1
|
Ballering AV, Olde Hartman TC, Rosmalen JG. Gender scores in epidemiological research: methods, advantages and implications. THE LANCET REGIONAL HEALTH. EUROPE 2024; 43:100962. [PMID: 38989448 PMCID: PMC11233999 DOI: 10.1016/j.lanepe.2024.100962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/14/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
Sex and gender-related factors are strongly associated with patients' illness trajectories, underscoring their essential role in epidemiological research and healthcare. Ignoring sex and gender in research and health inevitably results in inequities between women and men in terms of detection of disease, preventative measures, and effectiveness of treatment. Historical influences, including ideas of female inferiority and conservative notions of women's health only comprising reproductive health, reinforced the perceived irrelevance of sex and gender to health. Currently, these ideas are largely abandoned and epidemiology is becoming increasingly sensitive to sex. Gender-sensitivity, however, is lagging behind. This is potentially due to lacking knowledge and awareness about the relevance of both sex and gender to health and challenges in operationalizing gender in epidemiological research. Here, we thoroughly discuss the relevance of sex and gender to health, and pay special attention to the time, place, and culture-dependent embodiment of gender. We also discuss the operationalization of gender via composite gender scores in epidemiological studies. We argue to move beyond solely using these. Rather we should consider sex and gender in the initial stages of designing a study, to facilitate relevant, reproducible, and person-centric research.
Collapse
Affiliation(s)
- Aranka V. Ballering
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Tim C. Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Judith G.M. Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| |
Collapse
|
2
|
Glasser NJ, Jameson JC, Tung EL, Lindau ST, Pollack HA. Associations of Adolescent School Social Networks, Gender Norms, and Adolescent-to-Young Adult Changes in Male Gender Expression With Young Adult Substance Use. J Adolesc Health 2024; 74:755-763. [PMID: 38206221 PMCID: PMC11174146 DOI: 10.1016/j.jadohealth.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Male gender expression (MGE), which is shaped by sociocultural pressures around masculinity, has been previously associated with health. This study examines associations of adolescent social network variables and school gender norms with MGE changes from adolescence to young adulthood, and associations of these changes with young adult substance use. METHODS Analyzing data from Waves I (1994-95, adolescents, aged 12-18) and IV (2008-09, young adults, 24-32) of a nationally representative longitudinal cohort study, male participants' MGE was assessed in each wave using a validated, empirically derived measure. Linear regression was used to evaluate associations of adolescent-to-young adult MGE changes between waves with adolescent social network characteristics and school gender norms. Logistic regression was used to examine associations between adolescent-to-young adult MGE changes and young adult substance uses (cigarette, marijuana, heavy alcohol, and recreational drug use, and prescription drug misuse). RESULTS Among 4,776 male participants, adolescent-to-young adult MGE changes were significantly associated with school gender norms such that adolescents whose MGE markedly departed from their schools' average exhibited greater MGE changes in the direction of their schools' average (β = -0.83, p < .01) relative to those who were more similar to school means. Adolescent-to-young adult increases in MGE were significantly associated with greater odds of all young adult substance use behaviors except prescription drug misuse. DISCUSSION Adolescents' MGE relative to other males at their school was associated with MGE changes toward school norms, with implications for young adult substance use. Adolescent gender norms may be an underexplored strategy for interventions to reduce substance misuse.
Collapse
Affiliation(s)
- Nathaniel J Glasser
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois.
| | - Jacob C Jameson
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Elizabeth L Tung
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine - Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, Illinois; Department of Public Health Sciences, University of Chicago, Chicago, Illinois; Urban Health Lab, University of Chicago, Chicago, Illinois
| |
Collapse
|
3
|
Hernandez SM, Halpern CT, Conron KJ. Sexual orientation, gender expression and socioeconomic status in the National Longitudinal Study of Adolescent to Adult Health. J Epidemiol Community Health 2023; 78:jech-2022-220164. [PMID: 38053260 PMCID: PMC10850725 DOI: 10.1136/jech-2022-220164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 10/17/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is a fundamental contributor to health, yet it is rarely examined relative to gender expression, particularly gender non-conformity and sexual orientation. METHODS We use data from 11 242 Wave V respondents (aged 33-44) in the National Longitudinal Study of Adolescent to Adult Health (2016-2018) to examine associations between socially assigned gender expression, sexual orientation and SES, in logistic and multinomial regression models stratified by sex assigned at birth. RESULTS Among both women and men a general pattern of heightened risk for lower SES among gender non-conforming sexual minorities relative to gender conforming heterosexuals was observed. Gender non-conforming heterosexuals were also at elevated risk of lower SES compared with their conforming heterosexual peers. CONCLUSION Socioeconomic differences by sexual orientation and gender expression have important implications for understanding health disparities among gender non-conforming sexual minorities and their gender conforming heterosexual counterparts.
Collapse
Affiliation(s)
- Stephanie M Hernandez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Carolyn T Halpern
- Department of Maternal & Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kerith J Conron
- The Williams Institute, University of California School of Law, Los Angeles, California, USA
| |
Collapse
|
4
|
Vader SS, Lewis SM, Verdonk P, Verschuren WM, Picavet HSJ. Masculine gender affects sex differences in the prevalence of chronic health problems - the Doetinchem Cohort Study. Prev Med Rep 2023; 33:102202. [DOI: 10.1016/j.pmedr.2023.102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023] Open
|
5
|
The Association of Adolescent Gender Performance and Adult Intimate Partner Violence. J Adolesc Health 2022; 71:705-712. [PMID: 36088233 DOI: 10.1016/j.jadohealth.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE A quarter of women and nearly 1 in 10 men in the United States have reported experiencing intimate partner violence (IPV) that had lasting negative impacts at least once during their lifetime. To prevent IPV over the lifecourse, adolescence has been identified as an ideal period for healthy relationship education that addresses the various IPV risk factors. One of those risk factors is believing in traditional gender roles, but the behavioral aspect of gender performance has been understudied. This study explores the relationship between adolescent gender performance and adult IPV perpetration and victimization/survival. METHODS We used logistic regression to estimate associations of adolescent gender performance and adult IPV perpetration and victimization/survival in a sample of 2,197 males and 2,587 females from The National Longitudinal Study of Adolescent to Adult Health (Add Health) between 1994 and 2008. RESULTS Male adolescent gender performance was associated with increased adult IPV perpetration (adjusted odds ratio [AOR] = 1.11; 95% confidence interval [CI], 1.05-1.18 per 10% increase in gender performance) and victimization/survival (AOR = 1.07; 95% CI, 1.03-1.11 per 10% increase in gender performance). Female adolescent gender performance was not associated with adult IPV perpetration or victimization/survival. DISCUSSION The more similarly adolescent males behave to their adolescent male peers, the more likely they are to perpetrate and experience IPV in adulthood. This study supports the implementation of gender transformative education during adolescence and the specific need to address how the behaviors associated with male gender performance are risk factors for adult IPV.
Collapse
|
6
|
Wandschneider L, Sauzet O, Razum O, Miani C. Development of a gender score in a representative German population sample and its association with diverse social positions. FRONTIERS IN EPIDEMIOLOGY 2022; 2:914819. [PMID: 38455329 PMCID: PMC10910995 DOI: 10.3389/fepid.2022.914819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/02/2022] [Indexed: 03/09/2024]
Abstract
Background Gender as a relational concept is rarely considered in epidemiology. However, an in-depth reflection on gender conceptualisation and operationalisation can advance gender analysis in quantitative health research, allowing for more valid evidence to support public health interventions. We constructed a context-specific gender score to assess how its discriminatory power differed in sub-groups defined by social positions relevant to intersectional analyses, i.e., sex/gender, race, class, age and sexual attraction. Methods We created a gender score with the help of multivariable logistic regression models and conditional probabilities based on gendered social practices and expressed on a masculinity-femininity continuum, using data of the German Socioeconomic Panel. With density plots, we exploratively compared distributions of gendered social practices and their variation across social groups. Results We included 13 gender-related variables to define a gender score in our sample (n = 20,767). Variables on family and household structures presented with the highest weight for the gender score. When comparing social groups, we saw that young individuals, those without children, not living with a partner or currently living in a same-sex/gender partnership, showed more overlap between feminine/masculine social practices among females and males. Conclusions The distribution of gendered social practices differs among social groups, which empirically backs up the theoretical notion of gender being a context-specific construct. Economic participation and household structures remain essential drivers of heterogeneity in practices among women and men in most social positions. The gender score can be used in epidemiology to support concerted efforts to overcome these gender (in)equalities-which are important determinants of health inequalities.
Collapse
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Center for Statistics, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Research Institute Social Cohesion (RISC), Bielefeld University, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
7
|
Cislaghi B, Weber AM, Shakya HB, Abdalla S, Bhatia A, Domingue BW, Mejía-Guevara I, Stark L, Seff I, Richter LM, Baptista Menezes AM, Victora CG, Darmstadt GL. Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data. Soc Sci Med 2021; 293:114652. [PMID: 34915243 PMCID: PMC8819155 DOI: 10.1016/j.socscimed.2021.114652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 12/05/2022]
Abstract
Background Understanding how gender norms affect health is an important entry point into designing programs and policies to change norms and improve gender equality and health. However, it is rare for global health datasets to include questions on gender norms, especially questions that go beyond measuring gender-related attitudes, thus limiting gender analysis. Methods We developed five case studies using health survey data from six countries to demonstrate approaches to defining and operationalising proxy measures and analytic approaches to investigating how gender norms can affect health. Key findings, strengths and limitations of our norms proxies and methodological choices are summarised. Findings Case studies revealed links between gender norms and multiple adolescent health outcomes. Proxys for norms were derived from data on attitudes, beliefs, and behaviours, as well as differences between attitudes and behaviours. Data were cross-sectional, longitudinal, census- and social network-based. Analytic methods were diverse. We found that gender norms affect: 1) Intimate partner violence in Nigeria; 2) Unhealthy weight control behaviours in Brazil and South Africa; 3) HIV status in Zambia; 4) Health and social mobility in the US; and 5) Childbirth in Honduras. Interpretation Researchers can use existing global health survey data to examine pathways through which gender norms affect health by generating proxies for gender norms. While direct measures of gender norms can greatly improve the understanding of how gender affects health, proxy measures for norms can be designed for the specific health-related outcome and normative context, for instance by either aggregating behaviours or attitudes or quantifying the difference (dissonance) between them. These norm proxies enable evaluations of the influence of gender norms on health and insights into possible reference groups and sanctions for non-compliers, thus informing programmes and policies to shape norms and improve health. This article presents effective methods to study gender norms in existing global health survey data. We devised conceptual pathways linking gender norms to gender-based health disparities. We identified gender norms proxies and reference groups enforcing the norm. We tested hypotheses linking gender norms to health. These methods can aid policy and programme design to advance gender equality and health.
Collapse
Affiliation(s)
- Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | - Ann M Weber
- School of Public Health, University of Nevada, Reno, NV, USA
| | - Holly B Shakya
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA, USA
| | - Safa Abdalla
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | | | - Iván Mejía-Guevara
- Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, USA; Stanford Aging and Ethnogeriatrics (SAGE) Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ilana Seff
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda M Richter
- Centre of Excellence in Human Development, University of Witwatersrand, Durban, South Africa
| | - Ana Maria Baptista Menezes
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
8
|
Feigelman W, Coleman D, Rosen Z. Examining the social origins and young adult life trajectories of high traditional masculinity (HTM) males: A group at elevated suicide risk. Suicide Life Threat Behav 2021; 51:696-714. [PMID: 33823060 DOI: 10.1111/sltb.12753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We investigated whether male high school students displaying high traditional masculinity (HTM), defined briefly as overacting male roles, possessed distinctive social origins and adult lifestyle trajectories differentiating them from others. METHOD Based upon four survey waves of the National Longitudinal Study of Adolescent to Adult Health cross-linked to the National Death Index, we contrasted surveys 1 and 2 respondents reporting HTM, n = 3138, 31%, with the remaining 69% (n = 6849) on various sociodemographic characteristics, problem behaviors, suicides, and other premature mortalities. RESULTS High traditional masculinity males showed higher suicide rates, but no other differences in premature mortalities, compared with non-HTM peers. More likely to be White, younger, less close to their fathers, they were more likely to run away from home, get into fights, act delinquently, and engage in problem drinking and drug use. At survey wave 3, more had been arrested. By wave 4, when approaching their early thirties, HTM males showed higher drug uses, more delinquency, completed less schooling, and were less likely to marry. CONCLUSIONS These data not only suggest higher suicide risks among this population after high school, but judging from the durability of HTM characteristics, but also they appear at risk of "deaths of despair" during later life.
Collapse
Affiliation(s)
| | - Daniel Coleman
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | - Zohn Rosen
- Department of Psychology, New York Medical College, New York, NY, USA
| |
Collapse
|
9
|
Nagata JM, Domingue BW, Darmstadt GL, Weber AM, Meausoone V, Cislaghi B, Shakya HB. Gender Norms and Weight Control Behaviors in U.S. Adolescents: A Prospective Cohort Study (1994-2002). J Adolesc Health 2020; 66:S34-S41. [PMID: 31866036 PMCID: PMC6928570 DOI: 10.1016/j.jadohealth.2019.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this article was to determine the relationship between gender norms and weight control behaviors in U.S. adolescents. METHODS We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health (N = 9,861), at baseline in 1994-1995 (ages 11-18 years, Wave I), 1-year follow-up (ages 12-19 years, Wave II), and 7-year follow-up (ages 18-26 years, Wave III). The primary exposure variable was a measure of one's gender normativity based on the degree to which males and females behave in ways that are similar to the behaviors of their same-gender peers. The outcome variable was an individual's weight control attempts (trying to lose or gain weight) and behaviors (dieting, fasting/skipping meals, vomiting, or weight-loss pills/laxatives/diuretics to lose weight or ate different/more foods than usual or taking supplements to gain weight). RESULTS In logistic regression analyses controlling for potential confounders, a higher baseline individual gender normativity score (higher femininity in females and higher masculinity in males) was associated with weight loss attempts (β = .10; p = .01) and weight loss behaviors (β = .18; p < .001) in girls but was associated with weight gain attempts (β = .18; p < .001) and behaviors (β = .16; p < .001) in boys at 1-year follow-up. Higher individual gender normativity score was protective of weight loss attempts (β = -.15; p < .001) and weight loss behaviors (β = -.17; p < .001) in males but not females at 7-year follow-up. Loess plots provided visualizations of significant relationships. CONCLUSIONS Gender norms may reinforce a thinner body ideal for girls but a larger ideal for boys.
Collapse
Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, Nevada
| | - Valerie Meausoone
- Stanford Center for Population Health Sciences, Stanford University, Stanford, California
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Holly B Shakya
- Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, California
| |
Collapse
|
10
|
Domingue BW, Cislaghi B, Nagata JM, Shakya HB, Weber AM, Boardman JD, Darmstadt GL, Harris KM. Implications of gendered behaviour and contexts for social mobility in the USA: a nationally representative observational study. Lancet Planet Health 2019; 3:e420-e428. [PMID: 31625514 PMCID: PMC6876275 DOI: 10.1016/s2542-5196(19)30191-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND We constructed measures of an individual's gendered behaviour and their gendered environment to investigate the salience of gender norms during adolescence for social mobility during the next decade of life. METHODS In this nationally representative observational study, we collected individual-level data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), which enrolled a cohort of nationally representative school students aged 11-19 years from across the USA and followed them up for 14 years (ie, to age 25-33 years). We characterised gendered behaviour for adolescents in a performative sense via self-reports of behaviours and beliefs. We aggregated this individual-level measure to create a proxy measure of an individual's social context by taking averages for an individual's peers of the same sex and school year. FINDINGS Between Jan 5, 1994, and Dec 26, 1995, Add Health collected data on a cohort of 20 745 students. 14 540 respondents were followed-up 14 years later between April 3, 2007, and Feb 1, 2009, of whom 7722 (53·1%) were female. More masculine male respondents were downwardly mobile; they were enrolled in school for fewer years and were more likely to have lower status jobs than their less masculine same-sex school peers. More masculine male respondents were also more likely to have jobs in occupational categories with larger proportions of males than their same-sex school peers. Gendered behaviour was not predictive of future educational and occupational attainment for female respondents. Male adolescents in school years with more masculine same-sex peers than male adolescents in other school years also tended to have lower educational and occupational attainment than their male peers. Educational and occupational attainment in early midlife for female respondents was not affected by their gendered environment. INTERPRETATION Gender, when measured as a set of gender-distinct behaviours in adolescence, was associated with differential patterns of social mobility from adolescence to young adulthood. Moreover, variation in an individual's local gender norms has implications for subsequent socioeconomic attainment, especially for male adolescents. These findings have potential implications for observed health disparities. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Benjamin W Domingue
- Graduate School of Education and Population Health Sciences, Stanford University, Stanford, CA, USA.
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Holly B Shakya
- Center on Gender Equity and Health, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Jason D Boardman
- Institute of Behavioral Science and Department of Sociology, University of Colorado, Boulder, CO, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Kathleen Mullan Harris
- Carolina Population Center and Department of Sociology, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
11
|
Shakya HB, Domingue B, Nagata JM, Cislaghi B, Weber A, Darmstadt GL. Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:529-538. [PMID: 31155319 PMCID: PMC6686658 DOI: 10.1016/s2352-4642(19)30160-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous research has documented differences in health behaviours between men and women, with differential risks and health outcomes between the sexes. Although some sex-specific differences in health outcomes are caused by biological factors, many others are socially driven through gender norms. We therefore aimed to assess whether gender expression as an adolescent, determined by the degree to which an individual's behvaiours were typical of their gender, were associated with health behaviours and outcomes in adulthood. METHODS In this prospective cohort study, we used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of US adolescents from whom data were collected during adolescence (ages 11-18 years) and adulthood (ages 24-32 years). We created a measure of gender expression that was based on the degree to which male and female adolescents and adults behave in stereotypically masculine (for men) or feminine (for women) ways relative to their same-gender peers. Adolescents were assessed for baseline sociodemographic characteristics and gender expression, and these participants were later assessed, during adulthood, for their gender expression and health behaviours and outcomes, which included depression, self-rated health, drug and alcohol use, cardiovascular risk factors, experience of sexual violence, diet, and obesity. These data were collected via surveys, except for body-mass index, cholesterol, and blood pressure, which were collected as biomarkers. FINDINGS Between April and December, 1995, self-reported data were collected from 10 480 female and 10 263 male adolescents; similar data were subsequently collected in several waves in this cohort, with a final collection between January, 2008, and February, 2009, when participants were aged 24-32 years. We used data from this final wave and from baseline, and our study represents a secondary analysis of these data. Of these participants, complete follow-up data from 6721 (80%) adult women and 5885 (80%) adult men were available. Gender expression was stable for men and women from adolescence to adulthood. High masculinity (vs low masculinity) in adolescent and adult men was positively associated with smoking in the past month, use of marijuana and recreational drugs, prescription drug misuse (adult gender expression only), and consumption of fast food and soda (adolescent gender expression only) in the past week. However, higher masculine gender expression in adult men was negatively associated with diagnosed depression and high cholesterol in adulthood, and masculine gender expression in adolescent and adult men was negatively associated with high blood pressure in adults. High femininity (vs low femininity) in adolescent or adult women was positively associated with high cholesterol and blood pressure (both adult gender expression only), depression, migraines (adult gender expression only), and physical limitations (ie, health problems that limited their daily activities). However, higher femininity in adolescence was negatively associated with self-rated good health in adulthood. Although feminine gender expression in adolescents was predictive of adult recreational and prescription drug and marijuana use and experience of sexual violence, feminine gender expression in adulthood was negatively associated with adult substance use and experience of sexual violence, suggesting that expressions of femininity typical of adolescents impart risks that expression of femininity as an adult does not. Individuals who are highly masculine or feminine seem to be at greatest risk of adverse health outcomes and behaviours. INTERPRETATION We found compelling evidence that adolescent gender expression is correlated with health in adulthood independently of gender expression as an adult. Although more research is needed to identify causal mechanisms, our results suggest that those designing health behaviour interventions should carefully consider integrating gender transformative components into interventions. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development, Gender Equality, Integrated Delivery, HIV, Nutrition, Family Planning, and Water Sanitation and Hygiene Program Strategy Teams (Bill and Melinda Gates Foundation).
Collapse
Affiliation(s)
- Holly B Shakya
- Center on Gender Equity and Health, Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, CA, USA.
| | - Ben Domingue
- Department of Education, Stanford University, Stanford, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ann Weber
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| |
Collapse
|
12
|
Weber AM, Cislaghi B, Meausoone V, Abdalla S, Mejía-Guevara I, Loftus P, Hallgren E, Seff I, Stark L, Victora CG, Buffarini R, Barros AJD, Domingue BW, Bhushan D, Gupta R, Nagata JM, Shakya HB, Richter LM, Norris SA, Ngo TD, Chae S, Haberland N, McCarthy K, Cullen MR, Darmstadt GL. Gender norms and health: insights from global survey data. Lancet 2019; 393:2455-2468. [PMID: 31155273 DOI: 10.1016/s0140-6736(19)30765-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
Abstract
Despite global commitments to achieving gender equality and improving health and wellbeing for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and subnational data provide some key opportunities for testing associations between gender norms and health. Using innovative approaches to analysing proxies for gender norms, we generated evidence that gender norms impact the health of women and men across life stages, health sectors, and world regions. Six case studies showed that: (1) gender norms are complex and can intersect with other social factors to impact health over the life course; (2) early gender-normative influences by parents and peers can have multiple and differing health consequences for girls and boys; (3) non-conformity with, and transgression of, gender norms can be harmful to health, particularly when they trigger negative sanctions; and (4) the impact of gender norms on health can be context-specific, demanding care when designing effective gender-transformative health policies and programmes. Limitations of survey-based data are described that resulted in missed opportunities for investigating certain populations and domains. Recommendations for optimising and advancing research on the health impacts of gender norms are made.
Collapse
Affiliation(s)
- Ann M Weber
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
| | | | - Valerie Meausoone
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Iván Mejía-Guevara
- Department of Biology, Stanford University, Stanford, CA, USA; Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Pooja Loftus
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Emma Hallgren
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ilana Seff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lindsay Stark
- Brown School at Washington University in St Louis, St Louis, MO, USA
| | - Cesar G Victora
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Romina Buffarini
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Aluísio J D Barros
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | | | - Devika Bhushan
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Ribhav Gupta
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Jason M Nagata
- University of California San Francisco, Department of Pediatrics, San Francisco, CA, USA
| | - Holly B Shakya
- Department of Medicine, Center on Gender Equity and Health, University of California San Diego, La Jolla, CA, USA
| | - Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- Department of Paediatrics, SAMRC Developmental Pathways for Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Thoai D Ngo
- GIRL Center, Population Council, New York, NY, USA
| | - Sophia Chae
- GIRL Center, Population Council, New York, NY, USA
| | | | | | - Mark R Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
13
|
Geldenhuys M, Bosch A. A Rasch Adapted Version of the 30-Item Bem Sex Role Inventory (BSRI). J Pers Assess 2019; 102:428-439. [PMID: 30638408 DOI: 10.1080/00223891.2018.1527343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
As a foundational instrument in the measurement of gender, the study investigated the psychometric properties of the item scores on the 30-item Bem Sex Roles Inventory (BSRI) to address concerns raised in previous studies and to determine possible differential item functioning (DIF) by applying a Rasch measurement model on a multicultural South African sample. A quantitative cross-sectional research design with 55.3% women and 44.4% men was used. Overall, we found support for the reliability and validity of BSRI item scores, consistent with findings in North American and European contexts. The results supported the use of a 6-point response format as opposed to the original 7-point response format. The items "aggressive" (masculinity) and "loves children" (femininity) were removed. The Neutral dimension fit the data well. No DIF for the groupings of man/woman, race, and language (the latter 2 as measures of culture) were found. This study makes contributions by applying a Rasch measurement model to the BSRI, scores which have previously only been validated through classical test theory and often excludes the validation of the neutral dimension scores.
Collapse
Affiliation(s)
- Madelyn Geldenhuys
- Department of Industrial Psychology and People Management, University of Johannesburg, Johannesburg, South Africa
| | - Anita Bosch
- University of Stellenbosch Business School, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
14
|
Kahn NF, Halpern CT. Is developmental change in gender-typed behavior associated with adult sexual orientation? Dev Psychol 2018; 55:855-865. [PMID: 30550326 DOI: 10.1037/dev0000662] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of this article was to examine gender-typed behavior longitudinally and to consider its relationship with sexual orientation in adulthood. Data were from 10,624 respondents who completed Wave 1 (adolescence), Wave 3 (emerging adulthood), and Wave 4 (early adulthood) of the National Longitudinal Study of Adolescent to Adult Health. First, we described the distributions of gender-typed behavior by adult sexual orientation at each of the three developmental stages. Next, we performed multilevel mixed regression models to assess longitudinal variation in gender-typed behavior from adolescence to adulthood within sexual orientation groups. Results showed that gender-typed behavior varied both within and between sexual orientation groups, as well as over time. For males, the differences in gender-typed behavior among the sexual orientation groups were relatively consistent at each stage, whereas differences in gender-typed behavior among sexual orientation groups varied more at each stage among females. Longitudinal models exhibited curvilinear patterns, such that gender-typed behavior strengthened from adolescence to early adulthood but peaked in emerging adulthood. To our knowledge, this is the first study to use population representative data to study gender-typed behavior both prospectively and at multiple time points from adolescence to adulthood, and to consider how such behavior is related to adult sexual orientation. This research contributes to a growing body of prospective literature on the link between gendered behavior and sexual orientation and provides further justification for more age- and cohort-specific measures of gender-typed behavior in future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Nicole F Kahn
- Carolina Population Center, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Carolyn T Halpern
- Carolina Population Center, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| |
Collapse
|
15
|
Fleming PJ, Barrington C, Powell W, Gottert A, Lerebours L, Donastorg Y, Brito MO. The Association Between Men's Concern About Demonstrating Masculine Characteristics and Their Sexual Risk Behaviors: Findings from the Dominican Republic. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:507-515. [PMID: 27844313 PMCID: PMC5429985 DOI: 10.1007/s10508-016-0880-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 06/06/2023]
Abstract
Quantitative analyses exploring the relationship between masculinities and men's sexual risk behaviors have most commonly used one dimension of masculinities: men's gender ideology. Examining other dimensions may enhance our understanding of and ability to intervene upon this relationship. In this article, we examined the association between gender role conflict/stress (GRC/S)-men's concern about demonstrating masculine characteristics-and three different sexual risk behaviors (having two or more sex partners in the last 30 days; never/inconsistent condom use with non-steady partners; and drinking alcohol at last sex) among a sample of heterosexual men in the Dominican Republic who were participating in an HIV prevention intervention (n = 293). The GRC/S Scale we used was adapted for this specific cultural context and has 17 items (α = 0.75). We used logistic regression to assess the relationship between GRC/S and each sexual behavior, controlling for sociodemographic characteristics. In adjusted models, a higher GRC/S score was significantly associated with increased odds of having two or more sex partners in the past 30 days (AOR 1.33, 95 % CI 1.01-1.74), never/inconsistent condom use with non-steady partners (AOR 1.45, 95 % CI 1.04-2.01), and drinking alcohol at last sex (AOR 1.56, 95 % CI 1.13-2.17). These results highlight the importance of expanding beyond gender ideology to understanding the influence of GRC/S on men's sexual risk behaviors. Interventions should address men's concern about demonstrating masculine characteristics to reduce the social and internalized pressure men feel to engage in sexual risk behaviors.
Collapse
Affiliation(s)
- Paul J Fleming
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Wizdom Powell
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Yeycy Donastorg
- HIV Vaccine Trials Unit, Instituto Dermatológico y Cirugía de Piel, Santo Domingo, Dominican Republic
| | - Maximo O Brito
- Division of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
16
|
Wilkinson AL, Fleming PJ, Halpern CT, Herring AH, Harris KM. Adherence to gender-typical behavior and high frequency substance use from adolescence into young adulthood. PSYCHOLOGY OF MEN & MASCULINITY 2018; 19:145-155. [PMID: 29479292 PMCID: PMC5819748 DOI: 10.1037/men0000088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Substance use is prevalent among adolescents in the U.S., especially males. Understanding the cross-sectional and longitudinal associations between gender norms and substance use is necessary to tailor substance use prevention messages and efforts appropriately. This study investigates the relationship between adherence to gender-typical behavior (AGB) and substance use from adolescence into young adulthood. Participants in the National Longitudinal Study of Adolescent to Adult Health completed self-report measures on the frequency of binge drinking, cigarette smoking and marijuana use as well as various behaviors and emotional states that captured the latent construct of AGB. Sex-stratified logistic regression models revealed cross-sectional and longitudinal relationships between AGB and high frequency substance use. For example, an adolescent male who is more gender-adherent, compared to less adherent males, has 75% higher odds of high frequency binge drinking in adolescence and 22% higher odds of high frequency binge drinking in young adulthood. Sex-stratified multinomial logistic regression models also revealed cross-sectional and longitudinal relationships between AGB and patterns of use. For example, a more gender-adherent adolescent male, compared to one who is less adherent, is 256% more likely to use all three substances in adolescence and 66% more likely to use all three in young adulthood. Cross-sectional and longitudinal results for females indicate greater gender-adherence is associated with lower odds of high frequency substance use. These findings indicate adherence to gender norms may influence substance use behaviors across the developmental trajectory, and inform strategies for prevention efforts.
Collapse
Affiliation(s)
- Andra L Wilkinson
- Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445
| | - Paul J Fleming
- Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Carolyn Tucker Halpern
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 West Franklin St., Room 208, Chapel Hill, NC 27516
| | - Amy H Herring
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 West Franklin St., Room 208, Chapel Hill, NC 27516
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7420, Chapel Hill, NC 27599-7420
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 West Franklin St., Room 208, Chapel Hill, NC 27516
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, CB #3210, Chapel Hill, NC 27599-3210
| |
Collapse
|
17
|
Leaper C. Further Reflections on Sandra Lipsitz Bem’s Impact. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|