as last authors was 22.6% (CI 95% 21.3-23.9). Having a woman as the last author increased the presence of women in the first author position in scientific dental articles by 16% (prevalence ratio = 1.16, CI 95% [1.04-1.29]). The year of publication, journal, and region of the author were associated with an increase in the prevalence of women as last authors. From 2006 to 2016, the prevalence of women as last authors increased by 61%. Despite these trends, women were still underrepresented in science in the evaluated period. CONCLUSIONS There are meaningful gender inequalities in publications of scientific dental papers. Encouraging women to lead research groups can reduce the inequities observed in the present study.
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Affiliation(s)
| | | | | | | | | | - Luiz Alexandre Chisini
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Marcos Britto Correa
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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367
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Stewart R, Wright B, Smith L, Roberts S, Russell N. Gendered stereotypes and norms: A systematic review of interventions designed to shift attitudes and behaviour. Heliyon 2021; 7:e06660. [PMID: 33912699 PMCID: PMC8066375 DOI: 10.1016/j.heliyon.2021.e06660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/06/2020] [Accepted: 03/29/2021] [Indexed: 02/01/2023] Open
Abstract
In the face of ongoing attempts to achieve gender equality, there is increasing focus on the need to address outdated and detrimental gendered stereotypes and norms, to support societal and cultural change through individual attitudinal and behaviour change. This article systematically reviews interventions aiming to address gendered stereotypes and norms across several outcomes of gender inequality such as violence against women and sexual and reproductive health, to draw out common theory and practice and identify success factors. Three databases were searched; ProQuest Central, PsycINFO and Web of Science. Articles were included if they used established public health interventions types (direct participation programs, community mobilisation or strengthening, organisational or workforce development, communications, social marketing and social media, advocacy, legislative or policy reform) to shift attitudes and/or behaviour in relation to rigid gender stereotypes and norms. A total of 71 studies were included addressing norms and/or stereotypes across a range of intervention types and gender inequality outcomes, 55 of which reported statistically significant or mixed outcomes. The implicit theory of change in most studies was to change participants' attitudes by increasing their knowledge/awareness of gendered stereotypes or norms. Five additional strategies were identified that appear to strengthen intervention impact; peer engagement, addressing multiple levels of the ecological framework, developing agents of change, modelling/role models and co-design of interventions with participants or target populations. Consideration of cohort sex, length of intervention (multi-session vs single-session) and need for follow up data collection were all identified as factors influencing success. When it comes to engaging men and boys in particular, interventions with greater success include interactive learning, co-design and peer leadership. Several recommendations are made for program design, including that practitioners need to be cognisant of breaking down stereotypes amongst men (not just between genders) and the avoidance of reinforcing outdated stereotypes and norms inadvertently.
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Affiliation(s)
- Rebecca Stewart
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Breanna Wright
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Liam Smith
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Steven Roberts
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Victoria, Australia
| | - Natalie Russell
- Victorian Health Promotion Foundation (VicHealth), Melbourne, Victoria, Australia
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368
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Corley A, Glass N, Remy MM, Perrin N. A Latent Class Analysis of Gender Attitudes and Their Associations with Intimate Partner Violence and Mental Health in the Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084063. [PMID: 33921491 PMCID: PMC8068999 DOI: 10.3390/ijerph18084063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022]
Abstract
Gender role attitudes, views held by individuals regarding the roles men and women should play in society, are a powerful social determinant of health. However, work remains in elucidating the associations between gender attitudes and intimate partner violence (IPV) perpetration or victimization and mental health problems. We used latent class analysis to classify patterns of responses on survey items on gender attitudes by male and female adults in households that participated in an economic empowerment intervention and evaluation in rural villages in the Democratic Republic of Congo. Attitudes about IPV and gender equality were two subdomains to emerge from analysis and a 3-class model solution was found to best fit response patterns. Results indicated that, as compared to the least gender equitable class, individuals in the moderately gender equitable and fully gender equitable classes had lower odds of having experienced or perpetrated psychological abuse. Individuals within the moderately gender equitable class were at lower odds of having experienced or perpetrated physical or sexual violence. Further, individuals in the moderately gender equitable and fully gender equitable classes had significantly lower mean scores on symptoms associated with PTSD than individuals in the least gender equitable class. Future research should explore the relationships between gender attitudes, partner violence and mental health to build resilient families.
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Affiliation(s)
- Andrew Corley
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
- Correspondence:
| | - Nancy Glass
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
| | - Mitima Mpanano Remy
- Programme d’Appui aux Initiatives de Développement Economique au Kivu (PAIDEK), Bukavu, Democratic Republic of Congo;
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
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369
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Cid-Expósito MG, Alameda-Cuesta A. Sesgos de género y limitación del esfuerzo terapéutico. ENFERMERÍA INTENSIVA 2021. [DOI: 10.1016/j.enfi.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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370
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King K, Rice S, Schlichthorst M, Chondros P, Pirkis J. Gender norms and the wellbeing of girls and boys. LANCET GLOBAL HEALTH 2021; 9:e398. [DOI: 10.1016/s2214-109x(20)30551-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
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371
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Beia T, Kielmann K, Diaconu K. Changing men or changing health systems? A scoping review of interventions, services and programmes targeting men's health in sub-Saharan Africa. Int J Equity Health 2021; 20:87. [PMID: 33789688 PMCID: PMC8011198 DOI: 10.1186/s12939-021-01428-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/17/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sex and gender have been shown to influence health literacy, health seeking behaviour, and health outcomes. However, research examining the links between gender and health has mainly focused on women's health, which is a long-standing global health priority. We examine literature focused on the 'missing men' in global health research, in particular empirical studies that document interventions, programmes, and services targeting men's health issues in Sub-Saharan Africa. Within these studies, we identify dominant conceptualisations of men and men's health and how these have influenced the design of men's health interventions and services. METHODS This is a scoping review of published and grey literature. Following comprehensive searches, we included 56 studies in the review. We conducted a bibliographic analysis of all studies and used inductive methods to analyse textual excerpts referring to conceptualizations of men and service design. An existing framework to categorise services, interventions, or programs according to their gender-responsiveness was adapted and used for the latter analysis. RESULTS From the included studies, we distinguished four principal ways in which men were conceptualized in programs and interventions: men are variously depicted as 'gatekeepers'; 'masculine' men, 'marginal' men and as 'clients. Additionally, we classified the gender-responsiveness of interventions, services or programmes described in the studies within the following categories: gender-neutral, -partnering, -sensitive and -transformative. Interventions described are predominantly gender-neutral or gender-partnering, with limited data available on transformative interventions. Health systems design features - focused mainly on achieving women's access to, and uptake of services - may contribute to the latter gap leading to poor access and engagement of men with health services. CONCLUSION This review highlights the need for transformation in sub-Saharan African health systems towards greater consideration of men's health issues and health-seeking patterns.
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Affiliation(s)
- Thierry Beia
- Health Services Department, Copperbelt University, Jambo Drive, Riverside, Kitwe, Zambia.
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Musselburgh, EH21 6UU, Scotland, UK
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Musselburgh, EH21 6UU, Scotland, UK
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372
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Bae EH, Lim SY, Jung JH, Oh TR, Choi HS, Kim CS, Ma SK, Han KD, Kim SW. Chronic Kidney Disease Risk of Isolated Systolic or Diastolic Hypertension in Young Adults: A Nationwide Sample Based-Cohort Study. J Am Heart Assoc 2021; 10:e019764. [PMID: 33787312 PMCID: PMC8174338 DOI: 10.1161/jaha.120.019764] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Hypertension among young adults is common. However, the effect of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), or systolic and diastolic hypertension (SDH) among young adults on chronic kidney disease (CKD) development is unknown. Methods and Results From a nationwide health screening database, we included 3 030 884 participants aged 20 to 39 years who were not taking antihypertensives at baseline examination in 2009 to 2010. Participants were categorized as having normal blood pressure (BP), elevated BP, stage 1 IDH, stage 1 ISH, stage 1 SDH, stage 2 IDH, stage 2 ISH, and stage 2 SDH. The primary outcome was incident CKD. A total of 5853 (0.19%) CKD events occurred. With normal BP as the reference, multivariable‐adjusted hazard ratios (HRs) (95% CIs) for CKD were 1.14 (95% CI, 1.04–1.26), elevated BP; 1.19 (95% CI, 1.10–1.28), stage 1 IDH; 1.24 (95% CI, 1.08–1.42), stage 1 ISH; 1.39 (95% CI, 1.28–1.51), stage 1 SDH; 1.88 (95% CI, 1.63–2.16), stage 2 IDH; 1.84 (95% CI, 1.54–2.19), stage 2 ISH; 2.70 (95% CI, 2.44–2.98), stage 2 SDH. The HRs for CKD were attenuated in the patients who were antihypertensive and began medication within 1 year of medical checkup than in those without antihypertensives. Conclusions Among Korean young adults, those with elevated BP, stage 1 IDH, stage 1 ISH, stage 1 SDH, stage 2 IDH, stage 2 ISH, and stage 2 SDH were associated with a higher CKD risk than those with normal BP. The CKD risk in ISH and IDH groups was similar but lower than that in the SDH group. Antihypertensives attenuated the risk of CKD in young adults with hypertension.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
| | - Sang Yeob Lim
- Department of Internal Medicine Korea University Ansan Hospital Ansan Korea
| | - Jin-Hyung Jung
- Department of Medical Statistics College of Medicine The Catholic University of Korea Seoul Korea
| | - Tae Ryom Oh
- Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
| | - Hong Sang Choi
- Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
| | - Chang Seong Kim
- Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
| | - Seong Kwon Ma
- Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science Soongsil University Seoul Korea
| | - Soo Wan Kim
- Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
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373
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Patel SK, Santhya KG, Haberland N. What shapes gender attitudes among adolescent girls and boys? Evidence from the UDAYA Longitudinal Study in India. PLoS One 2021; 16:e0248766. [PMID: 33735285 PMCID: PMC7971892 DOI: 10.1371/journal.pone.0248766] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The role of gender norms in shaping education and work opportunities, distribution of power and resources, and health and wellbeing is well recognised. However, rigorous studies in low- and middle-income countries on when and how norms change over time and what factors shape adolescents’ and young adult’s gender attitudes are limited. This paper explores the factors that determine adolescents’ gender attitudes, as well as patterns in gender attitude shifts over time among younger and older adolescent boys and girls in India. Data and methods Data presented in this paper were drawn from a unique longitudinal study of adolescents aged 10–19 (Understanding the lives of adolescent and young adults–UDAYA study) in the states of Bihar and Uttar Pradesh in India, conducted during 2015–2016 (wave 1) and 2018–2019 (wave 2). The analysis presented in this paper drew on data from 4,428 boys and 7,607 girls who were aged 10–19 and unmarried at wave 1 and interviewed at both rounds of the survey. We used univariate and bivariate analyses to examine changes in adolescents’ gender role attitudes over time and the association between explanatory variables and gender role attitudes. We also used linear fixed effects regression models to identify factors that shape adolescents’ gender role attitudes. Results Gender role attitudes became more egalitarian over time among boys and girls, except among the older cohort of boys in our study. Among both younger and older cohorts, girls/young women held more egalitarian views than boys/young men and this pattern held over time for both cohorts. Factors that influenced gender role attitudes differed for younger and older adolescents, particularly among boys. While some predictors differed for boys and girls, there were substantial similarities as well. Gender attitudes were affected by factors at the individual, family, peer, and societal levels, as well as by community engagement. Conclusions Our findings show that it is possible to shift gender attitudes toward greater equity and, in so doing, contribute to improved health and rights.
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375
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Doyle K, Kazimbaya S, Levtov R, Banerjee J, Betron M, Sethi R, Kayirangwa MR, Vlahovicova K, Sayinzoga F, Morgan R. The relationship between inequitable gender norms and provider attitudes and quality of care in maternal health services in Rwanda: a mixed methods study. BMC Pregnancy Childbirth 2021; 21:156. [PMID: 33622278 PMCID: PMC7903699 DOI: 10.1186/s12884-021-03592-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/27/2021] [Indexed: 01/18/2023] Open
Abstract
Background Rwanda has made great progress in improving reproductive, maternal, and newborn health (RMNH) care; however, barriers to ensuring timely and full RMNH service utilization persist, including women’s limited decision-making power and poor-quality care. This study sought to better understand whether and how gender and power dynamics between providers and clients affect their perceptions and experiences of quality care during antenatal care, labor and childbirth. Methods This mixed methods study included a self-administered survey with 151 RMNH providers with questions on attitudes about gender roles, RMNH care, provider-client relations, labor and childbirth, which took place between January to February 2018. Two separate factor analyses were conducted on provider responses to create a Gender Attitudes Scale and an RMNH Quality of Care Scale. Three focus group discussions (FGDs) conducted in February 2019 with RMNH providers, female and male clients, explored attitudes about gender norms, provision and quality of RMNH care, provider-client interactions and power dynamics, and men’s involvement. Data were analyzed thematically. Results Inequitable gender norms and attitudes – among both RMNH care providers and clients – impact the quality of RMNH care. The qualitative results illustrate how gender norms and attitudes influence the provision of care and provider-client interactions, in addition to the impact of men’s involvement on the quality of care. Complementing this finding, the survey found a relationship between health providers’ gender attitudes and their attitudes towards quality RMNH care: gender equitable attitudes were associated with greater support for respectful, quality RMNH care. Conclusions Our findings suggest that gender attitudes and power dynamics between providers and their clients, and between female clients and their partners, can negatively impact the utilization and provision of quality RMNH care. There is a need for capacity building efforts to challenge health providers’ inequitable gender attitudes and practices and equip them to be aware of gender and power dynamics between themselves and their clients. These efforts can be made alongside community interventions to transform harmful gender norms, including those that increase women’s agency and autonomy over their bodies and their health care, promote uptake of health services, and improve couple power dynamics. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03592-0.
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Affiliation(s)
- Kate Doyle
- Promundo-US, 1367 Connecticut Avenue, NW, Suite 310, Washington, DC, 20036, USA.
| | - Shamsi Kazimbaya
- Promundo-US, 1367 Connecticut Avenue, NW, Suite 310, Washington, DC, 20036, USA
| | - Ruti Levtov
- Promundo-US, 1367 Connecticut Avenue, NW, Suite 310, Washington, DC, 20036, USA.,Present Address: The Prevention Collaborative, Washington, DC, USA
| | - Joya Banerjee
- Present Address: The Prevention Collaborative, Washington, DC, USA.,Present Address: CARE, 1899 L St NW #500, Washington, DC, 20036, USA
| | - Myra Betron
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Reena Sethi
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Marie Rose Kayirangwa
- Maternal and Child Survival Program/Jhpiego, 8 Avenue, Rwanda National Police (RNP Road), Kigali, Rwanda
| | | | - Felix Sayinzoga
- Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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376
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Bots SH, Inia JA, Peters SAE. Medication Adherence After Acute Coronary Syndrome in Women Compared With Men: A Systematic Review and Meta-Analysis. Front Glob Womens Health 2021; 2:637398. [PMID: 34816194 PMCID: PMC8594018 DOI: 10.3389/fgwh.2021.637398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Pharmacological treatment is an important component of secondary prevention in acute coronary syndrome (ACS) survivors. However, adherence to medication regimens is often suboptimal, reducing the effectiveness of treatment. It has been suggested that sex influences adherence to cardiovascular medication, but results differ across studies, and a systematic overview is lacking. Methods: We performed a systematic search of PubMed and EMBASE on 16 October 2019. Studies that reported sex-specific adherence for one or more specific medication classes for ACS patients were included. Odds ratios, or equivalent, were extracted per medication class and combined using a random effects model. Results: In total, we included 28 studies of which some had adherence data for more than one medication group. There were 7 studies for angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) (n = 100,909, 37% women), 8 studies for antiplatelet medication (n = 37,804, 27% women), 11 studies for beta-blockers (n = 191,339, 38% women), and 17 studies for lipid-lowering medication (n = 318,837, 35% women). Women were less adherent to lipid-lowering medication than men (OR = 0.87, 95% CI 0.82-0.92), but this sex difference was not observed for antiplatelet medication (OR = 0.95, 95% CI 0.83-1.09), ACEIs/ARBs (OR = 0.95, 95% CI 0.78-1.17), or beta-blockers (OR = 0.97, 95% CI 0.86-1.11). Conclusion: Women with ACS have poorer adherence to lipid-lowering medication than men with the same condition. There are no differences in adherence to antiplatelet medication, ACEIs/ARBs, and beta-blockers between women and men with ACS.
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Affiliation(s)
- Sophie H. Bots
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jose A. Inia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Imperial College London, The George Institute for Global Health, London, United Kingdom
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Nielsen MW, Stefanick ML, Peragine D, Neilands TB, Ioannidis JPA, Pilote L, Prochaska JJ, Cullen MR, Einstein G, Klinge I, LeBlanc H, Paik HY, Schiebinger L. Gender-related variables for health research. Biol Sex Differ 2021; 12:23. [PMID: 33618769 PMCID: PMC7898259 DOI: 10.1186/s13293-021-00366-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/03/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In this paper, we argue for Gender as a Sociocultural Variable (GASV) as a complement to Sex as a Biological Variable (SABV). Sex (biology) and gender (sociocultural behaviors and attitudes) interact to influence health and disease processes across the lifespan-which is currently playing out in the COVID-19 pandemic. This study develops a gender assessment tool-the Stanford Gender-Related Variables for Health Research-for use in clinical and population research, including large-scale health surveys involving diverse Western populations. While analyzing sex as a biological variable is widely mandated, gender as a sociocultural variable is not, largely because the field lacks quantitative tools for analyzing the influence of gender on health outcomes. METHODS We conducted a comprehensive review of English-language measures of gender from 1975 to 2015 to identify variables across three domains: gender norms, gender-related traits, and gender relations. This yielded 11 variables tested with 44 items in three US cross-sectional survey populations: two internet-based (N = 2051; N = 2135) and a patient-research registry (N = 489), conducted between May 2017 and January 2018. RESULTS Exploratory and confirmatory factor analyses reduced 11 constructs to 7 gender-related variables: caregiver strain, work strain, independence, risk-taking, emotional intelligence, social support, and discrimination. Regression analyses, adjusted for age, ethnicity, income, education, sex assigned at birth, and self-reported gender identity, identified associations between these gender-related variables and self-rated general health, physical and mental health, and health-risk behaviors. CONCLUSION Our new instrument represents an important step toward developing more comprehensive and precise survey-based measures of gender in relation to health. Our questionnaire is designed to shed light on how specific gender-related behaviors and attitudes contribute to health and disease processes, irrespective of-or in addition to-biological sex and self-reported gender identity. Use of these gender-related variables in experimental studies, such as clinical trials, may also help us understand if gender factors play an important role as treatment-effect modifiers and would thus need to be further considered in treatment decision-making.
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Affiliation(s)
- Mathias W. Nielsen
- Department of Sociology, University of Copenhagen, Øster Farimagsgade 5, Bld. 16, DK-1014 Copenhagen K, Denmark
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Rd, Stanford, CA 94305-5411 USA
| | - Diana Peragine
- Department of Psychology, University of Toronto, 100 St George St, Toronto, ON M5S 3G3 Canada
| | - Torsten B. Neilands
- Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94143 USA
| | - John P. A. Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Rd, Stanford, CA 94305-5411 USA
| | - Louise Pilote
- Department of Medicine, McGill University Health Center, McGill University, 5252 De Maisonneuve Blvd, Office 2B.39, Montréal, QC H4A 3S5 Canada
| | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Rd, Stanford, CA 94305-5411 USA
| | - Mark R. Cullen
- Stanford Center for Population Health Sciences, Stanford University, 1701 Page Mill Road, Palo Alto, 94304 USA
| | - Gillian Einstein
- Department of Psychology, University of Toronto, 100 St George St, Toronto, ON M5S 3G3 Canada
| | - Ineke Klinge
- Horizon 2020 Advisory Group for Gender, European Commission, Brussels, Belgium
| | - Hannah LeBlanc
- Department of Science & Technology Studies, Cornell University, 303 Morrill Hall, Ithaca, NY 14853 USA
| | - Hee Young Paik
- Center for Gendered Innovations in Science and Technology Research, 405 KSTC, 22 Teheranro-7gil, Gangnam-gu, Seoul, 06130 Republic of Korea
| | - Londa Schiebinger
- History of Science, Stanford University, Building 200, 450 Jane Stanford Way, Stanford, CA 94305 USA
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378
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Wilson LC, Rademacher KH, Rosenbaum J, Callahan RL, Nanda G, Fry S, Mackenzie ACL. Seeking synergies: understanding the evidence that links menstrual health and sexual and reproductive health and rights. Sex Reprod Health Matters 2021; 29:1882791. [PMID: 33599162 PMCID: PMC8009024 DOI: 10.1080/26410397.2021.1882791] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Global efforts to improve menstrual health and sexual and reproductive health and rights (SRHR) are fundamentally intertwined and share similar goals for improving health and well-being and increasing gender equality. Historically, however, the two fields have operated independently and missed opportunities to build upon their biological and sociocultural linkages. Biological touchpoints connecting the two fields include genital tract infections, menstrual disorders, contraception, and menopause. From a sociocultural perspective, intersections occur in relation to the experience of puberty and menarche, gender norms and equity, education, gender-based violence, and transactional sex. We describe evidence linking menstrual health and SRHR and offer recommendations for integration that could strengthen the impact of both fields.
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Affiliation(s)
- Lucy C Wilson
- Independent Consultant, Rising Outcomes, Hillsborough, NC, USA. Correspondence:
| | - Kate H Rademacher
- Senior Technical Advisor, Product Development & Introduction, FHI 360, Durham, NC, USA
| | - Julia Rosenbaum
- Senior WASH Behavior Change and Integration Specialist, FHI 360, Washington, DC, USA
| | - Rebecca L Callahan
- Associate Director, Product Development & Introduction, FHI 360, Durham, NC, USA
| | - Geeta Nanda
- Scientist, Maternal and Child Health, FHI 360, Washington, DC, USA
| | - Sarah Fry
- Senior Hygiene and School WASH Advisor, USAID WASHplus Project, FHI 360, Washington, DC, USA
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379
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Flaudias V, Zerhouni O, Pereira B, Cherpitel CJ, Boudesseul J, de Chazeron I, Romo L, Guillaume S, Samalin L, Cabe J, Bègue L, Gerbaud L, Rolland B, Llorca PM, Naassila M, Brousse G. The Early Impact of the COVID-19 Lockdown on Stress and Addictive Behaviors in an Alcohol-Consuming Student Population in France. Front Psychiatry 2021; 12:628631. [PMID: 33633612 PMCID: PMC7900161 DOI: 10.3389/fpsyt.2021.628631] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background: This study evaluated factors linked with perceived stress related to the COVID-19 pandemic and lockdown and addictive behaviors prior to and during lockdown in a sample of students who indicated engaging in alcohol consumption behaviors before lockdown. Methods: Cross-sectional study. French students from four universities participated in this study, and 2,760 students reported alcohol use. During the first week of lockdown, students reported their perceived levels of stress regarding COVID-19. Substance use and addictive behaviors were reported before and during lockdown, and media exposure, demographical, living conditions, and environmental stressors were reported during lockdown. Results: Women reported greater levels of stress (95% CI: 1.18 to 1.93, p < 0.001). Highly-stressed students also report less social support (95% CI: -1.04 to -0.39, p < 0.001) and were more likely to worry about the lockdown (95% CI: 0.27 to -0.65, p < 0.001). Alcohol-related problemswere more prevalent among the most stressed students (95% CI: 0.02 to 0.09, p = 0.004) as well as eating problems (95% CI: 0.04 to 0.36, p = 0.016) and problematic internet use (95% CI, 0.06 to 0.14, p < 0.001). Students reporting the highest levels of stress also indicated more compulsive eating during the previous seven days (95% CI, 0.21 to 1.19, p = 0.005). Conclusions: The level of stress was strongly related to four categories of variables: (i) intrinsic characteristics, (ii) addictive behaviors before lockdown, (iii) lockdown-specific conditions, and (iv) addictive behaviors during the lockdown. Several variables linked to COVID-19 were not directly linked with perceived stress, while perceived stress was found to correlate with daily life organization-related uncertainty and anticipated consequences of lockdown. Importantly, social support seems to be a protective factor on high level of stress.
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Affiliation(s)
- Valentin Flaudias
- CHU Clermont-Ferrand, Pôle Psychiatrie B, Clermont-Ferrand, France
- Université Clermont Ferrand, EA NPsy-Sydo, BP 10448, Clermont-Ferrand, France
| | - Oulmann Zerhouni
- Laboratoire Parisien de Psychologie Sociale, Département de Psychologie, University Paris Nanterre, Ad Hoc Lab, Nanterre, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Pôle Psychiatrie B, Clermont-Ferrand, France
- Université Clermont Ferrand, EA NPsy-Sydo, BP 10448, Clermont-Ferrand, France
| | | | - Jordane Boudesseul
- Facultad de Psicología, Instituto de Investigación Científica, Universidad de Lima, Lima, Peru
| | - Ingrid de Chazeron
- CHU Clermont-Ferrand, Pôle Psychiatrie B, Clermont-Ferrand, France
- Université Clermont Ferrand, EA NPsy-Sydo, BP 10448, Clermont-Ferrand, France
| | - Lucia Romo
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre University, Nanterre, France
- CMME, GHU Paris Psychiatrie et Neurosciences, U de Paris, Paris, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier/INSERM U1061, University of Montpellier, Montpellier, France
| | - Ludovic Samalin
- CHU Clermont-Ferrand, Pôle Psychiatrie B, Clermont-Ferrand, France
- Université Clermont Ferrand, EA NPsy-Sydo, BP 10448, Clermont-Ferrand, France
| | - Julien Cabe
- CHU Clermont-Ferrand, Pôle Psychiatrie B, Clermont-Ferrand, France
- Université Clermont Ferrand, EA NPsy-Sydo, BP 10448, Clermont-Ferrand, France
| | | | - Laurent Gerbaud
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, Groupe PEPRADE, Clermont-Ferrand, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CRNL, Inserm U1028, CNRS UMR5292, Université Lyon 1, Centre Hospitalier Le Vinatier, Bron, France
| | | | - Mickael Naassila
- Université de Picardie Jules Verne, Unité INSERM UMR 1247, Groupe de Recherche sur l'Alcool & les Pharmacodépendances, Centre Universitaire de Recherche en Santé, Amiens, France
| | - Georges Brousse
- CHU Clermont-Ferrand, Pôle Psychiatrie B, Clermont-Ferrand, France
- Université Clermont Ferrand, EA NPsy-Sydo, BP 10448, Clermont-Ferrand, France
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Medrado B, Lyra J, Nascimento M, Beiras A, Corrêa ÁCDP, Alvarenga EC, Lima MLC. Men, masculinity and the new coronavirus: sharing gender issues in the first phase of the pandemic. CIENCIA & SAUDE COLETIVA 2021; 26:179-183. [PMID: 33533839 DOI: 10.1590/1413-81232020261.35122020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022] Open
Abstract
This article presents reflections on masculinity and the social construction of gender - based on the global phenomenon of the new coronavirus pandemic - produced by researchers who are part of the national research team on comprehensive health care policy for men in Brazil. From a gender-based standpoint, the article contends that it is necessary to note that cis heteronormative male socialization is guided by three core issues: 1) the submission to practices of care of self and others; 2) the rejection of preventive health practices, due to a distorted matrix of risk perception (and a certain sense of "invulnerability"); 3) the domestic dynamics marked by postures of command, order, and honor. These dimensions of everyday life were profoundly upset in this first phase of the epidemic, in which confinement became the most recommended alternative. These issues are configured as recurring (though not recent) repertoires that glorify the central model of a male order that needs to become an object of reflection, insofar as they endanger the health of men and women and, more broadly, of the status quo of the accepted tenets of domestic and social order.
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Affiliation(s)
- Benedito Medrado
- Departamento de Psicologia, Centro de Filosofia e Ciências Humanas, Universidade Federal de Pernambuco. R. Academico Hélio Ramos s/n, Cidade Universitária. 50740-530 Recife PE Brasil.
| | - Jorge Lyra
- Departamento de Psicologia, Centro de Filosofia e Ciências Humanas, Universidade Federal de Pernambuco. R. Academico Hélio Ramos s/n, Cidade Universitária. 50740-530 Recife PE Brasil.
| | - Marcos Nascimento
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Fiocruz. Rio de Janeiro RJ Brasil
| | - Adriano Beiras
- Departamento de Psicologia, Centro de Filosofia e Ciências Humanas, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
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381
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Agadjanian V, Hayford SR, Jansen NA. Men's migration and women's mortality in rural Mozambique. Soc Sci Med 2021; 270:113519. [PMID: 33358449 PMCID: PMC7990049 DOI: 10.1016/j.socscimed.2020.113519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022]
Abstract
Labor migration is widespread and growing across the world. As migration grows, the economic outcomes of migration increasingly diversify, and so do its consequences for the well-being and health of both migrants and non-migrating household members. A considerable body of scholarship has examined the effects of migration on the physical and mental health of 'left-behind' household members. The impact of migration on mortality, particularly of non-migrating marital partners, is less well understood. Addressing this gap, we use data from a longitudinal survey of married women conducted over twelve years in rural Mozambique to examine the association between men's labor out-migration and their non-migrating wives' mortality. The analyses detect no significant differences when comparing non-migrants' wives to migrants' wives in the aggregate but point to instructive variation among migrants' wives according to the economic success of migration, as measured by the effects of migration on the household's material well-being. Specifically, women married to less successful migrants had higher mortality risks over the project span than women married to more successful migrants, regardless of other individual and household-level factors. Importantly for this setting with high HIV prevalence, the advantage of wives of more successful migrants is significant for HIV/AIDS-unrelated deaths but not for HIV/AIDS-related deaths. We situate these findings within the cross-national scholarship on migration and health.
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382
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Marini M, Waterman PD, Breedlove E, Chen JT, Testa C, Reisner SL, Pardee DJ, Mayer KH, Krieger N. The target/perpetrator brief-implicit association test (B-IAT): an implicit instrument for efficiently measuring discrimination based on race/ethnicity, sex, gender identity, sexual orientation, weight, and age. BMC Public Health 2021; 21:158. [PMID: 33468085 PMCID: PMC7814653 DOI: 10.1186/s12889-021-10171-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date, research assessing discrimination has employed primarily explicit measures (i.e., self-reports), which can be subject to intentional and social desirability processes. Only a few studies, focusing on sex and race/ethnicity discrimination, have relied on implicit measures (i.e., Implicit Association Test, IAT), which permit assessing mental representations that are outside of conscious control. This study aims to advance measurement of discrimination by extending the application of implicit measures to multiple types of discrimination and optimizing the time required for the administration of these instruments. METHODS Between September 27th 2019 and February 9th 2020, we conducted six experiments (984 participants) to assess implicit and explicit discrimination based on race/ethnicity, sex, gender identity, sexual orientation, weight, and age. Implicit discrimination was measured by using the Brief-Implicit Association Test (B-IAT), a new validated version of the IAT developed to shorten the time needed (from ≈15 to ≈2 min) to assess implicit mental representations, while explicit discrimination was assessed using self-reported items. RESULTS Among participants (mean age = 37.8), 68.6% were White Non-Hispanic; 69% were females; 76.1% were heterosexual; 90.7% were gender conforming; 52.8% were medium weight; and 41.5% had an advanced level of education. Overall, we found implicit and explicit recognition of discrimination towards all the target groups (stronger for members of the target than dominant groups). Some exceptions emerged in experiments investigating race/ethnicity and weight discrimination. In the racism experiment, only people of Color showed an implicit recognition of discrimination towards the target group, while White people were neutral. In the fatphobia experiment, participants who were not heavy showed a slight implicit recognition of discrimination towards the dominant group, while heavy participants were neutral. CONCLUSIONS This study provides evidence that the B-IAT is a valuable tool for quickly assessing multiple types of implicit discrimination. It shows also that implicit and explicit measures can display diverging results, thus indicating that research would benefit from the use of both these instruments. These results have important implications for the assessment of discrimination in health research as well as in social and psychological science.
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Affiliation(s)
| | | | - Emry Breedlove
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jarvis T Chen
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Sari L Reisner
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Nancy Krieger
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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383
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Lee J, Meijer E, Phillips D, Hu P. Disability Incidence Rates for Men and Women in 23 Countries: Evidence on Health Effects of Gender Inequality. J Gerontol A Biol Sci Med Sci 2021; 76:328-338. [PMID: 33216874 PMCID: PMC7812438 DOI: 10.1093/gerona/glaa288] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Inequality in gender varies across social contexts, which may influence the health of both men and women. Based on theories of gender as a social system, we examine whether systematic gender inequality at the macro-level influences health of men and women. METHOD Using harmonized panel data from the Gateway to Global Aging Data in 23 high- and middle-income countries (N = 168 873), we estimate disability prevalence and incidence for men and women ages 55-89 (2000-2016). Within each country or geographic region, we also investigate gender differences in age gradients of the probability of disability onset. We, then, pool data from all countries and test the hypothesis that gender inequality increases the probability of disability onset. RESULTS We found substantial cross-country variation in disability incidence rates, and this variation is greater for women than for men. Among ages 65-69, disability incidence rates ranged from 0.4 to 5.0 for men and from 0.5 to 9.4 for women. Our within-country analysis showed significant gender differences in age gradients of the probability of disability onset in the United States, Korea, Southern Europe, Mexico, and China, but not in Northern, Central, and Eastern Europe, England, and Israel. Testing hypothesized effects of gender inequality, we find that gender inequality is significantly associated with the probability of disability onset for women, but not for men. CONCLUSIONS Macro-level societal gender inequality is significantly associated with the probability of disability onset for women. Reducing and eliminating gender inequality is crucial to achieving good health for women.
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Affiliation(s)
- Jinkook Lee
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles
- Department of Economics, University of Southern California, Los Angeles
- RAND Corporation, Santa Monica, California
| | - Erik Meijer
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles
- RAND Corporation, Santa Monica, California
| | - Drystan Phillips
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles
| | - Peifeng Hu
- Division of Geriatric Medicine, David Geffen School of Medicine at University of California, Los Angeles
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384
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Crespí-Lloréns N, Hernández-Aguado I, Chilet-Rosell E. Have Policies Tackled Gender Inequalities in Health? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010327. [PMID: 33466282 PMCID: PMC7796005 DOI: 10.3390/ijerph18010327] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/20/2023]
Abstract
Gender is recognized as one of the most relevant determinants of health inequalities. This scoping review sought to identify and analyse policies, either implemented or formulated as proposals, which aimed to reduce gender inequalities in health. We searched Medline, Web of Science, and Scielo. Of 2895 records, 91 full text articles were analysed, and 33 papers were included. Of these papers, 22 described the process of formulation, implementation, or evaluation of policies whose aim was to reduce gender inequalities in health; six focused on recommendations, and the remaining five dealt with both issues. Our review showed that the policies aimed at reducing gender inequalities in health, either implemented or formulated as proposals, are scarce. Moreover, despite some success, overall progress has been slow. The studies show failures in design and particularly in the implementation process. We found a lack of awareness and capacity in the policy-making progress, under-financing, bureaucratization, shortage of relevant data, and absence of women’s participation in decision-making. Therefore, an emphasis on the design and implementation of gender-sensitive policies seems essential to advance gender equality in health. This scoping review gathers evidence to support the design of such policies and recommendations that can facilitate their implementation.
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Affiliation(s)
- Nuria Crespí-Lloréns
- Preventive Medicine Service, Hospital General de Elche, 03203 Elche, Spain
- Correspondence:
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (I.H.-A.); (E.C.-R.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (I.H.-A.); (E.C.-R.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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385
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Cini KI, Win PM, Swe ZY, Than KK, Win TM, Aung YW, Myint AA, Wulan NR, Burns LJ, Kennedy EC, Francis KL, Sanda, Myat SM, Swe S, Ko AK, Yadanar, Hellard M, Hughes CL, Patton GC, Mokdad AH, Azzopardi PS. Matching action to need: an analysis of Global Burden of Disease 2017 and population health data to focus adolescent health policy and actions in Myanmar. Glob Health Action 2021; 14:1844976. [PMID: 33446080 PMCID: PMC7833024 DOI: 10.1080/16549716.2020.1844976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/29/2020] [Indexed: 11/03/2022] Open
Abstract
Background: Myanmar is a country undergoing rapid transitions in health. Its national strategic policy for young people's health is being revised but there is a paucity of population data to inform local priorities and needs. Objective: In this paper we describe a comprehensive profile of adolescent health in Myanmar to focus policy and health actions. Methods: We used available primary data, and modelled estimates from the GBD 2017, to describe health outcomes (mortality and morbidity), health risks and determinants for adolescents in Myanmar between 1990-2017. A governance group of key stakeholders guided the framing of the study, interpretation of findings, and recommendations. Results: Overall health has improved for adolescents in Myanmar since 1990, however adolescent mortality remains high, particularly so for older adolescent males; all-cause mortality rate for 10-24 years was 70 per 100,000 for females and 149 per 100,000 for males (16,095 adolescent deaths in 2017). Overall, the dominant health problems were injuries for males and non-communicable disease for females in a context of ongoing burden of communicable and nutritional diseases for both sexes, and reproductive health needs for females. Health risks relating to undernutrition (thinness and anaemia) remain prevalent, with other health risks (overweight, binge alcohol use, and substance use) relatively low by global and regional standards but increasing. Gains have been made in social determinants such as adolescent fertility and modern contraception use; however, advances have been more limited in secondary education completion and engagement in employment and post education training. Conclusions: These results highlight the need to focus current efforts on addressing disease and mortality experienced by adolescents in Myanmar, with a specific focus on injury, mental health and non-communicable disease.
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Affiliation(s)
- Karly I. Cini
- Burnet Institute, Melbourne, Australia
- Centre for Adolescent Health, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | | | | | | | | | | | | | | | - Lia J. Burns
- Burnet Institute, Melbourne, Australia
- ChildFund Vietnam, Hanoi, Vietnam
| | - Elissa C. Kennedy
- Burnet Institute, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kate L. Francis
- Centre for Adolescent Health, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Sanda
- Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Su Mon Myat
- Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Sithu Swe
- World Health Organisation, Nay Pyi Taw, Myanmar
| | - Aung Ko Ko
- Myanmar Youth Affair Committee, Yangon, Myanmar
| | - Yadanar
- United Nations Population Fund, Yangon, Myanmar
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
- , Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | | | - George C. Patton
- Centre for Adolescent Health, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peter S. Azzopardi
- Burnet Institute, Melbourne, Australia
- Centre for Adolescent Health, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Institute, University of Adelaide, Adelaide, Australia
- School of Medicine, University of Adelaide, Adelaide, Australia
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386
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Dubbin L, Burke N, Fleming M, Thompson-Lastad A, Napoles TM, Yen I, Shim JK. Social Literacy: Nurses' Contribution Toward the Co-Production of Self-Management. Glob Qual Nurs Res 2021; 8:2333393621993451. [PMID: 33628867 PMCID: PMC7882743 DOI: 10.1177/2333393621993451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 01/23/2023] Open
Abstract
We share findings from a larger ethnographic study of two urban complex care management programs in the Western United States. The data presented stem from in-depth interviews conducted with 17 complex care management RNs and participant observations of home visits. We advance the concept of social literacy as a nursing attribute that comprises an RN's recognition and responses to the varied types of hinderances to self-management with which patients must contend in their lived environment. It is through social literacy that complex care management RNs reconceptualize and understand health literacy to be a product born out of the social circumstances in which patients live and the stratified nature of the health care systems that provide them care. Social literacy provides a broader framework for health literacy-one that is situated within the patient's social context through which complex care management RNs must navigate for self-management goals to be achieved.
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Affiliation(s)
| | - Nancy Burke
- University of California, San Francisco, USA
- University of California, Merced, USA
| | | | | | | | - Irene Yen
- University of California, Merced, USA
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387
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Darmstadt GL, Weng Y, Pepper KT, Ward VC, Mehta KM, Borkum E, Bentley J, Raheel H, Rangarajan A, Bhattacharya D, Tarigopula UK, Nanda P, Sridharan S, Rotz D, Carmichael SL, Abdalla S, Munar W. Impact of the Ananya program on reproductive, maternal, newborn and child health and nutrition in Bihar, India: early results from a quasi-experimental study. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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388
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Ravindran TKS, Govender V. Sexual and reproductive health services in universal health coverage: a review of recent evidence from low- and middle-income countries. Sex Reprod Health Matters 2020; 28:1779632. [PMID: 32530387 PMCID: PMC7887992 DOI: 10.1080/26410397.2020.1779632] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
If universal health coverage (UHC) cannot be achieved without the sexual and reproductive health (SRH) needs of the population being met, what then is the current situation vis-à-vis universal coverage of SRH services, and the extent to which SRH services have been prioritised in national UHC plans and processes? This was the central question that guided this critical review of more than 200 publications between 2010 and 2019. The findings are the following. The Essential Package of Healthcare Services (EPHS) across many countries excludes several critical SRH services (e.g. safe abortion services, reproductive cancers) that are already poorly available. Inadequate international and domestic public funding of SRH services contributes to a sustained burden of out-of-pocket expenditure (OOPE) and inequities in access to SRH services. Policy and legal barriers, restrictive gender norms and gender-based inequalities challenge the delivery and access to quality SRH services. The evidence is mixed as to whether an expanded role and scope of the private sector improves availability and access to services of underserved populations. As momentum gathers towards SRH and UHC, the following actions are necessary and urgent. Advocacy for greater priority for SRH in government EPHS and health budgets aligned with SRH and UHC goals is needed. Implementation of stable and sustained financing mechanisms that would reduce the proportion of SRH-financing from OOPE is a priority. Evidence, moving from descriptive towards explanatory studies which provide insights into the "hows" and "whys" of processes and pathways are essential for guiding policy and programme actions.
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Affiliation(s)
- T. K. Sundari Ravindran
- Principal Visiting Fellow, United Nations University, International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Veloshnee Govender
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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389
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Darmstadt GL, Weng Y, Pepper KT, Ward VC, Mehta KM, Borkum E, Bentley J, Raheel H, Rangarajan A, Bhattacharya D, Tarigopula UK, Nanda P, Sridharan S, Rotz D, Carmichael SL, Abdalla S, Munar W. Impact of the Ananya program on reproductive, maternal, newborn and child health and nutrition in Bihar, India: early results from a quasi-experimental study. J Glob Health 2020; 10:021002. [PMID: 33427822 PMCID: PMC7757842 DOI: 10.7189/jogh.10.021002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Government of Bihar (GoB) in India, the Bill and Melinda Gates Foundation and several non-governmental organisations launched the Ananya program aimed to support the GoB to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide. Here we summarise changes in indicators attained during the initial two-year pilot phase (2012-2013) of implementation in eight focus districts of approximately 28 million population, aimed to inform subsequent scale-up. METHODS The quasi-experimental impact evaluation included statewide household surveys at two time points during the pilot phase: January-April 2012 ("baseline") including an initial cohort of beneficiaries and January-April 2014 ("midline") with a new cohort. The two arms were: 1) eight intervention districts, and 2) a comparison arm comprised of the remaining 30 districts in Bihar where Ananya interventions were not implemented. We analysed changes in indicators across the RMNCHN continuum of care from baseline to midline in intervention and comparison districts using a difference-in-difference analysis. RESULTS Indicators in the two arms were similar at baseline. Overall, 40% of indicators (20 of 51) changed significantly from baseline to midline in the comparison districts unrelated to Ananya; two-thirds (n = 13) of secular indicator changes were in a direction expected to promote health. Statistically significant impact attributable to the Ananya program was found for 10% (five of 51) of RMNCHN indicators. Positive impacts were most prominent for mother's behaviours in contraceptive utilisation. CONCLUSIONS The Ananya program had limited impact in improving health-related outcomes during the first two-year period covered by this evaluation. The program's theories of change and action were not powered to observe statistically significant differences in RMNCHN indicators within two years, but rather aimed to help inform program improvements and scale-up. Evaluation of large-scale programs such as Ananya using theory-informed, equity-sensitive (including gender), mixed-methods approaches can help elucidate causality and better explain pathways through which supply- and demand-side interventions contribute to changes in behaviour among the actors involved in the production of population-level health outcomes. Evidence from Bihar indicates that deep structural constraints in health system organisation and delivery of interventions pose substantial limitations on behaviour change among health care providers and beneficiaries. STUDY REGISTRATION ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Hina Raheel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | | - Priya Nanda
- Bill & Melinda Gates Foundation, Delhi, India
| | | | - Dana Rotz
- Mathematica, Princeton, New Jersey, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Wolfgang Munar
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, D.C., USA
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390
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Josenhans V, Kavenagh M, Smith S, Wekerle C. Gender, rights and responsibilities: The need for a global analysis of the sexual exploitation of boys. CHILD ABUSE & NEGLECT 2020; 110:104291. [PMID: 31806378 DOI: 10.1016/j.chiabu.2019.104291] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/22/2019] [Accepted: 11/20/2019] [Indexed: 06/10/2023]
Abstract
The United Nations Convention on the Rights of the Child confirmed child and youth rights globally. Their right to participation is a critical driver for the 2030 Sustainable Development Goals (SDGs). Youth prioritize the need to end violence against them, charging adults with safeguarding, and identify gender inequality as an underlying cause of child sexual exploitation (CSE). SDG 5 includes targets for ending sexual exploitation of girls; however, it is critical to review whether we are supporting both boys and girls adequately. Based on recent research, it is clear that male victims of CSE are prevalent, yet they have been relatively excluded in policy, research, and interventions. The aim is not to minimize the importance of understanding and eliminating CSE of girls, but to acknowledge that vulnerable sub-groups of boys exist in community (street-connected boys, refugees, sexual minorities) and service systems (justice, child welfare, humanitarian aid). Gender-based challenges persist in protection, disclosure, help-seeking, professional recognition, programming and prevention. In this discussion article, we outline responsibilities in human rights law to understand and address boys' CSE and overview key literature on its impact on boys. It is argued that gender-, trauma-, and violence-informed approaches are expanded to address the contribution of harmful gender norms, and to target prevention in the adolescent years for sexually transmitted infections, mental health, and substance abuse and violence problems. This discussion advances a pressing need for a global analysis of CSE among boys.
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Affiliation(s)
- Valentine Josenhans
- ECPAT International, 328/1 Phaya Thai Road, Ratchathewi, Bangkok, 10400 Thailand
| | - Mark Kavenagh
- ECPAT International, 328/1 Phaya Thai Road, Ratchathewi, Bangkok, 10400 Thailand.
| | - Savanah Smith
- Department of Pediatrics, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
| | - Christine Wekerle
- Department of Pediatrics, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
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391
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Lindsay S, Kolne K. The training needs for gender-sensitive care in a pediatric rehabilitation hospital: a qualitative study. BMC MEDICAL EDUCATION 2020; 20:468. [PMID: 33238977 PMCID: PMC7690145 DOI: 10.1186/s12909-020-02384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/19/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Gender is an important social determinant of health; however, clinicians often lack training in how to provide gender-sensitive care. Offering appropriate and relevant training could help to address some gender-based health inequalities. Our objective was to identify and describe the training needs for gender-sensitive care among pediatric rehabilitation healthcare providers. METHODS This study used an interpretive descriptive qualitative design to conduct interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man), from a pediatric rehabilitation hospital in a large urban center, in Ontario, Canada from a range of disciplines. Interviews were transcribed verbatim and analyzed using an open-coding inductive thematic analysis. RESULTS Our analysis revealed the following themes: [1] lack of knowledge about gender-sensitive care and the need for more training; [2] content of the desired training (i.e., gender differences, effective communication and how to practice gender-sensitive care) and [3] delivery method of the training. CONCLUSIONS Enhanced gender-sensitive training for healthcare providers is required for optimizing patient outcomes and addressing gender-based health inequalities. Educators in pediatric rehabilitation should consider developing gender-sensitive care training that is embedded within post-graduate education and also continuing education within hospitals and community care centers.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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392
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Esteban-Gonzalo S, González-Pascual JL, Caballero-Galilea M, Esteban-Gonzalo L. Psychosocial Correlates of Mental Health and Well-Being During the COVID-19: The Spanish Case. Front Psychol 2020; 11:609815. [PMID: 33324307 PMCID: PMC7723862 DOI: 10.3389/fpsyg.2020.609815] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
Background The COVID-19 pandemic has hit almost all countries around the globe, seriously affecting the welfare of populations. Spain is especially hard-hit. In this context, the purpose of the present study is to analyze social, demographic, and economic correlates of mental health during the COVID-19 pandemic in the population residing in Spain. Method The sample of this cross-sectional study was comprised of 801 participants aged 18 or older and residing in Spain. Data collection was carried out during March and April 2020. Data of mental health (GHQ12) and well-being (Positive and Negative Affect Schedule) indicators, and those of a wide number of social, demographic, and economic variables were recorded. Linear regression models were built to value associations between mental health and social, demographic, and economic indicators. Results Mental health morbidity was higher in women, younger people, individuals with medium studies, people with fewer children, singles, students, and unemployed individuals. Positive affect was higher among women, people with a high level of studies, those not co-living with dependent seniors, the self-employed, the employed, and those working outside home. Negative affect was negatively associated with age and number of children and was higher among women, people with basic studies, singles, individuals co-living with dependent seniors, homemakers, and students. Conclusion The most vulnerable populations were found to be women, younger people, people with basic or medium studies, students and individuals with no remunerated activities, single populations, and those co-living with dependent seniors as well as those with a reduced number of children.
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Affiliation(s)
- Sara Esteban-Gonzalo
- Faculty of Biomedicine, Department of Psychology, Universidad Europea de Madrid, Madrid, Spain
| | | | | | - Laura Esteban-Gonzalo
- Faculty of Biomedicine, Department of Nursing, Universidad Europea de Madrid, Madrid, Spain.,Faculty of Medicine, Department of Nursing, Universidad Autónoma de Madrid, Madrid, Spain
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393
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The impact of information about tobacco-related reproductive vs. general health risks on South Indian women's tobacco use decisions. EVOLUTIONARY HUMAN SCIENCES 2020; 3. [PMID: 33778367 PMCID: PMC7996064 DOI: 10.1017/ehs.2020.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Smokeless tobacco use among Indian women is increasing despite prevention efforts. Evolutionary theories suggest that reproductive-aged women should be more concerned about immediate threats to reproduction than threats to survival occurring late in life. This study therefore compared an anti-tobacco intervention that emphasized near-term reproductive harms to one involving general harms occurring later in life. Scheduled Tribal women (N = 92) from Karnataka, India participated in this study. At baseline, women reported tobacco use and knowledge of harms, provided a saliva sample to assess use, and randomly viewed either a general harms presentation (GHP) or reproductive harms presentation (RHP). At followup, women reported their use, knowledge of harms and intentions to quit, and provided another saliva sample. At baseline, participants were aware of general harms but not reproductive harms. Both interventions increased knowledge of harms. Women in the RHP condition did not list more harms than women in the GHP condition, however, and the RHP was not more effective in reducing tobacco use than the GHP. In the RHP condition fetal health was particularly salient. In the GHP condition, oral health was highly salient, aligning with the local disease ecology and research on tobacco use and attractiveness.
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394
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Al-Rawi A, Siddiqi M, Morgan R, Vandan N, Smith J, Wenham C. COVID-19 and the Gendered Use of Emojis on Twitter: Infodemiology Study. J Med Internet Res 2020; 22:e21646. [PMID: 33052871 PMCID: PMC7647473 DOI: 10.2196/21646] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/31/2022] Open
Abstract
Background The online discussion around the COVID-19 pandemic is multifaceted, and it is important to examine the different ways by which online users express themselves. Since emojis are used as effective vehicles to convey ideas and sentiments, they can offer important insight into the public’s gendered discourses about the pandemic. Objective This study aims at exploring how people of different genders (eg, men, women, and sex and gender minorities) are discussed in relation to COVID-19 through the study of Twitter emojis. Methods We collected over 50 million tweets referencing the hashtags #Covid-19 and #Covid19 for a period of more than 2 months in early 2020. Using a mixed method, we extracted three data sets containing tweets that reference men, women, and sexual and gender minorities, and we then analyzed emoji use along each gender category. We identified five major themes in our analysis including morbidity fears, health concerns, employment and financial issues, praise for frontline workers, and unique gendered emoji use. The top 600 emojis were manually classified based on their sentiment, indicating how positive, negative, or neutral each emoji is and studying their use frequencies. Results The findings indicate that the majority of emojis are overwhelmingly positive in nature along the different genders, but sexual and gender minorities, and to a lesser extent women, are discussed more negatively than men. There were also many differences alongside discourses of men, women, and gender minorities when certain topics were discussed, such as death, financial and employment matters, gratitude, and health care, and several unique gendered emojis were used to express specific issues like community support. Conclusions Emoji research can shed light on the gendered impacts of COVID-19, offering researchers an important source of information on health crises as they happen in real time.
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Affiliation(s)
| | | | | | | | - Julia Smith
- Simon Fraser University, Burnaby, BC, Canada
| | - Clare Wenham
- London School of Economics, London, United Kingdom
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395
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Pollitt AM, Donnelly R, Mernitz SE, Umberson D. Differences in how spouses influence each other's alcohol use in same- and different-sex marriages: A daily diary study. Soc Sci Med 2020; 264:113398. [PMID: 33017734 PMCID: PMC7676150 DOI: 10.1016/j.socscimed.2020.113398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/14/2020] [Accepted: 09/21/2020] [Indexed: 01/15/2023]
Abstract
RATIONALE Different-sex spouses influence each other's alcohol consumption, with women having more influence on their spouses than men. Because women drink less than men, this long-term influence partly explains why married men and women consume less alcohol than their unmarried peers. However, much less is known about possible gender differences in the ways spouses influence each other's alcohol use on a day-to-day basis in same-compared to different-sex marriages. Because sexual minority people are at higher risk for alcohol use disorders compared to their heterosexual counterparts, such knowledge could shed light on ways to reduce this risk and alcohol use disparities between sexual minority and heterosexual people. METHOD We use 10 days of diary data collected in 2014-2015 in the United States from 157 female same-sex, 106 male same-sex, and 115 different-sex married couples in midlife (ages 35-65) to examine how one spouse's drinking influences how much the other spouse drinks on the following day. RESULTS Men reported higher levels of daily drinking than women; after including covariates, men in different-sex marriages reported drinking at the highest levels. Results from actor-partner interdependence models show that men in same- and different-sex marriages drink more, and women in different-sex marriages drink less when their spouse drinks more the previous day. Female same-sex spouses did not change their drinking behaviors in response to their spouse's drinking. CONCLUSIONS Overall higher rates of drinking among men in same-sex marriages suggest an accumulation effect of drinking that may contribute to sexual minority health disparities. Women and men in different-sex marriages may be engaging in social control or navigating masculinity norms. Women in same-sex marriages may not feel the need to adjust to low levels of drinking by their spouses. Findings suggest that spousal influence over alcohol consumption unfolds differently in same-sex compared to different-sex marriages.
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Affiliation(s)
- Amanda M Pollitt
- Department of Health Sciences, Northern Arizona University, USA.
| | | | - Sara E Mernitz
- Population Research Center, The University of Texas at Austin, USA.
| | - Debra Umberson
- Population Research Center, The University of Texas at Austin, USA; Department of Sociology, The University of Texas at Austin, USA.
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396
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Plouffe V, Bicaba F, Bicaba A, Druetz T. User fee policies and women's empowerment: a systematic scoping review. BMC Health Serv Res 2020; 20:982. [PMID: 33109172 PMCID: PMC7590470 DOI: 10.1186/s12913-020-05835-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Over the past decade, an increasing number of low- and middle-income countries have reduced or removed user fees for pregnant women and/or children under five as a strategy to achieve universal health coverage. Despite the large number of studies (including meta-analyses and systematic reviews) that have shown this strategy's positive effects impact on health-related indicators, the repercussions on women's empowerment or gender equality has been overlooked in the literature. The aim of this study is to systematically review the evidence on the association between user fee policies in low- and middle-income countries and women's empowerment. METHODS A systematic scoping review was conducted. Two reviewers conducted the database search in six health-focused databases (Pubmed, CAB Abstracts, Embase, Medline, Global Health, EBM Reviews) using English key words. The database search was conducted on February 20, 2020, with no publication date limitation. Qualitative analysis of the included articles was conducted using a thematic analysis approach. The material was organized based on the Gender at Work analytical framework. RESULTS Out of the 206 initial records, nine articles were included in the review. The study settings include three low-income countries (Burkina Faso, Mali, Sierra Leone) and two lower-middle countries (Kenya, India). Four of them examine a direct association between user fee policies and women's empowerment, while the others address this issue indirectly -mostly by examining gender equality or women's decision-making in the context of free healthcare. The evidence suggests that user fee removal contributes to improving women's capability to make health decisions through different mechanisms, but that the impact is limited. In the context of free healthcare, women's healthcare decision-making power remains undermined because of social norms that are prevalent in the household, the community and the healthcare centers. In addition, women continue to endure limited access to and control over resources (mainly education, information and economic resources). CONCLUSION User fee removal policies alone are not enough to improve women's healthcare decision-making power. Comprehensive and multi-sectoral approaches are needed to bring sustainable change regarding women's empowerment. A focus on "gender equitable access to healthcare" is needed to reconcile women's empowerment and the efforts to achieve universal health coverage.
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Affiliation(s)
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Thomas Druetz
- University of Montreal School of Public Health, Montreal, Canada.
- Centre de Recherche en Santé Publique, Montreal, Canada.
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA.
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397
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Cookson TP, Fuentes L, Saxena AS, Jha S. Programmatic norms change to eliminate violence against children: Insights for practitioners and researchers from a UNICEF global mapping study. Glob Public Health 2020; 16:870-881. [PMID: 33106092 DOI: 10.1080/17441692.2020.1839931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Interest in gender norms is rising within the field of global health and among its funders. With more resources available for norms change work, international institutions seek to develop thoughtful strategic and programmatic responses to a variety of issues, including violence against children. Yet changing deeply rooted gender norms requires sensitivity to local context. This can present a challenge for mid- to large sized organisations, as well as funders, who are typically required to develop strategies that encompass multiple contexts. This paper presents practical lessons learned from a mapping study of UNICEF's existing work to change discriminatory gender norms. As the world's leading children's rights organisation, preventing violence against children (0-9) and adolescents (ages 10-19) is a key component of UNICEF's work. This mapping formed the foundation of the institution's efforts to build out a coordinated strategy and programme of work around 'positive gender socialisation.' The mapping was unique in that it accounted for differences across and within regions and sought to develop an institutional programme of work based on local experience and existing priorities. The lessons learned are relevant to other organisations and practice-oriented research programmes embarking on work to change norms that lead to violence against children.
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Affiliation(s)
| | - Lorena Fuentes
- Ladysmith, and the Department of International Development Studies, University of California Los Angeles, USA
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398
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Kennedy E, Binder G, Humphries-Waa K, Tidhar T, Cini K, Comrie-Thomson L, Vaughan C, Francis K, Scott N, Wulan N, Patton G, Azzopardi P. Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region. LANCET GLOBAL HEALTH 2020; 8:e1473-e1488. [PMID: 33091371 DOI: 10.1016/s2214-109x(20)30354-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND By adulthood, gender inequalities in health and wellbeing are apparent. Yet, the timing and nature of gender inequalities during childhood and adolescence are less clear. We describe the emergence of gender inequalities in health and wellbeing across the first two decades of life. METHODS We focused on the 40 low-income and middle-income countries in Asia and the Pacific. A measurement framework was developed around four key domains of wellbeing across the first two decades: health, education and transition to employment, protection, and a safe environment. Specific measurement constructs were then defined by considering gender indicator frameworks, the Sustainable Development Goals, indicator frameworks for child and adolescent health and wellbeing, and key stakeholder input. Available data were then mapped to define 87 indicators, subsequently populated using databases (UN agencies and the Global Burden of Diseases, Injuries, and Risk Factors Study) and nationally representative surveys. Where possible, estimates in girls were compared with boys to report relative risks. FINDINGS Although son preference is evident in some settings-as shown by higher than expected male-to-female sex ratios at birth in India, Vietnam, and China (all >1·10 compared with an expected ratio of 1·05) and excess mortality of girl children in some South Asian and Pacific nations-it is during early adolescence where marked gender inequalities consistently emerged. Adolescent girls face considerable disadvantage in relation to sexual and reproductive health (notably in South Asia and the Pacific), with high rates of child marriage (≥30% of women aged 20-24 years married before 18 years in Bangladesh, Nepal, and Afghanistan), fertility (≥65 livebirths per 1000 girls in Nauru, Laos, Afghanistan, Nepal, Marshall Islands, Bangladesh, Vanuatu, and Papua New Guinea), and intimate partner violence (>20% in Timor Leste, Afghanistan, Pakistan, and Myanmar). Despite educational parity in many countries, females aged 15-24 years were less likely than males to be in education, employment, or training in 17 of 19 countries for which data were available. Compared with girls, adolescent boys experienced excess all-cause mortality and substantially higher mortality due to unintentional injury, interpersonal violence, alcohol and other drugs, and suicide, and higher prevalence of harmful drinking and tobacco smoking. INTERPRETATION These findings call for a focus on gender policy and programming in later childhood and early adolescence before gender inequalities become embedded. FUNDING UNICEF.
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Affiliation(s)
- Elissa Kennedy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Gerda Binder
- East Asia and Pacific Regional Office, UNICEF, Bangkok, Thailand
| | | | - Tom Tidhar
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Karly Cini
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Liz Comrie-Thomson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Cathy Vaughan
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kate Francis
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Nisaa Wulan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - George Patton
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter Azzopardi
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia; Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute and School of Medicine, University of Adelaide, Adelaide, SA, Australia.
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Mikolić A, van Klaveren D, Groeniger JO, Wiegers EJA, Lingsma HF, Zeldovich M, von Steinbüchel N, Maas AIR, Roeters van Lennep JE, Polinder S. Differences between Men and Women in Treatment and Outcome after Traumatic Brain Injury. J Neurotrauma 2020; 38:235-251. [PMID: 32838645 DOI: 10.1089/neu.2020.7228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of disability, but little is known about sex and gender differences after TBI. We aimed to analyze the association between sex/gender, and the broad range of care pathways, treatment characteristics, and outcomes following mild and moderate/severe TBI. We performed mixed-effects regression analyses in the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, stratified for injury severity and age, and adjusted for baseline characteristics. Outcomes were various care pathway and treatment variables, and 6-month measures of functional outcome, health-related quality of life (HRQoL), post-concussion symptoms (PCS), and mental health symptoms. The study included 2862 adults (36% women) with mild (mTBI; Glasgow Coma Scale [GCS] score 13-15), and 1333 adults (26% women) with moderate/severe TBI (GCS score 3-12). Women were less likely to be admitted to the intensive care unit (ICU; odds ratios [OR] 0.6, 95% confidence interval [CI]: 0.4-0.8) following mTBI. Following moderate/severe TBI, women had a shorter median hospital stay (OR 0.7, 95% CI: 0.5-1.0). Following mTBI, women had poorer outcomes; lower Glasgow Outcome Scale Extended (GOSE; OR 1.4, 95% CI: 1.2-1.6), lower generic and disease-specific HRQoL, and more severe PCS, depression, and anxiety. Among them, women under age 45 and above age 65 years showed worse 6-month outcomes compared with men of the same age. Following moderate/severe TBI, there was no difference in GOSE (OR 0.9, 95% CI: 0.7-1.2), but women reported more severe PCS (OR 1.7, 95% CI: 1.1-2.6). Men and women differ in care pathways and outcomes following TBI. Women generally report worse 6-month outcomes, but the size of differences depend on TBI severity and age. Future studies should examine factors that explain these differences.
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Affiliation(s)
- Ana Mikolić
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.,Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies/Tufts Medical Center, Boston, Massachusetts, USA
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Public Administration and Sociology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline J A Wiegers
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, Georg-August-University, Göttingen, Germany
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, Georg-August-University, Göttingen, Germany
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | | | - Suzanne Polinder
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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400
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Wandschneider L, Batram-Zantvoort S, Razum O, Miani C. Representation of gender in migrant health studies - a systematic review of the social epidemiological literature. Int J Equity Health 2020; 19:181. [PMID: 33054755 PMCID: PMC7556985 DOI: 10.1186/s12939-020-01289-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory. Simultaneously, migration influences the individual as well as societal definition and perception of gender roles. An explicit gender perspective in migration-related epidemiological research can contribute to adequately analyse and interpret the health of migrants. This systematic review gives a comprehensive overview on how gender has been conceptualised, operationalised and measured in social epidemiologic studies aiming to assess the influence of gender on health among migrants. Methods We searched PubMed, Embase, CINAHL, the Cochrane Library, EconLit and PsycINFO and conducted backward reference searching. Reviewers independently selected studies, extracted data and conducted the quality assessment. Eligible studies actively aimed to understand, identify or explain the influence of gender on migrants’ health, whereby the role of gender can encompass a variety of mechanisms, processes or states of differentiation, discrimination and/or inequality. Results Almost all of the 43 studies were cross-sectional and focussed on health outcomes in the post-migration phase. The most common theme of research was the health of male migrants in the US, and in particular of men who have sex with men (MSM). All studies treated gender as a binary variable (men vs. women), without discussing additional types of gender identities. A minority of studies differentiated clearly between sex and gender. Gender was mostly operationalised through attitudes toward gender roles and gender-based discrimination, experienced at the individual level. Community and societal level gender measures capturing structural gender determinants were underrepresented. Conclusions The intersections of migration and gender suggested synergistic effects on health that only become visible when considering those two social determinants together. Future research needs to embrace a multilevel and non-binary understanding of gender and reflect on the influence of gender in the different phases of the migration journey. Systematic review registration PROSPERO CRD42019124698.
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Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany.
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
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