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Auderset D, Amiguet M, Clair C, Riou J, Pittet V, Schwarz J, Mueller Y. Gender/Sex Disparities in the COVID-19 Cascade From Testing to Mortality: An Intersectional Analysis of Swiss Surveillance Data. Int J Public Health 2024; 69:1607063. [PMID: 38835806 PMCID: PMC11148283 DOI: 10.3389/ijph.2024.1607063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives This study investigates gender and sex disparities in COVID-19 epidemiology in the Canton of Vaud, Switzerland, focusing on the interplay with socioeconomic position (SEP) and age. Methods We analyzed COVID-19 surveillance data from March 2020 to June 2021, using an intersectional approach. Negative binomial regression models assessed disparities between women and men, across SEP quintiles and age groups, in testing, positivity, hospitalizations, ICU admissions, and mortality (Incidence Rate Ratios [IRR], with 95% Confidence Intervals [CI]). Results Women had higher testing and positivity rates than men, while men experienced more hospitalizations, ICU admissions, and deaths. The higher positivity in women under 50 was mitigated when accounting for their higher testing rates. Within SEP quintiles, gender/sex differences in testing and positivity were not significant. In the lowest quintile, women's mortality risk was 68% lower (Q1: IRR 0.32, CI 0.20-0.52), with decreasing disparities with increasing SEP quintiles (Q5: IRR 0.66, CI 0.41-1.06). Conclusion Our findings underscore the complex epidemiological patterns of COVID-19, shaped by the interactions of gender/sex, SEP, and age, highlighting the need for intersectional perspectives in both epidemiological research and public health strategy development.
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Affiliation(s)
- Diane Auderset
- Department of Family Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Michaël Amiguet
- Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Carole Clair
- Department of Ambulatory Care, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Julien Riou
- Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Valérie Pittet
- Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Joelle Schwarz
- Department of Ambulatory Care, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Yolanda Mueller
- Department of Family Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
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Martinez A, Grosclaude P, Lamy S, Delpierre C. The Influence of Sex and/or Gender on the Occurrence of Colorectal Cancer in the General Population in Developed Countries: A Scoping Review. Int J Public Health 2024; 69:1606736. [PMID: 38660497 PMCID: PMC11039791 DOI: 10.3389/ijph.2024.1606736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Objective: Gender as the "sociocultural role of sex" is underrepresented in colorectal cancer incidence studies, potentially resulting in underestimated risk factors' consequences and inequalities men/women. We aim to explore how literature focusing on differences between men and women in the incidence of colorectal cancer interprets these differences: through sex- or gender-related mechanisms, or both? Methods: We conducted a scoping review using PubMed and Google Scholar. We categorized studies based on their definitions of sex and/or gender variables. Results: We reviewed 99 studies, with 7 articles included in the analysis. All observed differences between men and women. Six articles examined colorectal cancer incidence by gender, but only 2 used the term "gender" to define exposure. One article defined its "sex" exposure variable as gender-related mechanisms, and two articles used "sex" and "gender" interchangeably to explain these inequalities. Gender mechanisms frequently manifest through health behaviors. Conclusion: Our results underscore the need for an explicit conceptual framework to disentangle sex and/or gender mechanisms in colorectal cancer incidence. Such understanding would contribute to the reduction and prevention of social health inequalities.
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Affiliation(s)
- Amalia Martinez
- Equity Research Team, Centre d’Epidémiologie et de Recherche en santé des POPulations, UMR 1295 (Équipe Labellisée Ligue Contre le Cancer), Inserm, University Toulouse III Paul Sabatier, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole (Institut Claudius Regaud), Toulouse, France
- Registre des Cancers du Tarn, Toulouse, France
| | - Pascale Grosclaude
- Institut Universitaire du Cancer de Toulouse-Oncopole (Institut Claudius Regaud), Toulouse, France
- Registre des Cancers du Tarn, Toulouse, France
| | - Sébastien Lamy
- Equity Research Team, Centre d’Epidémiologie et de Recherche en santé des POPulations, UMR 1295 (Équipe Labellisée Ligue Contre le Cancer), Inserm, University Toulouse III Paul Sabatier, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole (Institut Claudius Regaud), Toulouse, France
- Registre des Cancers du Tarn, Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer, Toulouse, France
| | - Cyrille Delpierre
- Equity Research Team, Centre d’Epidémiologie et de Recherche en santé des POPulations, UMR 1295 (Équipe Labellisée Ligue Contre le Cancer), Inserm, University Toulouse III Paul Sabatier, Toulouse, France
- Institut Universitaire du Cancer de Toulouse-Oncopole (Institut Claudius Regaud), Toulouse, France
- Equipe Labellisée Ligue Contre le Cancer, Toulouse, France
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Moreno X, Monsalves MJ, Rueda S, Dagnino P, Borghero F. Gender differences in life expectancy free of depressive symptoms in Chile between 2003 and 2016. Glob Ment Health (Camb) 2024; 11:e16. [PMID: 38390246 PMCID: PMC10882180 DOI: 10.1017/gmh.2024.9] [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: 08/12/2023] [Revised: 11/26/2023] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of the study was to analyze gender differences in life expectancy free of depressive symptoms among the adult population in Chile between 2003 and 2016. The Sullivan method was used to estimate the total and marginal life expectancy, based on prevalence data from the National Health Survey (2003, 2010 and 2016), and abridged life tables for the Chilean population. There was a compression of morbidity among middle-aged men during the first period and among younger and older women during the last one. Men at all ages could expect to live a higher proportion of their lives without depressive symptoms during the whole period. The gender gap in the proportion of life expectancy free of depressive symptoms reached 10 percent points or more, considering almost all ages and periods. Unemployment and lower education increased the probability of depressive symptoms, and these effects were more marked among women. Public policies should have a gender-sensitive approach to address the gap in depression and the disadvantage experienced by women in life expectancy free of depressive symptoms, considering those dimensions that intersect with gender, such as access to education, employment or income.
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Affiliation(s)
- Ximena Moreno
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Santiago, Chile
| | | | - Sarahí Rueda
- Millennium Institute for Care Research (MICARE), Santiago, Chile
| | - Paula Dagnino
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Santiago, Chile
- Millennium Institute for the Study of Personality and Depression (MIDAP), Santiago, Chile
| | - Francesca Borghero
- Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes (IMHAY), Santiago, Chile
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Melander S. Different logics of pain: the gendered dimension of chronic pain in a relational setting. Soc Sci Med 2023; 335:116229. [PMID: 37703783 DOI: 10.1016/j.socscimed.2023.116229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
This study aims to increase our understanding of the gendered dimension of living with chronic pain within a relational context. The empirical setting for this study is Sweden, a country widely recognised for its long history of gender equality. Interview responses from 21 women and 12 men were analysed using the feminist notion of the marriage contract, outlining the terms for women and men living together in a relationship. The result shows how living with chronic pain leads to processes of grief and altered priorities. Respondents emphasize the importance of equality. However, men and women apply different logics when deciding which tasks to prioritise. Although there is no distinct pattern regarding whether or not couples share housework equally, the allocation of responsibilities appears to follow a particular pattern: men tend to prioritise their rehabilitation to become good fathers, women are grateful and prioritise the family before her own well-being. The study indicates that while attitudes and the allocation of household chores may have changed in the past few decades, the marriage contract still restricts women from employment and rehabilitation.
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Affiliation(s)
- Stina Melander
- Department of Political Science, Lund University, Sweden.
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5
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Horstmann S, Hartig C, Kraus U, Palm K, Jacke K, Dandolo L, Schneider A, Bolte G. Consideration of sex/gender in publications of quantitative health-related research: Development and application of an assessment matrix. Front Public Health 2023; 11:992557. [PMID: 37081952 PMCID: PMC10110874 DOI: 10.3389/fpubh.2023.992557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
During the last years the need to integrate sex and gender in health-related research for better and fairer science became increasingly apparent. Various guidelines and checklists were developed to encourage and support researchers in considering the entangled dimensions of sex/gender in their research. However, a tool for the assessment of sex/gender consideration and its visualization is still missing. We aim to fill this gap by introducing an assessment matrix that can be used as a flexible instrument for comprehensively evaluating the sex/gender consideration in quantitative health-related research. The matrix was developed through an iterative and open process based on the interdisciplinary expertise represented in our research team and currently published guidelines. The final matrix consists of 14 different items covering the whole research process and the publication of results. Additionally, we introduced a method to graphically display this evaluation. By developing the matrix, we aim to provide users with a tool to systematically compare sex/gender consideration qualitatively between different publications and even different fields of study. This way, the assessment matrix represents a tool to identify research gaps and a basis for future research. In the long term, the implementation of this tool to evaluate the consideration of sex/gender should contribute to more sex/gender equitable health-related research.
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Affiliation(s)
- Sophie Horstmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- *Correspondence: Sophie Horstmann,
| | - Christina Hartig
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Ute Kraus
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Kerstin Palm
- Gender and Science Research Unit, Institute of History, Humboldt University of Berlin, Berlin, Germany
| | - Katharina Jacke
- Gender and Science Research Unit, Institute of History, Humboldt University of Berlin, Berlin, Germany
| | - Lisa Dandolo
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Alexandra Schneider
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Ziaei S, Hammarström A. The relationship between interpersonal violence in adulthood and mental health: a longitudinal study based on the Northern Swedish Cohort. BMC Public Health 2023; 23:637. [PMID: 37013550 PMCID: PMC10071752 DOI: 10.1186/s12889-023-15525-x] [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: 04/21/2022] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Longitudinal studies evaluating the negative effects of exposure to interpersonal violence in the adulthood on the mental health of both women and men are scarce. Using longitudinal data, we evaluated the relationship between the last year experience of violence and functional somatic and depressive symptoms at the ages of 30 and 43 among participants (n = 1006; 483 women and 523 men) in the Northern Swedish Cohort. Further, the relationship between cumulative exposure to violence over a decade and mental health symptoms among participants was evaluated. METHODS Participants' experience of interpersonal violence and symptoms of functional somatic and depressive symptoms were evaluated with standard questionnaires at the ages of 30 and 43. General linear models were used to evaluate the relationship between the experience of interpersonal violence and mental health symptoms among the participants. The interactions between gender and violence on functional somatic and depressive symptoms were evaluated separately, and models in which the interaction was significant, were split by gender. RESULTS We found that the last year experience of violence at the age of 30 was related to current functional somatic symptoms among all participants and depressive symptoms only among men, (β Adj for the experience of any violence among men: 0.21; CI: 0.12-0.29; Vs. among women: 0.06; CI: -0.04-0.16, p for interaction = 0.02). At the age of 43, last year experience of violence was related to both functional somatic and depressive symptoms in both genders. Finally, a cumulative relationship between the experience of violence over time and mental health symptoms was observed in all participants. CONCLUSIONS Our findings revealed that while the relationship between the experience of interpersonal violence and mental health symptoms may differ among men and women and with age, the experience of violence can be negatively related to the mental health in both genders.
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Affiliation(s)
- Shirin Ziaei
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm, Stockholm, Sweden.
| | - Anne Hammarström
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
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Colineaux H, Neufcourt L, Delpierre C, Kelly-Irving M, Lepage B. Explaining biological differences between men and women by gendered mechanisms. Emerg Themes Epidemiol 2023; 20:2. [PMID: 36959612 PMCID: PMC10037796 DOI: 10.1186/s12982-023-00121-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND The principal aim of this study was to explore if biological differences between men and women can be explained by gendered mechanisms. METHODS We used data from the 1958 National Child Development Study, including all the living subjects of the cohort at the outcome collection wave (44-45 years). We explored several biomarkers as outcomes: systolic blood pressure, triglycerides, LDL cholesterol, HbA1c, CRP, and cortisol. Three conceptualizations of gender have been used to define methodological strategies: (a) Gender as an individual characteristic; (b) Gender as an effect of sex on socio-behavioural characteristics; (c) Gender as an interaction between sex and the social environment, here the early-life social environment. We estimated the total effect of sex and the proportion of total effect of sex at birth eliminated by gender, measured by 3 different ways according to these 3 concepts, using g-computation. RESULTS The average level of each biomarker was significantly different according to sex at birth, higher in men for cardiometabolic biomarkers and higher in women for inflammatory and neuroendocrine biomarkers. The sizes of the differences were always smaller than one standard deviation but were larger than differences due to early-life deprivation, except for CRP. We observed gender mechanisms underlying these differences between men and women, even if the mediation effects were rarely statistically significant. These mechanisms were of three kinds: (1) mediation by socio-behavioural characteristics; (2) attenuation by gendered mechanisms; (3) interaction with early social environment. Indeed, we observed that being born into a deprived rather than non-deprived family increased metabolic and inflammatory biomarkers levels more strongly in females than in males. CONCLUSIONS The biological differences between men and women seem to not be purely explained by biological mechanisms. The exploration of gender mechanisms opens new perspectives, in terms of methodology, understanding and potential applications.
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Affiliation(s)
- Hélène Colineaux
- EQUITY Team, CERPOP, INSERM, 37 Allees Jules Guesde, 31062, Toulouse, France.
| | - Lola Neufcourt
- EQUITY Team, CERPOP, INSERM, 37 Allees Jules Guesde, 31062, Toulouse, France
| | - Cyrille Delpierre
- EQUITY Team, CERPOP, INSERM, 37 Allees Jules Guesde, 31062, Toulouse, France
| | | | - Benoit Lepage
- EQUITY Team, CERPOP, INSERM, 37 Allees Jules Guesde, 31062, Toulouse, France
- Epidemiology Department, CHU Toulouse, 37 Allees Jules Guesde, 31062, Toulouse, France
- Biostatistic Department, Toulouse III University, 37 Allees Jules Guesde, 31062, Toulouse, France
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Dandolo L, Telkmann K, Hartig C, Horstmann S, Pedron S, Schwettmann L, Selsam P, Schneider A, Bolte G. Do Multiple Sex/Gender Dimensions Play a Role in the Association of Green Space and Self-Rated Health? Model-Based Recursive Partitioning Results from the KORA INGER Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5241. [PMID: 37047857 PMCID: PMC10094300 DOI: 10.3390/ijerph20075241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
Exposure to green space has a positive impact on health. Whether sex/gender modifies the green space-health association has so far only been studied through the use of a binary sex/gender category; however, sex/gender should be considered more comprehensively as a multidimensional concept based on theoretical approaches. We therefore explored whether sex/gender, operationalized through multiple sex/gender- and intersectionality-related covariates, modifies the green space-self-rated health association. We collected data from participants involved in the German KORA study (Cooperative Health Research in the Region of Augsburg) in 2019. Self-rated health was assessed as a one-question item. The availability of green spaces was measured subjectively as well as objectively. The multiple sex/gender- and intersectionality-related covariates were measured via self-assessment. To analyze the data, we used model-based recursive partitioning, a decision tree method that can handle complex data, considering both multiple covariates and their possible interactions. We showed that none of the covariates operationalizing an individual sex/gender self-concept led to subgroups with heterogeneous effects in the model-based tree analyses; however, we found effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective, although they did not show the intersectional structuring of sex/gender dimensions. In one identified subgroup, those with a lower education level or a feeling of discrimination based on social position showed a positive green space-self-rated health association, while participants with a higher education level or no feeling of discrimination based on social position had a high level of self-rated health regardless of the availability of green spaces. Model-based recursive partitioning has the potential to detect subgroups exhibiting different exposure-outcome associations, with the possibility of integrating multiple sex/gender- and intersectionality-related covariates as potential effect modifiers. A comprehensive assessment of the relevance of sex/gender showed effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective.
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Affiliation(s)
- Lisa Dandolo
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Klaus Telkmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Christina Hartig
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Sophie Horstmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Sara Pedron
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- Professorship of Public Health and Prevention, Technical University of Munich, 80992 Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- Division for Health Economics, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, 26129 Oldenburg, Germany
| | - Peter Selsam
- Department Monitoring and Exploration Technologies, Helmholtz Centre for Environmental Research—UFZ, 04318 Leipzig, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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Shalit A, Vallely L, Nguyen R, Bohren M, Wilson A, Homer CSE, Vogel J. The representation of women on Australian clinical practice guideline panels, 2010-2020. Med J Aust 2023; 218:84-88. [PMID: 36599458 PMCID: PMC10953318 DOI: 10.5694/mja2.51831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the composition by gender of Australian clinical practice guideline development panels; to explore guideline development-related factors that influence the composition of panels. DESIGN, SETTING, PARTICIPANTS Survey of clinical guidelines published in Australia during 2010-2020 that observed the 2016 NHMRC Standards for Guidelines, identified (June 2021) in the NHMRC Clinical Practice Guideline Portal or by searching the Guideline International Network guidelines library, the Trip medical database, and PubMed. The gender of contributors to guideline development was inferred from gendered titles (guideline documents) or pronouns (online biographies). MAIN OUTCOME MEASURES The overall proportion of guideline panel members - the guideline contributors who formally considered evidence and formulated recommendations (ie, guideline panel chairs and members) - who were women. RESULTS Of 406 eligible guidelines, 335 listed the names of people who contributed to their development (82%). Of 7472 named contributors (including 511 guideline panel chairs [6.8%] and 5039 guideline panel members [67.4%]), 3514 were men (47.0%), 3345 were women (44.8%), and gender could not be determined for 612 (8.2%). A total of 215 guideline panel chairs were women (42.1%), 280 were men (54.8%); 2566 guideline panel members were men (50.9%), 2071 were women (41.1%). The proportion of female guideline panel members was smaller than 40% for 179 guidelines (53%) and larger than 60% for 71 guidelines (21%). The median guideline proportion of female panel members was smaller than 50% for all but two years (2017, 2018). CONCLUSIONS The representation of women in health leadership roles in Australia does not reflect their level of participation in the health care workforce. In particular, clinical guideline development bodies should develop transparent policies for increasing the participation of women in guideline development panels.
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Affiliation(s)
| | | | | | - Meghan Bohren
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVIC
| | | | | | - Joshua Vogel
- The Burnet InstituteMelbourneVIC
- Cochrane AustraliaMonash UniversityMelbourneVIC
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Kraus U, Jacke K, Dandolo L, Debiak M, Fichter S, Groth K, Kolossa-Gehring M, Hartig C, Horstmann S, Schneider A, Palm K, Bolte G. Operationalization of a multidimensional sex/gender concept for quantitative environmental health research and implementation in the KORA study: Results of the collaborative research project INGER. Front Public Health 2023; 11:1128918. [PMID: 37143983 PMCID: PMC10152671 DOI: 10.3389/fpubh.2023.1128918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background In environmental health research, sex and gender are not yet adequately considered. There is a need to improve data collection in population-based environmental health studies by comprehensively surveying sex/gender-related aspects according to gender theoretical concepts. Thus, within the joint project INGER we developed a multidimensional sex/gender concept which we aimed to operationalize and to test the operationalization for feasibility. Methods In an iterative process, we created questionnaire modules which quantitatively captured the requirements of the INGER sex/gender concept. We deployed it in the KORA cohort (Cooperative Health Research in the Region of Augsburg, Germany) in 2019 and evaluated response and missing rates. Results The individual sex/gender self-concept was surveyed via a two-step approach that asked for sex assigned at birth and the current sex/gender identity. Additionally, we used existing tools to query internalized sex/gender roles and externalized sex/gender expressions. Adapted to the KORA population, we asked for discrimination experiences and care and household activities contributing to explain structural sex/gender relations. Further intersectionality-related social categories (e.g., socio-economic position), lifestyle and psychosocial factors were covered through data available in KORA. We could not identify appropriate tools to assess the true biological sex, sexual orientation and ethnic/cultural identity, which have yet to be developed or improved. The response-rate was 71%, the evaluation of 3,743 questionnaires showed a low missing rate. Prevalence of marginalized groups regarding sex/gender identity and definable by experiences of discrimination was very low. Conclusion We have shown how the multidimensional INGER sex/gender concept can be operationalized according to an European and North American understanding of sex/gender for use in quantitative research. The questionnaire modules proved feasible in an epidemiologic cohort study. Being a balancing act between theoretical concepts and its quantitative implementation our operationalization paves the way for an adequate consideration of sex/gender in environmental health research.
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Affiliation(s)
- Ute Kraus
- German Research Center for Environmental Health, Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- *Correspondence: Ute Kraus
| | - Katharina Jacke
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, Berlin, Germany
| | - Lisa Dandolo
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Malgorzata Debiak
- Section II 1.2 Toxicology, Health-Related Environmental Monitoring, German Environment Agency, Berlin, Germany
| | - Sophie Fichter
- Section II 1.2 Toxicology, Health-Related Environmental Monitoring, German Environment Agency, Berlin, Germany
| | - Katrin Groth
- Section II 1.2 Toxicology, Health-Related Environmental Monitoring, German Environment Agency, Berlin, Germany
| | - Marike Kolossa-Gehring
- Section II 1.2 Toxicology, Health-Related Environmental Monitoring, German Environment Agency, Berlin, Germany
| | - Christina Hartig
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Sophie Horstmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Alexandra Schneider
- German Research Center for Environmental Health, Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Kerstin Palm
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, Berlin, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
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Jacques-Aviñó C, Medina-Perucha L, Young-Silva Y, Granés L, Lòpez-Jiménez T, Berenguera A. [Narratives on changes in health-related behaviours during lockdown in Spain according to gender]. GACETA SANITARIA 2023; 37:102296. [PMID: 36921453 DOI: 10.1016/j.gaceta.2023.102296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To explore experiences related to health-oriented behaviours during lockdown in the Spanish resident population from a gender perspective. METHOD Qualitative research with a critical and feminist approach. Twenty-nine semi-structured interviews (17 women and 12 men) were conducted between June and July 2020 via telephone with people who had previously answered an online survey. The interviews were transcribed and a thematic content analysis was carried out, differentiating between the experiences of women and men. The data were triangulated by the research team. RESULTS Among women, greater diversity emerged in terms of health behaviours. Among them, the difficult experiences related to COVID-19, the complexity of living together and doing unpaid care work, as well as the importance of support networks, stood out. Among men, there were different attitudes towards sport, self-care and having time for healthy eating were positively valued, and there was a good assessment of coexistence and organisation in household chores. In both men and women, work overload and economic problems were related to emotional distress and difficulties in carrying out healthy activities. CONCLUSIONS Health-oriented behaviours during lockdown differed according to gender. They were mostly limited to COVID-19 experiences, socio-economic conditions and burden of care. It is essential to tailor public health and primary care programmes according to people's life moments, taking into account their social context and questioning traditional gender roles.
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Affiliation(s)
- Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España.
| | - Laura Medina-Perucha
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - Yudy Young-Silva
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Unitat de Suport a la Recerca Girona, Girona, España; Departament d'Infermeria, Universitat de Girona, Girona, España
| | - Laura Granés
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Barcelona, España
| | - Tomás Lòpez-Jiménez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - Anna Berenguera
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Departament d'Infermeria, Universitat de Girona, Girona, España
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Fichter SC, Groth K, Fiedler N, Kolossa-Gehring M, Dębiak M. Lysmeral Exposure in Children and Adolescences Participating in the German Environmental Survey (2012-2015): Integrating Sex/Gender into Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17072. [PMID: 36554956 PMCID: PMC9778794 DOI: 10.3390/ijerph192417072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/24/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
Comprehensive consideration of the biological and social diversities of sex and gender as well as their interdependencies is mostly missing in human biomonitoring (HBM) studies. Using the INGER sex/gender concept as theoretical background, we analyzed differences in exposure to lysmeral, a compound commonly found as a fragrance in cosmetics, personal care, and household products, in 2294 children and adolescents in Germany using decision tree, regression, and mediation analysis. The variables "sex assigned at birth" and "age", as well as well as use of personal care products and fabric conditioner proved to have the highest explanatory value. Mediating effects of behaviour associated with societal gender expectations were observed, as the use of cosmetics correlated highly with lysmeral metabolites concentrations in girls between 6 and 17 years, with the strongest effect in adolescents between 14 and 17 years old. In the youngest age group (3-5 years) boys showed higher concentration of the metabolite tert-butylbenzoic acid (TBBA) compared to girls of the same age but only if TBBA urine concentrations were normalized on creatinine. Our study offers the first retrospective sex/gender assessment of HBM data. It demonstrates the possibilities to rethink and broaden sex/gender analysis in existing HBM-studies and highlights the need for inclusion of new sex/gender concepts in the design of new studies.
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Tsakmakis PL, Akter S, Bohren MA. A qualitative exploration of women’s and their partners’ experiences of birth trauma in Australia, utilising critical feminist theory. Women Birth 2022. [DOI: 10.1016/j.wombi.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Christianson M, Lehn S, Velandia M. The advancement of a gender ethics protocol to uncover gender ethical dilemmas in midwifery: a preliminary theory model. Reprod Health 2022; 19:211. [DOI: 10.1186/s12978-022-01515-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 10/13/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objectives
Ethical dilemmas at both the individual and structural level are part of the daily work of midwives and gender inequality and injustice can affect women’s sexual and reproductive health. Mainstream bioethical theory has been criticized for neglecting women’s issues. To ensure women’s experiences are addressed, a gender lens on ethics is crucial.
Aim
This study develops a theory model by exploring ethical dilemmas related to gender in the context of maternity care from the perspective of midwifery science and feminist ethics.
Methods
The research strategy followed a coherent stepwise approach: literature search, thematic analysis, elaboration of a gender ethics protocol, and the integration of various components into a preliminary gender ethics model for midwifery.
Findings
A literature search was performed using Scopus and Web of Science to identify ethical dilemmas in maternity care linked to gender and power. The search of articles published between 1996 and 2019 returned 61 abstracts. These abstracts were screened and assigned one of the following themes: The Midwifery Profession, The Rights of the Woman, Fetal Rights Dominate, and Medicalization of Pregnancy and Childbirth. A tentative gender ethics frame was developed and tested on two articles on abortion, one from Denmark and one from Japan. The protocol facilitated the gender analysis of ethical dilemmas related to abortion, which were related to the imbalance of power relations in health care. In the final step, we synthesized the dimensions of gender and power in a gender ethics model for midwifery.
Discussion
The gender ethics protocol developed revealed gendered dimensions of ethical dilemmas in midwifery. This gender analysis adds to the understanding of the “do no harm” principle by revealing assumptions and stereotypes that promote unequal power relations. The gender ethics model is an innovative approach that envisions and exposes power imbalance at the micro, meso, and macro levels.
Conclusions
The protocol could improve gender competence among researchers, midwives/professionals, and midwifery students throughout the world.
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van den Hurk L, Hiltner S, Oertelt-Prigione S. Operationalization and Reporting Practices in Manuscripts Addressing Gender Differences in Biomedical Research: A Cross-Sectional Bibliographical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14299. [PMID: 36361177 PMCID: PMC9653596 DOI: 10.3390/ijerph192114299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Historically, authors in the biomedical field have often conflated the terms sex and gender in their research significantly limiting the reproducibility of the reported results. In the present study, we investigated current reporting practices around gender in biomedical publications that claim the identification of "gender differences". Our systematic research identified 1117 articles for the year 2019. After random selection of 400 publications and application of inclusion criteria, 302 articles were included for analysis. Using a systematic evaluation grid, we assessed the provided methodological detail in the operationalization of gender and the provision of gender-related information throughout the manuscript. Of the 302 articles, 69 (23%) solely addressed biological sex. The remaining articles investigated gender, yet only 15 (6.5%) offered reproducible information about the operationalization of the gender dimension studied. Followingly, these manuscripts also provided more detailed gender-specific background, analyses and discussions compared to the ones not detailing the operationalization of gender. Overall, our study demonstrated persistent inadequacies in the conceptual understanding and methodological operationalization of gender in the biomedical field. Methodological rigor correlated with more nuanced and informative reporting, highlighting the need for appropriate training to increase output quality and reproducibility in the field.
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Affiliation(s)
- Lori van den Hurk
- Department of Primary and Community Care, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Sarah Hiltner
- Department of Primary and Community Care, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
- AG10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, 33615 Bielefeld, Germany
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Intergenerational reproduction and adult self-rated physical health in China. SSM Popul Health 2022; 19:101131. [PMID: 35694553 PMCID: PMC9178466 DOI: 10.1016/j.ssmph.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/05/2022] Open
Abstract
We used cross-sectional data from the 2017 Chinese General Social Survey to investigate whether and how Chinese parents utilize their socioeconomic resources to facilitate the acquisition of socioeconomic resources by their children that in turn affect the self-rated health of the adult children. We found that father's type of work unit (danwei) and father's membership in the Chinese Communist Party were not independently associated with the self-rated health of survey respondents. Father's education was associated with the self-rated health of women, especially younger women, and self-reported childhood social class was associated with the self-rated health of men and older women, most strongly so for younger men. Two thirds of the association between father's education and self-rated health among younger women was statistically explained by personal socioeconomic resources and almost a quarter of the association between self-reported childhood social class and self-rated health among younger men was statistically explained by personal socioeconomic resources. Our study illuminates the importance of intergenerational reproduction in fostering the good health of Chinese adults, especially for those who grew up after the Chinese economic reform of the 1970s.
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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.
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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
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Biology, Bias, or Both? The Contribution of Sex and Gender to the Disparity in Cardiovascular Outcomes Between Women and Men. Curr Atheroscler Rep 2022; 24:701-708. [PMID: 35773564 PMCID: PMC9399064 DOI: 10.1007/s11883-022-01046-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide for both men and women. However, CVD is understudied, underdiagnosed, and undertreated in women. This bias has resulted in women being disproportionately affected by CVD when compared to men. The aim of this narrative review is to explore the contribution of sex and gender on CVD outcomes in men and women and offer recommendations for researchers and clinicians. Recent Findings Evidence demonstrates that there are sex differences (e.g., menopause and pregnancy complications) and gender differences (e.g., socialization of gender) that contribute to the inequality in risk, presentation, and treatment of CVD in women. Summary To start addressing the CVD issues that disproportionately impact women, it is essential that these sex and gender differences are addressed through educating health care professionals on gender bias; offering patient-centered care and programs tailored to women’s needs; and conducting inclusive health research.
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19
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Dandolo L, Hartig C, Telkmann K, Horstmann S, Schwettmann L, Selsam P, Schneider A, Bolte G. Decision Tree Analyses to Explore the Relevance of Multiple Sex/Gender Dimensions for the Exposure to Green Spaces: Results from the KORA INGER Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127476. [PMID: 35742725 PMCID: PMC9224469 DOI: 10.3390/ijerph19127476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
Recently, attention has been drawn to the need to integrate sex/gender more comprehensively into environmental health research. Considering theoretical approaches, we define sex/gender as a multidimensional concept based on intersectionality. However, operationalizing sex/gender through multiple covariates requires the usage of statistical methods that are suitable for handling such complex data. We therefore applied two different decision tree approaches: classification and regression trees (CART) and conditional inference trees (CIT). We explored the relevance of multiple sex/gender covariates for the exposure to green spaces, measured both subjectively and objectively. Data from 3742 participants from the Cooperative Health Research in the Region of Augsburg (KORA) study were analyzed within the INGER (Integrating gender into environmental health research) project. We observed that the participants’ financial situation and discrimination experience was relevant for their access to high quality public green spaces, while the urban/rural context was most relevant for the general greenness in the residential environment. None of the covariates operationalizing the individual sex/gender self-concept were relevant for differences in exposure to green spaces. Results were largely consistent for both CART and CIT. Most importantly we showed that decision tree analyses are useful for exploring the relevance of multiple sex/gender dimensions and their interactions for environmental exposures. Further investigations in larger urban areas with less access to public green spaces and with a study population more heterogeneous with respect to age and social disparities may add more information about the relevance of multiple sex/gender dimensions for the exposure to green spaces.
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Affiliation(s)
- Lisa Dandolo
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany; (C.H.); (K.T.); (S.H.); (G.B.)
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
- Correspondence: ; Tel.: +49-421-218-68826
| | - Christina Hartig
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany; (C.H.); (K.T.); (S.H.); (G.B.)
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Klaus Telkmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany; (C.H.); (K.T.); (S.H.); (G.B.)
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Sophie Horstmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany; (C.H.); (K.T.); (S.H.); (G.B.)
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany;
- Department of Economics, Martin Luther University Halle-Wittenberg, 06108 Halle (Saale), Germany
| | - Peter Selsam
- Department Monitoring and Exploration Technologies, Helmholtz Centre for Environmental Research GmbH—UFZ, 04318 Leipzig, Germany;
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany;
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany; (C.H.); (K.T.); (S.H.); (G.B.)
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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The Operationalisation of Sex and Gender in Quantitative Health-Related Research: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127493. [PMID: 35742742 PMCID: PMC9224188 DOI: 10.3390/ijerph19127493] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022]
Abstract
Current trends in quantitative health research have highlighted the inadequacy of the usual operationalisation of sex and gender, resulting in a growing demand for more nuanced options. This scoping review provides an overview of recent instruments for the operationalisation of sex and gender in health-related research beyond a concept of mutually exclusive binary categories as male or masculine vs. female or feminine. Our search in three databases (Medline, Scopus and Web of Science) returned 9935 matches, of which 170 were included. From these, we identified 77 different instruments. The number and variety of instruments measuring sex and/or gender in quantitative health-related research increased over time. Most of these instruments were developed with a US-American student population. The majority of instruments focused on the assessment of gender based on a binary understanding, while sex or combinations of sex and gender were less frequently measured. Different populations may require the application of different instruments, and various research questions may ask for different dimensions of sex and gender to be studied. Despite the clear interest in the development of novel sex and/or gender instruments, future research needs to focus on new ways of operationalisation that account for their variability and multiple dimensions.
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Colineaux H, Soulier A, Lepage B, Kelly-Irving M. Considering sex and gender in Epidemiology: a challenge beyond terminology. From conceptual analysis to methodological strategies. Biol Sex Differ 2022; 13:23. [PMID: 35550193 PMCID: PMC9103114 DOI: 10.1186/s13293-022-00430-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background Epidemiologists need tools to measure effects of gender, a complex concept originating in the social sciences which is not easily operationalized in the discipline. Our aim is to clarify useful concepts, measures, paths, effects, and analytical strategies to explore mechanisms of health difference between men and women. Methods We reviewed concepts to clarify their definitions and limitations for their translation into usable measures in Epidemiology. Then we conducted methodological research using a causal framework to propose methodologically appropriate strategies for measuring sex and gender effects in health. Results (1) Concepts and measures. We define gender as a set of norms prescribed to individuals according to their attributed-at-birth sex. Gender pressure creates a systemic gap, at population level, in behaviors, activities, experiences, etc., between men and women. A pragmatic individual measure of gender would correspond to the level at which an individual complies with a set of elements constituting femininity or masculinity in a given population, place and time. (2) Main analytical strategy. Defining and measuring gender are not sufficient to distinguish the effects of sex and gender on a health outcome. We should also think in terms of mechanisms, i.e., how the variables are linked together, to define appropriate analytical strategies. A causal framework can help us to conceptualize “sex” as a “parent” of a gender or gendered variable. This implies that we cannot interpret sex effects as sexed mechanisms, and that we can explore gendered mechanisms of sex-differences by mediation analyses. (3) Alternative strategy. Gender could also be directly examined as a mechanism, rather than through a variable representing its realization in the individual, by approaching it as an interaction between sex and social environment. Conclusions Both analytical strategies have limitations relative to the impossibility of reducing a complex concept to a single or a few measures, and of capturing the entire effect of the phenomenon of gender. However, these strategies could lead to more accurate analyses of the mechanisms underlying health differences between men and women. A pragmatic individual measure of individual gender would correspond to the level at which an individual complies with a set of elements constituting femininity or masculinity in a given population, place and time Comparing outcomes by sex and gender is not sufficient, and even misleading, to understand the mechanisms underlying biological and health differences between men and women Causal analysis framework is a powerful tool for refining hypotheses and identifying the effects that can and should be estimated to meet the objectives Gender could also be measured at the populational-level as an interaction between sex and environment, which would be more compatible with the sociological concept of gender
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Affiliation(s)
- Hélène Colineaux
- EQUITY Team,, CERPOP, INSERM, Batiment E, 1er Etage, 37 Allées Jules Guesde, 31062, Toulouse, France.
| | | | - Benoit Lepage
- EQUITY Team,, CERPOP, INSERM, Batiment E, 1er Etage, 37 Allées Jules Guesde, 31062, Toulouse, France.,Epidemiology Department, CHU Toulouse, 37 Allées Jules Guesde, 31062, Toulouse, France.,Biostatistic Department, Toulouse III University, 37 Allées Jules Guesde, 31062, Toulouse, France
| | - Michelle Kelly-Irving
- EQUITY Team,, CERPOP, INSERM, Batiment E, 1er Etage, 37 Allées Jules Guesde, 31062, Toulouse, France
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22
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Vásquez-Vera C, Fernández A, Borrell C. Gender-based inequalities in the effects of housing on health: A critical review. SSM Popul Health 2022; 17:101068. [PMID: 35360438 PMCID: PMC8961216 DOI: 10.1016/j.ssmph.2022.101068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
Gender and its power relations are produced and reproduced in the housing sphere, leading to inequalities in living conditions and, therefore, in gender inequalities in health outcomes. The aim of the study is to review the published literature on gender, housing and health, to critically evaluate the incorporation of the gender perspective, and to incorporate this perspective into the conceptual framework of housing and health. Using the critical review method, we conducted a literature review in MEDLINE, Scopus, WOS and Redalyc, without restriction of publication date, including studies published up to October 2020. We analyzed the gender perspective in health research using the Gender Perspective in Health Research Questionnaire and described the results according to main housing dimensions. Of the 20,988 articles identified, we selected 90 for full-text analysis, of which 18 were included in the feminist research category, 27 in gender-sensitive, 31 in sex difference and 14 did not include any gender perspective. Regarding the association between housing and health, most studies analyzed affordability (36%) and physical conditions (32%), and trends in health outcomes by gender varied according to each exposure analyzed, although overall the effects were worse for women and non-binary or trans people. To date, very few studies consider the gender perspective. It is urgent to address gender relations in housing and health studies, and to open an interdisciplinary and intersectoral agenda to address this complex relationship.
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Lövgren A, Häggman-Henrikson B, Fjellman-Wiklund A, Begic A, Landgren H, Lundén V, Svensson P, Österlund C. The impact of gender of the examiner on orofacial pain perception and pain reporting among healthy volunteers. Clin Oral Investig 2021; 26:3033-3040. [PMID: 34902057 PMCID: PMC8898225 DOI: 10.1007/s00784-021-04286-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/01/2021] [Indexed: 12/03/2022]
Abstract
Objectives Pain on palpation of jaw muscles is a commonly used diagnostic criterion when examining patients with orofacial pain. It is not known, however, if pain reports are affected by the gender of the examiner. Our aim was to investigate if pressure pain threshold (PPT), pressure pain tolerance (PTol), and pain intensity assessed over the masseter muscles in healthy individuals are affected by the gender of the examiner. Materials and methods Healthy, pain-free individuals were recruited on a voluntary basis. PPT and PTol were assessed using pressure algometry. At the PTol level, participants also rated pain intensity on a 0–10 numeric rating scale. Assessments of PPT and PTol were conducted with six repeated measurements performed twice, separately by one female and one male examiner, on each participant. Results In total, 84 participants (43 women; median age 24, IQR 6) were included. With a female examiner, women reported higher pain intensity than men (Mann Whitney U, p = 0.005). In the multivariable analysis, significantly higher PTol was predicted by male examiner. Also, a higher ratio between PTol and reported pain intensity was predicted by male examiner. Conclusions The gender of the examiner influences pain reporting and perception in an experimental setting. This effect on pain perception related to gender of the examiner is probably related to normative gender behaviors rather than to biological alterations within the examined individual. Clinical relevance In clinical and experimental settings, gender of the examiner may affect not only pain perception but also pain reporting, with potential implications for diagnostics in patients with pain.
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Affiliation(s)
- A Lövgren
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden.
| | - B Häggman-Henrikson
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Fjellman-Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - A Begic
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
| | - H Landgren
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
| | - V Lundén
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
| | - P Svensson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - C Österlund
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
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Bolte G, Jacke K, Groth K, Kraus U, Dandolo L, Fiedel L, Debiak M, Kolossa-Gehring M, Schneider A, Palm K. Integrating Sex/Gender into Environmental Health Research: Development of a Conceptual Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12118. [PMID: 34831873 PMCID: PMC8621533 DOI: 10.3390/ijerph182212118] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
There is a growing awareness about the need to comprehensively integrate sex and gender into health research in order to enhance the validity and significance of research results. An in-depth consideration of differential exposures and vulnerability is lacking, especially within environmental risk assessment. Thus, the interdisciplinary team of the collaborative research project INGER (integrating gender into environmental health research) aimed to develop a multidimensional sex/gender concept as a theoretically grounded starting point for the operationalization of sex and gender in quantitative (environmental) health research. The iterative development process was based on gender theoretical and health science approaches and was inspired by previously published concepts or models of sex- and gender-related dimensions. The INGER sex/gender concept fulfills the four theoretically established prerequisites for comprehensively investigating sex and gender aspects in population health research: multidimensionality, variety, embodiment, and intersectionality. The theoretical foundation of INGER's multidimensional sex/gender concept will be laid out, as well as recent sex/gender conceptualization developments in health sciences. In conclusion, by building upon the latest state of research of several disciplines, the conceptual framework will significantly contribute to integrating gender theoretical concepts into (environmental) health research, improving the validity of research and, thus, supporting the promotion of health equity in the long term.
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Affiliation(s)
- Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany;
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Katharina Jacke
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, 10099 Berlin, Germany; (K.J.); (L.F.); (K.P.)
| | - Katrin Groth
- Section II 1.2 Toxicology, Health-Related Environmental Monitoring, German Environment Agency, 14195 Berlin, Germany; (K.G.); (M.D.); (M.K.-G.)
| | - Ute Kraus
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany; (U.K.); (A.S.)
| | - Lisa Dandolo
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany;
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Lotta Fiedel
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, 10099 Berlin, Germany; (K.J.); (L.F.); (K.P.)
| | - Malgorzata Debiak
- Section II 1.2 Toxicology, Health-Related Environmental Monitoring, German Environment Agency, 14195 Berlin, Germany; (K.G.); (M.D.); (M.K.-G.)
| | - Marike Kolossa-Gehring
- Section II 1.2 Toxicology, Health-Related Environmental Monitoring, German Environment Agency, 14195 Berlin, Germany; (K.G.); (M.D.); (M.K.-G.)
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany; (U.K.); (A.S.)
| | - Kerstin Palm
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, 10099 Berlin, Germany; (K.J.); (L.F.); (K.P.)
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25
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Miani C, Wandschneider L, Niemann J, Batram-Zantvoort S, Razum O. Measurement of gender as a social determinant of health in epidemiology-A scoping review. PLoS One 2021; 16:e0259223. [PMID: 34731177 PMCID: PMC8565751 DOI: 10.1371/journal.pone.0259223] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background The relevance of gender as a social determinant of health and its role in the production of health inequalities is now broadly acknowledged. However, the plethora of existing approaches to capture gender, which often stem from disciplines outside of epidemiology, makes it difficult to assess their practicality and relevance for a given research purpose. We conducted a scoping review to 1) map the evidence of how gender can be operationalised in quantitative epidemiology and 2) design a tool to critically evaluate the measures identified. Methods We identified peer-reviewed articles in electronic databases (PubMed, Embase and PsycINFO). Eligible sources described the quantitative operationalisation of the social dimension of gender. With the help of a newly developed checklist, we assessed their relevance from an analytical perspective (e.g. intersectionality) and their potential for implementation in epidemiology. Results Gender measures principally assessed gender roles and norms, gender-based discrimination and violence, and structural gender (in)equality. Of the 344 measures included in this review, the majority lacked theoretical foundation, and tended to reinforce the binary understanding of gender through stereotypes of femininity and masculinity. Only few measures allowed for an intersectional approach and a multilevel understanding of gender mechanisms. From a practical point of view, gender measures demonstrated potential for use in varied populations and contexts. Conclusions A range of gender measures are readily available for epidemiological research, addressing different levels and dimensions of gender as a social construct. With our theory-informed, practice-driven scoping review, we highlighted strengths and limitations of such measures and provided analytical tools for researchers interested in conducting intersectional, gender-sensitive analyses.
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Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- * E-mail:
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jana Niemann
- Institute of Medical Sociology, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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26
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Mena E, Bolte G. Classification tree analysis for an intersectionality-informed identification of population groups with non-daily vegetable intake. BMC Public Health 2021; 21:2007. [PMID: 34736424 PMCID: PMC8570019 DOI: 10.1186/s12889-021-12043-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Daily vegetable intake is considered an important behavioural health resource associated with improved immune function and lower incidence of non-communicable disease. Analyses of population-based data show that being female and having a high educational status is most strongly associated with increased vegetable intake. In contrast, men and individuals with a low educational status seem to be most affected by non-daily vegetable intake (non-DVI). From an intersectionality perspective, health inequalities are seen as a consequence of an unequal balance of power such as persisting gender inequality. Unravelling intersections of socially driven aspects underlying inequalities might be achieved by not relying exclusively on the male/female binary, but by considering different facets of gender roles as well. This study aims to analyse possible interactions of sex/gender or sex/gender related aspects with a variety of different socio-cultural, socio-demographic and socio-economic variables with regard to non-DVI as the health-related outcome. METHOD Comparative classification tree analyses with classification and regression tree (CART) and conditional inference tree (CIT) as quantitative, non-parametric, exploratory methods for the detection of subgroups with high prevalence of non-DVI were performed. Complete-case analyses (n = 19,512) were based on cross-sectional data from a National Health Telephone Interview Survey conducted in Germany. RESULTS The CART-algorithm constructed overall smaller trees when compared to CIT, but the subgroups detected by CART were also detected by CIT. The most strongly differentiating factor for non-DVI, when not considering any further sex/gender related aspects, was the male/female binary with a non-DVI prevalence of 61.7% in men and 42.7% in women. However, the inclusion of further sex/gender related aspects revealed a more heterogenous distribution of non-DVI across the sample, bringing gendered differences in main earner status and being a blue-collar worker to the foreground. In blue-collar workers who do not live with a partner on whom they can rely on financially, the non-DVI prevalence was 69.6% in men and 57.4% in women respectively. CONCLUSIONS Public health monitoring and reporting with an intersectionality-informed and gender-equitable perspective might benefit from an integration of further sex/gender related aspects into quantitative analyses in order to detect population subgroups most affected by non-DVI.
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Affiliation(s)
- Emily Mena
- Department of Social Epidemiology, University of Bremen, Institute of Public Health and Nursing Research, Grazer Straße 4, 28359, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | - Gabriele Bolte
- Department of Social Epidemiology, University of Bremen, Institute of Public Health and Nursing Research, Grazer Straße 4, 28359, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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27
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Knebusch V, Williams J, Yordi Aguirre I, Weber MW, Rakovac I, Breda J. Effects of the coronavirus disease 2019 pandemic and the policy response on childhood obesity risk factors: Gender and sex differences and recommendations for research. Obes Rev 2021; 22 Suppl 6:e13222. [PMID: 34184392 PMCID: PMC8420308 DOI: 10.1111/obr.13222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
Childhood obesity is a public health concern globally, with generally higher prevalence rates in boys compared to girls. Although biological sex is an important determinant, gender roles and norms influence the exposure and vulnerability to risk factors for noncommunicable diseases. Norms and roles might be reinforced or change due to coronavirus disease 2019 (COVID-19) related measures as well as the exposure to risk factors for childhood obesity. COVID-19 related changes, such as home confinement, influence a child's risk of obesity. Using Dahlgren and Whitehead's model of the main determinants of health, this paper aims to provide a roadmap for future research on sex, gender, and childhood obesity during the time of COVID-19. It examines how COVID-19 has led to important changes in children's general socioeconomic, cultural, and environmental conditions, social and community networks, and individual lifestyle factors and how these may affect a child's risk for obesity. It focuses on the influence of gender and sex and outlines key considerations and indicators to examine in future studies concerned with promoting health and gender equity and equality. We need to understand the differential impact of COVID-19 related measures on girls' and boys' risk for obesity to adequately react with preventive measures, policies, and programs.
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Affiliation(s)
- Veronika Knebusch
- Gender and Human Rights, WHO European Office for Investment for Health and Development, Venice, Italy
| | - Julianne Williams
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Isabel Yordi Aguirre
- Gender and Human Rights, WHO European Office for Investment for Health and Development, Venice, Italy
| | - Martin W Weber
- World Health Organization (WHO) Child and Adolescent Health and Development, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Ivo Rakovac
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - João Breda
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
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28
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Li W, Sun N, Kondracki AJ, Kiplagat S, Osibogun O, Kalan ME, Jebai R, Sun W, Wei Z. Exposure to famine in early life and self-rated health status among Chinese adults: a cross-sectional study from the Chinese Health and Retirement Longitudinal Study (CHARLS). BMJ Open 2021; 11:e048214. [PMID: 34642191 PMCID: PMC8513269 DOI: 10.1136/bmjopen-2020-048214] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE China's Great Famine between 1959 and 1961 has contributed to numerous adverse health outcomes in Chinese. This study aimed to examine the association between exposure to famine in early life and self-rated health (SRH) in adulthood. METHODS 4418 Chinese adults from the 2011 China Health and Retirement Longitudinal Study were included in the analysis. Multivariable logistic regression was conducted to estimate adjusted ORs (aORs) and 95% CIs of the association between exposure to famine in early life and SRH, stratified by sex. RESULTS Participants exposed to famine during infancy were more likely to report poor SRH (aOR 1.33; 95% CI 1.04 to 1.70) compared with the non-exposed group, adjusting for confounders. Males were 32% less likely than females to report poor SRH (aOR 0.68; 95% CI 0.54 to 0.86). Participants diagnosed with chronic diseases (aOR 3.11; 95% CI 2.68 to 3.61), disability (aOR 1.82; 95% CI 1.38 to 2.38) and vision impairment (aOR 2.07; 95% CI 1.72 to 2.49) were more likely to report poor SRH. Participants who were current alcohol users and with abnormal weight were less likely to report poor SRH. Stratification by sex showed no significant association between famine and SRH among males, but a consistently significant association was observed among females (aOR 1.46; 95% CI 1.02 to 2.12). CONCLUSIONS Findings from this study indicated that females exposed to famine in China during infancy were more likely to report poor SRH in their adulthood. Implementing interventions to those who were exposed to famine in early life, especially for females, may improve their long-term consequences.
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Affiliation(s)
- Wei Li
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Ning Sun
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Anthony J Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Sandra Kiplagat
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Mohammad Ebrahimi Kalan
- Department of Health Behavior, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rime Jebai
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Wenjie Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Zhen Wei
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
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29
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Hernández-Ruiz RE, Benavides-Reyes C, González-López S, Bolaños-Carmona MV. A gender- based approach to the current situation of Spanish dentists. J Clin Exp Dent 2021; 13:e873-e885. [PMID: 34603616 PMCID: PMC8464394 DOI: 10.4317/jced.58303] [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: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background To determine the perception of Spanish dentists about the situation of the profession nowadays and how the changes occurred in dental workforce (in number and gender of the past twenty years) have affected their personal and professional lives, under a gender-based approach.
Material and Methods An online survey comprising of 51 opinion and socio-economic questions, divided into 9 sections of different topics, which was administered between the members of 13 professional associations. Chi-squared tests were calculated (p<0.05).
Results Valid responses were received from 422 participants with a mean age of 41 years old and 66% of female dentists. Most dentists considered their selves in a “good” position, however, 72.3% of them said the profession “has had worsened”. Opinions significantly differed between women and men in gender equity and the pay gap between them could be observed (29.4% of males earned more of 4000 euros a month, while only 15.1% female dentists did). Also, 49.5% of female dentists felt underrepresented in the highest association of Spanish dentists (General Council of Dentist - Consejo General de Dentistas) and 38.4% declared they have had suffered verbal violence coming from patients repeatedly.
Conclusions A generally negative perception of dentists’ work quality was found among respondents. Also, opinions between males and females differed in important aspects of professional development. Further research projects are needed to have growing evidence on problems and disparities in the dental workforce which would help the institutions to make improvement actions. Key words:Dentists, Health Workforce, Survey, Gender, Spain.
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Affiliation(s)
- Rocío E Hernández-Ruiz
- Department of Operative Dentistry. School of Dentistry. University of Granada, Campus de Cartuja. Colegio Maximo s/n, E-18071, Granada, Spain
| | - Cristina Benavides-Reyes
- Department of Operative Dentistry. School of Dentistry. University of Granada, Campus de Cartuja. Colegio Maximo s/n, E-18071, Granada, Spain
| | - Santiago González-López
- Department of Operative Dentistry. School of Dentistry. University of Granada, Campus de Cartuja. Colegio Maximo s/n, E-18071, Granada, Spain
| | - Mª Victoria Bolaños-Carmona
- Department of Pediatric Dentistry, School of Dentistry, University of Granada, Campus de Cartuja. Colegio Maximo s/n, E-18071, Spain
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Rompel S, Schneider A, Peters A, Kraus U. Sex/Gender-Differences in the Health Effects of Environmental Noise Exposure on Hypertension and Ischemic Heart Disease-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189856. [PMID: 34574779 PMCID: PMC8465564 DOI: 10.3390/ijerph18189856] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022]
Abstract
Previous studies have demonstrated cardiovascular health effects of environmental noise exposure, partly showing different effect estimates for males and females. This cannot be explained by biological differences between males and females alone. It is assumed that health outcomes and exposure patterns also depend on gender, determined by social, economic, and cultural factors in society. This systematic review evaluated the current state of how sex/gender is integrated in studies on environmental noise associated with hypertension, blood pressure, and ischemic heart diseases. A systematic literature search was conducted in three different databases, identifying thirty studies published between 1 January 2000 and 2 February 2020. Effects varied, with no consistent findings for both males and females. All studies used a binary operationalization of sex/gender, assuming static differences between males and females. The differentiation between biological and social dimensions of sex/gender was not present in any of the studies and the terms “sex” and “gender” were used interchangeably. However, biological and social dimensions of sex/gender were unconsciously taken up in the discussion of the results. Integrating sex/gender-theoretical concepts into future studies offers great potential to increase the validity of research findings, thus making them more useful for prevention efforts, health promotion, and health care.
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31
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Stenberg G, Fjellman-Wiklund A, Strömbäck M, Eskilsson T, From C, Enberg B, Wiklund M. Gender matters in physiotherapy. Physiother Theory Pract 2021; 38:2316-2329. [PMID: 34470538 DOI: 10.1080/09593985.2021.1970867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.
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Affiliation(s)
- Gunilla Stenberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | | | - Maria Strömbäck
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Carin From
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Birgit Enberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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32
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Ruiz AM, Luebke J, Klein K, Moore K, Gonzalez M, Dressel A, Mkandawire-Valhmu L. An integrative literature review and critical reflection of intersectionality theory. Nurs Inq 2021; 28:e12414. [PMID: 34153140 DOI: 10.1111/nin.12414] [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: 07/03/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
Intersectionality theory has been used by nursing scholars to offer insight into how multiple systems of oppression mutually interact to impact health and to examine how multiple social modes of existence shape individual and group experiences of health inequality. The application of intersectionality theory, however, requires a reflexive critical lens to more effectively inform nursing science and practice. We draw on a comprehensive integrative literature review to offer a critical reflection by considering the semantic and structural consistency, generalizability, simplicity and complexity, and the utility and value of intersectionality theory to nursing science and practice. If nurses are to effectively utilize intersectionality theory, it is essential that we are able to analyze and speak to the multiple modes of existence based on historical, social, economic, and political processes that impact the health of those we serve. Critical examination of intersectionality enables nurses to further consider its value and usefulness when applied to nursing science and practice, particularly when addressing health and social inequalities.
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Affiliation(s)
- Ashley M Ruiz
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jeneile Luebke
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Katie Klein
- Women and Gender Studies, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kaylen Moore
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Michael Gonzalez
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Anne Dressel
- Center for Global Health Equity, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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33
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Czwikla G, Boen F, Cook DG, de Jong J, Harris T, Hilz LK, Iliffe S, Lechner L, Morris RW, Muellmann S, Peels DA, Pischke CR, Schüz B, Stevens M, Telkmann K, van Lenthe FJ, Vanderlinden J, Bolte G. Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy. Int J Behav Nutr Phys Act 2021; 18:65. [PMID: 34001171 PMCID: PMC8130354 DOI: 10.1186/s12966-021-01131-w] [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: 01/07/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. METHODS The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. RESULTS The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. CONCLUSIONS To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of 'hard to reach' groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.
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Affiliation(s)
- Gesa Czwikla
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | - Filip Boen
- Physical Activity, Sports & Health Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, London, UK
| | - Johan de Jong
- School of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Tess Harris
- Population Health Research Institute, St George's University of London, London, UK
| | - Lisa K Hilz
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Lilian Lechner
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Richard W Morris
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Saskia Muellmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Denise A Peels
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Claudia R Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine UniversityDuesseldorf, Duesseldorf, Germany
| | - Benjamin Schüz
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department of Prevention and Health Promotion, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaus Telkmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julie Vanderlinden
- Physical Activity, Sports & Health Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Staland-Nyman C, Houkes I, de Rijk A, Verdonk P, Hensing G. Gender equality in domestic work and sickness absence - a population-based study on women and men in Sweden. Women Health 2021; 61:325-336. [PMID: 33662217 DOI: 10.1080/03630242.2021.1872759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Division of domestic work by gender has been discussed as part of the explanation why women present a higher sickness absence rate than men. This study aimed to examine the association between gender equality in domestic work and sickness absence. Data from 2,609 co-habiting women and men (aged 19-64) collected in a general population in Sweden were used. Associations between different measures of gender equality in domestic work and numbers of sick-leave days were analyzed with logistic regression analysis adjusted for age, children, and paid work. Results show that women reported lower levels of gender equality than men did. Satisfaction with division of domestic work was in the final model associated with lower odds ratio (OR) for sickness absence in men irrespective of number of days. Work-family conflicts were associated with higher ORs for sickness absence in men, 1-7 sick-leave days (OR 1.51 (CI 1.04-2.18)), and in women, 8-30 days (OR 1.51 (1.00-2.33)). More knowledge on the meaning of gender equality in domestic work in relation to sickness absence for women and men are important for future prevention activities.
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Affiliation(s)
- C Staland-Nyman
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,School of Public Health and Community Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Houkes
- School for Public Health and Prim Care, Fac. Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - A de Rijk
- School for Public Health and Prim Care, Fac. Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - P Verdonk
- Department of Medical Humanities, VU University Medical Centre, The Netherlands
| | - G Hensing
- School of Public Health and Community Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mena E, Bolte G. CART-analysis embedded in social theory: A case study comparing quantitative data analysis strategies for intersectionality-based public health monitoring within and beyond the binaries. SSM Popul Health 2021; 13:100722. [PMID: 33385059 PMCID: PMC7772559 DOI: 10.1016/j.ssmph.2020.100722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 11/07/2022] Open
Abstract
Implementation of an intersectionality perspective into quantitative health research might support the process of unravelling complex socio-cultural and economic power relations which underly and shape patterns of health and disease within populations. Intersectionality-informed health monitoring and health reporting integrating a sex/gender-sensitive perspective could serve as a fertile ground to strengthen the essential function of health reporting to support political decision-making. We aimed at the integration of social theory into quantitative data analysis by taking into consideration 4 distinct central sex/gender theoretical concepts in health research. We developed and tested an intersectionality-based, sex/gender-sensitive strategy comparing 5 distinct models based on different combinations of the binary sex/gender variable, socio-cultural and economic variables (defined from an intersectionality perspective) as well as solution-linked sex/gender variables. We used CART-analysis as a quantitative, non-parametric, exploratory method to detect subgroups with high prevalence of frequent mental distress (FMD). Analyses were based on data from a National Health Telephone Interview Survey conducted in Germany. Depending on model and detected subgroup of our comparative approach, prevalence of FMD ranged between approximately 5 %-25%. Within the model including the binary sex/gender variable, socio-cultural and economic variables, sex/gender turned out to be the most important attribute. Comparing the models which included solution-linked sex/gender variables to the model not including these variables illustrated that the CART-algorithm was able to detect subgroups with the same prevalence of FMD, but with approximately 14% as opposed to 4.5% of the study population being affected. For these models, social support served as the primary splitting variable and not the binary sex/gender variable. Including or not including the binary sex/gender variable in the models with the solution-linked variables did not make a substantial difference. Embedding CART-analysis in social theory might have the potential to further sex/gender sensitivity in health reporting and might support decision-making when considering the allocation of health-related interventions.
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Affiliation(s)
- Emily Mena
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Gabriele Bolte
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - AdvanceGender Study Group
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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van Hagen LJ, Muntinga M, Appelman Y, Verdonk P. Sex- and gender-sensitive public health research: an analysis of research proposals in a research institute in the Netherlands. Women Health 2020; 61:109-119. [PMID: 33073744 DOI: 10.1080/03630242.2020.1834056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Taking sex and gender into account in public health research is essential to optimize methodological procedures, bridge the gender gap in public health knowledge, and advance gender equality. The aim of this study was to evaluate the current status of sex and gender considerations in public health research proposals in a Dutch research institute. We screened a random sample of 38 proposals submitted for review to the institute's science committee between 2011 and 2016. Using the Canadian Institutes of Health Research' Gender and Health Institute criteria for gender-sensitive research and qualitative content analysis, we assessed if, and how sex and gender were considered throughout the proposals (background, research aim, design, data collection, and analysis). Our results show that in general, both sex and gender were poorly considered. Gender was insufficiently taken into account throughout most proposals. When sex was mentioned in a proposal, its consideration was often inconsistent and fragmented. Finally, we identified common methodological pitfalls. We recommend that public health curricula and funding bodies increase their focus on implementing sex and gender in public health research, for instance through quality criteria, training programs for researchers and reviewers, and capacity building initiatives.
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Affiliation(s)
- Lisanne Jeannine van Hagen
- Amsterdam UMC-VUmc, Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maaike Muntinga
- Amsterdam UMC-VUmc, Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | - Petra Verdonk
- Amsterdam UMC-VUmc, Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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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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Kwak K. Secular trends in adolescents' diagnosed health status and healthcare consultation: examinations of Canadian national surveys from 2007 to 2016. Public Health 2020; 187:177-185. [PMID: 33002711 DOI: 10.1016/j.puhe.2020.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/05/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study was to investigate secular trends in adolescent health status and healthcare consultations. STUDY DESIGN The design of this study is cross-sectional comparisons of population survey outcomes. METHODS Canadian national population data from 2007 to 2016 (T1 N = 14,223; T2 N = 14,247; T3 N = 13,532; T4 N = 13,184; T5 N = 11,122; Total N = 66,308) were examined to find trends in health diagnosis (chronic illnesses and mental disorders) and healthcare consultation (general health practitioners and mental health professionals). Controlling demographics, Multivariate analysis of covariances (MANCOVAs) and correlations were carried out to compare differences by age group (A1: 12-14 years N = 25,180; A2: 15-17 years N = 25,825; A3: 18-19 years N = 15,303) and gender (girls N = 32,388; boys N = 33,920) across survey years. RESULTS Steady increases were found in diagnosed mental disorders and consultations with a mental health professional (MP) for girls, while chronic illnesses remained stable and general practitioner consultations declined for all adolescents over these years. Gender disparity in MP consultations grew with age, much more in recent years, whereas chronic illness diagnoses curved down for all in midadolescence. More integrated relations between health status and healthcare utilization were noted in T5 than in T1. CONCLUSIONS Differential secular trends were shown for adolescent physical versus mental health statuses and relevant healthcare consultations. Although girls' and older adolescents' mental health declined over the years, a positive direction was also found for improved awareness of mental health.
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Affiliation(s)
- K Kwak
- School of Law and Social Sciences, University of East London, London, E15 1NF, United Kingdom.
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Marcos-Marcos J, Gasch-Gallén A, Mateos JT, Álvarez-Dardet C. Advancing gender equ(al)ity, lifting men's health: dealing with the spirit of our time. J Epidemiol Community Health 2020; 75:100-104. [PMID: 32826292 DOI: 10.1136/jech-2019-213165] [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] [Received: 09/05/2019] [Revised: 02/04/2020] [Accepted: 07/25/2020] [Indexed: 11/03/2022]
Abstract
In this paper, we jointly address two connected issues that should be addressed together more purposefully within both public health policies and programmes: the health and well-being of men and boys, and the focus on equity versus equality from a gender perspective. Awareness of these issues has boosted the debate on the impacts of gender inequality on health and men's role within it. Although this essay is not intended as an in-depth review on the subject, we provide a brief approach to some critical factors interwoven in the process of achieving greater gender equality. We identify some of the challenges that may arise for both policy and new research that seek to assume a relational gender approach that also pays greater attention to men's health.
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Affiliation(s)
| | - Angel Gasch-Gallén
- Department of Physiatrist and Nursing, University of Zaragoza, Zaragoza, Spain
| | - José Tomás Mateos
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Carlos Álvarez-Dardet
- Public Health Research Group, University of Alicante, Alicante, Spain.,University Research Institute for Gender Studies, University of Alicante, Alicante, Spain.,Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
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Missing in Action: Sex and Gender in Substance Use Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072352. [PMID: 32244297 PMCID: PMC7177376 DOI: 10.3390/ijerph17072352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 01/12/2023]
Abstract
Substance use and misuse is a significant global health issue that requires a sex- and gender-based analysis. Substance use patterns and trends are gendered: that is, women and men, girls and boys, and gender-diverse people often exhibit different rates of use of substances, reasons for use, modes of administration, and effects of use. Sex-specific effects and responses to substances are also important, with various substances affecting females and males differentially. Nevertheless, much research and practice in responding to substance use and misuse remains gender blind, ignoring the impacts of sex and gender on this important health issue. This special issue identifies how various aspects of sex and gender matter in substance use, illustrates the application of sex- and gender-based analyses to a range of substances, populations and settings, and assists in progressing sex and gender science in relation to substance use.
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Nasreddine L, Chamieh MC, Ayoub J, Hwalla N, Sibai AM, Naja F. Sex disparities in dietary intake across the lifespan: the case of Lebanon. Nutr J 2020; 19:24. [PMID: 32216804 PMCID: PMC7098147 DOI: 10.1186/s12937-020-00543-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/11/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Little is known about sex-based dietary differences in middle-income countries, particularly those undergoing the nutrition transition. This study aims at examining sex disparities in energy and macronutrients' intakes, food consumption patterns, and micronutrients' adequacy in Lebanon, while adopting a life course approach. METHODS Data were derived from a national cross-sectional survey conducted in Lebanon in 2008/2009. The study sample consisted of 3636 subjects: 956 children and adolescents aged 6-19.9 years; 2239 adults aged 20-59.9 years and 441 older adults aged above 60 years. At the households, trained nutritionists conducted face-to-face interviews with participants to complete a sociodemographic questionnaire and one 24-h diet recall. Food items were categorized into 25 food groups. The Nutritionist Pro software was used for the analysis of dietary intake data and the estimation of energy, macronutrients', and micronutrients' intakes. RESULTS In all age groups, males had significantly higher energy intakes, while females had significantly higher fiber intakes. In addition, in adolescents aged 12-19.9 years, females had higher fat intakes as compared to males (37.02 ± 0.6% vs 35.03 ± 0.61%), and in adults aged 20-59.9 years, females had significantly higher total fat (37.73 ± 0.33% vs 36.45 ± 0.38%) and saturated fat intakes (11.24 ± 0.15% vs 10.45 ± 0.18%). These differences in macronutrient intakes were not observed in younger children nor in older adults. Sex-based differences in food groups' intakes were also observed: men and boys had significantly higher intakes of red and processed meat, bread, fast food, soft drinks, and alcohol, while girls and women had higher intakes of fruits, vegetables, milk, and sweets. In all age groups, females had lower micronutrient intakes compared to males, including calcium, iron, and zinc. CONCLUSIONS This study identified sex-specific priorities that ought to be tackled by context-specific interventions to promote healthier diets in Lebanon. The fact that sex-based differences in nutrient intakes and food consumption patterns were the most noticeable in the adolescent and adult years, hence women's reproductive years call for concerted efforts to improve nutrition for women and girls as this would lay the foundation not only for their future education, productivity, and economic empowerment, but also for the health of future generations.
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Affiliation(s)
- Lara Nasreddine
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Marie Claire Chamieh
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jennifer Ayoub
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Abla-Mehio Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Naja
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
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Pöge K, Strasser SM, Saß AC, Rommel A. Civil society stakeholders' participation in national health reporting on sex/gender issues: a study protocol for an intersectionality-informed and sex/gender-sensitive approach to focus group research. BMJ Open 2020; 10:e033412. [PMID: 31937654 PMCID: PMC7045200 DOI: 10.1136/bmjopen-2019-033412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Health reporting is one of the foundations on which public health interventions and policies as well as prevention measures are developed. However, it faces the challenge of adequately reflecting social and sex/gender-related heterogeneity. The German Federal Ministry of Education and Research-funded joint project, AdvanceGender, aims to develop guidelines for sex/gender-sensitive and intersectional approach to population-based studies and health reporting. In its subproject, AdvanceHealthReport, four focus groups will be conducted to provide essential information on possible ways of participation of civil society stakeholders and on communication of health information for the further development of the guidelines (research period: from January 2019 to March 2020). METHODS AND ANALYSIS The civil society stakeholders provide valuable information which health topics are relevant in regard to specific populations and how health information should be communicated in a non-stigmatising way. The groups will also discuss how civil society stakeholders should participate in health reporting. The starting point for intersections will be sex/gender. The intersection of sex/gender and migration and sex/gender and sexual orientation is particularly taken into account. The focus groups will be recorded, transcribed, anonymised and then analysed according to the qualitative content analysis. RESULTS The results will show the pathways as well as benefits and possible limitations of civil society stakeholder involvement in national health reporting and will contribute in developing guidelines for sex/gender-sensitive and intersectional health reporting. ETHICS AND DISSEMINATION The results of the focus groups will be published in scientific journals and presented at various national and international conferences. Furthermore, the findings will be incorporated into guidelines for research and health reporting. The study was approved by the Ethics Commission of Brandenburg Medical School Theodor Fontane (AZ: E-01-20180529).
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Affiliation(s)
- Kathleen Pöge
- Department 2, Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Anke-Christine Saß
- Department 2, Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Alexander Rommel
- Department 2, Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Mena E, Bolte G. Intersectionality-based quantitative health research and sex/gender sensitivity: a scoping review. Int J Equity Health 2019; 18:199. [PMID: 31864366 PMCID: PMC6925460 DOI: 10.1186/s12939-019-1098-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/18/2019] [Indexed: 01/23/2023] Open
Abstract
Background The implementation of a theoretical intersectionality framework into quantitative data analyses is gaining increasing interest in health research. The substantive foundation of intersectionality was established in the U.S., based on the claim of black feminists to broaden the scope of contemporary gender studies by considering the intersection between sex/gender and race/ethnicity more firmly. The aim of our scoping review with particular emphasis on sex/gender was to assess how intersectionality-informed studies in epidemiological research considered different social dimensions in their multivariable and multivariate analyses. Methods Following the PRISMA Extension for Scoping Reviews (PRISMA-ScR), we conducted a literature review in PubMed. Three distinct health-related fields were brought into focus: diabetes representing a frequent chronic disease, smoking as a wide-spread behavioural health determinant and physical activity as a central target for health promotion. Initially, we compared which and how different social dimensions were accounted for and how inter-categorical and intersectionality-informed analyses were conducted. Further, we assessed sex/gender sensitivity by comparing operationalisation of sex/gender, how sex/gender theories were used and which central theoretical sex/gender concepts were referred to when aiming at explanation of (intersectional) sex/gender differences. Results Our results suggest, that intersectionality-based analyses within the three selected health-related fields are mainly conducted in the U.S. and focused on the intersection between sex/gender and race/ethnicity by using them jointly as subgrouping variables and as parts of interaction terms in regression analyses. Income and education as proxies for social class as well as age are mainly used for adjustment in quantitative analyses. Other approaches for calculating interactions (i.a. synergy-index, CART-analysis) are an exception. Even though sex/gender was considered in every included study and Gender was the most frequent theoretical sex/gender concept referred to when theoretically explaining sex/gender differences, it was exclusively operationalised as binary and solution-linked sex/gender variables were hardly considered in quantitative analyses. Conclusion The systematic integration of solution-linked variables indicating modifiable aspects of sex/gender-related living conditions and disadvantages could improve sex/gender sensitivity as part of intersectionality-based quantitative data analysis in health research.
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Affiliation(s)
- Emily Mena
- Institute of Public Health and Nursing Research, Department of Social Epidemiology, Faculty of Human and Health Sciences, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany. .,Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | - Gabriele Bolte
- Institute of Public Health and Nursing Research, Department of Social Epidemiology, Faculty of Human and Health Sciences, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
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Milner A, Scovelle AJ, King T. Treatment-seeking differences for mental health problems in male- and non-male-dominated occupations: evidence from the HILDA cohort. Epidemiol Psychiatr Sci 2019; 28:630-637. [PMID: 30033889 PMCID: PMC6998979 DOI: 10.1017/s2045796018000367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is a well-established gender divide among people who do and do not seek professional help from mental health professionals. Females are typically more likely to report, and seek help for, mental health problems. The current paper sought to examine the role of employment context on help-seeking for mental health issues. We hypothesised that men and women in male-dominated occupations would be less likely to seek help than those in non-male-dominated occupations. METHODS Data from the Household, Income and Labour Dynamics in Australia survey were used. Help-seeking, measured in 2013, was defined as whether a person reported attending a mental health professional in the 12 months prior to the survey. The exposure, male- and non-male-dominated occupations (measured in 2012), was defined using census data based on self-reported occupation. Analyses were stratified by gender and controlled for relevant confounders (measured in 2012), including mental health and prior help-seeking. We conducted multivariate logistic and propensity score analyses to improve exchangeability of those exposed and unexposed. RESULTS For males, being in a male-dominated occupation was independently associated with reduced likelihood of help-seeking (OR 0.66, 95% CI 0.46-0.95) in the adjusted model, although this result fell just out of significance in the propensity score analysis. There was no independent effect of being in a male-/non-male-dominated occupation for help-seeking among women. CONCLUSIONS Results suggest that male-dominated occupations may negatively influence help-seeking among males. There is a need for more research to understand this relationship and for workplace-based prevention initiatives.
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Affiliation(s)
- A. Milner
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - A. J. Scovelle
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - T. King
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Sex/Gender Differences in the Association between Residential Green Space and Self-Rated Health-A Sex/Gender-Focused Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234818. [PMID: 31801219 PMCID: PMC6926795 DOI: 10.3390/ijerph16234818] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 01/12/2023]
Abstract
Though sex/gender is an important social determinant of health, sex/gender inequalities have not been considered comprehensively in environmental health research thus far. The aim of this systematic review was to clarify whether sex/gender theoretical concepts were addressed in studies on the impact of residential green space on self-rated health and whether effect modification by sex/gender was observed. Three electronic databases were searched to identify epidemiological studies on perceived or objective residential green/blue space and self-rated health. Necessary for study inclusion was mentioning at least one keyword for sex/gender in title or abstract, adult study participants and data on self-rated health and on availability and/or use of green/blue spaces. Decisive for study inclusion was consideration of sex/gender differences in the impact of perceived or objective residential green/blue spaces on self-rated health in the analysis and presentation of results. Seven studies were included. They presented an overall positive impact of green space on self-rated health. No consistent sex/gender differences in the impact of green space on self-rated health were found in these studies. However, all studies used a binary operationalization male/female without further theoretical foundation. Research quality could be enhanced by integrating sex/gender-theoretical concepts into study design and interpretation of results.
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Assarsson R, Petersen S, Högberg B, Strandh M, Johansson K. Gender inequality and adolescent suicide ideation across Africa, Asia, the South Pacific and Latin America - a cross-sectional study based on the Global School Health Survey (GSHS). Glob Health Action 2019; 11:1663619. [PMID: 31544685 PMCID: PMC6764350 DOI: 10.1080/16549716.2019.1663619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Suicide ideation is a health issue affecting adolescents worldwide. There are significant variations in suicide ideation between countries and genders, which have not been fully explained. Research is especially lacking in countries outside Europe and North America. Gender equality has been shown to matter in other aspects of adolescent mental health, such as life satisfaction, but has not been researched in relation to suicide ideation at national level. Objective: To investigate how national gender inequality is related to self-reported suicide ideation among adolescents, and whether this association differs between boys and girls. Methods: This is a cross-national, cross-sectional study using individual survey data from the Global School-based Student Health Survey, a survey in Africa, Asia, Latin America and the South Pacific, developed and supported by among others the WHO and the CDC; connecting this to national data: the gender inequality index from the UNDP; controlling for GDP per capita and secondary school enrolment. The data was analysed using a multilevel logistic regression method and included 149,306 students from 37 countries. Results: Higher national gender inequality, as measured by the gender inequality index, was significantly associated with a higher likelihood of suicide ideation in both girls and boys (odds ratio: 1.38 p-value: 0.015), but for girls and both sexes this was only after adjusting for selection bias due to secondary school enrolment (as well as GDP/capita). Interaction models showed that this association was stronger in boys than in girls. Conclusions: National gender inequality seems to be associated with higher levels of suicide ideation among adolescents in mainly low- and middle-income countries, especially among boys.
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Affiliation(s)
- Rebecka Assarsson
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Solveig Petersen
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Björn Högberg
- Department of Social Work, Umeå University , Umeå , Sweden
| | - Mattias Strandh
- Department of Social Work, Umeå University , Umeå , Sweden.,Center for Research on Child and Adolescent Mental Health, Karlstad University , Karlstad , Sweden
| | - Klara Johansson
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
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Sledge P. From decision to incision: Ideologies of gender in surgical cancer care. Soc Sci Med 2019; 239:112550. [PMID: 31542648 DOI: 10.1016/j.socscimed.2019.112550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 01/06/2023]
Abstract
In this paper, I draw on the narratives of 57 individuals whose gender identities and decisions about their bodies trouble the medical protocols for breast and gynecological cancer care. I focus here on the decision-making process for three groups of elective surgeries: hysterectomy, prophylactic bilateral and contralateral mastectomy, and breast reconstruction. These elective surgeries illustrate places in medical interactions where patients and providers rely on frames of gender to determine whether a given surgery is an appropriate option for cancer prevention or care. These cases also explain how patient experiences of medical interactions are shaped by and thus reproduce ideologies of gender through the bodies of patients. While clinical practice and medical decisions are supposedly determined through the principles of evidence-based medicine and patient-centered care, I show that ideas about gender can actually supersede both medical evidence and patient desires for their bodies in the care of gynecological and breast cancers.
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Equity-Specific Effects of Interventions to Promote Physical Activity among Middle-Aged and Older Adults: Development of a Collaborative Equity-Specific Re-Analysis Strategy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173195. [PMID: 31480561 PMCID: PMC6747170 DOI: 10.3390/ijerph16173195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023]
Abstract
Reducing social inequalities in physical activity (PA) has become a priority for public health. However, evidence concerning the impact of interventions on inequalities in PA is scarce. This study aims to develop and test the application of a strategy for re-analyzing equity-specific effects of existing PA intervention studies in middle-aged and older adults, as part of an international interdisciplinary collaboration. This article aims to describe (1) the establishment and characteristics of the collaboration; and (2) the jointly developed equity-specific re-analysis strategy as a first result of the collaboration. To develop the strategy, a collaboration based on a convenience sample of eight published studies of individual-level PA interventions among the general population of adults aged ≥45 years was initiated (UK, n = 3; The Netherlands, n = 3; Belgium, n = 1; Germany, n = 1). Researchers from these studies participated in a workshop and subsequent e-mail correspondence. The developed strategy will be used to investigate social inequalities in intervention adherence, dropout, and efficacy. This will allow for a comprehensive assessment of social inequalities within intervention benefits. The application of the strategy within and beyond the collaboration will help to extend the limited evidence regarding the effects of interventions on social inequalities in PA among middle-aged and older adults.
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Migliorini L, De Piccoli N. Challenging gender perspective in the community to promote well-being and health. J Prev Interv Community 2019; 48:121-131. [PMID: 31184547 DOI: 10.1080/10852352.2019.1624352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The community is an excellent potential arena in which to challenge gender perspective and change power structures in society because of its pivotal role in socializing gender and shaping social context. The community influences the availability of positive and negative role models, the accessibility of specific settings, the ease with which relationships are formed, and a variety of emotions and attitudes. The literature shows that paying attention to gender equity affects numerous indicators of community well-being. Attention to gender equity makes communities more competent, which creates human and social capital that enables community well-being. We will examine the role of gender not only as a social construction but also as a context to create a healthy setting in the community and to promote the health and wellness of gender perspectives in the scientific domain, which seems resistant to change.
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Affiliation(s)
- Laura Migliorini
- Department of Education Sciences, University of Genoa, Genoa, Italy
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van der Borg WE, Verdonk P, de Jong-Camerik JG, Schipper K, Abma TA. A continuous juggle of invisible forces: How fatigued dialysis patients manage daily life. J Health Psychol 2019; 26:917-934. [PMID: 31170828 DOI: 10.1177/1359105319853340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dialysis patients commonly experience severe fatigue. Fatigue is known as an intrusive symptom strongly affecting perceived quality of life. A total of 23 interviews were conducted to explore how dialysis patients respond to fatigue symptoms and its consequences in daily life. A constructivist grounded theory approach guided data analysis and conceptualization of findings. Patients find themselves within a continuous decision loop, considering ones (physical) abilities and questioning ones normative beliefs and values. This inner process interacts with the outside world, and contains various ambiguities. Improved understanding of this demanding process could help to better address fatigue and positively contribute to the quality of life of dialysis patients.
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