Explaining biological differences between men and women by gendered mechanisms

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.

Considering sex and gender in Epidemiology: a challenge beyond terminology. From conceptual analysis to methodological strategies

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

Examining the Role of Traditional Masculinity and Depression in Men's Risk for Contracting COVID-19

In the light of the COVID-19 pandemic and claims that traditional masculinity may put some men at increased risk for infection, research reporting men's health behaviors is critically important. Traditional masculine norms such as self-reliance and toughness are associated with a lower likelihood to vaccinate or follow safety restrictions. Furthermore, infection risk and traditional masculinity should be investigated in a differentiated manner including gender role orientation, underlying traditional masculine ideologies and male gender role conflict. In this pre-registered online survey conducted during March/April 2021 in German-speaking countries in Europe, 490 men completed questionnaires regarding contracting COVID-19 as confirmed by a validated test, fear of COVID-19 (FCV-19S), and experience of psychological burden due to COVID-19. In addition, depression symptomatology was assessed by using prototypical internalizing and male-typical externalizing depression symptoms. Furthermore, self-identified masculine gender orientation, endorsement of traditional masculinity ideologies, and gender role conflict were measured. A total of 6.9% of men (n = 34) reported having contracted COVID-19 since the beginning of the pandemic. Group comparisons revealed that men who had contracted COVID-19 exhibited higher overall traditional masculine ideology and gender role conflict. Logistic regression controlling for confounders (age, income, education, and sexual orientation) indicated that only depression symptoms are independently associated with the risk of having contracted COVID-19. While prototypical depression symptoms were negatively associated with the risk of having contracted COVID-19, male-typical externalizing depression symptoms were positively associated with the risk of contracting COVID-19. For traditional masculinity, no robust association for an increased risk of contracting COVID-19 could be established, while higher male-typical externalizing depression symptoms were associated with an increased risk of contracting COVID-19.

Gender/Sex Differences in the Relationship between Psychosocial Work Exposures and Work and Life Stress

Objectives

Stress is an important factor affecting the health of working population. While work exposures are determinants of levels of work and life stress, we do not know whether similar or different exposures are related to stress levels for men and women. This study aimed to formally examine male/female differences in the relationships between psychosocial work exposures and work and life stress in a representative sample of Canadian labour market participants.

Methods

We used data from 2012 cycle of the Canadian Community Health Survey (CCHS), a representative population-based survey conducted by Statistics Canada. The sample was restricted to employed labour force participants working 15+ hours per week (N = 8328, 48% female). To examine the relationship between work exposures and work and life stress, we conducted path analyses. Psychosocial work exposures included social support, job insecurity, job control, and job strain. Differences between estimates for men and women were explored using multigroup analyses, constraining paths between male and female models to be equivalent and examining the impact on change in model fit.

Results

Male/female differences were observed in the relationships between supervisor support and work stress levels as well as between job control, job insecurity, job strain, and life stress levels. Higher levels of supervisor support at work were associated with lower work stress among women, but not among men. Low job control had a direct protective effect on life stress for men but not for women, while high job strain had a direct adverse effect on life stress among women but not among men. Higher job insecurity was more strongly associated with higher life stress among men compared with women. The relationship between work stress and life stress was similar among men and women.

Discussion

The findings of this study suggest that the relationships between psychosocial exposures and work and life stress differ for men and women. Our study also raised important questions about which work exposures are considered when assessing work stress, with level of job control not related to work stress but associated with levels of life stress among men.

Conclusion

Our study highlights the role of psychosocial work environment for both work and life stress and suggests differences in the importance of specific psychosocial work dimensions for feelings of stress among men and women, and for work stress versus life stress. Future study designs should ensure that measures are included to better disentangle the relative contribution of social and biological factors in explaining these differences among men and women.

Personality Traits in Adolescence as Predictors of Religiousness in Early Adulthood: Findings from the Terman Longitudinal Study

The authors examined the associations of the Big Five personality factors with religiousness in adulthood for a 19-year longitudinal sample of 492 adolescents age 12 to 18. Among the Big Five, Conscientiousness in adolescence was uniquely related to higher religiousness in early adulthood. For adolescents high in Emotional Stability, the link between strength of religious upbringing and religiousness in adulthood was weaker than it was for adolescents who were less emotionally stable. These findings replicate the work of others demonstrating the importance of Conscientiousness as a predictor of religiousness and suggest that emotionally unstable adolescents might be more likely to adopt levels of religiousness that are similar to those of their parents.

Gender and Ethnic Differences in Health Beliefs and Behaviors

This study explored the extent to which college men and women of various racial and ethnic groups differ in their health beliefs and behaviors. Exploratory factor analyses of survey responses from a diverse sample of 1816 undergraduate students identified 21 items in six cohesive domains: Diet; Anger and Stress; Preventive Care; Medical Compliance; Substance Use; and Beliefs about Masculinity. Analyses of variance explored group differences across these domains. Findings revealed consistent gender differences, with men engaging in riskier behaviors and holding riskier beliefs than women. Main effects for ethnicity were also observed, but only for the diet domain was a gender by ethnicity interaction found. Implications for establishing gender- and ethnicity-based health promotion and disease prevention interventions are discussed.

Measuring gender when you don't have a gender measure: constructing a gender index using survey data

Background

Disentangling the impacts of sex and gender in understanding male and female differences is increasingly recognised as an important aspect for advancing research and addressing knowledge gaps in the field of work-health. However, achieving this goal in secondary data analyses where direct measures of gender have not been collected is challenging. This study outlines the development of a gender index, focused on gender roles and institutionalised gender, using secondary survey data from the Canadian Labour Force survey. Using this index we then examined the distribution of gender index scores among men and women, and changes in gender roles among male and female labour force participants between 1997 and 2014.

Methods

We created our Labour Force Gender Index (LFGI) using information in four areas: responsibility for caring for children; occupation segregation; hours of work; and level of education. LFGI scores ranged from 0 to 10, with higher scores indicating more feminine gender roles. We examined correlations between each component in our measure and our total LFGI score. Using multivariable linear regression we examined change in LFGI score for male and female labour force participants between 1997 and 2014.

Results

Although women had higher LFGI scores, indicating greater feminine gender roles, men and women were represented across the range of LFGI scores in both 1997 and 2014. Correlations indicated no redundancy between measures used to calculate LFGI scores. Between 1997 and 2014 LFGI scores increased marginally for men and decreased marginally for women. However, LFGI scores among women were still more than 1.5 points higher on average than for men in 2014.

Conclusions

We have described and applied a method to create a measure of gender roles using survey data, where no direct measure of gender (masculinity/femininity) was available. This measure showed good variation among both men and women, and was responsive to change over time. The article concludes by outlining an approach to use this measure to examine the relative contribution of gender and sex on differences in health status (or other outcomes) between men and women.

Gender, male-typicality, and social norms predicting adolescent alcohol intoxication and marijuana use

OBJECTIVE

This study examined the direct and interactive effects of gender, male-typicality, and social norms in predicting the initiation and longitudinal patterns of alcohol intoxication and marijuana use in U.S. youth.

METHOD

Data were drawn from a longitudinal survey of 10,588 youth who participated in the in-home survey of the National Longitudinal Study of Adolescent Health (Add Health). Multilevel growth modeling used data from three time points to assess trajectories of substance use from adolescence to young adulthood.

RESULTS

Analyses indicated that gender, male-typicality, as well as home availability, friend social norms, and schoolmate social norms predicted initial levels of intoxication and marijuana use, with gender, friend norms, and schoolmate norms also predicting differential rates of growth over time in intoxication and marijuana use. Interaction results indicated that gender moderated male-typicality's relationship to both substance use variables, and home availability's relationship to alcohol intoxication.

CONCLUSIONS

These findings extend the literatures regarding interrelations among gender, gender roles, social norms, and health risk behaviors by (a) locating the genesis of those effects in adolescence, (b) identifying gender and social norms to be salient in terms of both initiation and growth of substance use over time, (c) suggesting that gender differences should be understood as moderated by other social-contextual variables, and (d) arguing that prevention efforts should address gender and gender roles more explicitly in programming.

Understanding preventive behaviors among mid-Western African-American men: a pilot qualitative study of prostate screening

BACKGROUND: African-American men bear a disproportionate burden for disease compared to other ethnic and racial groups. Due to gender differences in socialization and lifestyle practices, men are more likely to adopt attitudes and beliefs that undermine their health and well-being, including beliefs related to masculinity. The purpose of this study was to explore and understand the contextual factors in the attitudes and beliefs of African-American men's view of health in general, and as related to prostate cancer in particular. METHODS: Qualitative data from 15 African-American men were collected from two focus groups and analyzed for common themes using a qualitative descriptive design. RESULTS: Three themes emerged that focused on the beliefs and attitudes regarding general health and prostate cancer screening: (i) traditional beliefs about masculinity; (ii) psychosocial impact from family medical history; and (iii) sexual mores regarding digital rectal exams. CONCLUSIONS: The socialization of African-American men and masculinity ideologies may be significant factors in the focus group member's decisions to seek preventive health behavior changes. Further research is needed to examine the determinants of African-American men's health seeking behavior, in particular on the influence of masculine beliefs.

Original Research: Men's awareness and knowledge of male breast cancer

OBJECTIVE

This article reports on the findings of a qualitative study that explored the awareness and knowledge of male breast cancer among English-speaking men. The primary goal was to elicit information to guide both clinical practice and the development of gender-specific educational interventions.

METHODS

Interviews with 28 adult men, all of whom had no history of breast cancer themselves but had at least one maternal blood relative with the disease, were conducted and analyzed, using qualitative methods, to describe participants' awareness of male breast cancer, their knowledge of the disease, and how they thought awareness of male breast cancer could be increased in health care providers and the lay public.

RESULTS

Nearly 80% of participants weren't aware that men can get breast cancer; and although all were at higher risk given their positive family history, all reported that their providers had never discussed the disease with them. A majority couldn't identify any symptoms other than a lump in the breast. About 43% voiced concerns that a diagnosis of breast cancer would cause them to question their masculinity. Participants also suggested ways that men, as well as providers and the lay public, could be better made aware of and educated about their risk for this disease.

CONCLUSION

This study provides much-needed insight into men's awareness and knowledge of male breast cancer. While further research with larger samples is needed, these findings offer a starting point for the development of evidence-based, gender-specific, health promotion and disease prevention interventions for men.

KEYWORDS

male breast cancer; breast cancer, male; breast neoplasms, male; men's health; patient education; qualitative research.

Mortality predictors in a 60-year follow-up of adolescent males: exploring delinquency, socioeconomic status, IQ, high-school drop-out status, and personality

OBJECTIVE

To examine whether socioeconomic status (SES), high school (HS) completion, IQ, and personality traits that predict delinquency in adolescence also could explain men's delinquency-related (Dq-r) mortality risk across the life span.

METHODS

Through a 60-year Social Security Death Index (SSDI) follow-up of 1812 men from Hathaway's adolescent normative Minnesota Multiphasic Personality Inventory (MMPI) sample, we examined mortality risk at various ages and at various levels of prior delinquency severity. We examined SES (using family rent level), HS completion, IQ, and MMPI indicators simultaneously as mortality predictors and tested for SES (rent level) interactions with IQ and personality.

RESULTS

We ascertained 418 decedents. Dq-r mortality peaked between ages 45 years to 64 years and continued through age 75 years, with high delinquency severity showing earlier and higher mortality risk. IQ and rent level failed to explain Dq-r mortality. HS completion robustly conferred mortality protection through ages 55 years and 75 years, explained IQ and rent level-related risk, but did not fully explain Dq-r risk. Dq-r MMPI scales, Psychopathic Deviate, and Social Introversion, respectively, predicted risk for and protection from mortality by age 75 years, explaining mortality risk otherwise attributable to delinquency. Wiggins' scales also explained Dq-r mortality risk, as Authority Conflict conferred risk for and Social Maladjustment and Hypomania conferred protection from mortality by age 75 years.

CONCLUSIONS

HS completion robustly predicts mortality by ages 55 years and 75 years. Dq-r personality traits predict mortality by age 75 years, accounting, in part, for Dq-r mortality.

Masculinity causes speeding in young men

The goal of this study was to examine if masculinity is causally responsible for speeding in young men. Participants (83 males) were randomly assigned to a masculine, feminine, or neutral priming condition. Priming consisted in active listening to either masculine, feminine, or neutral words coming from the car radio while driving in a high-end driving simulator. Results showed that when the concept of masculinity was activated by priming, participants' driving speed increased significantly from the beginning to the end of the driving simulation as compared to the neutral and the feminine condition. Results are discussed with respect to real life health implications.

Subdomains of gender-related occupational interests: do they form a cohesive bipolar M-F dimension?

In four studies, with a total of 1780 male and 2969 female participants, subdomains of masculine and feminine occupations were identified from sets of occupational preference items. Identified masculine subdomains included "blue-collar realistic" (e.g., carpenter), "educated realistic" (electrical engineer), and "flashy, risk-taking" (jet pilot). Feminine subdomains included "fashion-related" (fashion model), "artistic" (author), "helping" (social worker), and "children-related" (manager of childcare center). In all studies, principal components analyses of subdomain preference scales showed that masculine subdomains were bipolar opposites of feminine subdomains. This bipolar structure emerged in analyses conducted on combined-sex groups, high-school boys, high-school girls, men, women, heterosexual men, gay men, heterosexual women, and lesbian women. The results suggest that, although there are distinct masculine and feminine occupational subdomains, gender-related occupational preferences, nonetheless, form a replicable, cohesive, bipolar individual difference dimension, which is not an artifact of studying mixed-sex or mixed-sexual-orientation groups.

Does personality mediate the relation between alcohol consumption and cardiovascular disease morbidity and mortality?

Alcohol volume and pattern have been previously demonstrated to predict cardiovascular disease (CVD) in these data. The objective of this study is to assess whether personality is a mediator in this relationship. Interview data from 1154 men and women aged 18-64 in Winnipeg, Canada were linked to health care utilization and mortality records, with 8 years of follow-up. Cox regressions were performed for men and women on time to first event for physician visits, hospitalizations, and deaths due to coronary heart disease (CHD), hypertension, or other CVD. Models linking drinking to CHD outcomes were unaffected by personality covariates. Models of hypertension and other CVD outcomes were significantly affected by inclusion of personality covariates, but the only significant individual personality covariate was in the effect on other CVD in men: Ego strength had a protective effect [hazard ratio (HR)=0.95]. Personality covariates as measured by the Eysenck Personality Questionnaire (EPQ) and Barron's Ego Strength Scale make only a modest contribution to statistical models of the relation between drinking and cardiovascular health.

Masculinity-femininity guides sexual union formation in adolescents

The authors test the idea that patterns of masculinity-femininity (MF) help sort adolescents into romantic couples. Using a nationally representative sample of adolescents in Grades 7 to 12 from a probability sample of secondary schools in the United States, an MF measure was constructed by selecting a set of questionnaire items demonstrating sex differences. For each respondent, the probability of being a boy was predicted. Respondents identified opposite-sex romantic partners within their school. When the partner identified also was interviewed, the authors were able to create MF for both members of the couple. Trichotomizing MF scores for each sex, it was determined that couples with a very masculine boy and very feminine girl are most likely to have sex, and to have sex the soonest. The couples for which both members are in the average MF range for their sex are the quickest to break up. The pattern of MF is a strong influence on the behavior of adolescent romantic couples.